Is CBD really a natural cure-all for anxiety, pain, and insomnia? A Kaiser Permanente doctor shares what we know about CBD. Prescribing CBD oil still is relatively unexplored territory for physicians in terms of legal liability. But medical boards want clarity. 11 Things You Didn’t Know About CBD Gummies Everyone is talking about CBD gummies. Now that hemp-derived CBD products are federally legalized (as long as they have 0.30% or less THC). There are
What you need to know about CBD
The buzz around CBD is at an all-time high. CBD, or cannabis-based products, are hailed by devotees as natural cure-alls for all sorts of health conditions — everything from chronic pain to anxiety, insomnia, and more. And the number of products you can get your hands on feels like it grows more and more every day. There are CBD beauty products, CBD foods, CBD drinks, CBD pills, and even CBD pet products.
So, should you get that CBD massage? Or eat those CBD chocolates? Here, Ebonie M. Vázquez, MD, a psychiatrist and addiction medicine specialist at Kaiser Permanente in Southern California, breaks down what we do and don’t know about CBD products.
What is CBD?
CBD stands for cannabidiol. It’s a natural chemical found in the cannabis sativa plant, more commonly known as marijuana or hemp. 1
“CBD doesn’t contain THC (tetrahydrocannabinol), the major psychoactive ingredient in marijuana that makes you feel high,” says Dr. Vázquez. As a result, CBD products are sold as a way to enjoy the calming effects of marijuana without the high.
Does CBD get you high?
“Pure CBD doesn’t contain THC, so it shouldn’t make you feel high,” says Dr. Vázquez. “But the keyword there is ‘pure.’” It’s hard to know if you’re really getting pure CBD in current products, which aren’t screened for purity or safety.
In fact, over the last few years, the Food and Drug Administration (FDA) tested several CBD products and found that many contained different levels of CBD than they claimed. Some products actually had THC in them, and some are suspected of containing unsafe toxins like pesticides and heavy metals. 2 In general, if your CBD product doesn’t have any other additives, it shouldn’t make you high.
What do we know about the health benefits of CBD?
There’s a lot of buzz around CBD helping with anxiety, pain, stress, and insomnia. But there’s not enough research to prove the hype. “There’s currently research underway to see if CBD can help with Parkinson’s disease, schizophrenia, multiple sclerosis, insomnia, and anxiety,” says Dr. Vázquez. “But it’s too soon to know whether or not CBD effectively treats these conditions.”
Right now, the only CBD health benefit we have scientific evidence for is epilepsy treatment. The FDA has only approved one CBD product — Epidiolex — a prescription drug used to treat 2 severe and rare forms of childhood epilepsy (Dravet syndrome and Lennox-Gastaut syndrome). 2,3
Are there any health risks associated with CBD?
Some potential side effects of CBD are nausea, fatigue, and irritability. But the bigger risk with CBD is with drug interactions.
“CBD may react with a lot of common medications people take,” Dr. Vázquez says. “For example, pain medications, psychiatric medications, blood thinners, antihistamines, and more.” If you’re taking CBD, let your doctor know so they can review your medications to help you avoid a bad reaction.
In addition, some CBD products may contain harmful impurities in them (like pesticides and bacteria) which can put you at additional risk. As a result, pregnant and breastfeeding women shouldn’t use CBD products. 4
Is CBD regulated?
CBD products aren’t regulated or evaluated by any government agency. And aside from the prescription epilepsy drug Epidiolex, the FDA hasn’t approved any CBD products. This includes cosmetics, foods, dietary supplements, and pet products.
CBD products that claim to prevent, treat, or cure diseases (like cancer and Alzheimer’s disease) also haven’t been approved by the FDA. To try to protect the public’s health, the agency has actually warned companies to stop selling CBD products that claim to cure diseases. 5
“Due to this lack of regulation, there’s a lot of variation in product quality,” Dr. Vázquez explains. “There’s no guarantee you’re getting what the label says you’re getting.” And dosage is also murky territory. Since the FDA hasn’t evaluated CBD products for proper dosage, there are no clear guidelines yet on how much CBD is safe to take — whether it’s in pill, oil, or topical form. 6
Will CBD show up on a drug test?
CBD shouldn’t show up on a drug test. But it’s possible. “If your CBD product happens to contain THC,” Dr. Vázquez explains, “it may result in a positive drug test.”
Is it safe to try CBD?
“At this point, I don’t recommend the use of CBD products,” Dr. Vázquez says. “We just don’t have enough evidence right now on the health benefits, and a big concern is the lack of regulation and possible health risks.”
If you’re going to try CBD, it’s important to be cautious and know the risks. And whether you’re interested or already using CBD, Dr. Vázquez encourages you to talk to your doctor about it. “Please don’t hide it from your doctor because you think they might be anti-CBD. We want to hear about your experience and make sure you’re safe,” she says. At the very least, your doctor can review your medications with you to help make sure you’re not at risk for any drug interactions.
And over time, if CBD products are found to be effective and safe, they’ll eventually come under FDA regulation. “Then doctors may feel more comfortable with patients using CBD products,” she says. “But right now, it’s just too new.”
Not sure about CBD?
Reach out to your doctor. They can help explain the potential benefits and risks of CBD.
1 “Cannabidiol (CBD),” U.S National Library of Medicine, November 13, 2019, accessed February 6, 2020.
CBD oil and physician liability
Cannabidiol oil (CBD), a cannabinoid derived from cannabis that doesn’t create the “high” associated with marijuana since it lacks the cannabinoid THC, is gaining interest among health practitioners for its long list of potential benefits.
CBD oil for pain is one of the most widely discussed medical uses for the oil, although the list is much longer and includes seizure reduction, cancer treatment, anxiety relief and more cosmetic purposes such as acne reduction, among others.
There are three main issues with CBD oil for physicians who might prescribe it, however. First, cannabis and CBD oil remain illegal under federal law since it is classified as a schedule 1 drug under the Controlled Substances Act. More than 23 states have decriminalized its use for medical purposes, but this still comes in conflict with federal law and the Drug Enforcement Agency. Going near CBD oil in a healthcare setting is tricky.
Second, its status as an illegal substance makes it hard to test and run clinical trials that definitively prove its medical efficacy. This creates a vicious circle where marijuana and CBD are not fully legal because there is no data on its safety and efficacy, and its medical use in not proven because there is not enough testing due to being illegal.
Then there’s the liability of prescribing CBD oil and any product related to cannabis. Does the regulatory environment and the risk of malpractice outweigh the benefits for patients? This article will focus on this third challenge related to CBD oil for medical use.
Currently, prescribing CBD oil still is relatively unexplored territory for physicians in terms of legal liability. But medical boards want clarity.
In 2016, the Federation of State Medical Boards (FSMB) surveyed member boards regarding the issues related to cannabis and medical regulation. The survey found that the issues most important to board about CBD and marijuana included guidance on handling recreational use by physicians (31.4%), guidance on handling marijuana products for medical use by physicians (47.1%), and model guidelines for recommending marijuana products for medical purposes to patients (49.0%).
The trouble is that CBD oil, despite its potential medical benefits, lacks the certainty of an FDA-approved drug. The legal framework for that just isn’t there yet, which puts physicians in a bind.
To reduce the risk of liability, however, the FSMB has developed some guidelines for the recommendation of cannabis and cannabinoids such as CBD oil in medical settings as part of its Workgroup on Marijuana and Medical Regulation.
Guidelines for Minimizing Liability Around CBD Oil Recommendation
The FSMB workgroup recommends several conditions for safeguarding the ethical recommendation of cannabis-based products such as CBD oil for medical use.
1. Establish a Preexisting Medical Relationship with the Patient
To avoid questions of inappropriate prescription of CBD oil for medical conditions, the FSMB recommends that physicians first make sure they have a documented, existing medical relationship with the patient before recommending products such as CBD oil.
Consistent with prevailing ethical standards, physicians also should not recommend, attest or authorize CBD oil for themselves or family members.
2. Documented Patient Evaluation
A second key to reducing liability around recommending CBD oil for medical use suggested by the workgroup is taking extra pains to document that an in-person medical evaluation and collection of relevant medical history is performed before considering if CBD oil is appropriate for the patient.
While less applicable to CBD oil because it lacks the high of THC that is present in medical marijuana prescriptions, physicians should nonetheless also ensure the patient does not have a history of substance abuse. This ensures that physicians are covering their bases even if THC is not present in CBD oil.
3. Advise and Decide Together with the Patient
Physicians should discuss the risks and benefits of CBD oil with the patient before making a recommendation because CBD oil is clinically unproven and lacks the standardization present with many other potential treatments, according the FSMB workgroup.
This is key for minimizing the potential for liability because then the choice is not made by the doctor alone, shifting responsibility. It also is important because due to the current legalities of cannabis-related treatments, physicians cannot actually prescribe CBD oil—they can only recommend it as a possible treatment.
4. Include a Treatment Agreement
Physicians that recommend CBD oil should also document alternative options available to the patient in the form of a treatment agreement.
- Review of other measures attempted to ease the suffering caused by the terminal or debilitating medical condition that do not involve the recommendation of CBD oil.
- Advice about other options for managing the terminal or debilitating medical condition.
- Determination that the patient with a terminal or debilitating medical condition may benefit from the recommendation of CBD oil.
- Advice about the potential risks of the medical use of CBD oil, including the variability of quality and concentration of CBD oil.
- Additional diagnostic evaluations or other planned treatments.
- A specific duration for the CBD oil authorization for a period.
- A specific ongoing treatment plan as medically appropriate.
5. Avoid Any Other Relationship with Cannabis-based Products
Finally, one of the most important ways that physicians can reduce the potential liability from recommending CBD oil is by having a clear and impartial relationship to CBD oil and marijuana in general.
That means that doctors should not have a professional office at or near a marijuana dispensary or cultivation center, or receive compensation from or hold a financial interest in a CBD-related business.
By clearly demonstrating that the recommendation of CBD oil is for medical purposes and not based on personal considerations, physicians will help cut the liability associated with CBD recommendation.
That noted, there is no clear-cut way to completely reduce liability when recommending CBD oil to a patient any more than there is a way to completely eliminate the chances of malpractice when advising patients. Some potential for liability is inherent.
As the use of CBD oil and marijuana for medical purposes increased, and further standards and regulations develop, recommending it should become less legally fraught. Until then, reducing the potential risk of liability is the best that physicians can do in the case of CBD oil.
This article is for information only, and does not constitute legal advice.
11 Things You Didn’t Know About CBD Gummies
Everyone is talking about CBD gummies. Now that hemp-derived CBD products are federally legalized (as long as they have 0.30% or less THC). There are many people who live in states without a medical cannabis program. And CBD supplements can unlock some of the medicinal benefits of cannabinoids for symptom management.
If you have been thinking about buying CBD gummies, the first thing you should know is that not all CBD supplements are created equal. There is a difference between clinical grade CBD and other products that may be available on the market. Read the label carefully to educate yourself on the difference. The Food and Drug Administration (FDA) does not currently have standards for CBD products, which means a high number of ‘fake CBD’ supplements available online.
Here are eleven important things you should know about CBD gummy supplements:
1. They Taste Good
In the early days of innovating edibles, gummies had a medicinal taste. That’s not the case anymore. While a CBD supplement in the form of a gummy shape with fruit flavoring will never taste as good as candy, it doesn’t smell like cannabis. And it doesn’t taste like cannabis either.
The CBD is derived from hemp, which is not as pungent or strong smelling. So, if you open a package of gummies in the car, your vehicle is not going to smell like weed, which is a good thing. Part of the appeal is that CBD gummies can provide most of the health benefits of cannabis, discreetly and conveniently.
Many people try CBD oil. It is convenient and affordable to use by sublingual uptake. That is administering drops under the tongue for rapid absorption. The problem? The oil typically tastes bad. There is a reason why some people add their CBD oil to coffee or tea or orange juice. And it leaves an aftertaste. Most CBD gummies taste great and have no aftertaste.
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2. CBD Gummies May Help With Inflammation
Did you know that most chronic diseases are caused by inflammation? We tend to think of inflammation as swelling after an injury. But at the cellular level, your body is constantly fighting inflammation because it can do a lot of damage to your health.
Our modern diets aren’t the best. Even when you try to eat a healthy and balanced diet, you are eating preservatives unless you are shopping exclusively at a health food store. Chemicals that are not natural and not found in organic food sources. They are meant to extend shelf life. Make the food we eat to look better and taste better. But these artificial additives wreak havoc on our bodies.
One of the scary things about inflammation is that you may not recognize the signs. Often, people suffer from high inflammation where the symptoms are virtually invisible for years. Your physician may not even realize it as a health problem for you until you develop an associated chronic disease.
The health risks associated with chronic or long-term inflammation include:
- Memory impairment
- Cholesterol imbalance
- Elevated CRP levels
- Aches and pains
- Skin problems
- Digestive issues
Chronic Inflammatory Diseases (CIDs) can trigger your body to overreact in defense responses. For example, inflammation is one of the causes of the most severe cases of Covid-19. For Covid-19 patients, a cytokine storm happens, which attacks the body’s immune defenses. Chronic inflammation is one of the common features for patients most at risk for life-threatening response to the coronavirus.
3. You Can Get Low-Carb or Keto CBD Gummies
Some people with health conditions like diabetes have to be very careful about the number of carbohydrates they consume daily. There are carbohydrates in healthy foods too, which are not as bad for you. For example, the fruit has naturally occurring sugars but also fiber. That helps offset the impact on blood glucose levels.
But other foods, which are simple carbohydrates, are high on the glycemic index. That means it is just a small amount of simple carbohydrates, and your blood sugar will rise quickly. The immediate effect for people with diabetes are symptoms like dry mouth, headaches, hyperactivity, or mood variances like irritability.
Over the long-term, a diet that is high in carbohydrates can create health problems. For people with diabetes, vision damage and nerve damage resulting in numbness or neuropathic pain. High blood sugar also weakens the immune system, leaving some people with chronic diseases prone to serious infections. And sometimes, those infections can be life-threatening. So, choosing low-carbohydrate foods and supplements is a good idea.
Many manufacturers of CBD gummy supplements are now using Monk Fruit to sweeten their products. That is a sweetener that is healthier than other alternatives, and it is low on the glycemic index. You may have to search around for a CBD gummy made with Stevia or Monk Fruit, but they are out there for people on carbohydrate restricted diets.
4. CBD Gummies Are Easier on Your Throat and Lungs
When you take a CBD edible, it is non-psychoactive. That means you will not experience the same intoxicating effects of smoking medical cannabis. That makes CBD ideal for daytime use when you have symptoms of pain, inflammation, or anxiety.
Some people have respiratory conditions like asthma or emphysema. That makes smokable CBD varieties (vape oil), or smokable hemp flower is not a good alternative. The inhalation of smoke can irritate or aggravate symptoms.
Eating a CBD gummy is safer than smokable varieties, but CBD absorption through the digestive tract is slower. That means that the benefits of the cannabinoids last longer and are released over time, which is also economical and convenient for people who want to use CBD to naturally manage pain and inflammation symptoms.
5. Very Minimal Side Effects with CBD Gummies
Some people with health conditions are concerned about the interaction between prescription medications and medical marijuana. There are very few medications that can be contraindicated with medical marijuana. Talk to your doctor for advice if you have a medical card and prescription medication review.
It is virtually impossible to ingest too much cannabidiol with CBD gummies. Taking CBD gummies may produce only two side effects:
- Dry mouth
- Decreased ability to absorb prescription medications or other supplements
One of the safety considerations about CBD gummies that you should discuss with your doctor pertains to liver functioning. Supplement CBD gummies can impact the way your liver absorbs prescription drugs. That is why it is very important to discuss your use of CBD gummy supplements with your primary care physician (PCP).
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6. Supplementing CBD Can Boost Your Antioxidant Levels
Every day we are ingesting things called free radicals into our body. Think of free radicals like these microscopic invaders that enter the body, and attach to healthy cells. And when they do, they create damage to the cell. Damage that spreads and can result in serious health risks over time through cellular oxidation.
Free radical damage is also linked to premature aging and impaired organ functioning. Clinical studies have also connected free radical damage to chronic diseases like diabetes, Alzheimer’s, and other neurodegenerative disorders.
The human body has a natural defense against free radicals. Glutathione and other antioxidants are produced in the liver. The antioxidants are like a security team that is dispatched to “seek and destroy” free radicals. And remove them from the body.
Clinical grade CBD gummies also provide an antioxidant boost for your body. And can help reduce free radicals and cellular damage linked to chronic and neurodegenerative diseases.
7. CBD Supplements May Help Reduce Cancer Activity
There are many clinical studies that have reported CBD may help reduce certain types of cancer. In animal testing on mice and rats who were dosed with CBD, there were antitumoral results. In plain language, the CBD appeared to reduce the growth rate of test subjects’ tumors.
Some of the studies suggested that:
- Cannabidiol may inhibit functions in the body (including inflammation) that can increase cancer risk.
- CBD may prevent tumor cells from spreading.
- Cancer cell growth may be inhibited with the long-term use of cannabidiol.
- CBD may help kill tumors or help achieve cancer remission for certain types of cancer.
There is no hard evidence that cannabidiol will cure cancer. However, an exciting new study was published that is providing new hope for patients living with cancer. Read: “Cannabinoids in Cancer Treatment: Therapeutic Potential and Legislation.”
8. Cannabidiol (CBD) May Help Reduce the Severity of Seizures
How effective are cannabinoids at reducing some of the symptoms of epilepsy? This is one area of cannabinoid research that has been conclusive. Patients with epilepsy who receive cannabinoid treatments can experience fewer seizures. It can also help reduce the severity of seizures for children and adults with moderate to severe epilepsy.
Cannabinoids work to reduce seizures that the U.S. Food and Drug Administration fast-tracked prescription medications that are cannabis derived. Specifically for Dravet Syndrome or Severe Myoclonic Epilepsy, which is diagnosed in children.
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9. CBD Gummies Daily May Help With Anxiety and Depression
Did you know that anxiety disorders are the most common mental health condition in the United States? It is estimated that there are about 40 million American adults who have one or more types of anxiety disorders. Or approximately 18.1% of the population, according to The Anxiety & Depression Association of America.
Many people living with anxiety do not seek formal treatment. Even though there are a variety of treatment options available, including prescription medications and talk-therapy. According to the ADAA, this is concerning because as many as 36.9% of Americans never seek treatment or help for their anxiety disorder. And anxiety predisposes patients to other health risks, including compromise of the immune system and psychiatric disorders.
Supplementing CBD Can Help Balance Receptors Responsible for Mood and Healthy Sleep
Cannabidiol (CBD) can reduce anxiety and depression by acting on two different regions and functions of the brain. The adenosine and serotonin receptors are responsible for controlling heightened emotions when someone experiences anxiety. And serotonin is responsible for overall mood, including happiness and sadness and symptoms of depression.
When adenosine receptors are working well, your body effectively manages stress. But if the receptors are impaired and not working, anxiety levels can peak. People who struggle with depression or low mood have in common the impaired functioning of serotonin receptors. And if serotonin receptors are also not working correctly, it can cause insomnia.
Researchers do not fully understand how it works. But what they do know through clinical studies is that cannabidiol can positively affect both the serotonin and the adenosine receptors. That can provide relief for people who struggle with anxiety or depression.
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10. People With Insomnia May Improve Sleep Quality
You may not have depression or anxiety, but you could have chronic insomnia. This condition impacts approximately 30% to 48% of older adults in the United States. The Sleep Foundation reports that 23.8% of teenagers may have chronic anxiety.
Cannabidiol may help people with chronic insomnia improve their sleep quality. In one study, while comparing to a placebo, patients dosed with CBD slept longer, with fewer interruptions. With doses of 25 – 175 mg, after a three-month study and follow -up 51.6% of the participants had reported improved sleep. But 26.8% of people had reported sleep quality declined.
That suggests that CBD may work for many people who struggle with insomnia. And because CBD gummies are easy to take (and tasty) before bed, it makes the supplement an excellent alternative to consider compared to prescription sleep medications.
Some people with insomnia experience higher levels of the stress hormone cortisol at night. It is normal for higher levels of cortisol to happen in the morning to provide additional ‘wake up energy.’ Cannabidiol may help regulate or lower cortisol levels gently to improve sleep.
11. Can Help Reduce Bacterial Infections
People who have autoimmune diseases like cancer, lupus, diabetes, multiple sclerosis, and celiac disease are prone to infections. That means bacterial and viral infections can become serious. Or even life-threatening for people with chronic diseases. And there are some bacterial infections like MRSA and sepsis that have been shown to resist treatment with antibiotics.
Prior to the Covid-19 health crisis and pandemic, clinical researchers evaluated CBD as a potential treatment for superbugs. Those are types of bacteria that are resistant to antibiotics. It is important to research because the World Health Organization has acknowledged that antibiotic-resistant bacteria are approaching dangerous levels of threat worldwide.
Researchers that tested CBD against bacteria strains (staph) and streptococcus (strep) found some interesting results. The clinical tests showed that:
- CBD is less likely to increase the resistance of bacteria.
- CBD can kill certain types of bacteria within three (3) hours. That is compared to an average of 6-8 hours for standard prescription antibiotics.
- CBD works best for gram-positive bacteria. That includes bacterial infections that cause skin infections and pneumonia. It was less effective for gram-negative bacteria like E.coli and salmonella or gastrointestinal infections.
With more clinical testing and medical data, we may see a future where physicians routinely prescribe clinical-grade cannabidiol (CBD) to patients with infections. Or for post-operative care to help reduce skin or surface infections after discharge from the hospital. This could include CBD gummies and topical ointments applied for daily wound care.
Patients with chronic and autoimmune diseases may also use CBD to reduce the risk of contracting a bacterial infection. Since the side-effects are nominal for most patients, taking a daily CBD supplement may prove beneficial.
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