CBD is the newest trend in healthcare. It's available in health food stores, mall kiosks, pharmacies, and even gas stations. Can you think of another health product that is available in so many locations and in so many brands?

What is CBD?

"CBD" is the common abbreviation for cannabidiol, which is one component of the hemp and marijuana plant. It has become, hands down, the most widely hyped treatment in recent memory. Purveyors of CBD tout its benefits for anxiety, insomnia, arthritis, digestion problems, and depression, to name just a few. Patients who have long suffered with chronic illness have turned to CBD for hope when there was none for so long.

Indeed, the first FDA-approved prescription form of CBD (brand name: Epidiolex) was approved in 2018.  Its intended use is very specific: a rare but debilitating form of childhood epilepsy. For parents with children who have mutliple seizures per day, this approval must have seemed like a godsend. And in fact, Epidolex was groundbreaking - an official endorsement of a cannabis product for treating a chronic disease. For thousands of years, cannabis derivatives have been used for both health and recreation, but its inclusion in the Controlled Substances Act of 1970 severely limited how cannabis could be studied.

Why is CBD business booming?

Only in the last decade has this prohibition been reconsidered.  With the Hemp Farming Act of 2018, hemp was reclassified as an agricultural commodity and removed from the controlled substances list.  Hemp is a plant in the cannabis family that has very low levels of THC, the psychoactive component people mostly associate with recreational marijuana products. The new act allowed hemp with a THC concentration less than 0.3% to be sold, studied, and traded on commodity markets.

CBD is a product of hemp.  Clinical studies of CBD in humans and animals seem promising - it seems to have widespread anti-inflammatory effects, not just in the brain, but all over the body.  This would indicate that disease states that are caused by inflammatory states could be treated with CBD, at least in part. Because there are natural CBD receptors in the human brain, there seems to be a role in central nervous system conditions (anxiety, pain, depression) as well.

So what are the downsides?

You might ask yourself, if CBD seems to help so many conditions, why are doctors and pharmacists not putting all their patients on it?  The devil, is, as usual, in the details. If CBD were taken alone, with no other medications, it appears for most people it is safe and well-tolerated.  However, the concern comes when CBD is added to an existing medication regimen.

CBD has many drug interactions

The human liver is the main site for breaking down the medications we take.  It does so mainly by enzymes called CYP450.  The way that CBD interacts with these CYP450 liver enzymes is critical in how the other medicines in our bodies behave.

CBD displaces its "competitors" (other drugs) in the CYP450 system.  In so doing, it prevents those drugs from behaving the way they're intended.  The extent to which CBD inhibits the liver's work varies; it depends on the CBD dose, the CBD formulation, and the route by which it is administered. There is no clearly-established dose at which CBD does not interact with other drugs.

For example, CBD can be especially confounding when used in combination with medications that treat seizures, heart conditions, and sedatives. If these medicaitons are blocked by CBD from being deactivated by the liver, they spend more time circulating in the blood stream.  This could dangerously increase the side effects of the affected medications.  CBD may also block activation of some drugs by the CYP450 system, thereby lessening the intended effect. So, adding CBD to a medication taken for blood pressure could make you feel dizzy, drowsy, and even put you more at risk for falling and fracturing a bone.  Adding CBD to a medication for epilepsy could make seizure frequency increase.

The bottom line on CBD

The bottom line is this: there seems to be a promising role for CBD in our overall health picture. There are reputable and not-so-reputable sellers of CBD products.  Some dosage forms are absorbed into the bloodstream, and some are not. Much more rigorous study needs to be done to determine how and when CBD is best incorporated into a therapy regimen.

In the meantime, patients who want to take a "try and see" approach should definitely include a cannabis-trained pharmacist and other health providers in the plan.