Answers to the top questions about cannabis extract – Harvard Health – Harvard Health

Sales of cannabidiol-infused products are expected to top $2 billion by 2021. But is CBD right for you?

Cannabidiol (CBD) is touted as a natural wonder that can help treat symptoms of everything from anxiety to arthritis pain. The plant extract comes from two varieties of cannabis — hemp and marijuana — and is available in creams, tinctures, oils, patches, gummy bears, capsules, and more. You can even add CBD to a latte if you walk into a coffee shop in some cities.

But is CBD safe for older adults? There haven’t been a lot of large studies of CBD’s safety, but more traditional medicines for pain and anxiety are not free of adverse effects, either. “I think CBD is likely safer than many other treatments people use for pain, insomnia, or anxiety,” says Dr. Peter Grinspoon, a primary care physician with Harvard-affiliated Massachusetts General Hospital. Other physicians don’t think we know enough about the safety profile of CBD to be sure.

What is CBD?

CBD is different from tetrahydrocannabinol (THC), the psychoactive chemical in cannabis that some people use to get high. CBD doesn’t produce a high, and it’s not addictive. “It doesn’t get you stoned or woozy, and it doesn’t affect driving,” Dr. Grinspoon says.

It’s not yet fully understood how CBD works to alleviate symptoms of various ailments. Our bodies make natural cannabinoids that help regulate sleep, appetite, and mood. It is believed that CBD from plants binds to CBD receptors in the body, and therefore may affect body systems.

How is CBD used?

People typically take CBD by mouth (such as a drop or two of oil placed under the tongue, or in pills or edible products like gummies) to help reduce symptoms of many conditions, including anxiety, bipolar disorder, arthritis, diabetes, a muscle disorder called dystonia, seizures, multiple sclerosis, Parkinson’s disease, Crohn’s disease, chronic pain, post-traumatic stress disorder, and insomnia.

CBD is also used in many other products: liquids that are vaporized and inhaled; creams that are rubbed onto aching joints; and cosmetics such as creams, lip balms, and even salt scrubs.

Does it work?

The National Institutes of Health (NIH) notes there is some evidence that CBD helps reduce pain, anxiety, and symptoms of psychotic conditions (such as schizophrenia). However, the NIH points out that we don’t yet have enough evidence to prove that CBD reduces anything except epileptic seizures. Most evidence comes from studies with lab animals.

As we reported in March, the FDA recently approved the first marijuana-derived CBD (Epidolex) for the treatment of seizures associated with rare forms of epilepsy.

In his clinic, Dr. Grinspoon sees CBD making a difference for people with insomnia and anxiety. “It seems to take the edge off people’s anxiety. And for insomnia, it seems to help you get to sleep and stay asleep,” he says.

But not everyone who uses CBD has success. “The feedback I am getting is mixed. I have one patient who feels the CBD cream she uses every day for her hands has gotten rid of the pain. Another said it did nothing,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Is it safe?

While the World Health Organization maintains CBD is considered generally safe and well tolerated, it’s not clear yet what quantity of CBD is safe and for how long.

According to NIH, CBD supplements in pill form have been used safely for six months in daily doses of up to 300 milligrams (mg), and for up to four weeks in daily pill doses of 1,200 to 1,500 mg. A 2.5-mg dose of CBD spray under the tongue has been used for up to two weeks safely.

These are some of the known risks:

Side effects. These can include diarrhea, upset stomach, nausea, fatigue, irritability, low blood pressure, lightheadedness, or drowsiness.

Medication interference. CBD can decrease or slow the way some medications are broken down in the body. “That means CBD may increase the levels of some medications in the blood,” Dr. Grinspoon says. The big concern is with the blood thinner warfarin (Coumadin), but there are other medications that may be affected as well, including the heartburn drug omeprazole (Prilosec, Omesec) and the antidepressant amitriptyline (Elavil).

Is it legal?

CBD comes mostly from hemp plants, which contain a trace amount (0.3%) of THC. In December 2018, Congress legalized hemp in all 50 states, removing hemp from the controlled substances list. But there are still restrictions and regulations in place at the federal level that dictate where, how, and if CBD products can be sold. For example, CBD-infused edibles cannot be sold across state lines but may be legal within your state, and all CBD supplements are illegal if they are marketed with medical or therapeutic claims.

But laws are changing rapidly; it may or may not be legal to buy or possess CBD-infused products in your state, and you may or may not need a doctor’s prescription, depending on laws in your community.

Contact a pharmacist or your local health or police department for more information.

CBD can also come from marijuana plants, which are abundant in THC but have less CBD. Marijuana use is legal for recreational use in 10 states and the District of Columbia. Medical marijuana use is legal in 33 states.

What’s in your CBD product?

The FDA does not test CBD products. This means that you don’t really know what’s in the CBD product you’re buying — just like supplements you purchase in a drugstore.

The risks? First, the product may not have the expected amount of CBD in it, or any at all. Second, it may contain THC without your realizing it. “The THC content is concerning. If you don’t know you’re taking THC and get behind the wheel, your driving could be impaired,” Dr. Grinspoon says.

Which kind of CBD is best?

Hemp-derived CBD and marijuana-derived CBD are widely available online, in retail stores, or in cannabis dispensaries, depending on your state’s laws. Which type of CBD is best? “It certainly is safer to start with hemp-derived CBD, as there won’t be the psychoactivity associated with THC,” Dr. Grinspoon says.

On the other hand, a small amount of THC added to marijuana-derived CBD may aid the CBD’s effectiveness, even though it also increases the chance a person will become a little high and have problems functioning.

Should you try it?

Only you and your doctor can decide if CBD is right for you. If you get a green light, Dr. Grinspoon recommends using products made from cannabis grown in the United States or in Canada (which both have stricter safety regulations than other countries) that list the amount of CBD and THC on the label, and do not make claims to cure anything.

How should you take it?

“Start with a low dose,” Dr. Grinspoon suggests. How much CBD you use depends on the delivery system (whether it’s an edible, tincture, or pill, for example) and your individual needs. And of course, as with any new drug, try it first in a safe environment, when you know you’ll be home and you’ll have someone there to make sure you’re okay. Write down side effects and report them to your doctor if they’re concerning.

There’s still a lot we don’t know about CBD. “We’re in the very early stages of this,” Dr. Salamon says, “but I suspect that in the next couple of years, we will know a lot more, for better or worse.”