CBD oil products abound, but do they really work? Some say yes while experts urge caution – Greenville News

The pain in Andy Arnold’s neck had grown so severe that it radiated down his left side, leaving his hand numb. 

Unable to turn his head or even lay flat in bed, the Greenville attorney missed more than a week of work.

He was sent for an MRI, underwent chiropractic treatments and even ultrasound therapy. But the pain persisted.

“I have some pretty significant neck issues,” he told The Greenville News. “I had a terrible time with it.”

Finally, his doctor advised him to give up his martial arts classes.

So a year ago, he decided to try CBD oil, an increasingly popular product proliferating on store shelves everywhere.

“It worked,” Arnold said. “There was a clear difference. Not even a doubt.”

Getting relief

Greenville businesswoman Liz Daly-Korybski, owner of Liz Daly Designs and Eisch USA, had been seeing two specialists for agonizing shoulder pain.

Because she can’t take conventional medications, they recommended she try CBD oil.

That was two years ago and she’s been using it ever since.

“I was in excruciating pain,” she said. “And it’s done wonders.”

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What’s more, she said, she knows several other people who’ve been helped by CBD as well, including an 80-year-old with Parkinson’s disease whose tremors were markedly reduced, and two friends with anxiety so severe they were home-bound who can now function in society again.

“I feel people are really starting to go towards it,” she said, “trying to find other natural ways of getting pain free.”

Little research

More and more people are using CBD, or cannabidiol, a compound in hemp and marijuana that does not produce a “high.”

Based on a January survey of more than 4,000 Americans, the nonprofit Consumer Reports estimated that 64 million people — or a quarter of the population — have tried CBD.

In addition to oils, tinctures, salves and capsules containing CBD, the product is now being added to bottled water, soda, gummies, popcorn, candies, cakes and even shampoo, cosmetics and pet treats.

It’s become so mainstream that it’s sold at pharmacies and grocery stores in addition to health food stores and other specialty shops as well as online.

Proponents say it helps relieve pain, anxiety and insomnia, among other ailments.

Others say it can benefit everything from multiple sclerosis and Parkinson’s disease to psoriasis and schizophrenia.

It’s been approved by the FDA to treat childhood seizures. But experts say nobody knows if the other claims are true because there’s so little research.

‘Claims outpacing the science’

“We don’t know yet what it works for,” said Dr. Peter Grinspoon, a Harvard Medical School professor on staff at Massachusetts General Hospital.

“That’s not to say it doesn’t. Just that it hasn’t been shown to do these things,” he added. “The claims are far outpacing the actual science.”

But many medications have come from plants. Aspirin from willow bark, digitalis from the foxglove and codeine from the poppy, for example. So it wouldn’t be unreasonable for hemp to have a medicinal quality.

Dr. Prakash Nagarkatti, vice president for research at the University of South Carolina, said there has been research in animals to show that CBD oil is effective in suppressing inflammation, which is the driving force behind many diseases like arthritis.

But there’s been little research in humans, he said.

“Inflammation is the underlying cause of a lot of diseases, cardiovascular disease, cancers … autoimmune diseases like lupus,” he said. “Based on our research, and a large number of publications … CBD does have the potential of treating a large number of diseases in which inflammation is the critical role.”

‘An attractive alternative’

Greenville psychiatrist Dr. Patrick Mullen agrees that CBD oil hasn’t been studied with the same kind of rigor as an FDA-approved drug and that some of the claims about it are no doubt hype.

Nonetheless, he has five patients who take CBD oil, including a veteran with PTSD, and it’s helping them, he said. It can also benefit people who are taking opioids for intractable pain, he said.

“I tell all my patients who are in chronic pain and getting dumped off their opiates … about CBD oil,” he said. “And someone who comes to me who has anxiety or depression, I tell them about CBD oil.”

And because many traditional medications for depression and anxiety are addictive and have some harsh side effects, CBD oil is a safer alternative, he said.

“If you take Xanax every day for a year, then you can’t stop it. So I’m glad we’ve got something that appears to be much less addictive and less harmful than we’ve come to think benzodiazepines are,” he said.

“With the current fear of addiction, some good, effective medications are being restricted to the point that we won’t be able to use them. What will replace them?” he added. “CBD oil is a very attractive alternative.”

Impact on public health

There are lots of testimonials from people who say they have benefited from CBD oil but scant evidence, said Dr. Henry Bynum, a physician with Keystone Family Medicine of Prisma Health-Upstate, formerly Greenville Health System.

“You hear any and every symptom and diagnosis can be improved or treated with CBD products. And we don’t have great studies to back that up,” he said. “But as it’s better studied, it’s certainly plausible we will find some good, evidence-based reasons to use CBD products.”

And studies are underway. The National Institutes of Health alone funded 330 research projects totaling almost $140 million in 2017 looking into the potential health benefits of CBD oil.

The Greenwood Genetic Center is even involved in research to see whether a synthetic CBD oil can help in the treatment of Fragile X Syndrome, a rare inherited condition marked by varying degrees of intellectual disability, anxiety, irritability and other symptoms akin to autism, said Dr. Carrie Buchanan, the developmental behavioral pediatrician heading up the study.

But it will likely be several years before these studies yield results, experts say.

In the meantime, the FDA says it recognizes the potential of cannabis-derived compounds as well as the widespread interest in them, but is concerned about the scope of CBD products being sold for therapeutic or medical uses because they haven’t been proven safe or effective. The agency also says there have been reports of adverse effects in some patients using cannabis or cannabis-derived products to treat medical conditions.

So the FDA is holding a public hearing next month to gather information related to product safety and has formed an internal working group to explore the potential for supplements and conventional foods containing CBD to be lawfully marketed — including any potential statutory or regulatory changes — and the impact on the public health.

Quality control 

Among the concerns is purity of the product and the dosage.

Grinspoon said studies have shown that CBD oil can contain more or less of the product than advertised. Others say that since CBD oil is not regulated by the FDA, there’s no telling what’s in some of the products.

So consumers should only purchase CBD products that have certificates of quality from independent third-party labs that show they’re not only free of pesticides, heavy metals and other chemicals, but that they contain the amount of CBD that’s on the label, Grinspoon said.

“The stuff … at Joe’s Souvenir Shop,” he said, “who knows what’s in it?”

Bynum and Nagarkatti agree.

“I tell patients I don’t recommend for or against it … and to take it at their own risk,” Bynum said. “But if you wish to try it, do your best … to find a reputable company.”

“If somebody wants to cheat and mislabel it, consumers won’t know,” said Nagarkatti, adding that there are reputable producers.

“But that’s true with dietary supplements too.”

CBD is the in thing

Arnold and Daly-Korybski say they use only products from reputable companies that are certified through a third-party lab.

“We all trust labeling,” Arnold said, “and I don’t know any reason why CBD would be much different.” 

“I would not use any CBD oil that is not third-party verified. You don’t know what you’re going to get without that,” said Daly-Korybski, noting that the vendors she uses support regulation.

While quality reports could be faked, Grinspoon said that would attract the attention of regulators.

And although health claims not supported by data can be dangerous to certain patients, CBD is “pretty non-toxic,” Grinspoon said.

Nagarkatti said there is no data to support claims that personal care products or cosmetics that contain CBD have any beneficial properties.

“It’s a fad,” he said. “It’s the in thing right now.”

The real problem, Grinspoon said, is that like with a lot of health fads which go in and out of fashion, it’s a false promise and an unnecessary expense.

Market factors

And cost is a problem, he said, because CBD products can be very expensive.

But with passage of the federal Farm Bill last December — which meant hemp containing less than 0.3 percent of THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana, is no longer considered a controlled substance — more companies are making CBD oil, so the price should come down, Grinspoon said.

“I have a lot of patients who try it,” he said. “Some have some benefit and some have no benefit and felt like they wasted their money.”

It’s unknown why some patients feel no relief, he said. It could be they’re getting low-quality CBD, that CBD might not be strong enough for the intensity of their pain, or because not all drugs work for all people.

Cost could play a role in that as well, said Arnold.

“One thing I think most people is do is take too little because it’s so expensive,” he said.

Bynum says he’s had a handful of patients who’ve tried CBD oil, usually for anxiety, depression or pain. And an equal number report they are getting relief as aren’t.

Placebo effect?

“It could be a placebo effect,” he said. “We just don’t know at this point.”

Daly-Korybski, 49, said she doesn’t believe it’s placebo effect because she’s tried some products that worked well and others that didn’t.

“When I’m using it, the joints tend to work really well,” she says with a chuckle.

Like one in seven users, according to the Consumer Reports survey, Arnold, 51, uses CBD oil every day. When he runs out, he sometimes wonders whether he should get more.

“And then my neck starts acting up,” he said. “And it always helps.”

Nonetheless, Arnold said there has been “a gold rush-type mentality” when it comes to CBD oil and that there should be questions about it.

In addition to only using products with third-party testing, Grinspoon said his best advice for consumers wanting to try CBD is to discuss it with their doctor because it can interact with other medications. And because dosing is trial and error, start low and go slow, he said.

More research

While every drug has side effects — some that can be serious – Grinspoon said CBD is generally well-tolerated. Arnold and Daly-Korybski say they’ve experienced no side effects.

But Bynum said the long-term effects are yet to be determined.

“Before we dive in and start using these products,” he said, “we ought to do a little more research to see how this will impact us long-term.”

Another potential impact of using CBD oil is testing positive for THC, he said.

Arnold, an employment attorney, said potential employers have no way of knowing whether it was from CBD oil or from smoking marijuana.

“There are possible legal claims that can arise out of that,” he said. “How do you deal with a company that says it won’t hire someone who tests positive for THC?”

Too early to tell

Despite the lack of evidence, Grinspoon said there is intriguing research that CBD could be helpful in treating psychosis and addiction.

“It does have promise for these things,” he said. “And there’s some good evidence that it does help people with anxiety.”

As the government relaxes restrictions on research, the answers will come, Grinspoon said.

“It was just approved for childhood epilepsy,” he said. “And if the U.S. government approved a medication for seizures, it can’t contend it has no medical utility.”

Bynum said that in time, research may show that CBD is safer and more effective than some of the medications used regularly today, like opioids. 

“Who knows?” he said. “It’s too early to tell.”

 

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