What Are Medical Marijuana and Cannabidiol (CBD)? Everything You Need to Know
The cannabis plant, from which marijuana is derived, is often smoked for recreational purposes. But people are increasingly using marijuana to treat medical conditions — and this medical marijuana is not always smoked. It comes in many forms:
- Marijuana cigarettes containing the cannabinoids (chemical compounds) tetrahydrocannabinol (THC) or cannabidiol (CBD), or both THC and CBD
- CBD oils, edibles, tinctures, creams, and capsules
- Cannabis-derived pharmaceutical products approved by the Food and Drug Administration (FDA)
Studies suggest that the medical use of marijuana may help treat the following conditions or help alleviate the following symptoms: (1)
- Anxiety, particularly social anxiety disorder
- Chronic pain
Some research has suggested that the cannabinoids in marijuana could also be useful in managing these conditions: (2,3,4,5,6,7)
- HIV/AIDS like Crohn’s disease and irritable bowel syndrome (IBS)
According to a 2017 report from the National Academies of the Sciences, Medicine, and Engineering (NASME), the strongest scientific evidence so far has been found in support of using marijuana for chronic pain, cancer-related nausea and vomiting, and MS-related spasticity. (1)
This NASME report, one of the largest of its kind, looked at more than 10,000 studies published since 1999.
How Does Marijuana Affect the Body?
It depends on whether THC or CBD is the cannabinoid at work. They produce similar effects, but there are differences in intensity because they each affect a different neural pathway.
THC is thought to engage with the body’s endocannabinoid system, which helps regulate physiological functioning. THC is similar to a chemical that’s present in this system, and when these two chemicals meet, the similarity allows THC to exert an influence on the body and brain in ways that alter coordination, memory, decision-making, appetite, and mood.
The endocannabinoid system also helps regulate gastrointestinal functions, and this may explain why medical marijuana seems to help digestive disorders like IBS.
CBD, scientists think, affects the brain because of the way it interacts with the neurological pathways that regulate serotonin, the hormone that regulates anxiety, pain, nausea, and appetite.
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How Can Marijuana Help Opioid Use Disorder?
Some individuals use marijuana instead of addictive opioids to treat pain. In these cases, marijuana may actually be responsible for a decrease in the use of — and deaths from — these prescription drugs.
A study published in May 2018 in JAMA Internal Medicine reported that prescriptions for opioids decreased in states that have medical marijuana laws. Researchers looked at Medicare data from 2010 to 2015 and found that states with active dispensaries saw 3.742 million fewer daily doses of opioids filled by pharmacies. (8)
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Another study, published in October 2014 in JAMA Internal Medicine, found that states with medical cannabis laws had a 24.8 percent lower annual overdose rate than states without such laws. (9)
Some states, like Pennsylvania and New York, now consider opioid use disorder as a qualifying condition for medical marijuana use. New York, for example, allows people who qualify to use medical marijuana instead of opioids to treat pain.
What Is Cannabidiol and How Will It Affect Me?
Cannabidiol is the cannabinoid in marijuana that, along with interacting with the brain’s serotonin system, may also help relax and calm you, but it doesn’t alter your perception or affect physical reactions too much. CBD may be particularly effective for: (10)
- Anxiety disorders
- Nausea and vomiting
- Psychotic disorders
- Non-cancer-related pain
- Sleep problems (Dravet syndrome and Lennox-Gastaut syndrome)
Staci Gruber, MD , is an associate professor of psychiatry at Harvard Medical School in Boston and the director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital in Belmont, Massachusetts, which is researching the neurological effects of medical marijuana use.
In a large study that she’s conducting on the use of medical marijuana, Dr. Gruber says the second most commonly reported use of medical marijuana among subjects is for anxiety. She’s also about to begin an FDA-approved clinical trial of a CBD sublingual (administered under the tongue) tincture, consisting of CBD in a coconut oil base, for the treatment of anxiety. (Tinctures are medicines — in this case CBD — dissolved in a liquid like alcohol or glycerine.)
Indeed, anecdotal evidence points to the effectiveness of CBD as an anxiety and stress reducer, as well as a sleep aid. Eric*, a busy sales executive in San Francisco, has been sleeping more soundly since he started using a high-CBD, low-THC product via a vaporizer three months ago for work-related stress and anxiety.
“The quality of my sleep is better, I’m sleeping longer and deeper, and I now have no problem falling and staying asleep,” he says. “It has changed my life.”
In addition to being a potentially powerful treatment for anxiety disorders, a growing body of research is suggesting that CBD may help treat symptoms of neurological disorders such as Parkinson’s disease and Alzheimer’s disease . (11,12)
Scientists think that CBD acts in yet to be determined ways that protect the brain against inflammation and oxidative stress. (13)
Research also points to CBD as a potential treatment for psychosis and schizophrenia . (14,15)
Medical marijuana may also be effective in palliative care. In one Canadian case study, published in 2013 in Case Reports in Oncology, physicians reported that CBD oil, administered orally, was a successful treatment for a 14-year-old patient in palliative care with an aggressive form of leukemia. (16)
Cannabidiol (CBD)-what we know and what we don’t
Cannabidiol (CBD) is often covered in the media, and you may see it touted as an add-in booster to your post-workout smoothie or morning coffee. You can even buy a CBD-infused sports bra. But what exactly is CBD? And why is it so popular?
How is cannabidiol different from marijuana, cannabis and hemp?
CBD, or cannabidiol, is the second most prevalent active ingredient in cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. One of hundreds of components in marijuana, CBD does not cause a “high” by itself. According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”
Is cannabidiol legal?
CBD is readily obtainable in most parts of the United States, though its exact legal status has been in flux. All 50 states have laws legalizing CBD with varying degrees of restriction. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. In 2018, the Farm Bill made hemp legal in the United States, making it virtually impossible to keep CBD illegal – that would be like making oranges legal, but keeping orange juice illegal.
The Farm Bill removed all hemp-derived products, including CBD, from the Controlled Substances Act, which criminalizes the possession of drugs. In essence, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) – even though it is the exact same molecule. Currently, many people obtain CBD online without a medical marijuana license, which is legal in most states.
The evidence for cannabidiol health benefits
CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, stop them altogether. Epidiolex, which contains CBD, is the first cannabis-derived medicine approved by the FDA for these conditions.
Animal studies, and self-reports or research in humans, suggest CBD may also help with:
Studies and clinical trials are exploring the common report that CBD can reduce anxiety.
- Insomnia. Studies suggest that CBD may help with both falling asleep and staying asleep.
- Chronic pain. Further human studies are needed to substantiate claims that CBD helps control pain. One animal study from the European Journal of Pain suggests CBD could help lower pain and inflammation due to arthritis when applied to skin. Other research identifies how CBD may inhibit inflammatory and neuropathic pain, which are difficult treat.
- Addiction. CBD can help lower cravings for tobacco and heroin under certain conditions, according to some research in humans. Animal models of addiction suggest it may also help lessen cravings for alcohol, cannabis, opiates, and stimulants.
Is CBD safe?
Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level of blood thinning and other medicines in your blood by competing for the liver enzymes that break down these drugs. Grapefruit has a similar effect with certain medicines.
People taking high doses of CBD may show abnormalities in liver related blood tests. Many non-prescription drugs, such as acetaminophen (Tylenol), have this same effect. So, you should let your doctor know if you are regularly using CBD.
A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot be sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other unknown elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
How can CBD be taken?
CBD comes in many forms, including oils, extracts, capsules, patches, vapes, and topical preparations for use on skin. If you’re hoping to reduce inflammation and relieve muscle and joint pain, a topical CBD-infused oil, lotion or cream – or even a bath bomb — may be the best option. Alternatively, a CBC patch or a tincture or spray designed to be placed under the tongue allows CBD to directly enter the bloodstream.
Outside of the US, the prescription drug Sativex, which uses CBD as an active ingredient, is approved for muscle spasticity associated with multiple sclerosis and for cancer pain. Within the US, Epidiolex is approved for certain types of epilepsy and tuberous sclerosis.
The bottom line on cannabidiol
Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer or COVID-19, which it is not. We need more research but CBD may prove to be a helpful, relatively non-toxic option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies, we can’t pinpoint effective doses, and because CBD currently is typically available as an unregulated supplement, it’s hard to know exactly what you are getting.
If you decide to try CBD, make sure you are getting it from a reputable source. And talk with your doctor to make sure that it won’t affect any other medicines you take.