One question I get asked a lot lately is this: “Is it OK for me to use CBD oil?”
First of all, CBD oil and associated preparations are types of alternative medications, medicines that might not be mainstream or readily prescribed by doctors, but are nevertheless used by many people on their own. Alcohol and marijuana are two substances that are often used as “medicines” by those that think they function better with them than without them. Many people self-treat medical as well as psychological symptoms with nonstandard therapies.
Some of these agents, like CBD oil, do not currently have FDA approval for treatment of specific psychiatric illnesses. If you choose to use them, either alone or in combination with standard therapies, you must understand that there are several things to consider. First, they may have unexpected side effects. Secondly, they may interact with other foods or drugs that you already use. And lastly, they may or may not be legal for general public use. I will address some of these issues in the rest of this column.
According to WebMD, cannabidiol is found in the cannabis sativa or marijuana plant. There are eighty similar chemicals in these plants. THC is the major active ingredient, but cannabidiol makes up forty percent of overall cannabis extracts. Cannabidiol may have antipsychotic properties, but we are not sure why. It might also actively block some of the effects of THC. There is really insufficient evidence for use of cannabidiol in bipolar disorder, dystonia, epilepsy, Parkinson’s disease, schizophrenia, or social anxiety. Side effects due to cannabidiol use might include dry mouth, decreased blood pressure, lightheadedness, and drowsiness. There is no good data on the use of cannabidiol in pregnancy or breastfeeding, nor for many specific drug-drug interactions.
Some of these concerns were addressed in a recent interview where Columbia University Chief Resident Angela Coombs, MD, interviewed Diana Martinez, MD, professor of psychiatry at Columbia and an addiction expert. Dr. Martinez stated that there is really very little known about how CBD affects humans and why. It may have some legitimate medicinal effects, but the jury is still out on some of these. She stated that if you buy CBD at stores, the advertised doses may not be realistic or true. Some websites of companies that manufacture CBD and have their products tested by legitimate outside companies will more likely list the actual amount of CBD available in their products. It might be very important to know about the presence or absence of contaminants as well. Some states like Colorado may do a better job at this point in testing products for factual labeling and overall safety.
CBD may be effective in treating seizures in some children with specific illnesses such as Dravet Syndrome or Lennox Gastaut Syndrome, obviously a very small group of people. If they do not respond to more traditional medication therapies, high doses of CBD in the neighborhood of 1000 mg might be effective.
The positive symptoms of schizophrenia (such as hallucinations) may be reduced with the use of CBD, but this is in the presence of traditional antipsychotics, not in place of them.
There is not much research to address the use of CBD oil in the treatment of anxiety or social anxiety. Dosing is largely unknown. 300-600 mg seems to be helpful for anxiety.
Dr. Martinez also addressed the drug-drug interactions that might occur when CBD is added to other, more traditional therapies. When the enzyme systems in the liver are affected by substances such as CBD, metabolism of other drugs might be sped up or slowed down, affecting the amount of those medications available in the bloodstream. This might lead to compromised treatment with seizure medications or antipsychotics. She also was not able to clearly answer the question about the legality of CBD at this time. Because of various bills, the DEA, the FDA, and other regulators, there is not one specific answer as to the legality of buying, possessing, and using these agents. Will it be regulated anytime soon? She was also not able to directly answer that question.
So, if you are thinking about using alternative therapies like cannabidiol, what are some of the things that you might need to consider?
- Is the substance an additive, food, plant, chemical, alcohol preparation, or another kind of substance?
- Is it approved by the Food and Drug Administration?
- Is it regulated by the FDA, DEA, or other agencies?
- Is it checked for safety by an independent lab or company for purity, quality, concentration, adulterants, etc.?
- Is it expensive or affordable?
- Is it legal in your state or nationwide?
- Does it interact with food, alcohol, or other drugs? Are any of these interactions life-threatening?
There is no hard and fast advice on the use of CBD oil yet, and much more research is needed.
Greg Smith is a psychiatrist who blogs at gregsmithmd.