cbd hemp oil for pain & anxiety

CBD sales are soaring, but evidence is still slim that the cannabis derivative makes a difference for anxiety or pain

Dr. Marusak is supported, in part, by grants from the National Institute of Mental Health.

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Wayne State University provides funding as a member of The Conversation US.

Many people have turned to cannabis and its derivatives as they search for pandemic relief, and one of the most widely available ones is CBD. It is also legal. You can buy oils, tinctures, capsules, gummies, cosmetics and even toilet paper said to contain the molecule. Martha Stewart has a line of CBD products, and some companies are marketing CBD products for holiday gifts. And, you can even buy CBD products for your pet.

An investment bank has estimated that this market will be worth US$16 billion by 2025, even though many of the products that allegedly contain CBD may not contain any CBD all. And, if they do, the amount often is far less than the amount stated on the product bottle or box.

The CBD craze started in 2018, after the U.S. Food and Drug Administration approved Epidiolex, the first drug containing CBD, used to treat two rare and severe types of childhood epilepsy. Since that approval, research on the possible medical applications of CBD has risen sharply.

But while the ads boasting its benefits are ubiquitous, there is still much we scientists don’t know, including whether CBD can actually reduce stress and anxiety.

That said, as a neuroscientist who studies childhood anxiety disorders and the neurobiology of stress and anxiety, I am encouraged by some of the preliminary research. For example, pre-clinical studies show that CBD can reduce fear and anxiety-related behaviors in mice. Neuroimaging studies in humans show that CBD can reduce activity in the amygdala and anterior cingulate cortex, brain regions associated with stress and anxiety. Yet more research must take place before we can be certain.

What is CBD?

CBD is only one of more than 100 cannabinoids and other molecules found in the marijuana plant (Cannabis Sativa). Cannabinoids are known as signaling molecules: They interact with other molecules in the body, including the brain. For example, THC, the plant’s most abundant cannabinoid, interacts with brain receptors to cause the “high” feeling. Cannabinoids can also impact the immune system; this may help alleviate inflammation, arthritic conditions and neuropathic pain.

CBD, the plant’s second most abundant cannabinoid, does not contain THC, and therefore does not have psychoactive effects. There is no high. CBD also doesn’t seem to bind strongly with typical cannabinoid receptors. Instead, it interacts with other signaling molecules in the brain and throughout the body. For example, CBD may act on the serotonin system, particularly serotonin 5-HT1A receptors, which are involved in signaling pathways that regulate pain, depression and anxiety.

Evidence suggests that CBD may interact with the body’s own natural cannabinoid system – the endocannabinoid system – to boost levels of anandamide, the “bliss molecule,” our body’s natural version of THC, perhaps changing the way people think and feel. And CBD may act with the body’s natural opioid system. This would explain some of the reported pain-relieving qualities. Yet with all of these potential effects, we still don’t understand how CBD works to alleviate pain, anxiety, inflammation and even epilepsy, the only disorder for which a drug containing CBD has been FDA-approved.

In medicine, to see if something works, a randomized placebo-controlled trial is the gold standard. most common mental disorder. There are several types of anxiety disorders, including generalized anxiety, which relates to excess worrying about everyday life, and social anxiety disorder, which includes intense fear around social interactions. Symptoms of anxiety can also vary, including feeling tense, irritable or jumpy, and also feeling that your heart is racing, sweating, headaches, stomachaches and insomnia.

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Recent studies show that COVID-19 has exacerbated some already existing mental health problems. And, even for people without a history of mental health problems, a COVID-19 diagnosis increases the risk of anxiety and other psychiatric disorders.

Preliminary and recent studies on the potential for CBD to reduce stress and anxiety are promising. Two small preliminary studies, for instance, tested whether CBD reduced anxiety in individuals with social anxiety disorder and in healthy volunteers. A public speaking test was simulated; those given CBD reported lower anxiety compared to those given a placebo (sugar pill). But we must wait for results of larger clinical trials to know if CBD works, and under what conditions.

Popularity outpaces science

In November, voters in four states – Arizona, Montana, New Jersey and South Dakota – voted to join 11 other states to legalize recreational cannabis use in the U.S. But the rise in legalization and decriminalization of cannabinoids, along with their widespread popularity, significantly outpaces the science. There is more research today on the potential medical applications of cannabinoids than ever before – including $196 million from the National Institutes of Health, along with $31 million on CBD in the year 2020.

Still, this is a relatively new area of medical research. CBD was discovered in 1940; the body’s own endocannabinoid system wasn’t discovered until 1992. This is shocking given that humans have been using cannabis and cannabis-based products for thousands of years. Evidence suggests medical use of cannabis dates back to ancient times, including around 2700 B.C., when Emperor Shen Nung – known as the father of Chinese medicine – was exploring cannabis use to treat over 100 different ailments, including gout, rheumatism and malaria.

But today, doctors, nurses and other medical providers are generally not well prepared to answer patients’ questions about potential risks, benefits and applications. This may be because cannabis and CBD are not a part of standard medical education. For example, a 2017 survey of medical residents and fellows in St. Louis found that 84.9% reported receiving no medical education about cannabis.

Government restrictions also contribute to the lag. Cannabis is still illegal at the federal level. In 2016, the U.S. Drug Enforcement Administration affirmed its classification of cannabis as a Schedule I drug. That put it in the same category as deadly and addictive drugs: opioids (like heroine and oxycodone). This is in stark contrast to research that shows cannabis is relatively safe and with a low potential for abuse. But because of this federal classification, scientific and medical study of cannabis is tightly regulated. Researchers need a special license from the DEA to study it. Physicians may also feel poorly trained because more and higher-quality research is needed before they make recommendations to their patients.

Researching CBD and other cannabis derivatives is also difficult. CBD products are currently unregulated by the U.S. Food and Drug Administration. This means CBD is not considered a dietary supplement, and marketed CBD products cannot make any health-related claims. This also means there’s no oversight on what’s in CBD products, which is why they are frequently mislabeled. This creates a “Wild West” environment for consumers.

So should you try CBD for stress and anxiety? The bottom line: It’s too early to tell. Those CBD gummies might just be an expensive placebo. In the meantime, turn to evidence-based treatments for stress and anxiety relief – like good old-fashioned exercise.

Everything You Need to Know About Using CBD for Pain and Anxiety

James Joliat, a 35-year-old video producer in Denver, has long experienced muscle and joint pain—mostly related to sports injuries. He says he started looking at natural remedies as an alternative to the prescription patches and pills his doctor recommended. After experimenting with homemade rubs infused with plant compounds—stuff like arnica and turmeric—he eventually stumbled onto topical cannabidiol (CBD) rubs.

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“I put that on my ankle after hiking or on my lower back, and it just feels like it really penetrates and has good anti-inflammatory properties,” he says. “I also fucked up my shoulder, and I felt like it helped a lot with the pain.”

He’s been using topical CBD for years with good results, and he recently tried ingesting CBD oil, which he called an “amazing” experience. “I just felt super relaxed—kind of an anti-anxiety type of feeling,” he says. “My body felt super mellow and limber, but not in a tired kind of way.”

“I just felt good,” he adds. “But I wasn’t high at all.” Joliat’s anecdotal experience with CBD is a common one. Some informal polling suggests a lot of people today are at least vaguely familiar with cannabidiol, and have either used it themselves or know someone who has. But even some people who use it don’t seem to know exactly what it is or whether there’s any hard science out there to back up its benefits.

What Is CBD?

“Cannabidiol is a compound found in the cannabis plant,” says Jerzy Szaflarski, a professor of neurology and director of the Division of Epilepsy at the University of Alabama, Birmingham.

Szaflarski explains that cannabis contains about 500 different compounds, some of which—including CBD and THC—interact with certain chemical receptors in the human nervous system. But unlike THC, CBD isn’t psychoactive—meaning it doesn’t cause any kind of a high. Despite that, the US Drug Enforcement Agency classifies CBD (and other cannabis compounds) as schedule I substances, making their sale illegal in many states.

“The brain has these receptors that respond to endocannabinoids, which are neurotransmitters that are naturally produced in the body and brain,” says Jerald Simmons, a neurologist at Houston’s Comprehensive Sleep Medicine Associates. “Some of the cannabinoids in the marijuana plant are very similar to the endocannabinoids in the brain, and they act on the same receptors.”

The nervous system’s endocannabinoid system is not well understood. But it’s thought to play a role in regulating pain, sleep, mood, memory, appetite, and other cognitive and physical processes. Because CBD is able to mimic the actions of some natural brain chemicals, its potential therapeutic benefits are wide-ranging but—at this point—nebulous. “We know that cannabidiol modulates the endocannabinoid system, but we don’t know how it works,” Szaflarski says. That said, there are theories.

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“THC”—the more-famous, high-inducing compound in cannabis—“works directly on the cannabinoid system, meaning it attaches to receptors and mimics some of our own internal endocannabinoids,” says Igor Grant, a professor and chair of psychiatry at the University of California, San Diego School of Medicine. But CBD’s interaction with the endocannabinoid system is subtler. “Normally, these endocannabinoid-signaling molecules are broken down by enzymes, and one thing CBD does is interfere with the actions of those enzymes.”

Grant says this may lead to a “dampening” or mellowing of some neurochemical processes, including those linked to pain. “CBD may also react with other receptors, like those for serotonin, and it may have actions that reduce the inflammatory molecules produced whenever there is tissue damage or bacteria coming in,” he says. “But we really don’t know the mechanisms.”

Should I take CBD to treat pain?

Talk to people or spend time on internet message boards, and you’ll see CBD is thought to have anti-pain, anti-soreness, and anti-inflammatory benefits. Some rat studies have linked topical CBD treatments to a drop in arthritis-related pain and swelling, and more research suggests it could help relieve headaches.

That headache study cites research linking CBD to lower rates of anxiety. (Since anxiety often produces headaches, the authors say, CBD could be a plausible headache remedy if those anti-anxiety benefits are legit.) Grant says he’s looked at the literature on CBD and anxiety, and some of it is enticing. He mentions a Brazilian study, for instance, that found people with a fear of public speaking felt less anxiety and less discomfort about their phobia after taking CBD, compared to those who took a placebo.

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“There’s also some evidence it reduces psychotic symptoms in people with schizophrenia and psychotic disorders,” Grant says. “But there are a lot of open questions at this point.”

One area where CBD is clearly helpful: the treatment of seizures associated with one form of epilepsy. A 2017 New England Journal of Medicine study found ingesting oral CBD dramatically cut down most patients’ seizure frequency—a finding that prompted the FDA to support the approval of one CBD drug for use in the treatment of some epilepsy patients.

How do people take CBD?

It’s usually sold as a droplet-administered oil or a balm, but it’s also sold in caplets, under-the-tongue tabs, lotions, face serums, and other products.

Some users speculate about appropriate dosages or methods of application—including whether or not a small amount of THC boosts CBD’s effects, or whether different methods of administration lead to quicker or more significant effects. Some CBD producers also claim that it has a cumulative effect, and so needs to be used regularly to produce a benefit. But Grant says it’s tough to say at this point exactly how people should (or shouldn’t) be using CBD.

“Even where marijuana is legal, you often don’t know exactly what you’re getting,” he says. “I’m sure some of these [CBD] producers have labs and do correct labelling, but none of it’s secure like it is with pharmaceuticals.”

The nutrition and supplement industry—which includes CBD products—is almost wholly unregulated. “The concentrations in products are only approximate, and I don’t know how well they’re tracked,” Szaflarski says. Even if you could absolutely trust a product’s label—and many CBD manufacturers, aware of the current scrutiny on their industry, go to great lengths to assure consumers of the quality of their products—there aren’t a lot of concrete facts when it comes to the type or amount of CBD a person should take for a specific ailment or aim.

Are there any risks to taking CBD?

Some studies have turned up evidence—nearly all of it from lab work or animal research—that CBD could potentially affect cell health, fertility, and the breakdown and metabolism of drugs in the liver. “There may be some interactions with pharmaceutical drugs,” Szaflarski says, mentioning drowsiness as one (but not the only) possibility.

In human studies, including one that found anti-seizure benefits among epileptics, some people have reported diarrhea, vomiting, fever, and fatigue while taking CBD.

“But so far, the main risks are that it does seem to have a sedative action, so people could get drowsy,” Grant says. “I have not read about major side effects or bad reactions, so it seems relatively safe as far as we know, but we need systematic research on this.”

While there are more unknowns than knowns at this point, Grant says he doesn’t discount all the anecdotal CBD reports. “You hear somebody say, ‘Hey, I gave this to myself and my kid and we feel a lot better,’ and we should never dismiss that kind of information,” he says. He points out that many modern medicines were discovered when researchers followed up on exactly this sort of human trial-and-error evidence. “But we still need to do the studies that confirm whether all the good things are true, and how much to give, and how to give it,” he says. “These are all questions that need to be answered.”

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