CBD: What We Know and What We Don't

Now widely available for legal purchase, CBD (cannabidiol) still presents questions for researchers examining the therapeutic claims of proponents. CBD is the non-psychoactive component of the cannabis plant and its cousin, hemp. Unlike its fellow cannabinoid THC (Tetrahydrocannabinol), CBD does its magic with no stupefying effect, making it a natural support for numerous health conditions.

CBD has become an attractive and popular choice for people seeking a complement to traditional medicine or as a natural boost to their overall health. But there’s plenty we still don’t know about CBD. Now that it’s a legal substance, research is ramping up exponentially, allowing us to answer some pressing questions about the extent of its value to human health and wellbeing.

The CBD Explosion

The 2018 Farm Bill was a red-letter day for CBD, legalizing hemp cultivation. With hemp legal, there was no longer any pretext for the Schedule 1 status of CBD as a direct hemp derivative. And while the process of CBD losing its status as a “dangerous drug” has proved time-consuming, a clear line has been drawn between hemp and cannabis. The result of this important change has been a flood of CBD producers and products into the legal market.

As with any new industry, kinks abound. One of those kinks is the absence of regulatory structures. At the beginning of this year, the FDA announced it would be working with Congress to create clearer regulations for an industry that has been something of a viral sensation. While it’s clearly time for the feds to step up to the regulatory bat, it’s possible that demands from the business sector were at least partially responsible for the FDA’s decision to act.

The problem with being a viral sensation, suggested Christopher McCurdy, CEO of the American Association of Pharmaceutical Scientists, is scale. McCurdy points out that the proliferation and popularity of CBD have led to there being “...more anecdotal evidence than scientific evidence” about how it works. To translate, science can’t be expected to keep up with the organic growth rate of enthusiastic - but unproven - claims of miracle cures.

So, what do we know about CBD? What is it about this component of the cannabis and hemp plants that has so many people singing its praises?

What We Know About CBD and the Endocannabinoid System

An important and perhaps foundational piece of knowledge about CBD is its correspondence to the Endocannabinoid System (ECS) in the human body. Only discovered by science in the 1990s, the ECS is in charge of everything from memory to temperature control, inflammatory response, sleep, eating, and reproduction. Consisting of endocannabinoids, enzymes, and receptors, the ECS is your personal “smart” house control and the largest system of neurotransmitters in the human body.

A network of CB1 receptors throughout the ECS maintains control of neurotransmitters, reducing or increasing their activity when necessary. This activity helps to maintain a state of balance or homeostasis, keeping the body’s highways and byways happily functioning.

The cannabinoid molecules active in the ECS are structurally similar to CBD. When CBD hemp flower is smoked or consumed, CBD adheres to CB1 or CB2 receptors. CB2 receptors are responsible for regulating the immune system and conditions which lead to inflammation, often responsible for pain.

As you read this, research is seeking clear evidence of CBD’s efficacy for the treatment of addiction, specifically examining CB2 cannabinoid receptors. We’ve heard that CBD has a role in treating addictions, with similar claims made about Kratom. But these claims have not yet been scientifically verified. While the evidence is being collected, a larger body of such empirical support is needed.

Confirmed Healthcare Applications

CBD is still being examined intensely. While science continues to accumulate data, there is great hope and even influence in the pharmaceutical sector that is already changing treatment protocols for:

Epilepsy: Under the brand name Epidiolex, CBD is treating epilepsy in two specific forms of the condition, with evidence suggesting it controls seizures, decreasing their frequency.

PTSD: CBD has been found to reduce symptoms associated with PTSD in controlled trials. When combined with THC, an entourage effect has been observed which may hold a key to effectively treating this condition.

Arthritis: The American Arthritis Foundation has written guidelines for CBD as a complementary treatment. While not offering its full-throated support for CBD, guidelines like these signal an institutional sea change that will result in similar medical associations responding to patient input.

Depression: A 2019 study revealed that CBD has a material impact on depression symptoms due to the molecular realities in play. Science continues to gather a body of evidentiary support for CBD’s therapeutic effectiveness in treating depression.

These examples of CBD’s validity as a complementary or alternative treatment all require a larger body of study findings as support. What’s clear is the compelling motivation for continuing research based on what’s already known. Public support for CBD is also key to that motivation.

What We Don’t Know

Two of the most important challenges facing the FDA and Congress as they create a regulatory discipline for CBD are dosages and drug contraindications (reactions between CBD and other medicines or possible influence on existing health conditions). In the absence of regulation, these factors have fallen between the cracks, exposing consumers to possible harm.

The FDA has advised Congress that the Agency won’t regulate the inclusion of CBD in supplements and food products. Limitations in the agency’s infrastructure for managing the potential risks of doing so were cited. Congress has been asked to delineate guidelines in this respect.

There’s no indication of any “overdose” potential with CBD. The problem is that there has been little effort made in establishing appropriate dosages to treat specific health conditions. Drug contraindications - reactions between CBD and other medications - must also be studied, as well as factors like allergies or previous drug or alcohol addictions. In a statement, FDA Deputy Commissioner Dr. Janet Woodcock outlined the Agency’s concerns around effects on male reproduction, impact on the liver, and pregnancy.

As traditional Western medicine discovers the value of natural substances for treating illness, CBD’s influence will undoubtedly be validated by research. Until then, the body of evidence grows. Soon, we’ll not only be able to enjoy wonders like CBD home delivery, but we’ll also have a regulatory framework that clarifies the value and scope of CBD’s value to human health.