This week my search for something interesting and useful to blog about has landed in the Journal of the American Medical Association with an article titled, “Cannabidiol Products Are Everywhere, but Should People Be Using Them” by Rita Rubin MA. Anyone who has read my blog or tweets knows that I hold a dim view of recreational marijuana use. Marijuana is an addictive drug with significant side effects. This article does not deal with cannabis for recreational or medicinal use, but does look at the growing popularity of cannabidiol or CBD oil products.
As I drive through my midwestern suburb, I see signs advertising the sale of CBD oil and CBD containing products most everywhere. Drug stores, convenience stores, video stores, and pizza parlors all seem to be attempting to supplement their income by selling CBD. As I see patients, many of them have added CBD to their medicine lists without a great deal of thought about the effectiveness, safety or even the legality of doing so. Most of them swear it works and who am I to question their truth? Well, this article does just that.
The first question to ask ought to be, is CBD safe? The answer is no one really knows. We lack well designed controlled studies that look at what the adverse effects might be. What we do know is that for the one FDA approved prescription form of CBD oil used to treat intractable seizures, there are side effects. They include adverse effect on the liver, diarrhea, somnolence and decreased appetite. The effect included elevation of blood tests that would indicate damage to liver cells. 
Another problem is that the content of nearly all over the counter CBD products is not regulated by anyone. Some may think that is a great idea, but the problem is that those who buy these products have no guarantee what is in them. One study in the article noted that of 20 different popular CBD products “only 3 contained what the label said.” Eight had 20% less CBD in them than labeled and 2 contained no CBD at all. The author suggested that people who choose to use CBD buy only from suppliers that they trust. Certainly it appears that the buyer should beware.
The next question addressed in the article, was whether or not CBD actually works. Information concerning effectiveness is lacking. The author notes that there is one FDA approved form of CBD that is indicated to treat seizures that do not respond to any other treatment. Beyond that, little to nothing is known as to whether CBD actually helps the long list of things that it is claimed to improve. There are studies in progress that are testing effectiveness for treating psychosis, but none for depression, anxiety, Tourette syndrome, or ADHD. 
The last question the article deals with is whether or not CBD is legal. My state passed a law making it legal to sell. The complication arises that since there is an FDA approved form of CBD oil, it’s illegal by FDA standards. This is a complicated situation that will require further legislation to remedy.
So, the question comes down to whether or not you should consider using CBD and whether or not I would recommend it. The author notes that children, pregnant women, and those taking other prescribed medications should not take CBD oil at this time. Not enough is known as to the adverse effects and interactions with other medications to say that it is safe. Until good research is done that establishes using CBD oil to be safe and effective, I would not recommend it’s use.
 Rubin R. Cannabidiol Products Are Everywhere, but Should People Be Using Them? JAMA. Published online November 20, 2019. doi:https://doi.org/10.1001/jama.2019.17361
All factual information for this blog comes from this article. CBD oil is a derivative of Hemp or the Marijuana plant that does not contain any significant THC, the intoxicating portion of marijuana.
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