To CBD Or Not CBD?, That Is the Question

June 7, 2019

By Lauren Fournier, PT, DPT

Several of our patients have inquired about the use and effectiveness of the relatively new product called CBD oil, or cannabidiol, to help with pain and other ailments, so we took it upon ourselves to get the latest information out there.

What are the benefits?

CBD’s most discussed health benefit may be its anti-inflammatory properties throughout the body, including the central nervous system and the brain. Joseph Maroon, M.D., a clinical professor of neurological surgery at the University of Pittsburgh Medical Center and his colleagues conducted a review in 2018 which concluded such effects could possibly reduce anxiety, depression, seizures, and post-traumatic stress disorder (PTSD), and even benefit people who have had a concussion. Studies in the Journal of the American Medical Association found that, in states where people could legally use marijuana, the number of filled opioid prescriptions dropped significantly and there were lower rates of opioid overdose and death compared with states without legal cannabis. There have even been reports of CBD helping people with their cravings while quitting smoking and help them replace opioid or other OTC pain medications.

Will it make me feel high?

CBD products from hemp sold in retail stores and online aren’t supposed to contain more than 0.3 percent THC, or tetrahydrocannabinol, the compound in marijuana that can get you high, but some CBD products could have more THC than the label claims. That’s why it’s important to ask to see a product’s certificate of analysis (or COA). This will show how a product performed on tests checking for CBD and THC levels, and the presence of any contaminants. Due to the variability of regulations in each state, testing may or may not be required or be consistent. If an online manufacturer or a retail store doesn’t have the information, or refuses to share it, avoid the product and the retailer.

Will I test positive on a drug test?

The urine test most commonly used for drug testing doesn’t look for CBD, but instead a compound the body creates when it metabolizes THC. Barry Sample, senior director of science and technology at Quest Diagnostics, the largest administrator of drug tests in the U.S., says “There isn’t going to be a laboratory analytical false positive confusing CBD with a THC metabolite.” A positive result could be possible if the product taken had more THC than the allowed 0.3 percent. It’s also possible that over time, the small amounts of THC allowed in CBD products could build up in the body to detectable levels. Therefore, if you are in a position where you expect to take a drug test, it may be safer to stop taking CBD 2-3 weeks before you plan on taking the test just to be sure.

How is it sold?

Sold in pill form, oils, tinctures, topical lotions, and even in bottled water, coffee, beer, and cosmetics, CBD can be bought in retail stores, online, or at a Massachusetts dispensary (if you’re deliberately looking for CBD products with THC levels above the allowable limit for CBD-only products).

What form would be right for me?

For very quick relief of muscle cramps or anxiety, inhaling CBD may be most effective, via either a vape pen (similar to an e-cigarette) or cigarette-style. For effects within a few minutes, oil drops under the tongue may be useful. Effects from topical lotions, rubbed onto the skin, vary from person to person—some may feel it right away, others not for several hours. CBD in food products is likely to take longer (30 minutes or more) to be absorbed into your system.

What to look/look out for:

Look for products that show how much CBD is in each dose, not just the whole product. Dosages, which are expressed in milligrams, or mg, vary depending on the form of the product, and experts often suggest starting with products that have relatively low doses. For example, with tinctures, Mitch Earleywine, Ph.D., a professor of psychology at the University at Albany, State University of New York suggests generally starting with a product that has just 10 mg per dose.

Avoid products that make sweeping health claims, because they’re often inaccurate and illegal.

If you choose to vape your CBD, know that the concentrated oils used could contain a solvent called propylene glycol. When burned at high temperatures, it can degrade into formaldehyde, which can irritate the nose and eyes and could increase the risk of asthma and cancer. Therefore, consider CBD vape pens that advertise “solvent-free oils.”

If you want a product that probably has a little THC but not so much to get you high (there is some evidence CBD works best in the presence of some THC), look for one made from hemp. Most hemp used in CBD products sold in the U.S. comes from Colorado or Oregon (which have long histories with cannabis) or Kentucky (which passed a law to support hemp growers in 2013). Colorado is considered to have the most robust hemp program according to the experts. The state’s agricultural program performs spot-tests of hemp plants while they are still in the field to check THC levels and will investigate the potential use of any illegal pesticides based on complaints. Products made with hemp grown overseas can be even more problematic, because they are not subject to any state or federal testing.

Overall, it appears that the benefits of CBD are promising, but every resource concludes their studies with a phrase along the lines of “more research is needed” and/or “be sure to consult with your doctor.”


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