Should you take CBD oil?

Since Indiana legalized CBD oil earlier this year many patients have asked me what I think about it and whether they should try it or not.  My answer is a qualified “yes,” with the caveats and cautions below.

A few basics- the brain has its own “endogenous” cannabinoid receptors, just like we have serotonin, norepinephrine, dopamine, and opiate receptors.  The THC (tetrahydrocannabinol) in marijuana gets people “high” or intoxicated- CBD oil by law can’t have more than 0.3% THC, and rather than producing intoxication is used to medicinally treat various psychiatric and medical conditions.  A pharmaceutical-grade CBD oil has been approved by the FDA as a prescription medication to treat childhood seizures.  Over-the-counter CBD oil is available for purchase without a prescription, either online or in various retail locations.  It’s most commonly used as a “tincture”, or liquid form, although you can also get capsules and topical creams.

What’s it used for?  It’s being touted as a panacea that’s “good for what ails you,” which makes my skeptical mind a bit suspicious.  It’s most commonly used for pain issues, and psychiatrically for anxiety and insomnia.

What are the drawbacks?  Unfortunately the US government has quashed most scientific research into cannabis and cannabinoids since the War on Drugs began about 50 years ago, so there’s very little high-quality scientific research on it- most of the evidence is with case reports and anecdotal.  The medical field has always been plagued with quackery and a high placebo effect for bogus treatments.  That doesn’t mean CBD oil won’t be helpful for you, or that it won’t be proven helpful in general in the future- it means we have limited knowledge in the present about how well it works, and what it should be used for.

CBD oil shares with other complementary/alternative treatments that you’re not sure what you’re buying is what you’re really buying and at the correct strength- unlike prescription medications there’s very little regulation of over-the-counter medications.  CBD oil is also relatively expensive compared to other alternative remedies- it’s easy to drop $50-$100 per month at typical doses/prices.  Finally, like most chemicals it’s detoxed in the liver and is supposed to affect the liver enzymes (the “cytochrome P450 system”) which metabolize other medications- at least theoretically it could affect the blood levels of your antianxiety meds, antidepressants, etc.  So far this hasn’t seemed to be a problem for my patients, but caution is always wise. . .

With all this being said, I think an argument could be made that CBD oil would be safer both in the short and long term than benzodiazepines and benzodiazepine analogues for the treatment of anxiety and insomnia- meds such as Ambien (zolpidem), Lunesta (ezsopiclone), Klonopin (clonazepam), Xanax (alprazolam), and others.  If CBD oil allows you to substantially reduce or eliminate the use of these drugs, go for it!  Similarly, CBD oil is almost certainly preferable to opiates (hydrocodone, oxycodone, etc.) for pain control- if it works for you.

The saying “start low and go slow” is wise for any medication and would apply to CBD oil.  I would start at 10 mg daily and increase every 2-3 days as tolerated.  As always with complementary medications, recommended dosing ranges vary widely and you’ll read different things from different sources on the internet.

That’s pretty much what I know about CBD oil!