CBD is short for cannabidiol, a chemical which is extracted from the hemp plant and then diluted with a carrier oil like coconut or hemp seed oil. While both CBD and marijuana are derived from the cannabis plant, CBD does not contain enough tetrahydrocannabinol (THC) to produce mind-altering effects. Hemp contains 0.3% or less THC, while marijuana contains higher than 0.3% THC.
CBD interacts with the body’s endocannabinoid system (ECS), which helps regulate the immune system, appetite, sleep, mood, digestion, inflammation, pain, motor control, temperature regulation, reproduction, and memory.
The FDA and CBD oil
Although CBD oil is legal in most states within the U.S. and can be purchased at your local drug/health food stores, smoke shops, and gas stations, only one CBD product has been reviewed by the Food and Drug Administration (FDA) for safety. That drug, Epidiolex, is a purified form of CBD that was approved by the FDA in 2018 for the treatment of certain seizure disorders. During their review of Epidiolex, the FDA did identify an increased risk of liver injury from the product but determined the risk could be managed provided the drug was taken under medical supervision.
Other than Epidiolex, the FDA warns that no CBD products have undergone a strict evaluation process to determine if they are “safe and effective to treat a particular disease, what the proper dosage is, how they could interact with other drugs or foods, or whether they have dangerous side effects or other safety concerns.”
The FDA also warns that testing of some CBD products has revealed the presence of contaminants like pesticides and heavy metals, and that some did not contain the levels of CBD claimed.
It is illegal for companies to promote their CBD products as a cure, treatment, or prevention of any specific disease or condition. Companies that make such claims are sent a warning letter from the FDA.
Why do people use CBD oil?
Although there have yet to be any large-scale human studies on CBD, there is scientific evidence that the oil may relieve pain, reduce anxiety and depression, reduce side-effects of cancer treatment, reduce epileptic seizures, and lower blood pressure, as well as deliver anti-inflammatory and other beneficial effects.
The Mayo Clinic reports that while CBD is usually well-tolerated, it can cause such side effects as dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. Some users have also reported experiencing nausea and irritability.
Potential risks with CBD oil
Harvard Health Publishing says two of the biggest concerns with CBD use are:
- CBD can increase the levels of other medications in the body the same way grapefruit juice does.
- CBD is sold as a supplement and not required to undergo the same stringent testing as FDA-approved medications.
Agreeing with the FDA, Harvard warns the lack of regulation means consumers can’t be certain what is contained in the product and whether the dose is accurately stated.
While some CBD providers submit their products for independent lab testing, other providers do not and have no verifiable way of proving what is contained within their oil. Since the industry is largely unregulated currently, consumers often have little insight into what the products contain unless they are able to access the results.
And because a large segment of the U.S. population takes one or more prescribed and/or over the counter medications while also taking CBD oil, many are at increased risk of a dangerous interaction. A study published in JAMA Internal Medicine found that due to concurrent use of prescription medications and dietary supplements in 2011, “15% of older adults [are] potentially at risk for a major drug-drug interaction.” This estimated risk had increased from 8.4% in 2005.
Drug interactions not only impact the efficacy of a medication, but they can also cause harmful side effects. Many drugs and toxins are broken down in the body by a vital enzyme called CYP3A4, mostly found in the liver, allowing them to be eliminated by the body. Grapefruit has been found to interfere with the metabolization process, allowing the drug to build up in the body, which can be dangerous.
CBD appears to have a similar effect, which is quite concerning, as approximately 60% of medications on the market interact with CYP3A4 enzymes. Check the FDA website for information about which drugs don’t interact well with grapefruit. And always consult your healthcare provider, prior to using CBD, for medical advice specific to your needs.
Risks of CBD when used with other medications
Research indicates that CBD can interact with medications including:
- Blood Thinners: A study published in the journal Epilepsy and Behavior Case Reports found a “clinically significant interaction between pharmaceutical grade cannabidiol (Epidiolex®) and warfarin, one of the most widely used oral anticoagulants.” If CBD disrupts the metabolization of a blood thinner like warfarin, the build-up of drug levels in the body could result in dangerous bleeding. It’s important that patients prescribed Epidiolex are carefully monitored by health professionals.
- Epilepsy Drugs: Even though the FDA approved the CBD drug Epidiolex to treat certain forms of epileptic seizures, incorrect doses can result in more aggressive seizures. This drug should only be used under close medical supervision.
- Chemotherapy Drugs: As with most drugs, chemo drugs are manufactured considering the likely rate of metabolization. If CBD slows down that rate, concentrations of the drug can build up in the body which could result in toxicity.
Other research has also linked CBD to interactions with:
- Antidepressants and Anti-anxiety Medications
- Cold or Flu Medications
- Blood Pressure Medications (Beta Blockers)
Always consult a doctor if you’re taking any of the medications above to understand their interaction risks.
The FDA continues to advise the public to be cautious about using CBD until more scientific research supports its efficacy and safety.
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