CBD Oil (Cannabidiol)

A safer alternative to marijuana

Marijuana is a complex plant. Also called cannabis, marijuana has over 100 active drugs, or cannabinoids. Among them, the most harmful is THC (tetrahydrocannabinol), while the healthier ingredient is CBD (cannabidio).

THC causes anxiety, paranoia, and cognitive problems. CBD reverses some of those problems, reducing anxiety and paranoia. While THC is responsible for marijuana’s addictive highs, CBD is generally not considered addictive (see more below). Another positive feature of CBD is that it protects brain cells.

In recent years we’ve seen major shifts in how these two are used and understood:

1. CBD entered medical use in 2018, when it was released as Epidiolex to treat seizures.

2. Over-the-counter CBD oil has gained popularity as people seek a safer version of marijuana.

3. Meanwhile, THC has risen in recreational marijuana use as dealers have tried to make a more addictive product.

Delta THC

Delta 8 and 9 are variants of THC. Their legal status is in flux, and they are sometimes sold in stores. However, these are psychoactive drugs with many of the same properties as THC. They have little in common with CBD and are best avoided.

What CBD Treats

We are just starting to understand CBD’s psychiatric benefits. This drug has complex effects in the brain, so results vary a lot by person. Overall the studies are small, but they generally show positive effects in:

1. Anxiety
2. Post Traumatic Stress Disorder (PTSD)
3. Schizophrenia and psychosis

Studies are underway in depression, insomnia, and drug abuse, but so far the results are unclear there.

How to Take CBD

Most CBD products are packed in very low doses, 5-10 times less than what was used in clinical trials. For anxiety, the dose is 300 mg/day, which can be taken all at night or divided throughout the day. Some studies tested 150 mg, and some went as high as 600-800 mg.

In everyday use, people report benefits with low doses (10-50 mg/day), but it’s not clear that those effects are any better than a placebo.

CBD oil can be taken regularly or as needed for anxiety and sleep. It is available as an oil-based capsule, vaporized liquid, and gummy. Topical forms (applied to the skin) are not recommended for psychiatric use.

For seizures, prescription CBD is dosed based on weight, 2.5-5 mg/kg, which equates to about 350-1,400 mg daily.

Side Effects & Drug Interactions

CBD is generally well tolerated. Potential side effects include dry mouth, diarrhea, low appetite, drowsiness, and low blood pressure. CBD also interacts with many psychiatric and other medications. It raises levels of other meds by blocking metabolic enzymes in the liver (eg, CYP3A4 and CYP2D6). This interaction can be dangerous, such as with blood thinners.

Is CBD Addictive?

CBD is not known to cause problematic addiction. As a prescription medication, the DEA lists it as “Schedule V” – which means it has a low risk of abuse. The FDA goes further to say that there was no evidence of abuse, reward, or withdrawal in human and animal studes. Nor did CBD lead to THC use.

As a safer cannabinoid, CBD is a good option to for marijuana users to switch to, and in one study a high dose (200 mg twice a day) helped them stop marijuana.

Warning: Positive Drug Tests

CBD oil can cause failed drug test as it may register a false-positive for marijuana. The risk varies from 10-50% and is worse with higher doses.

Legality

CBD exists in a legal netherworld. It is regulated as a prescription medication, but sold over the counter. The FDA has attempted to shut down these sales, but so far that has not lead to arrests or stoppage. It has, however, caused the price to go up due to supply limitations.

Choosing a CBD Product

Consumer Lab tests products for purity and accuracy of ingredients. Only a few brands were fully THC free: cbdMD, Garden of Life, Green Roads Relax. and MedTerra. Among these, cbdMD Broad Spectrum Gummies is the most affordable (though still pricey at $180/month for a 300 mg daily dose).

These brands contained trace amounts of THC: Ananda, Bluebird Botanicals, Lazarus Naturals, and Swanson.

Going outside of these recommendations is risky. In one study, 20% of CBD products contained THC, and many did not delivery the advertised dose of CBD.

Stay away from “synthetic CBDs” like 4-CCB. These are not what they appear and have caused hallucinations, seizures, and loss of consciousness.

Here’s a link to FDA testing on CBD products.

The Bottom Line

Although CBD is promising, it is not a top choice among natural products. Other natural options have a better track record of safety and efficacy. However, if you use marijuana to treat symptoms and would like a safer alternative, CBD fits the bill.

–Chris Aiken, MD, Updated 5/30/2024

Key Points

• Marijuana has many ingredients. THC is the more dangerous one, while CBD is on the safer side.
• CBD oil may reduce anxiety and paranoia, but the studies are small and the results inconsistent.
• CBD is expensive and can raise levels of other medications.