Sales of CBD products have grown exponentially, but there is only one proven use for the drug so far. Two epilepsy specialists give their thoughts on the CBD craze. CBD (cannabidiol) has become a trend before scientists have even fully figured out how it works with our bodies. What will that mean for its future medical use and perception?
‘Snake oil salesmen’: Two neurologists respond to the CBD craze
The CBD craze has taken the world by storm, seizing promotional and consumer dollars as fast as anything in recent memory: cryptocurrencies, fake (but edible and delicious) meat, or vaping. According to estimates from data research firm Brightfield, the U.S. CBD market in 2019 is expected to reach $5 billion — 706% growth compared to 2018.
But while celebrity after celebrity has endorsed cannabidiol (CBD) products, to which they can “personally” attest to the benefits, the science isn’t so sure.
Kim Kardashian is one of many celebrities and athletes to have endorsed CBD products. (Photo by Angela Weiss / AFP)
While the efficacy of CBD to treat everything from anxiety to Crohn’s disease isn’t clear, it’s a real substance with real medical potential.
In June 2018, the FDA approved the first drug containing CBD oil, an epilepsy drug called Epidiolex from Greenwich Biosciences, a subsidiary of GW Pharmaceuticals (GWPH). On Nov. 5, GW reported $91 million in sales in the third quarter, of which $86 million came from Epidiolex, which helped the company beat sales expectations.
But the rest of CBD’s claims remain untested and unapproved as far as FDA standards are concerned. Yahoo Finance spoke to Dr. Susan M. Lippmann and Dr. William E. Rosenfeld, neurologists and co-directors at the Comprehensive Epilepsy Care Center for Children and Adults in St. Louis, Mo.
The duo have performed studies on epilepsy drugs for over 40 years through Phases I, II, III, and IV of the FDA approval process. They performed the double-blind FDA trials for Epidiolex, and though they saw positive results in terms of epilepsy, the pair remain skeptical of the drug’s meteoric entry into mainstream society and the business world.
Emoji gummies by JustCBD are displayed at the Cannabis World Congress & Business Exposition trade show, Thursday, May 30, 2019 in New York. The treats contain non-psychoactive cannabidiol, CBD. (AP Photo/Jeremy Rehm)
“We believe it has been proven by double-blind placebo studies to be successful in reducing certain types of seizures,” said the doctors in a joint email to Yahoo Finance. “For other diseases, much of the information out in the public domain is not based on FDA studies and is based on hearsay and anecdotes.”
Lippmann and Rosenfeld were quick to point out that this doesn’t mean that some of these usages won’t later prove to be true, but without the studies, there’s no proof.
Double-blind studies — when neither the researchers nor the patients know which drugs are placebo and which are real — are especially important given the fact that the “placebo effect” can typically result in 10% to 30% improvements in epilepsy studies, and potentially higher for other diseases, according to Lippmann and Rosenfeld.
The CBD craze is not based on proof
Looking at the surge of CBD products, the physicians view the CBD craze as based on people’s own perceptions about cannabis combined with big business hype.
“It is large financial interests who want to take advantage of a financial boom,” Lippmannn and Rosenfeld said. “Some well-meaning individuals may even be taking advantage of a potential boom, basing it only on a personal bias, having used CBD oil themselves and feeling it ‘helped’ them, all the while not realizing the potential for the well-known ‘placebo effect.’”
For epilepsy, the doctors said, a 10 to 30% improvement for patients can come from the placebo effect, and in other diseases it can be even more pronounced.
“Unfortunately to date, the sale of CBD is based on little fully blinded proven data, much like the ‘snake oil’ salesman or ‘Carter’s little liver pill’ of days gone past,” the doctors said. “Will CBD make lots of money for its growers and sales stores and corporations? I am sure it will. Is it all based on science? The answer is no.”
The doses are extremely different
The trials Lippmann and Rosenfeld performed used a dosage of 10 to 30 mg/kg/day and the recommended dosage for the approved drug is 10 to 20 mg/kg/day for Lennox Gastaut or Dravet’s Syndrome, with a starting dose of 5 mg/kg/day. For a 150-pound person, that’s 680 mg to 2041 mg. Contrast this with capsules on the market that are 25 mg of CBD.
“Many patients come to the office and are only taking ‘droppers’ amounts of CBD with very minimal amounts of CBD,” the doctors said. “Some of these may well be placebo doses. This may well explain why patients often feel they are having little or no side effects.”
In the doses that were effective for epilepsy, CBD does have side effects, on both the liver and cognitive functions.
“People feel that because it comes from a plant, they believe there are no side effects,” said Rosenfeld and Lippmann. “They do not realize that many drugs come from plants and that clearly there is a potential for side effects from CBD.”
The doctors pointed out a key additional problem with other CBD drugs that comes from the fact that the space is almost entirely unregulated by the FDA or other parts of the federal government. Many CBD products “could easily contain little or no CBD or contaminants which could be potentially very toxic,” Lippmann and Rosenfeld said.
Ethan Wolff-Mann is a writer at Yahoo Finance focusing on consumer issues, personal finance, retail, airlines, and more. Follow him on Twitter @ewolffmann.
Are we turning CBD into snake oil?
B12 deficiency nearly caused my death in 2015; did you have any idea that’s something to worry about? Like me four years ago, you probably didn’t—and it’s largely due to a fellow known as “ Dr. Feelgood .” This charlatan popularized B12 in the 1960s, administering it in a decidedly not-medical fashion, giving it to those without a deficiency because of the energy boost it offered, often combining it with intoxicants and other substances.
CBD has become a trend before scientists have even fully figured out how it works with our bodies.
This eventually led to it culturally being thought of as a “snake oil,” or basically worthless and unnecessary medicine—which had unfortunate and severe effects on how it’s now treated by the medical community at large. And this happened despite the 1934 Nobel Prize in Medicine being awarded to the man who stopped the formerly frequent deaths of the deficiency, then known as pernicious anemia.
In our culture, we like things simple. Even though B12 deficiency was an extremely common cause of death a mere century ago, doctors are now hardly taught about it; they’re not even taught to screen for it correctly , and often not testing even serum levels unless they see anemia, a late-stage symptom that doesn’t happen in everyone.
Let’s talk about what this means for cannabis. CBD , or cannabidiol, is trendy. So trendy, it’s showing up at dinner parties , high-end juice bars , even Carl’s Jr. —and it’s at risk of falling into the same fate as B12.
The Big Deal
Within each and every one of us is a system of receptors that interact with cannabis, allowing us to experience its pleasurable and therapeutic effects. It’s called the endocannabinoid system , or ECS for short. Yet most doctors haven’t been taught about the endocannabinoid system at all, ever.
Despite the willful ignorance of the medical field in this regard, experts have been studying the ECS for nearly 30 years, understanding that it acts as a balancing force in all of the other bodily systems. Put simply, the ECS is an important biological network that medical professionals have yet to fully understand.
What if the result of CBD-mania could be that the medical prowess of the ECS, and the cannabinoids that interact with it, aren’t ever taken seriously?
Because it interacts with the other bodily systems to help achieve homeostasis (or balance), when the ECS isn’t functioning properly, it may affect the body in a multitude of ways , and often in a severe manner.
This is also why cannabinoids like CBD are such medical powerhouses—because they can help the ECS function when it can’t produce enough endocannabinoids (the cannabinoid-like compounds our body naturally produces) to run properly. Different cannabinoids in cannabis work with the ECS in a multitude of ways, empowering it to aid the cacophony of symptoms that can be caused by ECS imbalance.
The “Dr. Feelgoods” of CBD
By way of its effects on the ECS, CBD is a serious subject, and the way it’s regarded has very real implications. All of us need to start treating it appropriately, but especially medical professionals and those profiting from CBD. Since the passing of the Farm Bill , CBD has completed saturated our culture—and the pyramid schemes, ice cream flavors, and sketchy (untested!) products from random websites are affecting the way CBD is viewed.
The stigma around cannabis has already led to a major bodily system being largely ignored by the people who are responsible for protecting our health. CBD has become a trend before scientists have even fully figured out how it works with our bodies.
In our culture, if people think something is irrelevant, history has shown that it will be treated as so, regardless of overwhelming facts to the contrary. Even though the ECS was discovered in the early 90’s, its relation to a stigmatized plant means that it’s been ignored. Our nation has been swept up in the miraculous power of a cannabinoid without even really knowing what it is, or that there’s many more of them waiting to be studied and benefited from.
CBD has already proven to be an important medicine for serious conditions. But if we keep treating CBD with all the relevance of a fidget spinner, it’s hard to imagine that the dinosaur pace of cannabis science will hasten. This means that the lack of an even rudimentary test for endocannabinoid deficiency or dysfunction will persist, and people will continue to be diagnosed with “incurable” and misunderstood diseases—and still suffer the symptoms .