It is everywhere, promoted for almost everything. I can hardly walk down the street without having a card pressed into my hand that extols its therapeutic virtues and offers free samples at my neighborhood store. It might be an ingredient in a smoothie or a muffin consumed by an unsuspecting buyer. Mothers feed it to their children.

Cannabidiol (CBD) is a cannabinoid constituent of the marijuana plant. It is the only natural marijuana product approved by the FDA for any indication (2 rare types of seizures: Dravet syndrome and Lennox-Gastaut syndrome). CBD does not cause euphoria. In clinical trials for epilepsy, its main adverse effects were diarrhea, somnolence, and aminotransferase elevations. But of course the huge public interest in this substance is not the result of its demonstrated efficacy in rare forms of epilepsy. The card I recently accepted in the street claimed that some individuals experience the following benefits: pain and inflammation relief; reduced nausea and anxiety; lower incidence of diabetes; relief from seizures and other neurological disorders; promotion of cardiovascular health; cancer-fighting properties; and anti-psychotic effects.

Is any of it true? Well, CBD has an impressive bibliography, concentrated especially on psychiatric symptoms such as anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, cognitive impairment, and psychosis. The common denominator seemed to be that preclinical results (mostly small uncontrolled studies in animals and some in patients) were promising or offered proof of principle. Large controlled clinical trials were absent. One study in a mouse model of Alzheimer’s disease found that the drug reversed memory defects, but only after intraventricular injections several times a week. Preclinical indeed.

And then of course there is the problem we have with any unapproved over-the-counter dietary supplement. Except for those certified by the USP, we don’t really know what could be in them. THC, the main psychoactive constituent in marijuana? Yes, demonstrated in some products. CBD? Entirely absent in others. Valium? Xanax? Prozac? Toxic solvents? Who knows? It’s difficult to believe that mothers who would not vaccinate their children against measles would give them an untested over-the-counter product like CBD. But that is what’s happening.

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  1. marc e sternberg says:

    Just think, placebo is about .333. Tony Gwynn went to the hall of fame batting that. Not bad odds I’d say.

  2. Katherine says:

    I was born a skeptic of almost anything, assumed placebo effect. However, I can first hand tell you – menopause symtoms were greatly improved – hot flashes, fatigue, muscle aches, and I was beyong miserable before using CBD oil spray. I used it for about 18-24 months, worked wonders. Now I tapered off and am doing great.
    Several friends also have good results.

  3. Because of all the hype, CBD must have the highest placebo rating of all time. Patients tell me it’s good for whatever ails them,

  4. Andrea Ries MD says:

    can’t get people to take flu vaccine, or their bp drugs. But otc unregulated cbd anything goes, no price limit.

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