Straight Dope on Medicine: CBD

Author

Scott Ganser
October 23, 2023

What, pray tell, is CBD?

Its true name is Cannabidiol.

It is the second most prevalent active ingredient in cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. One of hundreds of components in marijuana, CBD does not cause a "high" by itself.[i]

What are the active ingredients in marijuana?

Cannabis is a natural product, the main psychoactive constituent of which is tetrahydrocannabinol (Δ9-THC). The cannabis plant (Cannabis sativa L.) is broadly distributed and grows in temperate and tropical areas. Together with tobacco, alcohol and caffeine, it is one of the most widely consumed drugs throughout the world and has been used as a drug and a source of fiber since historical times.[ii]

THC

CBD is Just One Molecule in the Vast Chemical Space of Cannabinoids

Formally, CBD can be considered to have a tetrahydrobiphenyl skeleton: a bicyclic core that represents an adduct formed by the monoterpene, p-cymene, and the alkylresorcinol derivative, olivetol. CBD can be converted into the tricyclic dibenzopyran, Δ9-THC (THC), via an acid-catalyzed reaction. (17,18) While CBD and THC are prominent members of the cannabinoid family of compounds, they are just a part of the numerous representatives of the chemical subspace of the terpenylalkylresorcinol metabolome of plants of the Cannabis genus.[iii]

Proliferation

Cannabidiol — better known as CBD — seems to be everywhere: in gummies, lotions, oils, lollipops, vapes, toothpaste, even a high-end sports bra. It’s been touted as a treatment for such concerns as anxiety, insomnia, pain, PTSD, and depression.

The medication Epidiolex — the only CBD-based treatment approved by the U.S. Food and Drug Administration (FDA) — has been proven effective for severe seizure disorders. A twice-daily oral solution, Epidiolex has been shown to be effective in a number of clinical trials, including a 2021 study that found a median decrease in certain seizures ranging from nearly 50% to over 70%.

Is cannabidiol legal?

CBD is readily obtainable in most parts of the United States, though its exact legal status has been in flux. All 50 states have laws legalizing CBD with varying degrees of restriction. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. In 2018, the Farm Bill made hemp legal in the United States, making it virtually impossible to keep CBD illegal – that would be like making oranges legal, but keeping orange juice illegal.

The Farm Bill removed all hemp-derived products, including CBD, from the Controlled Substances Act, which criminalizes the possession of drugs. In essence, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) – even though it is the exact same molecule. Currently, many people obtain CBD online without a medical marijuana license, which is legal in most states.

Saying that CBD from hemp is legal and CBD from marijuana is illegal is fantastically stupid and inconsistent, but those descriptors never stopped our government before.

CBD is CBD. The source is irrelevant.

Logical Fallacies

Ad hominem

Ad hominem (Latin for 'to the person'), short for argumentum ad hominem, is a term that refers to several types of arguments, most of which are fallacious. Typically this term refers to a rhetorical strategy where the speaker attacks the character, motive, or some other attribute of the person making an argument rather than attacking the substance of the argument itself.[iv]

False dilemma

A false dilemma, also referred to as false dichotomy or false binary, is an informal fallacy based on a premise that erroneously limits what options are available. The source of the fallacy lies not in an invalid form of inference but in a false premise. This premise has the form of a disjunctive claim: it asserts that one among a number of alternatives must be true. This disjunction is problematic because it oversimplifies the choice by excluding viable alternatives, presenting the viewer with only two absolute choices when in fact, there could be many.[v]

Should I be rich and great or wise and powerful?

Red herring

A red herring is something that misleads or distracts from a relevant or important question.[1] It may be either a logical fallacy or a literary device that leads readers or audiences toward a false conclusion.[vi] A red herring may be used intentionally, as in mystery fiction or as part of rhetorical strategies (e.g., in politics), or may be used in argumentation inadvertently.[2]

The term was popularized in 1807 by English polemicist William Cobbett, who told a story of having used a strong-smelling smoked fish to divert and distract hounds from chasing a rabbit.[3]

Sherlock Holmes inspects a fake clue. It appears to be informative, but it is wholly invalid.

Post hoc ergo propter hoc

 (Latin: 'after this, therefore because of this') is an informal fallacy that states: "Since event Y followed event X, event Y must have been caused by event X." It is often shortened simply to post hoc fallacy.

Post hoc is a particularly tempting error because correlation sometimes appears to suggest causality. The fallacy lies in a conclusion based solely on the order of events, rather than taking into account other factors potentially responsible for the result that might rule out the connection.[2]

There are more ways to get it wrong, but those are four good ones.

Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level of blood thinning and other medicines in your blood by competing for the liver enzymes that break down these drugs. Grapefruit has a similar effect with certain medicines.

People taking high doses of CBD may show abnormalities in liver related blood tests. Many non-prescription drugs, such as acetaminophen (Tylenol), have this same effect. So, you should let your doctor know if you are regularly using CBD.

A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot be sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other unknown elements. We also don't know the most effective therapeutic dose of CBD for any particular medical condition.

The bottom line on cannabidiol

Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer or COVID-19, which it is not. We need more research, but CBD may prove to be a helpful, relatively non-toxic option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies, we can't pinpoint effective doses, and because CBD currently is typically available as an unregulated supplement, it's hard to know exactly what you are getting.

Last year, 64% of U.S. adults reported trying a CBD product— and nearly half of those did so at a doctor's suggestion, according to a Forbes Health survey. In 2022, the CBD market was valued at $18 billion, and it's expected to more than triple in the next 10 years.[vii]

Conclusion:

Why? Why? Why?

I don’t see the point.

Every indication I see has an alternative. Maybe people think it’s cool and stylish to consume something derived from hemp or marijuana? As far as I’m concerned, it is jst a fad that needs to run its course. But then again, the marketing may just convince the masses for generations to come.