Champions of CBD claim the compound is a natural, safe alternative to painkillers, without risk for addiction or long-term damage to your body. Is that true? Let's dig into what's known so far. Cannabidiol, abbreviated as CBD, has gained massive popularity since 2018, when it becamein the US.
The chemical compound is derived from the hemp plant, and touted as a way to manage everything from anxiety to attention deficit hyperactivity disorder. In a 2018 study of self-selected respondents who use CBD, 62 percent said they used it to treat a medical condition, most commonly chronic pain, arthritis and joint pain, or anxiety and depression.
This story discusses substances that are legal in some places but not in others and is for informational purposes only, not for the purpose of providing legal advice. You shouldn't do things that are illegal -- this story does not endorse or encourage illegal drug use.
"I think there's definitely a lot of excitement about [medical marijuana]," says Kevin Boehnke, who has a doctorate in environmental health sciences, and is a research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center at the University of Michigan. "It's always nice to have an extra tool in the toolbox, especially one that has been used for thousands of years and that people know to be relatively safe."
But relatively safe and effective are two different things. When it comes to treating pain, does CBD actually work, and how well?
What constitutes 'pain'?
Before digging into the research, it's helpful to understand how experts classify pain.
"In the [research] group that I'm part of, we think of pain as coming in three different flavors," Boehnke says. "One of them is neuropathic pain, and that's caused by damage to or inflammation of the nerves." Think: carpal tunnel syndrome or sciatica.
"Then there's acute, or nociceptive, pain," he says: Acute pain typically occurs as a result of an injury or tissue damage, like a broken bone or arthritis caused by bone rubbing on bone.
"Lastly, there is centralized pain, which has very recently been called nociplastic," says Boehnke. "And that's something more like fibromyalgia or some of the other chronic overlapping pain conditions -- migraines, tension headaches -- that have been more difficult to characterize scientifically and clinically because there's not a specific pathology that you can identify on an X-ray or fMRI."
Because the different types of pain don't always respond to medication the same way, it can be difficult to make sweeping generalizations about the effect of CBD on pain. But, with that said, here's what researchers know so far.
Early research is promising, but limited
There aren't many high-quality studies that specifically test CBD's effect on pain. Up until December 2018, CBD was classified by the federal government as a Schedule I substance along with marijuana, making it extremely difficult to study. Since then, a limited number amount of studies have been conducted to determine if CBD is effective for treating pain, but more research is needed.
In 2021, Syracuse University published a study showing that CBD can reduce pain, but that participants reported a decrease in pain both when they were given CBD and when they were told they were getting CBD but received a placebo instead. That said, compared with the control group there was a decrease in "pain unpleasantness" even among those who were given active CBD but were told they had not been.
A study from the University of Michigan, led by Boehnke and published in The Journal of Pain in 2021, found that out of 878 patients with fibromyalgia, 72% reported using CBD instead of pharmaceutical pain medications to manage their pain. The primary reasons given were that CBD helped decrease their pain better than other drug therapies and caused fewer side effects.
Another study from 2021, published in the Journal of Cannabis Research, found that patients with moderate to severe pain reported an improvement in their pain after three months of using a "CBD-rich treatment at a network of clinics dedicated to medical cannabis in Quebec, Canada," while there was no improvement for those with mild symptoms.
CBD plus THC
Other studies suggest that CBD might be more effective at relieving pain when combined with THC, or delta-9-tetrahydrocannabinol -- the compound in cannabis that can make you "high." However, given that THC is still a controlled substance, it's difficult to conduct research on its benefits.
"Although grounded in simplicity, it may be presumptuous to assume that the major clinical effects of cannabis are derived solely from THC and cannabidiol (CBD)," Canadian researchers Drs. Amol Deshpande and Angela Mailis wrote in The Journal of Applied Laboratory Medicine. "What becomes lost in the rhetoric is the importance of associated compounds found in the whole plant ... Although the biological activity of many of these still needs to be explored, preliminary work suggests that some may operate synergistically to produce an entourage effect."
"It seems like if you take them together, you can tolerate more THC without having the same types of side effects," says Boehnke, referring to THC's penchant for causing intoxication and impairment. "Also, taking CBD and THC together, compared to a similar amount of THC alone or CBD alone, seems to have better analgesic effects."
While early research seems promising, many results are based on self-reporting from patients, which can be flawed. Experts believe that the long-term effects of using CBD still need to be studied in order to determine if CBD is a safe and effective treatment for pain and other maladies.
Beware of what you buy
Researchers are concerned by the explosion of CBD products on the market, which are unregulated and often contain more or less CBD than advertised, according to FDA testing.
According to Medical News Today, in 2020, the FDA reported that between 2014 and 2019 it tested 147 randomly selected CBD products for harmful compounds and to evaluate if the advertised dose matched the actual CBD content. Of the 102 products that advertised a specific amount of CBD per package or serving, only 46 products contained CBD within 20% of the advertised amount. So, you're not always getting what you pay for.
The therapeutic benefits of CBD in some studies were achieved through specific doses, something that might be difficult to replicate at home with a CBD product you buy at a local drug store or online. Until there's more regulation of these products, it's hard to know what you're getting.
As NASEM noted in its 2017 review, "very little is known about the efficacy, dose, routes of administration or side effects of commonly used and commercially available cannabis products in the United States."
What the future holds
The DEA's rescheduling of CBD and the FDA's approval of Epidiolex, a CBD-based medication used to treat rare forms of epilepsy, will likely have a huge effect on the research space. "It means that clinical studies of CBD could potentially be done a lot more easily," says Boehnke. And there may be more prescription drugs on the horizon.
Sativex, a cannabis-based pharmaceutical product containing THC and CBD in a 1:1 ratio, is already approved in multiple countries to treat neuropathic pain, multiple sclerosis-related muscle spasms and stiffness, and severe pain from advanced cancer and is currently undergoing evaluation in clinical trials in the US.
Another bright spot? Cannabis' potential effect on the opioid epidemic: A growing body of research shows that the combination of cannabinoids and opioids is stronger than opioids alone, which could result in reduced opiate dosages. And a 2019 study found that 80% of chronic pain sufferers who use medical marijuana say they've substituted cannabis for traditional pain medications (both opioids and benzodiazepines) after experiencing fewer side effects and better symptom management.
Although CBD and cannabis research is promising, experts acknowledge the current limitations. In May 2019, the American Academy of Pain Medicine published a statement urging federal agencies to reschedule medical cannabis in order to encourage research leading to responsible regulation. Whether new legislation will follow remains to be seen.
"It's frustrating," says Boehnke. "Because we're in this space where people are using these things all the time, but the science is pretty far behind the policy."
Originally published in 2019. Updated with the current available research on CBD.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.