CBD or Hemp to the Rescue?
Chronic pain affects the lives of 50 million US adults, which is roughly 20% of the US population. An article published by the Center for Disease Control in September of 2018 explains how chronic pain leads to an increase in diseases such as depression, anxiety, and insomnia, as well as opioid and other substance use disorders. Physical exercise is limited due to chronic pain which can lead to other illnesses such as high blood pressure and diabetes. People affected by chronic pain often feel a loss of control and perceive their overall health to be of lesser quality when compared to those who do not suffer from chronic pain.
Traditionally, patients and their physicians have tried to address pain and the associated anxiety and depression in many different ways:
- Topical treatments such as application of heat, ice and topical creams
- Muscle-based treatments such as rest and strengthening which can improve functional status
- Medications including anti-inflammatories, opioids and anti-depressants are routinely used
- Relaxation techniques such as mindfulness and clinical hypnosis are often added to help reframe personal responses to pain and set functional goals
- Manual therapies such as massage, PT, chiropractic care, and acupuncture play an important part in supportive care of chronic pain patients
Despite best efforts by patients and medical providers to address chronic pain, the incidence of chronic pain continues to increase, and unfortunately so do the associated complications, including drug abuse and overuse. Overdose deaths have doubled in the past decade with more than 70,000 US adults dying of drug overdose in 2017. Opioids were the second most commonly overdosed drug, and benzodiazepines took 5th place.
In the last few years, plant-based medicine such as homeopathy, aromatherapy, and CBD use have become more popular and mainstream. If there are safer plant-based alternatives for treating chronic pain and the associated anxiety and depression, it seems natural that we should look at these more closely.
What is the difference between CBD and THC?
CBD is short for cannabidiol which is one of the many substances derived from the flower of the hemp plant. CBD is thought to help in relaxation, pain control, and increasing parasympathetic nervous system activity. Our parasympathetic nervous system is active when we get to rest and relax which helps to restore body and mind.
Tetrahydrocannabinol, or THC, is another substance derived from the flowers of the hemp plant. THC is known to be a psychotropic agent which means it can alter perception, behavior, mood, and cognition when used.
Cannabis vs. Hemp vs. Marijuana
Cannabis is part of the scientific name for the hemp plant. Different species of the hemp or cannabis plant can produce varying amounts of CBD and THC. How much CBD and THC a plant produces depends on the specific variety of the plant and when the flowers are picked and processed.
What is the evidence for CBD?
At this time, CBD has only been approved by the FDA in the form of a drug called Epidiolex. This drug is specifically used for two seizure disorders (Lennox-Gastaut Syndrome and Dravet Syndrome).
No other uses have been approved by the FDA due to lack of evidence based studies. These studies have been difficult to gather, as CBD had been considered an illegal substance up until the passage of the Farm Bill on December 20, 2018. This bill made farming and selling hemp products legal as long as they contain less than 0.3% of THC when tested. Clinicians and researchers interested in the potential of plant-based care are hopeful that research will occur to provide evidence to existing anecdotal knowledge.
Patient testimony shows CBD in varying quantities to be effective for the treatment of chronic pain syndromes such as back pain, anxiety, panic attacks, and insomnia. In my practice use of CBD has helped patients lower the amount and even stop taking medications such as narcotics and benzodiazepines.
Where can I purchase CBD products?
CBD is currently sold in the form of sprays, drops to place under the tongue, salves, and capsules. CBD can be purchased locally at pharmacies, clinics, stores specializing in hemp products, gyms, hair salons, and vape shops just to name a few. It can be purchased on the internet as well. I recommend knowing who supplies your CBD oil and where the hemp used for the oil has been grown. Have the growers used sustainable and ideally organic growing practices? Has their product been 3rd party tested?
Due to patient interest, we sell CBD oil products at Sunrise Clinic. As a physician I have spent time educating myself on the rules and regulations surrounding CBD oil, as well as plant-based care specific to CBD oil. I feel this has helped me choose a product I can offer to my patients that matches my quality standards and business ethics.
Ask your medical care team about CBD oil and how familiar they are with regulations and medical uses. Depending on their level of comfort with CBD oil, they may be able help you navigate the market and find a product that is safe and works for you.
How is CBD oil used?
CBD oil can be applied topically to achy joints and muscles, to the upper back and neck for headaches, or massaged onto the abdomen in case of menstrual cramps. CBD oil can be ingested as well. To help with chronic pain, anxiety, panic attacks, insomnia, and menstrual cramps, drops of CBD oil can be placed under the tongue. Sprays can be used in a similar fashion as well.
If you have never used CBD oil before, it is recommended that you start with two drops under your tongue. Assess how you feel after one hour. If you took the CBD to help with pain — are you in a bit less pain? If you took it because of anxiety — are you a bit more relaxed? If your answer is yes, then two drops is your dose to be used daily or up to four times daily. Should you feel there was no change in your symptoms, add another two drops and keep increasing by two drops every hour until you feel the desired effect. CBD oil effects will usually last 4–6 hours. Add up the total dose of CBD oil taken over 4–6 hours and that would be the effective dose that can be taken all at once in the future.
As a rule of thumb from patient experience, 2–6 drops taken before bed seem sufficient to help with insomnia. Anxiety treatment is often effective with 4–6 drops taken 2–3 times daily, however some people require 10 drops or more. Chronic pain often seems to require higher dosages such as 30 or more drops 2–3 times daily.
As with many plant-based therapies, use of CBD will have to be adjusted to fit individual needs. Talk to your medical team so they can help you add plant-based treatment to your existing medical regimen.
Side-effects of CBD oil use
Side-effects generally are described as mild and can include relaxation and increase in sleepiness (but not drowsiness). Some people have reported that they cry more when they start taking CBD oil. However, they do not describe symptoms of depression, but rather a feeling of crying that is relieving inner stress. Overall CBD oil seems to be tolerated well.
Does CBD have any drugs interactions?
Highly concentrated products may affect warfarin, antidepressants, and statin drug dosing. It is a good idea to inform your medical providers about any plant-based medications you may be taking.
Is CBD legal?
Yes, as long as the product you are using contains less than 0.3% of THC. The product must be third-party tested. It is a good idea to ask the person supplying your CBD product if you may see the third-party lab testing. In my practice we provide clients a copy of the testing which we encourage clients to take with — especially if they plan to travel with their CBD oil.
Is CBD safe?
The FDA does not currently regulate the purity or safety of dietary products which is what the FDA classifies CBD as. A study by the MN state health department showed that of the CBD available over the counter, only 31% correctly stated the amount of CBD in the product. Almost all samples taken were adulterated — meaning that chemical assessment found substances not listed as ingredients on the bottle. Therefore, the MN state health department issued a warning stating over the counter CBD as “unsafe for use — especially if ingested”.
Customers should consider the source of the CBD oil they purchase as a quality indicator. Due to high demand for CBD, companies wanting to make a profit may grow hemp plants in poor soil. Soil like this may contain heavy metals and these heavy metals would concentrate in the oil produced and be unhealthy when ingested.
How expensive should CBD oil be?
Chris Buske is the owner of Wonders Of Nature hemp specialty store who produces the CBD oil products sold at his store in Eau Claire and at Sunrise Family Care Clinic in Chippewa Falls. Chris likes to say, “Plant-based medicine is by the people and for the people. If we make it too expensive and people cannot afford it, then it is no longer for the people.” He practices this statement by selling a pure product priced at the current fair market value of CBD oil. This means you should expect to pay $70–80 for a 1000mg bottle of CBD.
Will CBD oil show up on a urine drug screen if it is ingested?
This depends on how much you use and how soon after ingesting the CBD oil you are tested. It is best to inform your employer that you are taking CBD oil so that they are aware before you complete the urine drug screening. It is always best to inform all of your medical team as well.
- Cannabidiol is approved by the FDA for 2 seizure disorders only. The name of the approved cannabidiol is Epidiolex. No other form of cannabidiol is currently FDA approved.
- Anecdotally, CBD oil is used successfully as additional therapy in the management of chronic pain, anxiety, panic attacks, insomnia and menstrual cramps.
- CBD oil is legal if it contains less than 0.3% THC and this is verified by 3rd party testing.
- Know the source of the CBD oil you use, and for legal reasons and your personal safety, check for 3rd party testing!
- Inform your medical team of any and all plant-based supplements you are adding to your regimen.
As your medical providers we wish to know what you are taking so we can do our best to provide you the care and expertise you have come to trust.
Written by: Mary Landwehr, MD
Sunrise Family Care Clinic
For information or to schedule an appointment:
715-726-3096 | sunrisefamilycareclinic.com
Dr. Landwehr sees patients in Chippewa Falls.