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Cannabidiol (CBD) is a modern wonder drug. Millions of people are using it for a huge variety of medical conditions, but how much has actually been proven? Is it just a fad or is there genuinely some good evidence that it can help?
And what do you mean when you say proven? There are some very important distinctions that change depending on who you ask. Some people are willing to follow what some person on Instagram says, no matter what. Other people, hopefully, you included, dear reader, look for more evidence and some solid proof before you take a drug. In the next thousand or so words, we shall discuss what medical conditions CBD has been proven to help and which ones might be proven in the future.
For a medicine to be approved in the United States or elsewhere, there are strict tests it has to pass before it can be given to the public. A strong evidence base, using at least the minimum standards of modern scientific evaluation – usually a double-blind, placebo-controlled trial (the “gold standard”), is needed for legislators and regulators to be happy that the drug they are letting people take is safe.
The problem with CBD at the moment is that these trials, in the majority of cases, have not been carried out. Small-scale trials are commonplace. Most of the evidence we have is from animal and lab studies, and these generally do not make it through to stage 3 clinical trials, which will be the deciders of their safety and efficacy.
So far, in the USA, only 2 uses of CBD as a medicine have been approved. The Food and Drug Administration (FDA) is the regulator of medicines and recently they approved CBD for use with Lennox-Gastaut and Dravet syndromes. These are rare and previously untreatable forms of severe epilepsy that can cause up to dozens of seizures a day. Most drugs had not worked for the children with the condition but CBD had shown some serious promise.
After several groups of scientists proved in trials of appropriate size that CBD could be safely and effectively used with children and adults with these two syndromes, the FDA accepted the findings, made their own assessment using the available evidence, and approved the drug for prescription for children over the age of 2. This is the first time that a cannabinoid has been studied well enough that it meets the standards required for the American government to approve it. More cannabinoids and uses are likely to follow.
Lots of people use CBD for many different conditions and this article is not meant to cast doubt on their experiences, only on the “proof” that some people espouse to support (usually) them selling you CBD.
Anxiety and Depression?
It is almost impossible to escape CBD’s role as the next antidepressant or anxiolytic drug, it seems everyone is using it. However, there are few reliable data from human clinical trials to support this. Several animal studies have identified how CBD works in the brain to relieve anxiety and depression, the mechanism is about halfway understood, and the results are consistent. When humans have been studied, the results look good – CBD can reduce anxiety in PTSD and other mood disorders.
However, none of the studies was good enough for it to be clinically approved. This is probably going to change soon, there are some big studies on the horizon.
Recent reviews have cast doubt on cannabis and CBD use in MS. Patients seem to think it helps, which is good, but when they are tested, neither smoking cannabis or a CBD/THC mix called Sativex was objectively any better than the alternatives. However, Sativex is available to people in Canada and Sweden.
Irritable Bowel Syndrome?
Once again, lots of people use it but there are few data to support its genuine efficacy.
Small-scale studies on animals and occasionally humans have shown very promising results. Humans have used cannabis products for thousands of years to treat this condition, but so far, there have been no large-scale double-blind clinical trials to back up this perception.
CBD’s psychoactive cousin, THC, is generally regarded as a better antiemetic than CBD, but it seems a mix of the two are more effective at preventing the nausea and vomiting that come with cancer chemotherapy. Individual states in the USA have long approved the use of cannabis and CBD for emesis but there is a surprisingly small amount of high quality data to support its use. Some initial data have suggested that CBD can fight tumours by preventing them from spreading and growing, and even killing them. Predictably, there have been few follows up and it remains preclinical data.
Psychosis and Schizophrenia?
The mood-regulating effects of CBD are relatively well known. Recent data have shown that CBD can work as an antipsychotic medication in Parkinson’s disease, Alzheimer’s, and schizophrenia. However, none of the studies was conclusive enough for the drug to be approved anywhere for this use. The word “potential” is used a lot.
Some very promising studies on heart disease have shown that the endocannabinoid system, the receptors and ligands that CBD interacts with, is very important in heart health and healing after a heart attack. Preliminary evidence suggests CBD could be used to promote healing and limit damage, but you guessed it, there is not enough evidence yet.
CBD has sebostatic and anti-inflammatory effects, so it follows that CBD could be used to reduce sebum production and the pain and swelling that make acne so problematic. Preliminary evidence supports this, but nobody has properly tested it yet, as usual.
Many forms of dementia, including the most common, Alzheimer’s disease, are thought to be autoimmune conditions. CBD looks like it can help prevent the delusions and distress caused by Alzheimer’s, and it might even play a role as a way to slow the onset of the disease, but as yet, the evidence is still inconclusive.
Proof? What Proof?
Many people will be happy to take the preliminary data from the trials and see if CBD has the same effect in their bodies. The safety profile of CBD is good enough that it can be experimented with easily and safely, so it is of less concern than with some other commonly used drugs.
Unfortunately, there are very few medical conditions CBD can be said to be “proven” to help. Anecdotal evidence and the pre-clinical trials referenced here suggest otherwise, but the reasons that there are such high standards of proof are good ones. When the rules were more relaxed around prescription and over-the-counter drugs, people could get drugs that were harmful to them but they never knew. A series of scandals where people died or were seriously harmed brought the medical establishment to the place it is right now: requiring a lot of high quality data before any decisions can be made.
This is to keep you safe and it works. Unfortunately, cannabidiol does not have the required levels of evidence yet, due largely to the difficulty in studying it. Now that it is getting legalized and approved, it will be much easier to study and soon you will have the proof you need.
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