With all the buzz about medical and recreational marijuana, you may have heard about a related product called CBD oil or CBD hemp oil. While research on CBD oil is still limited, it does seem to be very useful in managing chronic pain and other conditions. Here is a little information about CBD oil – what it is, how we think it works, and how to get it.

Cannabis

CBD stands for cannabidiol, one of the 100 or so substances found in marijuana and related plants that are active in the human body, called cannabinoids. CBD oil is extracted from hemp, a plant related to marijuana, but grown for oil and fiber. Marijuana and hemp come from the same species, Cannabis sativa, but marijuana is a shorter, stockier plant bred for high levels of cannabinoids, while hemp is a tall (sometimes up to 20 feet!) slender plant. Most marijuana strains are some degree of hybrid between the two closely related species Cannabis sativa and Cannabis indica. Marijuana often has high levels of THC, the cannabinoid most popular for recreational use, although THC also has medical uses. THC levels in marijuana are generally between 5% and 30%. In contrast, in order for hemp to be called hemp, the plant must have a THC content of less than 0.3%, but can have high levels of CBD. Some strains of hemp have very low levels of CBD, and are used for nutritional and body care oils, or for fibers for clothing and rope. There are thousands of uses for hemp products.

Endocannabinoid System (How we think CBD works in the body)

Many substances have an effect on the human body through proteins in cell membranes called receptors. Specific substances fit into specific receptors, similar to a key into a lock, and cause a specific change in the activity of the cell. Receptors are a way that cells communicate with other cells, but they are also a way that we can alter the function of the body, by using drugs that also fit into the receptors. One receptor system in the body is the endocannabinoid system. Endocannabinoid receptors are present in large numbers in the nervous system and the immune system, as well as glands, connective tissue, and some organs. The overall function of the endocannabinoid system seems to be homeostasis (the maintenance of a stable and balanced environment inside the body) and communication between intersecting systems in the body. Because endocannabinoid receptors are found in so many types of cells in the body, there are many types of responses to cannabinoids, and the endocannabinoid system may be involved in regulation of appetite, insulin sensitivity, the immune system, the body’s response to stress, and the utilization of nutrients. The endocannabinoid system also seems to be involved in anxiety, mood, sleep, and the perception of pain.

THC and CBD are the two most well-known and well-studied cannabinoids. THC is mostly active at the endocannabinoid receptor type called CB1, which is found in the highest concentrations in nerve cells and lowest in immune system cells. CBD seems to be active at all types of cannabinoid receptors, and the function seems to be to increase the overall activity of the endocannabinoid system, and reduce inflammation, especially in the nervous system, including the brain.

An interesting side note: Endocannabinoids, the natural substances in the body that bind with endocannabinoid receptors, increase dramatically during exercise, and may contribute to exercise-induced euphoria, also known as runner’s high.

Uses of CBD oil

Most of the research about the effects of CBD oil has been in animals, with very little research in humans, but what we have seen is promising. Some of the most interesting research has been done regarding the beneficial effects of CBD in multiple sclerosis and epilepsy. Arthritis pain is reported to be improved with CBD oil, and markers of inflammation are reduced. Many people report reduction in chronic pain, including hard-to-treat pain such as fibromyalgia. As an added bonus, tolerance to the effects does not seem to develop, unlike opioids. Speaking of opioids, CBD oil has shown some promise in the treatment of opioid and nicotine addiction, and may reduce the symptoms of opioid withdrawal. CBD oil may also have some benefit in the treatment of mental health conditions such as anxiety, insomnia, PTSD and OCD, all of which are also associated with chronic pain.

Adverse effects and risks of CBD oil

Of course, everything that has an effect also has possible adverse effects. The most common adverse effects of CBD oil are not generally severe, and include fatigue, diarrhea, changes in appetite and weight (up or down), nausea, changes in sleep, and irritability. CBD oil may change the way the body responds to other medications, so it is always important to check with your prescriber before trying CBD oil. Of particular concern are medications such as Coumadin (warfarin), chemotherapy drugs, anti-epileptic drugs, and psychiatric drugs.

Another possible adverse effect is that, in some people, CBD oil can reduce the body’s inflammatory response too much, and may result in increased risk of infection, especially in the lungs.

A rare condition called cannabis hyperemesis syndrome, causing severe cyclical nausea and vomiting in people who use a lot of marijuana, does not seem to be associated with CBD oil.

Legality of CBD oil

Hemp has a complicated legal history in the US. Hemp was a common crop during Colonial times – in fact, George Washington rather famously had a large hemp crop. In a political gaffe, hemp was grouped with “cannabis” and included in the Marijuana Tax Act of 1937, then included in Nixon’s War on Drugs in 1970. This made growing hemp illegal in the US, although during World War II, growing hemp was encouraged as part of the “Hemp for Victory” program, because of the many industrial uses of hemp. In 2014, the Farm Bill signed by President Obama included a section outlining the “legitimacy of industrial hemp research.” Today, from a federal standpoint, growing hemp is illegal, but buying and selling hemp products is not. As a result, most of the hemp products sold in the US are from hemp grown in Canada, Europe and China. There are 3 states that have passed legislation allowing hemp farming for commercial purposes (Vermont, Colorado and Oregon), and 6 states that allow research crops. Thirty-three states have introduced legislation to legalize hemp farming.

CBD hemp oil is legal to buy and sell in the US. It is considered a dietary supplement by the FDA, so there is not much regulation concerning quality, purity, additives, strength, labelling or dosing. In fact, because of the status of CBD oil as a dietary supplement, portions are referred to as “servings,” not “doses.” This lack of regulation, combined with the increasing popularity of CBD oil, means that unscrupulous manufacturers trying to get rich quick may produce a very inferior product, so it’s best to do some research about different manufacturers before you buy.

Drug tests do not test for CBD, but often test for THC. Most CBD hemp oils have very low concentrations of THC, but using CBD hemp oil could result in a drug test positive for THC. There are CBD hemp oil preparations that claim to have no detectible levels of THC, however these are often more expensive.

Buying CBD oil

CBD oil is commonly purchased from online vendors, but there are brick-and-mortar stores that carry it. Medical marijuana dispensaries do not typically carry CBD hemp oil, and it will likely not be available at pot shops in Massachusetts when they open. Purchasing CBD oil is definitely “buyer-beware,” but with a little research, it is not difficult to find a supplier and a product that will meet your needs.

  • Read labelling of CBD oil carefully, because there is no standardization in labelling. Does the label list mg of CBD oil or mg of active CBD? For example, 100 mg of CBD oil that is 20% active CBD will only be 20 mg of active CBD. Does the label tell you the strength of the oil? This is usually listed in mg/ml or percent.
  • Request lab results done by a third party, not the manufacturer or seller, to determine potency, the presence of pesticides or other toxins, additives, and residual solvent. A reputable manufacturer or seller will be able to provide these results.
  • Check online reviews. This can be a good source of information about the product and the company you are considering.
  • Some companies selling CBD oil offer various risk-free trial options, which might be good option.
  • CBD oil comes in various preparations, including sprays, tinctures, and capsules for oral or topical use; creams and patches for topical use only; and vapes. Concentrates are also available, so you can make your own topical or oral preparations.

Hemp seeds and hemp oil are considered nutritional “super-foods” and contain a high level of beneficial nutrients, but do not contain CBD.

As a final caveat: As with any medication or therapy, talk to your health care provider before trying CBD oil

For more information:

General info about CBD oil


At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.