There's a lot we don't know about CBD

To people suffering chronic pain - from arthritis, multiple sclerosis, diabetes or other conditions - CBD oil sounds like a miracle cure. Pop a pill, chew a gummy or spread cream on your skin and your pain will be eased, CBD purveyors claim.

Like a lot of things in medicine, the reality is much less clear cut. There may be health benefits to CBD, but there are also risks. If you're thinking about trying CBD to ease pain, anxiety or sleeplessness, you need to examine the risks and benefits and, of course, talk to your doctor.

What is CBD?

The full name of CBD is cannabidiol, a compound found in cannabis (marijuana) and hemp. It's one of the two most abundant components of marijuana, the other being THC, which is what produces the "high" associated with marijuana.

Hemp is a member of the cannabis family, but it contains very little THC. When Congress passed the 2018 Farm Bill, it removed hemp from the list of controlled substances. That opened new horizons for those who wanted to produce hemp and explore the rumored health benefits of CBD.

Is it a drug or a supplement?

CBD is sold over the counter in many forms: oils, pills, gummies, tinctures that you drop under your tongue, vape cartridges, creams and foods like candy bars. The quality and amount of CBD varies widely in these products, and not all companies are clear about how much CBD is in their products. It's also possible that CBD derived from marijuana (now legal to grow and consume in 18 states, including Illinois) may contain THC, which will cause a high.

A significant safety concern with CBD is that it's primarily marketed and sold as a supplement, not a medication, and so is unregulated by the U.S. Food and Drug Administration. There is only one FDA-approved CBD drug, Epidiolex, for the treatment of seizures associated with tuberous sclerosis complex (TSC) and two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

Are there health benefits?

The most common phrases in CBD research papers seem to be "there is some evidence ..." and "much more research is needed."

So, with that caveat in mind, here are some of the conditions scientists are exploring that may benefit from CBD:

• Arthritis

• Nerve pain (neuropathy)

• Inflammation

• Muscle spasms associated with multiple sclerosis

• Anxiety (as in Alzheimer's patients)

• Breast cancer

• Acne

• Addiction

However, we don't know the most effective therapeutic dose of CBD for any particular medical condition. And, researchers at the Johns Hopkins University School of Medicine concluded in 2019: "Rigorous, controlled evidence for the therapeutic efficacy of CBD is lacking for many health conditions."

The FDA has sent warning letters to several CBD companies that, it said, were promoting unsubstantiated health benefits. Of course, websites selling CBD will tell you there are "proven" health benefits, so please take what you find online with many grains of salt.

Side effects and risks

So far, CBD doesn't seem to cause serious side effects. When used to treat epilepsy, users reported fatigue, sleepiness, diarrhea and changes in appetite.

Researchers in the journal Current Neuropharmacology reported that adverse effects in animals included toxicity, fetal death, liver damage and other risks.

"Adverse effects and potential drug-drug interactions must be taken into consideration" by doctors before recommending their patients use CBD, the writers said.

So, what's the bottom line?

If you listen to Martha Stewart, CBD is the best thing since sliced bread. "I've found that CBD supplements are a simple way to enhance my own health and wellness, especially when it comes to managing the stresses of daily life," says Stewart, who partnered with a Canadian company to market her own line of CBD supplements.

But, for me, the jury is still out on CBD. Anecdotally, people say it helps alleviate their anxiety and pain, but is it the CBD or is it a placebo effect? The FDA is working to compile more data to identify safety concerns in the CBD market. Researchers are being very cautious.

Since there seems to be the potential for drug interactions and liver toxicity with CBD, don't start taking or using it without first talking to your doctor. The only thing for certain is that the companies that sell CBD are capitalizing on the promise of better health.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.