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CBD—snake oil or panacea?

Nikolas Harter
From the top of Hippie Hill at this years 420 festival.

Have you heard about the popular new cannabis health product, CBD? THC’s non-psychoactive cousin, CBD gained fame earlier this decade after being used to successfully treat children with intractable epilepsy. Since then it’s been claimed to alleviate a whole host of conditions, including anxiety, inflammation, pain, and even acne.

If and when the 2018 Farm Bill passes, this cannabis-derived molecule could be legal in all 50 states. But questions remain about its safety and efficacy.

I was talking about CBD with Bob Williams and John Lambeth at this year’s 4/20 festival on Hippie Hill in San Francisco. Bob and John had never smoked cannabis in their lives. They weren’t at the 4/20 festival to get stoned; they were there to spread the word about the medical benefits of CBD.

CBD, or cannabidiol, is a molecule that occurs naturally in the cannabis plant, like THC. I’d actually tried CBD for my first time shortly before meeting Bob and John. After I had my wisdom teeth removed, I took edible CBD oil instead of the opioids the doctor gave me.

It worked great! I felt relaxed, I didn’t have any pain, and most importantly, I was clear headed. Because unlike THC, which is the main psychoactive molecule in cannabis, CBD doesn’t get you high. In fact, CBD counteracts the psychoactive effects of THC.

Bob and John had their own personal stories of discovering CBD. They both involved long-term chronic pain that wasn’t being effectively managed with traditional medicine. They also told me some pretty incredible stories about other people whose lives had been literally saved after taking this medicine.

“She was sent home by the doctors to die,” said John as he showed me a picture of a smiling, older woman on his phone. “She had breast cancer, stage 4, and it had ulcerated, oozing, just a mess. Her cell cancer rate at that time was about 1,400 and change, and as of last February it’s somewhere around 140.”

The stories they told me were amazing. Almost unbelievable. And even though it comes from cannabis, they said CBD is legal in all 50 states. How is that possible? And does it really work? It was easy to believe CBD could treat inflammation and pain, but could it really send cancer into remission? I decided I needed to do some fact checking.

The Facts

It is true that CBD has arguably been legal at a federal level for the last four years. That’s because the 2014 Farm Bill legalized the cultivation of industrial hemp for research purposes.

Industrial hemp is defined by the government as any variety of the cannabis plant with less than .3% THC. Hemp can be used to make rope, cloth, paper, and health products such as hemp oil and CBD oil.

Retailers selling hemp products have been allowed to do so these last four years, because in the eyes of Congress it counts as “market research.” Once the 2018 Farm Bill passes, with support from Mitch McConnell and fellow Republicans, industrial hemp and its byproducts (including CBD) will be fully and unequivocally legalized for commercial use.

You can already find CBD products in over 100 7/11 stores nationwide, and the company has plans to put them in thousands more stores by the end of next year. The market for CBD nearly doubled from 2015 to 2016, and it’s expected to keep doubling until it passes a billion dollars by 2021. Big companies do not want to miss out on what’s quickly becoming the next big health-fad.

Credit Nikolas Harter / KALW News
Inside the country’s longest running cannabis dispensary. Alan Clark, the budtender in this story, stands at the right-hand register.

The Chemistry

It’s an exciting moment for cannabis activists; it’s a sign that cannabis is going mainstream. But it’s also concerning, because unlike with recreational cannabis in the eight states where it’s been legalized, CBD made from industrial hemp has no strict regulations. It doesn’t have to be lab tested for pesticides, mold, and other contaminants, and there’s no government agency responsible for assuring product quality or label honesty.

I bounced some of these concerns off of Constance Finley, CEO of Constance Therapeutics in San Francisco’s SoMa District. She’s a pioneer in the medical cannabis industry and has been making CBD rich cannabis extracts since 2009. That’s before most people in the industry even knew what CBD was. The value of safety and standardization was apparent when I visited her at her company’s lab.

The lab itself reminded me of my old chemistry classroom, with linoleum floors, smooth black counters, and big chrome cupboards. But the toys they had were bigger and far more epic. For example, The Extraction Machine: three hollow glass columns more than six feet tall attached to a steel box by various tubes. Two of these glass columns were filled with long hot pink coils.
“The heated column turns the ethanol to vapor, that vapor is pulled up through the pink coils by a vacuum, condensing the ethanol vapor back into a liquid, and that’s collected at our bottom jug here,” said Constance.

Basically, they’re using ethanol to pull the CBD and other active compounds out of the cannabis. The Extraction Machine removes the ethanol, and eventually you’re left with a thick, potent oil that is virtually the same every time.

This practice of ethanol extraction is ancient, really since humans first distilled alcohol. What the fancy modern machines allow Constance and her team to do is make a standardized product. When you’re making medicine for patients, standardization is vital. That’s how Constance, who used to be a stockbroker, got into the medical cannabis industry in the first place. She was sick, and couldn’t find consistent, quality medicine.

“My invention was because of my need, and my pain, and other people can copy that story, but if you see the process is not as intensely pure as ours, then you know they're in it for the money,” she said.

In 2013 Constance caused a media stir after her cannabis extracts, in addition to traditional medicines, were used to successfully treat 25 patients with terminal, stage 4 cancer. Constance’s extracts were credited with helping to extend their lifetimes well past their doctor’s predictions.

It’s hard to say exactly what role cannabis may have played in reversing their symptoms, but there is a growing body of small studies which show that cannabis does have some tumor-reducing effects. Since those first patients in 2013, Constance’s company has helped treat more than 4,000 people with its standardized, CBD-rich extracts.

I asked Constance if we should be worried about fraud when purchasing a CBD product.

“I think so,” she said. “Those of us who were early proponents of CBD and worked for evidence-based responses to it have kind of been shoved aside by the green rush of people seeing that they can make so much money.”

Since 2015, the FDA has cracked down on more than a dozen online CBD retailers for making exaggerated, or unproven medical claims. At the same time, a University of Pennsylvania study conducted last year showed that nearly half of CBD products sold online contained less CBD than their labels stated. That means some CBD retailers have made claims like, “This will cure your cancer,” while selling a placebo product.

“You encounter those stories in the face of seeing the true efficacy of what CBD and THC can do,” said Constance, “and you understand that the good science can be buried under the greed.”

There is a lot of good science to prove the efficacy of CBD and THC for medical use. Cannabis’s classification as a Schedule 1 drug has made it difficult to conduct large, double-blind, placebo controlled studies, which are necessary for cannabis to be accepted by the wider medical community. But the smaller studies are out there, and the anecdotal evidence is overwhelming.

“Lots and lots of doctors insist on saying something very unscientific and that's, ‘We don't know,’ and, ‘There's no research done,’ and, ‘We can't recommend.’ And the last is true. Federally they can get in big trouble. They can lose their license.”

Constance Therapeutics, in partnership with the multi-million dollar pharmaceutical company Tetra Bio Pharma, will soon be conducting large-scale, FDA-approved research in Canada, where cannabis was recently legalized. Until that same kind of research can be conducted in the United States, most doctors will be too afraid of legal repercussions to recommend or prescribe CBD, even if they’re in a state where cannabis is legal.

So if you’re curious about CBD, you’re options are either to look online, or, if you’re lucky enough to live in a state where cannabis is regulated, you can go to a dispensary.

The Industry

I visited Berkeley Patients Group, the longest running dispensary in the nation, to sample some CBD for myself. Standing at the edge of a glass counter filled with a smorgasbord of cannabis products, I flipped through an extensive menu on an iPad while, behind the counter, a flat screen TV showed a display of marijuana strains.

Berkeley Patients Group is similar to Constance’s company in that it has a strong focus on the medical benefits of cannabis. So naturally, it carries a variety of CBD products.

“You can smoke it in flowers, you can take it as an edible, you can use it as a tincture, you can use it in a vapor pen, you can use it as a topical,” Alan Clark, my budtender, said.

I told Alan I was looking to lower my general anxiety levels, and he guided me to the right CBD product for my needs, just like a doctor would. He asked me what my symptoms were and then recommended I purchase some CBD capsules. The capsules have a delayed onset, but they last longer, good for lowering stress levels throughout the day.  

I asked Alan how he felt about being put in this doctoral position of prescribing medication, sometimes for quite serious conditions.

“I’m not a doctor, and I’ll say that outright. I do have a lot of experience with cannabis, but I don’t have that physiological education.”

Alan was careful with his words. He never claimed that CBD, or any cannabis product, would cure a given condition. It’s always, “This may help,” or, “This could alleviate.”

Any retailer who does make absolute claims about the medical benefits of CBD should be treated with a healthy dose of skepticism. While the professionals I spoke with were excited about the potential benefits of CBD, they all acknowledged there’s still a lot of research that needs to be done before we can know anything for sure.

“If I can alleviate some of your symptoms, cool,” said Alan. “But I'm not gonna say, ‘Hey, quit your treatment, start smoking cannabis, because that'll cure your cancer.’ That'd be irresponsible of me, and not true.”

Not surprisingly, unregulated online retailers aren’t as motivated to be responsible as those working in government supervised dispensaries. Just this year, more than 50 people in Utah were hospitalized after taking what they thought was CBD, but what turned out to be a toxic synthetic imitation of CBD. Again, this is possible because there’s no federal government agency responsible for testing industrial hemp, or its byproducts, like CBD.

In the back offices of Berkeley Patient’s Group, past ceiling-high padlocked metal cupboards they used to use to store their product, I talked with communications manager Lauren Watson. I asked her whether they carry CBD products made from industrial hemp. She said they decided not to anymore, because the “regulations are a little funky.”

CBD extracted from hemp has also been proven to be less medically effective than CBD made from regular cannabis. That’s because CBD works best in tandem with a little bit of THC, and the other naturally occurring compounds in cannabis known as cannabinoids and terpenes. Lauren calls it “the ensemble effect.”

“So think of THC as the trumpet,” she said. “It’s great by itself, but if you add in some percussion from CBD, and some strings from CBN, and some terpenes, it's a more complete effect.”

In states where it’s legal, CBD made from regular cannabis is tested and regulated just like any other cannabis product. Considering that CBD extracted from hemp is less effective, and potentially fraudulent, if not toxic, I asked Lauren if she would recommend avoiding online retailers altogether.

“That's tough,” she said. “It's easy for me to say never buy CBD online if you live in a state where you have access to medical cannabis. There are people incredibly desperate for something to help them treat their children, or their parents, or themselves. So for those people the primary thing is to understand where it's coming from. Do as much research as possible, but ultimately you are taking a risk.”

If you do live in a state where cannabis is regulated, like California, then of course it’s safer to go to a dispensary to purchase CBD. There you can have access to products which have been vouched for by the dispensary, and tested to assure you’re actually getting what the label says.

“And ask them. Ask where the CBD comes from. Ask if it's hemp derived?” Lauren said. “If it's cannabis derived, you know its' been through a rigorous test. You know it's safe for consumption.”

I don’t want to make CBD itself seem dangerous. It’s the lack of regulation with CBD made from industrial hemp that’s dangerous. Like THC, and cannabis as a whole, CBD is not physically addictive and has no serious side effects. As long as you can be assured that your CBD product is free of pesticides, toxins, mold, etc., then there aren’t actually any known health risks.

That’s why CBD is becoming such a health-fad, because it is so safe, and because it could potentially alleviate a whole host of symptoms.

“It's good to be skeptical,” Lauren told me, “but it's good to know you can experiment without fear of doing serious serious harm to your body.”

Before I left Berkeley Patients Group, my CBD capsules packed in a little brown bag, Alan gave me what I thought was good advice for really anyone using any kind of medication. He told me to keep a notebook, so I can track when I take my CBD, how much I take, if it does what I was hoping for, and how it may have fallen short.  

“You gotta help me help you,” he said. “I can give you this stuff, but if you don't take it, if you don't really regard how you take it, just take it, pop it in your mouth, or smoke up a joint, then you're really not gonna get any answers until you apply yourself to understanding what your medicine is doing for you.”

If you are someone who’s curious about CBD, do your research, remember to keep a notebook, and get it from a dispensary, if you can. Consult a doctor who’s cannabis-friendly. And when you start seeing CBD infused smoothies at your local Health Foods store, feel free to ask them, “Is this CBD sourced from industrial hemp, or cannabis?”

Because the details matter.

You can find resources about CBDs and cannabis-friendly doctors here, on Berkeley Patient Groups website.

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