Debunking CBD: Does it Really Help with Pain or is it Overhyped?

If this is your first episode , hi , my name is Casey Grover and I am an addiction medicine doctor working on the Central Coast of California , and if you are a regular , I am so glad to have you back .

Before we get going , I would like to give a quick thank you to the Montage Health Foundation for their support of this podcast and please help me spread the word about this podcast . We need both healthcare providers and people in general to learn more about addiction so we can improve the care of patients with substance use disorders .

So please share this podcast with a colleague and consider giving me a five-star review on whatever podcatcher you are using . Now I have a few things that have been on my mind that I wanted to share with you before we start this episode . First , I had the distinct pleasure of meeting a fantastic musician this month .

His name is Matt Butler and he is playing music about addiction and life challenges in prisons and jails . One of the surgeons at my hospital invited him to come play for Our Doctors as a part of an educational program for Our Doctors at my hospital about addiction . He plays his album Reckless Son in prisons , in jails , and it's fantastic .

I was actually listening to it as I wrote this episode . His work can be found at mattbutlersongscom and the best part is that I will be hosting him as a guest on this podcast later this year to talk about his work . I also just finished a fantastic book that was about the process of grieving after a loved one dies of overdose .

It's entitled Everything is Wonderful and Horrible and it is by Stephanie Whittleswax . She writes about the time before and after her brother died of an overdose . It was extremely honest and it was full of raw emotion that she felt as she lived through her brother's overdose .

I will add that there was a lot of adult language in the book , which is a testimony as to how honest and raw it is , but probably not something to listen to with your kids . Highly recommend it . I learned a lot and it was a great read . Okay , on to today's article , which is on CBD .

I had hinted at doing a podcast on this article a few episodes ago , and in this episode we're going to dig into this topic and this article in detail . The title of the article that we're going to be reviewing today is Cannabidiol Products for Pain Ineffective , expensive and with Potential Harms .

The first author is Andrew Moore , and the article was published in 2024 in the Journal of Pain . Let's get started with the introduction . The authors begin with a description of CBD . Cannabidiol , also known as CBD , is a cannabinoid chemical found in the cannabis plant . Cbd is often marketed as a product for natural pain management .

It turns out that the global CBD market is huge . It's projected to be worth 60 billion US dollars by 2030 . Cbd is used frequently , with as many as 26% of people in the United States between the ages of 16 and 65 using it each year .

It is most often used for chronic conditions , with the average user spending more than $140 per month on CBD , and the most common chronic condition treated by CBD is pain . Now CBD , it turns out , is available as a prescription under the brand name Epidiolex . It's used to treat seizures from Lennox-Gastaut syndrome , dravet syndrome or tuberous sclerosis .

However , cbd is much more often used in its non-prescription form . It can be bought online or in brick and mortar stores and dispensaries . Cbd is frequently advertised as being effective for pain relief . The authors note that , while the product is advertised widely , they feel that more research on the health benefits and harms of CBD is needed .

So that is what they wanted to do is to see how much research is out there and what more needs to be learned . And that brings us to the methods section of this paper . They did an exhaustive search of PubMed and Google Scholar to see what existing research on CBD we have .

They focused on pain outcomes for any painful condition and looked at multiple routes of CBD administration . So the methods were pretty brief , which brings us to the results . What did they find ? They actually wrote up their results in a very interesting way . I don't recall seeing this before .

They asked a clinical question in the results section and then answered it based on the information that they found in their literature review . So let's go through their questions . And they broke the results into two sections non-pharmaceutical CBD and pharmaceutical CBD . And they started with non-pharmaceutical CBD . First question is non-prescription CBD a natural product ?

Is non-prescription CBD a natural product ? The authors note that CBD can be synthesized , but most often CBD is derived from the hemp plant . Next is non-prescription CBD pure . The authors note that it is hard to assess this due to the lax labeling of CBD products . Most CBD formulations have other substances in them .

Hemp can apparently have over 100 different cannabinoid compounds in it . The authors also found that CBD products are often contaminated with THC . One study looked at topical CBD products and 35% also contained THC . One study looked at topical CBD products and 35% also contained THC . One product actually contained 100 milligrams of THC , which is quite a lot .

For reference . The recreational dose of THC is between 2.5 and 15 milligrams . So just to sum this up sometimes CBD contains THC even if the label doesn't mention it . Next question is the non-prescription CBD content as advertised ? Here's the answer , and I'm going to quote the authors quote mostly , not end quote .

The authors note that only one in four products were accurately labeled . One in five had less than 90% of the advertised amount of CBD , while one in two had more than 110% of the advertised amount of CBD . Also , the dose of CBD in different products varied from very little in some products to very high in others .

Unfortunately , the authors don't actually give the dosing range on the products , and then , obviously , contaminants were not going to be listed or advertised on any packaging . Moving on , is non-prescription CBD safe ? The authors interestingly found some sporadic cases of serious harm from CBD products , including Stevens-Johnson syndrome . I was not aware of that .

There were also cases of unintentional toxicity when people took large amounts of CBD . As the package reported the product to be healthy and safe , the authors did not comment on what toxicity was experienced . There were also adverse effects from THC when people used CBD products that also contained THC . The authors then pivoted to look at pharmaceutical CBD .

They first looked at the efficacy of CBD for various types of pain . There have apparently been 16 clinical trials looking at CBD for pain . Cbd was evaluated for use orally , topically and buckly slash , sublingually . They then focused on 11 trials , which were randomized , double-blinded and placebo-controlled . So this is obviously the highest quality research .

In 10 of these 11 trials , cbd was found to have little or no pain relief , with no statistically or clinically significant pain relief benefits over placebo . In the last trial , which was a small study of 18 patients with thumb arthritis , all patients who received CBD went from moderate to severe pain down to mild pain as compared to placebo .

The next question that the authors asked was is pharmaceutical-grade CBD safe ? The authors opened by saying that CBD is not quote risk-free . End quote . They go on to elaborate One study looked at patients with seizures treated with Epidiolex . Apparently , about 10% had at least one adverse event .

But again , unfortunately , the authors don't specify what the adverse effects were . The authors go on to note that CBD can cause hepatotoxicity , with elevated liver enzymes being seen in about 7% of CBD users .

The authors go on to add more , noting that with CBD there can apparently be somnolence which could pose a risk for driving a vehicle or operating heavy machinery or certain activities like swimming or rock climbing .

Epidiolex contains the following warning quote prescribers should monitor patients for somnolence and sedation and should advise patients not to drive or operate machinery until they have gained sufficient experience on Epidiolex to gauge whether it adversely affects their ability to drive or operate machinery . End quote .

The next section of the paper is actually the conclusion section . It's a relatively brief article . The authors sum up the article as follows quote for people living with pain . The evidence for CBD or hemp extract shows that it is expensive , does not work and is possibly harmful . End quote .

And they go on to add quote healthcare professionals should use this evaluation to help people living with pain to inform their decisions about unconventional , unproven substances being sold as therapeutic . End quote .

And finally , the authors add quote regulatory authorities should also take note of the considerable deficiencies existing in the products sold , especially the incorrect labeling of many products and possible contamination with psychoactive compounds . End quote . And that is the end of this article . It was pretty brief . Now let's stop and reflect here a bit .

The authors pretty clearly have a negative view of CBD . Now I , from what they shared with us , feel like I might actually have more questions than answers about CBD , but the authors themselves were pretty clear with their conclusions that they do not think much of CBD .

I will be honest , though hearing that 10 out of 11 randomized controlled trials of CBD for pain did not show benefit for pain is pretty good evidence that it doesn't work too well . Oh well , let's wrap this episode up with some take-home points

. Number one cannabidiol , also known as CBD , is a cannabinoid chemical found in the cannabis plant . Number two cannabidiol is available as a pharmaceutical product called Epidiolex to treat various seizure disorders . And CBD is also available as a non-pharmaceutical product available in stores or online where it is marketed as a treatment for pain .

Number three more research is needed on CBD , but existing research does not show that it is reliably effective to treat pain . Existing research does not show that it is reliably effective to treat pain . Number four CBD products may contain other compounds , including significant amounts of THC .

And number five while overall adverse effects from CBD are low , it can cause sedation and has also been shown to cause hepatotoxicity . And that is it for this episode . Thank you so much for listening and thank you for what you do , and let's never forget that treating addiction saves lives . Thank you ,