Cannabidiol confusion: lofty promises and barriers to research

As cannabis researchers, we work in a field whose unknowns could positively or negatively affect the health of millions of Americans. But the U.S. government’s decades-long prohibition of cannabis research forcefully limits what we might learn. Adding to the absurdity, the recent relaxation of this prohibition may promote a public health threat.

A recent Washington Post commentary by former Food and Drug Administration Commissioner Scott Gottlieb raised compelling points about products containing cannabidiol (CBD), a non-intoxicating molecule made by the cannabis plant. It also exposed our policymakers’ dysfunctional lack of discernment between the closely related cannabis and hemp plants. Today, cannabis is federally criminalized and research into its potential medical value is stifled, while hemp products are widely commercialized with almost no oversight.

For consumers, the confusion over what is legal where is only heightened by the proliferation of CBD balms, potions, and tinctures near cash registers everywhere and, of course, online.

A brief primer might be helpful at this point.

Cannabis plants produce various levels of CBD and tetrahydrocannabinol (THC, the mind-altering ingredient of cannabis). Those that produce THC at a concentration higher than 0.3% are labeled as cannabis; those that produce less than that are labeled as hemp.

Hemp and cannabis have been used by humankind for thousands of years for industrial, medicinal, religious, and mind-altering purposes. Yet in 1937, against the advice of the American Medical Society (now the American Medical Association) and without scientific reasoning, the United States criminalized all use of cannabis. In 1942 it was removed from the U.S. pharmacopoeia.

Fast forward to 2018, when hemp-derived CBD products containing less than 0.3% of THC became legal under the Farm Bill of 2018. CBD sales took off, and are estimated to exceed $20 billion within five years. An online search for “CBD coffee Seattle” yields a generous list of shops serving a “feel good” CBD latte. Walk to the local pharmacy and you can find a display of CBD products, full of promises as thin as air.

What most consumers don’t know — because public education on the topic has been absent to date — is the safety of the CBD products they buy. Beyond food and drink, these products are not federally regulated. In Washington state, where we live and work, they also are not held to the same stringent standards set for medical marijuana by the Department of Health.

In fact, recent studies document that the hemp-derived “CBD oil” available in drugstores, coffee shops, and online may contain no CBD at all, or CBD at different concentrations than the labels report. It may also contain contaminants ranging from heavy metals to pesticides. These products often come from China and U.S. states that have traditionally produced hemp for industrial use, not for human consumption.

Contaminants and variable concentrations of CBD raise health risks for consumers, particularly immunocompromised individuals who would have a harder time fighting ingested fungus or mold, common contaminants of cannabis plants. And charlatan CBD products threaten to undercut public support for research into cannabis’ largely unexplored potential medical value because the public may think that wide availability means safe, tested products.

Gottlieb correctly pointed out that the research available on CBD, although in its infancy, has identified therapeutic benefits. For instance, many families now have the option to use an FDA-approved CBD oral solution to treat two seizure disorders in children. And the federal repository of clinical trials, ClinicalTrials.gov, lists more than three dozen trials in process to determine CBD’s ability to mitigate post-traumatic stress, anxiety disorders, chronic pain associated with inflammation, and even some cancers, among other conditions.

More research is warranted into all forms of cannabinoids, not just CBD. While THC has detrimental effects if used indiscriminately, it presents immense potential as an analgesic, particularly for chronic pain and for symptoms of autoimmune diseases.

Yet the federal government continues to maintain barriers to research. These barriers harm mainly people who have medical conditions that lack therapies or who, for some reason, cannot access novel CBD-based medicines.

We know that CBD is not a panacea. It may, however, help with a range of conditions. But we won’t know until rigorous research can be conducted. That’s why we urge the federal government to end barriers to research on the benefits and risks of cannabinoids and to implement a sound system to manage CBD-based products. Because so many diseases remain without treatment and cure, more rational governmental regulations are needed regarding the availability of cannabis for clinical trials. We also urge state agencies to develop public health campaigns to educate communities about unregulated CBD in food and drink.

At the very least, shouldn’t we know exactly what is being stirred into our lattes?

Beatriz H. Carlini, Ph.D., is a research scientist at the University of Washington (UW) Alcohol and Drug Abuse Institute and affiliate associate professor at the UW School of Public Health. Gregory Carter, M.D., is clinical assistant professor of family medicine at the UW School of Medicine and chief medical officer of St. Luke’s Rehabilitation Hospital in Spokane. Nephi Stella, Ph.D., is professor of pharmacology at the UW School of Medicine. Stella and Carlini direct the newly formed UW Center for Cannabis Research.