CBD oil products promise miracle cures. But does science support the hype?

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By Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta

In order to survive wearing high heels at the Oscars this year, Melissa McCarthy put a dab of CBD oil between her toes. Both US Magazine and Women’s Health called the move “genius!

Over the course of several decades, cannabis products have gone from something that could lead to “murder, insanity and death,” as a 1935 government warning declared, to a highly sought-after wellness product. The justifications for the past demonization of cannabis are both historically complex and often irrational. So, to some degree, the pendulum swing from risk to benefit makes sense and is a welcome change. Still, the totality of the cultural shift in the framing of cannabis is dramatic.

Big picture, I think marijuana legalization is a good idea. It will help control consumption, particularly among the young, and allow for useful research and, eventually, biomedical applications. But I also think that the current hype surrounding cannabis is problematic, and this includes all the emerging products derived from cannabis.

The current hype surrounding cannabis products is problematic, and this includes all the emerging products derived from cannabis.

Most of the cannabis-focused wellness products contain cannabidiol, commonly referred to as CBD. This is a cannabis extract that does not contain the buzz-inducing THC. Almost overnight, CBD is absolutely everywhere. It is often portrayed as some kind of cure-all. There are CBD-infused shampoos, toothpastes, lotions and soaps. CBD is being used and promoted by professional athletes as a way to facilitate recovery and as an anti-aging compound.

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You can get CBD supplements for both your dog (to help with “separation anxiety” and “fear of fireworks and thunder”) and your cat (because anxiety is the “most under-diagnosed condition affecting cats” — at least, according to this enterprising vet.) Soon you will be able to turn to none other than Martha Stewart — a name not often associated in the past with bongs and dime bags — to purchase your pet’s pot pills. She recently partnered with Canopy Grow, one of the world’s largest legal cannabis producers, to create a line of “sensible products for people’s beloved pets.”

Cannabis is, of course, also being marketed for a range of more serious health issues, including childhood ADHD, autism, anxiety and, perhaps most frequently, pain.

As I said, it is everywhere. It has been estimated that the CBD market will be worth approximately $22 billion by 2022.

But despite all the positive press, money and pop culture noise, the science remains pretty foggy. There is no doubt that CBD is an interesting compound. And the liberalization of the laws in many jurisdictions throughout the world is leading to a lot of intriguing research on the plant. To date, however, there is little or no evidence to support the vast majority of the wellness and performance claims we are seeing in pop culture. As noted by the World Health Organization in a 2018 review of CBD: “for most indications, there is only pre-clinical evidence.” In other words, there aren’t a lot of studies involving humans.

My friend and University of British Columbia pharmacy professor, James McCormack, summarized the state of the science thus: “There are lots of people who claim CBD improves numerous medical issues and symptoms. However, while there is reasonable evidence (well designed placebo controlled trials) for a few conditions (such as intractable seizures in children) the highest level of evidence for most conditions is just anecdotes. We need a lot more well-designed clinical studies.”

There are a number of interesting social trends feeding this love affair with all-things cannabis.

This near complete lack of good clinical evidence hasn’t slowed the momentum of the hype, of CBD or marijuana more generally. Recent research found that almost all of news coverage about cannabis “communicates a more positive message than is warranted by current evidence.” A study by the group Health Feedback — a collection of biomedical academics that assess the credibility of news stories — found that the top social media story of 2018 was one that claimed marijuana was one hundred times less toxic than alcohol. A claim that is, at best, a hefty exaggeration.

There are a number of interesting social trends feeding this love affair with all-things cannabis. Because it is perceived as “natural” (an odd classification given that it is a chemical like any pharmaceutical products) it fits perfectly with the ethos of the burgeoning wellness industry. Many proprietors of cannabis products, including a growing list of alternative practitioners, present them as a natural and/or organic alternative — which, as we know from research in other domains, can help to sell a lot of product and create a strong and persuasive health halo. If it is natural, it must be better!

In addition, purchasing a cannabis product still comes with a bit of ideological cache. Cannabis is, or so its proponents want us to believe, the anti-Big Pharma drug of choice. Its secret benefits have been hidden from the masses by a number of nefarious players, most notably the biomedical industrial complex (or so the story goes). “News” websites like Natural News have played to this intuitively appealing narrative with headlines that declare, “Big Pharma and the government are suppressing marijuana’s medicinal benefits.” This kind of messaging adds to the allure of cannabis and allows it to maintain a smidge of counter-culture cred, even if your cat is dabbling in the same products. (In reality, pharmaceutical companies are also getting into the cannabis game.)

And, of course, celebrities have also played a big role. Melissa McCarthy’s CBD toe therapy was reported in the press as a logical application of an emerging therapy. No scientific proof required.

Why is all this hype concerning? Much of it is straight up misleading marketing that can generate inaccurate and harmful public perceptions.

Why is all this hype concerning? Much of it is straight up misleading marketing that can generate inaccurate and harmful public perceptions. As noted in a recent statement from the FDA about questionable cannabis products: “deceptive marketing of unproven treatments raises significant public health concerns,” including the potential to “keep some patients from accessing appropriate, recognized therapies.”

All this positive press might also lead people to overlook the possible risks associated with cannabis products. One study, for example, found that the positive portrayals of the health applications of cannabis have an impact on the perception of recreational use. And while the emerging evidence suggests that CBD is well tolerated, we need to recognize that we don’t have a lot of safety data, particularly in the context of long-term use.

The buzz around cannabis is understandable. I am hopeful that in the relatively near future we will know much more about benefits and risks. But we aren’t there yet. For now, you can ignore most of the cannabis noise, whether you are thinking about something for your tension, toes or our tabby.