Here I go again! Only this time, I’m eager to join the action…I think.
As you may know, in two previous posts, I’ve written about my ambivalence concerning the legalization of marijuana. Each time, I got new subscribers among the happy pot community, who somehow overlooked my ambivalence (or seized on my description of my single, and singular, pot experience) and adopted me as a kindred spirit.
That’s fine; I welcome anyone who’s interested in what I have to say—and I would be happy to have them join our dialogue, though so far they’ve merely silently “liked” my posts.
For the record, in researching a response to a comment after my second post on the topic, I came across an LA Times Op-Ed that stressed we know much less about the impact of marijuana than we might because the federal government has for so long forbidden its use—even for research.
I found that editorial persuasive, so I’ve moved from ambivalence to being cautiously OK with legalization. I am also bowing to the inevitable, and hoping legalization does all the good things proponents claim (like diminishing the racial injustice in prosecutions and reducing the power of drug lords).
But I still worry about young brains because that’s where the most deleterious effects of use occur. In fact, though many states have passed legislation legalizing marijuana for individuals age 21 or older, some experts say it should be 25 because the developing brain is still deeply affected until then.
That’s not my purpose here, however.
Today we’re talking CBD (cannabidiol), derived from the part of the marijuana/hemp plant that, unlike THC (delta-9-tetrahydrocannabinol), doesn’t create a high.
Interestingly, though the federal government continues to consider marijuana illegal, it holds a patent for CBD; National Institutes of Health scientists found several decades ago that in test tubes, an in-depth Sunday New York Times Magazine article reported,
“…the molecule shielded neurons from oxidative stress, a damaging process common in many neurological disorders, including epilepsy.”
That finding has been validated, as described below.
And now there’s a federal law legalizing CBD products made from hemp, provided they contain 0.3 percent or less of THC.
Unless you’ve adopted a net-free existence on some desert isle, the chances are you’ve heard about CBD. It’s available everywhere, purportedly for everything that ails you, from back pain to anxiety to alleged cancer cures (the FDA cracked down on that one), to social phobia (that’s in the testing stage). My dentist is now selling it in his office, for goodness sake!
While CBD seems to have taken the country by storm, thus far its efficacy has been documented only in treating epilepsy in children; it’s FDA-approved for that indication.
But according to a Consumer Reports survey, 64 million Americans have tried CBD in the past year, and most said it was effective, particularly for anxiety. Almost three-fourths reported no side effects,
Based on anecdotal evidence and what I’ve read to date, I’ve been intrigued by the prospect that it might be helpful to me by a) reducing the frequency of my migraines; b) relieving my stomach issues that I know—as one of a long line of “gut” people—have an anxiety component; and c) alleviating my arthritic knee pain, thereby forestalling my need for a second knee replacement, which I most emphatically don’t want to have.
I discussed the possibility of my using CBD with my neurologist, a superb physician/researcher and compassionate soul.
He said he had no objection to my trying it, and it had, in fact, helped some of his migraine patients. However, he hasn’t sought a license to prescribe it because it isn’t evidence-based for migraines at this point. He referred me to a neurologist who does prescribe it.
I made an appointment. For a mere $750 initial visit (this doctor doesn’t accept Medicare), he would take my migraine history, give me a thorough exam, and hand me a prescription to a dispensary he deals with.
But when I looked over the forms I was to complete before seeing this new physician, I realized that none of the questions were relevant to me. I do get more migraines per month than my neurologist and I would like, but I don’t suffer from them. That’s due to the wonders of the pharmaceutical industry.
Yeah, they’re doing lots of awful things with pricing, and regulation is clearly needed. But I must acknowledge that the appearance of sumatriptan decades ago transformed my life.
Before it, I lost full days to intractable pain and nausea that made me think: If only the nausea would go away, I could tolerate the pain. Now, I feel a twinge, take a pill, and I’m good to go ten minutes later. So I didn’t need this new doctor’s extensive questioning, to which I would repeatedly respond with NA (not applicable).
I also didn’t need a thorough exam, as I’d just had one in the very capable hands of my neurologist’s fellow—under his guidance.
So the second thoughts arose, and not solely from my wallet, which was sending clear question marks to my prefrontal cortex, something along the lines of “Are you nuts? Paying $750 for a prescription to take to a pharmacy?”
I cancelled the appointment and sought my neurologist’s advice about how to proceed. He hadn’t known his colleague didn’t accept Medicare. When I explained why I cancelled, he said: “For you to spend $750 to get handed a prescription to take to a pharmacy is nuts!”
Most people buy CBD independently—without a doctor’s involvement. I felt concerns about that approach because this is an unregulated market. It’s caveat emptor: Let the buyer beware!
With the gold rush out there, the unsuspecting consumer may be buying a product that has too much or too little CBD, and/or it may be adulterated.
For example, The New York Times described a graduate student in Virginia who complained of a “heart-pounding, hallucinogenic high he had neither expected nor wanted to have.”
Testing revealed he had vaped a liquid containing CBD, but it also contained a synthetic compound, 5F-ADB, that the Drug Enforcement Administration has associated with anxiety, concussions, psychosis, and even death.
So I was concerned about quality and dosage. Actually, I was more concerned about dosage because I had located a few sources that seemed reasonable, including my dentist, who assured me he’d fully investigated the purity of the products he planned to sell.
I’m also considering two other possible sources: one is owned by a Florida pharmacist who developed the product and seemed very cautious when I heard her on an NPR discussion; another is being frequented by many parents of children with epilepsy, who spoke highly of it in that lengthy Sunday New York Times Magazine article.
That left the question of dosage, and my neurologist said he’d do some research and advise me about what would be appropriate.
So stay tuned for the next installment of “Annie Goes for the Gummies.” I’m not sure why, but one of the companies under consideration offers many of their products (for adults) in the form of Gummies. Should that send me a warning signal? I’m fine with a tincture under my tongue, as some friends have described, or a capsule, or a cream for my knee. But Gummies? (And yet, I occasionally indulge a strong desire for Swedish Fish, suspecting that my body sometimes has a weird need for red dye #whatever, so maybe the Gummies hold some promise…)
If you or someone you know has had experiences with CBD that you’re willing to share, I’d love to hear about them.
Annie
annieasksyou... 
Hi Anne,
I was anxiously awaiting your visit to the CBD dispensing neurologist so I read your blog post with some disappointment but $750? Sounds like old-fashioned drug dealer prices! So I totally understand your decision.
As I told you David S. has been taking CBD which he gets through his pharmacy to insure safety and efficacy. You might want to touch base with him. I saw my new internist on Thursday and she basically said what the other docs have said – not enough research.
I have THC cream which seems to help as a topical aid for arthritis pain. I used to have CBD cream which I think worked better. Aunt Marcia gave it to me.
Keep me posted with updates as you explore further.
S >
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I’ll do that—and thanks for the reminder about David S.
Can’t you get CBD cream if you feel it helped your arthritis more than the THC?
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So glad you are exploring this. Want to know more
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More to come…I think!
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Interesting post, and as you know Marijuana in general is legal now in Canada, but I am one for evidence based medicine, and also concerned re safety and purity. Canadians tend to be a cautious lot and you don’t see too many physicians jumping on the band wagon here. A few are trialing the CBD extracts in nursing home patients here but even that concerns me, as yes they are able to taper some patients off 3 or 4 drugs (anxiety pills, sleeping pills, narcotics etc) and replace it with one – but what do we really know about the long term effects of that one. And how do you do proper studies when the products aren’t standardized and the different strains are all over the map. If we are worried about effects on brain development in younger people then why not dementia and Alzheimer in the elderly – as they are potentially giving them something which they know affects the brain, not just the pain. In our profit driven society there is a lot of money to be had in the pain market, as per the fiasco re the high dose narcotics which they pushed knowing the addiction risk and side effects. I believe some US lawsuits were settled recently. I see the same thing here in Canada – grow-ops springing up in nurserys all over, lots of companies applying for licenses etc. Are we going to see the same long term damage in ten or 20 years from this too. I’m cautious with any new drug, and esp with this one, but I wish you well Annie should you decide to try it. There’s my two cents! Also, we now have to contend with the driving and alcohol issue. Since it was legalized here, there has been an increase in driving under the influence, often in combo with alcohol, leading to more car accidents, with often deadly results. One recent case, the driver had twice the legal limit of alcohol, and had used marijuana and cocaine in the previous two hours? He killed someone, but tried to justify it as it is legal now??? I don’t even think they have seen that much of a decrease in crime, as users say the government approved dispensaries are too expensive compared to the street sources. In Ontario there are not many legal dispensaries yet, a government lottery decides where they will be, although they have an online store which delivers.
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I mentioned similar concerns in my two posts about legalizing marijuana. One interesting bit about your concerns re: Alzheimer’s and other dementias is that there is evidence that the body’s own endocannabinoid system seeks homeostasis. So with pot, in younger people who have sufficient cannabinoids, the excess may be responsible for the ill effects on the developing brain, including memory loss. But in older people, the additional cannabinoids may boost failing memory.
My neurologist is extremely cautious, knowledgeable, and steeped in research. I would not be considering CBD if he hadn’t given me his approval. To be continued—thanks for your thoughtful comment.
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Thanks for that info Annie – I can’t say I have researched it well, as I am retired now, and my eyes tend to glaze over at the mention of any work related reading.
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If I decide to cover this topic more fully, I’ll describe the reasons there’s excitement among scientists about CBD, including its possibly extensive anti inflammatory qualities.
You’ve mentioned that you worked in the medical community. Have you written about that work—or have you chosen to leave it in the past? (I’m fascinated by all things medical.)
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I have not mentioned what I did for 40 years on the blog directly, just that I worked in a medical profession, (but there’s a hint in my Pioneer Village post if you are curious). I feel like I’ve left all that behind. I was thinking after I shut the computer off last night that I should research the topic a bit, as it is a timely topic, so I pulled out a whole stack of the monthly journals that I have received since last fall and have not read (I gave up my license last fall), and there were four with marijuana topics listed on the cover, so I will check those out when I am able, and get back to you with a more informed opinion! The other thought that occurred to me is about studies. Studies can show anything, good or bad, but the thing to consider is are they good non-biased double blind controlled studies involving sufficiently large numbers of people. Are they sponsored by drug companies or someone with a link to them? We have a wonderful young doctor here who left family practice to pursue the marijuana field, (he now has his own company), and I see his articles in the newspaper every once in a while trying to get everyone on the bandwagon, and he’s trialed CBD in nursing homes on twelve patients. Encouraging results, but twelve patients is not sufficient in evidence based medicine. You have to remember though that in my job I would see the end result of all those drug side effects, often a year or two after a drug was released, as it would have been used on enough patients by then to see the issues. I’ve seen many drugs taken off the market in my career, so of course that influences my point of view. Of course, if I was in a great deal of pain, I might think otherwise! I realize people are desperate for pain relief. It would be difficult to get good studies unless you have a standardized formula – that’s the same problem with herbals of which I am equally dubious. While natural, they are still drugs, metabolized and excreted in the body, but drugs we know less about. The latest anti-inflammatory herbal being promoted is the spice turmeric? You will never see good large studies on it as no one owns the patent, so no money to be made. I don’t really even trust our federal government agencies anymore, as there is so much corruption everywhere in the world, and a lot of chemicals are outsourced, and they can’t possible police/inspect all that. We have a real problem with drug shortages here in Canada (because the government has manipulated generic pricing so low that the Canadian companies just stop making products), so now we are outsourcing many of our drug chemicals from China and India, countries in which corruption is sometimes routine. Lots of contaminants, manufacturing facilities not meeting safety standards etc. A few years ago there was a big law case in the US where the CEO of a generic company had smuggled brand name Lipitor into India and substituted it for the required clinical tests on the generic. Someone blew the whistle and the story made the papers, but you have to wonder, how often does that happen? I’ve read it all…..enough to be cynical, which is another reason why I don’t post anything medical. But I am here on your blog site, and I bet you’re sorry you asked me!
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Not sorry at all. I did a good deal of medical writing and editing, so I am aware of much of what you’ve written—especially about the importance of large, placebo-controlled trials—and the fact that some drugs are taken off the market after they’ve done harm. I am also dubious about herbals. And concerned about our weakened regulatory structure when we need watchdogs the most as generics are largely imported.
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PS. One other thing, a doctor here would not be allowed to sell his own drug products from his office, as it would be considered a conflict of interest, according to professional standards, although some do try.
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Annie,
I wonder how many of the anecdotal claims of success for CBD are actually real. Consider the placebo effect; false claims by sellers; lack of proper dosage information for each condition; concurrent medical conditions which who knows how would affect the CBD or how the CBD would affect those conditions; different sources of CBD from ‘experts’ who have researched their particular product; etc.
It may be too soon to categorize CBD as a drug that cures- what- ails you. Need proper scientific based studies as well as regulations based on those studies as to how the drug can be sold.. Also it’s probably too soon to say there aren’t any side effects,
I would hope it turns out to be an important drug that will benefit many people with minimal side effects. Don
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Hi, Don–
All valid points. I acknowledge the hype and concerns. I would be much happier if there were strong evidence-based studies demonstrating CBD’s efficacy. And although most in the Consumer Reports study reported no side effects, others (according to The Times article) have noted that some of the children treated with certain nonprescription CBD oils had mood changes. In addition, CBD can interfere with the time it takes for the body to break down other meds. That could be important for individuals with various conditions.
I am relying on my belief that my neurologist would not steer me wrong, and since he’s up on all sorts of research and has a sharp, analytical mind, I feel comfortable trying CBD with his approval. Many scientists are quite excited about it, and if I continue down this journey, I’ll explain why.
Thanks for your thoughtful comment.
Annie
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Show me the results of the double blind study(Oestricher) and the peer reviewed article(s) and I quickly become a supporter and believer in and user of new treatments. In the meantime, one must follow the recommendations of one’s…hopefully…top notch physician and not embark down new paths without his/her green light. One must understand , for example, the impact of a new treatment on conditions other than the one for which the new treatment is being taken and in
Meds being taken for those other conditions.
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Hi again–
I certainly understand, Dennis, and I welcome this discussion and the caveats you and others have raised. As I’ve noted to other commenters, I have the utmost faith in my neurologist, who has a stellar reputation and has accurately diagnosed me over the phone when I’ve had headaches I thought weren’t migraines (they weren’t–and 3 questions later, I had an appointment for treatment that banished them soon thereafter). I would not pursue this journey without his approval. He is very cautious and skeptical, is active in clinical trials, and serves as a peer reviewer and lecturer. He knows my history, all the meds I take, and my quirks and philosophy of life. There is no clinician in whom I’ve ever had more confidence. (He’s also a terrific human being!)
Unlike you, however, I tend to be reluctant to take newly prescribed meds–even though they’ve been approved following double-blind, placebo controlled trials–because too many drugs have been taken off the market after doing real damage following approval. Many years ago, my then-gyn thought I was unbelievably foolish for refusing to take hormone replacement therapy, which was all the rage. I’ve never regretted that decision.
One more thing: though I certainly support the peer review process, in my years as a medical writer and editor, I saw more than a few instances of its being abused for profit. Like any other human endeavor, it can be subject to corruption. So I think a healthy skepticism, self-education, and asking lots of questions is usually a worthwhile stance for patients/consumers.
Annie
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I’m glad I live in a country with Medicare for all.
If I had to pay $750 for a doctor’s visit, not only would that wipe out 90% of the government medical benefits pension I get each month but I wouldn’t be able to pay rent for a month.
Cannabis gummies will be legal in Canada in October if you’d like to take a trip north to try one.
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Yeah; healthcare in the US is a national disgrace. And in my case, these are merely discomfort issues. People are dying because they can’t pay for the insulin they need for diabetes, etc. I hope the fervor that elected the 2018 Congress on this issue builds for 2020.
CBD (cannabidiol), the non-high-producing part of marijuana/hemp, is now legal everywhere. So as soon as I hear my neurologist’s report, I’ll probably try it. Of course, it’s not covered by Medicare, and it’s not inexpensive. So we’ll see.
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$750? Goodness! I have son who suffered with epilepsy as an infant up through 3 years of age. We tried everything. He is well and fine now (pushing 30 years old) but I wonder if the CBD could have helped. Thanks for your work, as always! I learn so much.
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Thank you, Denise. And so great that your son overcame that scary and potentially dangerous condition. If you haven’t already read the Sunday Times article, I recommend it. It shows the huge role that parents of children with epilepsy played in gaining acceptance and FDA approval of CBD.
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Reblogged this on Commentary, Outrages, Prose and Poetry and commented:
A thoroughly enjoyable excursion into the weeds of weed (and its cognomen sans high CBD) of which most recently news has come that some (or perhaps just one) purveyors have been spiking the punch, as it were, with non 0.0((?)3. I am less than inclined to allow norml(yes, pun intended)ization of cannabis, especially to teens and younger with keys to elders med-cabinets. I encountered pot in the Marine Corps at age 20…and firmly believe I should have waited five more years for more development of cost-benefit ratio rationalizations not to mention better munchies. Now that so many of my peers either have graduated to other drugs and either jail or death or both, do I ascribe their falls to the drugs or to their stars? I will have to ask the kid (early 30s) who caambors out of his house to light a fire under what I suspect is CBD (with additives) to share as I trek towndowardly to The Library where now I sit keyboarding the above if, in fact, I have been ingesting CBD (but with slight high). He has young kids and both he and wife belch tobacco as well, which if done in confines with preteens I find reprehensible. But I suspect I am on the losing end of the wave of WE WANT IT NOW, IF NOT YESTERDAY. I always have held that if you must ingest, eat and do not corrode (the lungs) Lasts longer, less expensive, and encourages more brushing of The Ivories. Now, I do gotta get back to mine own misplaced efforts. Oh! ‘for I forget: Phoebe’s (Phoebe Chi) new nomen is Phoebe, MD; Med(illegible by my own scrubbke) and Poetry.
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So interesting–especially the wish for the wait til age 25!
Thanks again.
Annie
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