Cannabis—also called marijuana—is the dried flowers, leaves, stems, and seeds of the cannabis plant. This plant contains more than 100 compounds including tetrahydrocannabinol (THC), which is impairing or mind-altering, as well as other active compounds that are not mind-altering, such as cannabidiol (CBD).1
Cannabidiol (CBD) is not the same thing as cannabis. Cannabis refers to the dried flowers, leaves, stems, and seeds of the cannabis plant, while CBD is 1 of many compounds present in the cannabis plant. CBD does not cause a “high” by itself. CBD can be derived from the Cannabis sativa plant or produced synthetically.1
Yes. In 2018 the US Food and Drug Administration (FDA) approved the prescription medication Epidiolex, which consists primarily of a standardized formulation of plant-derived CBD extracts. The FDA approved this agent for 2 rare forms of epilepsy—Lennox-Gastaut syndrome and Dravet syndrome—and it is now also approved for tuberous sclerosis complex.
For patients who are interested in trying cannabidiol treatment, it is important to set realistic expectations. The efficacy of CBD can vary among patients, which has been demonstrated in clinical studies.2 While CBD is often well-tolerated, it can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness, and fatigue. It can also interact with other medications, such as blood thinners. Additionally, the unreliability of the purity and dosage of CBD in over-the-counter products is a concern. Some data show that more than a quarter of products contained less CBD than labeled, and some may also contain small amounts of THC. The 1 formulation approved by the FDA undergoes rigorous preparation methods to ensure purity.
The effects of CBD vary from person to person. When using an oral spray or dropper, the effects are typically seen within 30 to 60 minutes and can last up to 6 hours, depending on the dose administered. Generally, it is a good idea to start with a lower dose and build up to a comfortable level that is right for you. Involve your healthcare provider in the best way to do this.
Side effects of CBD include drowsiness, changes in mood (irritability, agitation), decreased appetite, gastrointestinal symptoms/distress, dry mouth, and other minor side effects. CBD may also produce psychotic effects or cognitive impairment in individuals who also regularly use THC products such as marijuana. CBD use has been associated with adverse events such as liver injury, interactions with other drugs, injuries following periods of sedation or drowsiness, and male reproductive harm. Both patients and clinicians need to be aware of factors influencing the likelihood of CBD-associated adverse events and side effects. These factors include the strength and purity of the product, amount used, mode of administration, concurrent substance use and misuse, and interactions with prescribed medications.3
Shared decision-making about cannabis-derived products between patients and providers is encouraged to form and maintain safe and effective treatment plans.4 Be sure to be open with your healthcare provider about your concerns and questions about CBD use so they can help you make the best decision for you.
