Ask the Pharmacist

Q)  I have tried all kinds of prescription drugs and none of them seem to help me.  I’m thinking of trying CBD, but I have no idea of just how to start.  Could you provide me with some guidance?

 A)  In many ways, CBD dosing is the snake oil of modern medicine.  There are a zillion products available from a multitude of providers (some legal, others not so much) coming in all kinds of forms with claims that do not always stand up to scrutiny.  It can be hard to know where to get started in treating yourself or a loved one and a little intimidating given the stigma that cannabis products still hold for many of us over the age of 40.  

As a quick reminder, CBD stands for Cannabidiol and is one of the main active ingredients found in cannabis (marijuana) plants.  Unlike tetrahydrocannabinol (better known as THC), CBD does not produce a “high” and is being extensively studied to see what health benefits it might offer.  Regrettably, these studies are still in the early stages so getting well defined proven recommendations as to what and how much to use are still a few years away.  That said, there is enough legitimate information out there to give some guidance in helping you make your selection. 

The first thing to know is that there is a strong consensus of opinion that CBD is safe.  So, if you are wanting to try some to help you with pain, sleep or another ailment, it is extremely unlikely to be hurtful.  Like anything, if you take too much it can cause harm but studies have shown doses of up to 1,500 mg (way, way above the doses we will be suggesting today) are generally well tolerated. 

Some people do get side effects from CBD but these tend to be unpleasant rather than harmful such as a dry mouth, nausea, diarrhea, drowsiness, light-headedness and disorientation.  Very rarely, liver damage has been reported. 

Keep in mind that this safety depends upon the source.  If you are buying from legal licensed outlets, your risk is minimal. However, If you are trying to save a few dollars and use the black market, you should know that there is a decent chance the amounts of CBD (& THC) on the label may be inaccurate and some chance that other drugs have been added to it (yes possibly even fentanyl) in order to make it more potent and addictive. 

As well, CBD can interact with other medications that you take so before trying a product, it is a good idea to run it by your health practitioners for some advice.  In doing so, you shouldn’t have to worry about being judged.  Most modern doctors and pharmacists recognize that there is a role for CBD and that modern prescription medicines don’t always provide a perfect answer to whatever is ailing you.  The vast majority of us just want you to feel better in a safe manner. 

The first choice you’ll need to make when selecting a CBD product is the form that it comes in.  There are many options but the main ones that should suit most purposes are: 

  • Edibles– there are many options in this category and can vary in potency, flavour and price.  Common selections include gummies, brownies, cookies, chocolates…. These can be slow to work (30 minutes to 2 hours depending on a number of factors), have a low absorption (so you may need to take a larger dose to get the same effects) and can stay in your system for a number of hours (which is once again highly dependent on a number of variables) so one should start out cautiously.  Edibles provide more a “fun” option than a great choice for regular therapeutic use as they contain lots of sugar and other additives and the dosage, especially in “home-made” concoctions can be all over the place leading to inconsistent results. 
  • Topical– these are creams that are frequently effective for localized pain and swelling such as an arthritic hip or knee and is the option recommended first for this type of pain.  Their benefit is limited to the affected area they are applied to but they come with an extremely low risk of side effects and tend to work quickly. 
  • Capsules – This is a great choice for most people who want to try CBD for systemic concerns such as sleep or anxiety for example.  While they do have the same slow onset and low absorption noted with edibles, it is the easiest dosage form to get a consistent dose and may be gradually increased or decreased depending on their effect upon you.  
  • Oils and Tinctures –  These usually come in a liquid form.  They are usually given as drops (but oils could also come in a capsule) directly into the mouth or added to food or a drink.  The dosing can be complicated for some as figuring out the amount of CBD in a drop or ml of liquid is not easy math for everyone.  As well, it is very easy to accidentally ingest an extra drop thereby making this form a less accurate way to maintain a consistent therapeutic dosage each time. 
  • Vapes & Dried hemp plant that’s smoked –  This is easily the least preferred way of taking CBD for medical purposes for two reasons.  One, the amount you inhale can be widely variable making this a poor choice for finding a consistent and reliable therapeutic effect.  As well, there is a growing body of data indicating that this method of using CBD may cause serious damage to the tissues within your lungs. 

The above gives examples of the various ways one can provide CBD to the body.  Next week we will focus on what types of dosages should be used for the various indications that people use CBD to treat.  For more information about this or any other health related questions, contact your pharmacist.