CBD Safety

In our previous article, CBD 101, we gave the brief conclusion that trying CBD is still an experimental undertaking, but also mentioned that it’s generally safe. The key word here is generally. CBD has a complex range of actions in the body – around 20 mechanisms described to date (1) – which makes it really difficult to assess all the potential risks.

While research shows CBD’s side effects are generally mild (2), specific cases of drug interactions have been reported (3, 4, 5), and there is evidence that others are possible (6). We don’t know much in detail about these potential interactions yet, and we know even less when it comes to things like CBD and pregnancy/breastfeeding or long-term use.

This article is meant to highlight notable areas of concern and give a basic idea of both what the associated risks are (or might be) and how well we understand them so far – not to scare anyone, but to help those interested in CBD make safe and informed decisions. And of course, this article isn’t meant to be a substitute for professional medical advice – we’ll talk more about that as well.

CBD Safety Quick Reference

As a quick point of clarification, keep in mind that there may be long-term risks to reproductive health and pregnancy/breastfeeding in addition to any other long-term risks. Also, we’ve listed the side effect risk as “currently low”, as further clinical studies and analysis may show otherwise. The most current analysis (excluding epilepsy studies) includes 233 patients from 7 studies (2), so the evidence is looking good so far.

When do the Risks Outweigh the Benefits?

That’s a good question, and a tough one. Indeed, the whole point of investigating the medical worth of a substance is to weigh the potential benefits against the potential risks. Often times, potential benefits depend on quality of life: in the case of children with severe treatment-resistant epilepsy, things like mild side effects and unknown long-term risks associated with CBD pale in comparison to the benefit of having 25-100% less seizures.

But a medical professional is best equipped to help navigate a situation like this. A good example is a 2018 case study where a man who, among other complications, had treatment-resistant epilepsy and was also taking warfarin, a blood-thinning medication. He had entered a CBD research program for his epilepsy, but after starting the researchers noted that his INR – a number measuring how long blood takes to clot (15) – had increased, indicating there was more warfarin in his blood than usual, and in turn a drug interaction between CBD and warfarin. Throughout the program, his warfarin dose was lowered by about 30%, bringing his INR back to normal.

Seeking Professional Advice

Unfortunately this one can also be tough. Two years ago a relative of mine asked her specialist about using CBD for pain while she was on heart medication. The specialist just shrugged at her. While this experience is now two years out of date, I’m not sure how much better it’s gotten – Michael Eisenstein’s 2019 article in Nature outlines some rough circumstances in New York City, where the director of the Addiction Institute of Mount Sinai talks about “physicians who have no clue how to address the requests they get from patients” constantly calling and emailing.

If you ask your doctor and they don’t know enough to help, consider trying to get them to work with you: perhaps you’re on medication but have other complications and think CBD might help more than hurt – ask if they can monitor you through follow-up appointments. Maybe they can help adjust doses of other medications in response to how CBD affects you. Again, I’m not sure how knowledgeable doctors are about CBD in 2020, but I’d love to hear comments about others’ experiences with asking their doctors about CBD.

Thanks for tuning in everybody – hopefully this puts you on a path towards safer choices with CBD, or helping others do the same! Stay tuned for next time, where we’ll be talking about some of the commonly-encountered jargon in the world of CBD.