CBD oral spray is among a number of a forms the chemical compound is sold in.
David Kawai/BloombergOlder patients’ interest in CBD has been on the rise, but doctors differ on their views of its safety given limited testing and regulatory oversight. As a result, it’s best to proceed with caution, if at all.
CBD, as cannabidiol is more commonly known, is the nonintoxicating chemical found in the resinous flowers of cannabis and hemp. CBD made from hemp was legalized under the 2018 Farm Bill and now can be found everywhere from gas stations to tony boutiques. The products can’t claim any therapeutic benefit or they would then become subject to regulation by the Food and Drug Administration.
“CBD products are wildly popular with older customers—older cancer patients, people with chronic pain, people seeking an alternative to marijuana,” says Jenni Otwell, owner of Magic City Organics in Birmingham, Ala. “Older people want to talk through the purchase more and flow through what their options are. But the interest is incredible.”
Otwell’s experience isn’t just anecdotal. A January 2020 Consumer Reports survey found that 20% of Americans 65 and older said they’d tried CBD, up from 14% in January 2019.
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Magic City Organics does virtual consultations, as well as in-person discussions in the store. Otwell ships all over the country. Topical CBD products, rather than edible products, are most popular with her older clients, she said.
CBD isn’t addictive, according to a 2017 World Health Organization report that found that CBD isn’t a compound with a high dependence or abuse potential.
Still, there are concerns about the quality and efficacy of CBD products. Epidiolex, a prescription CBD medication, is the only CBD product approved by the FDA. The liquid CBD product is used to treat seizures related to three rare disorders.
What’s more, CBD products can have negative drug interactions and experts urge CBD consumers to disclose their use to physicians and pharmacists to help prevent adverse effects.
A 2020 analysis in the medical journal “Geriatrics” found that CBD can increase blood levels of certain cholesterol-lowering statin drugs, antihistamines and antidepressants. Basically, CBD can increase the other drugs in your system by using the same molecules that you need to break down and clear medications from your body.
“The concerns are not specific to older people, but become bigger issues as you get older,” said Pieter Cohen, associate professor of medicine at Harvard Medical School. “It can take longer to digest medicines as you age. The kidneys and liver behave differently in older people. For the elderly, the risks of THC or other contaminants being in the CBD products — they’re more susceptible and have amplified risk.”
Daniel Clauw, professor of anesthesiology, medicine and psychiatry at the University of Michigan, agrees that it’s important for patients to tell their medical providers if they are taking CBD, but he says they generally aren’t clinically significant.
“And in many older patients the risks of taking CBD, for example for pain, might be far less than the known risks of other drugs they might use instead, such as opioids or even NSAIDS,” said Clauw, who’s also the director of the Chronic Pain and Fatigue Research Center. “It is not approved for use in pain, but we are using [Epidiolex] in several NIH-funded studies for pain,” he added, referring to the National Institutes of Health.
Differing medical opinions aside, it’s tough to know what you’re really buying with CBD products.
A 2017 article in the Journal of American Medical Association looked at the labeling accuracy of CBD extracts sold online. It found that 43% of products under-labeled the ingredients, 26% over-labeled, and only 31% were labeled accurately with the correct amount of CBD included. Also, it found that THC was found as a contaminant in 21% of the CBD products tested.
“We don’t have assurances that CBD products are accurately labeled and packaged. There’s not a pathway to market for CBD that’s monitored by the FDA,” Cohen said. “Right now, it’s not something we can recommend because we can’t determine product ingredients or decide on dosage because there’s no data on this. Consumers are at the mercy of the manufacturer. It’s all in a gray area.”
Cannabidiol, or CBD, is the nonintoxicating chemical found in the resinous flowers of cannabis and hemp.
Waldo Swiegers/BloombergThose who choose to pursue CBD should know there is a broad array of products — from topical creams to edible gummies to oils and tinctures. Some doctors suggest that topicals may be less likely to cause any negative side-effects, but also may be less effective for severe pain.
Joseph Maroon, clinical professor in the department of neurological surgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh Medical Center, calls the CBD market the “wild west,” but he suggested several ways to ensure patients get safer products.
Maroon said patients should look for a QR code on the product labeling, as well as a “Certificate of Analysis” and an 800-number to call in case of adverse reactions.
The QR code can help customers identify the toxicology results, any published pre-clinical data on the product, randomized controlled trials and post-marketing adverse event reports.
“Unless you have that, you have no idea the content of what you’re buying,” Maroon said.
CBD, in doses ranging from 15 mg to 75 mg a day, tend to show no reported significant adverse reactions, Maroon said.
“The major reasons people use CBD products is for pain relief, sleep and stress control,” Maroon said. “Other products for pain for arthritis or disc disease — like ibuprofen and aspirin — have very significant side effects such as stomach ulcers. As a result, CBD is a reasonable product to try in amounts used for wellness.”
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