CBD products and related items from Kulture (Photo by Ash Daniel)
Sixty-year-old George Ogburn first used CBD in 2014 to help wean himself off Percocet, a prescription opiate pain reliever he’d been prescribed after a near-fatal motorcycle wreck.
On June 5, 2008, Ogburn was riding his Harley-Davidson on his way to work at a home improvement store. It was the day before his 10th wedding anniversary, when a Honda Accord collided head-on with his motorcycle. Ogburn, a resident of Kenbridge, about 70 miles southwest of Richmond, has undergone four neck and back surgeries since then, and he was taking 180 Percocet pills and 150 Valium each month for pain relief.
“It was eating me up and messing me up,” he says. A trip to Colorado in 2014, shortly after the state legalized marijuana, opened his eyes to the possibilities of alternative medicine. He began doing research and decided to try CBD.
“I didn’t feel drugged, but I felt good,” says Ogburn, who is currently seeking to own and operate a hemp company. “I didn’t feel down or bummed out, and the pain was gone.”
CBD, or cannabidiol, is one of hundreds of compounds derived from the cannabis family, but unlike its cousin THC (tetrahydrocannabinol), CBD doesn’t produce a high, leaving behind the couch-locked, late-night fridge raids or paranoia often associated with THC.
CBD is being promoted as a cure for ailments ranging from sleep disorders to epilepsy, and it’s popping up in products ranging from coffee and ice cream to tinctures and topicals. It’s also found a home in the medicine cabinets of soccer moms, grandmas and millennials alike.
Few had heard of the compound until recently because the majority of cannabis research had previously been focused on THC, not hemp and CBD. With the budding legalization of medicinal and recreational marijuana slowly spreading across the country, paired with an increasing consumer spotlight on health and wellness and a desire to limit prescription meds, CBD is having its shining moment.
Jenn Michelle Pedini, development director for NORML (Photo by Ash Daniel)
“CBD has become the poster child for the health benefits of marijuana,” says Jenn Michelle Pedini, development director for NORML, a nonprofit advocacy group that seeks to reform marijuana laws. She’s also executive director of its Virginia affiliate.
Esther Blessing, an assistant professor at New York University School of Medicine who’s conducting a study of CBD as a treatment for post-traumatic stress disorder and alcohol use disorders, said in a New York Times report that CBD is “the most promising drug that has come out for neuropsychiatric disease in the last 50 years.”
But CBD has appeal because it’s also being used to treat everyday concerns. Phillip Shepperd, a 27-year-old pharmacist from Richmond, says he tried a CBD tincture to aid with sleep and anxiety after hearing about it from a family friend. “I figured it was worth a try since it doesn’t require a prescription,” he says. “I was drawn to giving it a shot because I’ve tried other sleep aids, but mostly they knock you out, and you can feel it in the morning.”
He describes CBD’s effect as “subtle, yet noticeable.” It took him several days to settle on a dosage that worked for him.
Although CBD appears to be beneficial, potential consumers should be wary of health claims. Aside from one drug recently approved for people with epilepsy, no other CBD product has federal Food and Drug Administration approval because of marijuana’s Schedule I status, which makes it difficult to study in FDA-approved clinical trials. Most CBD products come with a label that states they have not been evaluated by the FDA and are not intended to “diagnose, treat, cure or prevent any disease or ailment.”
Before taking CBD, consumers should consult with their doctor and be aware that it can take time to find the appropriate dosage and strength.
Dr. Louis Duchin is one of almost 200 registered physicians in Virginia who can recommend CBD to patients. (Photo by Ash Daniel)
How it Works, With Some Caveats
Researchers believe CBD works through its interaction with the body’s endocannabinoid system (ECS), which is associated with how the body maintains symptom balance, including modulating pain and inflammation.
Louis Duchin, a psychiatrist at Trinity Mental Health in Chesterfield, has been practicing medicine for 32 years. While doing research on the ECS, he read about CBD. Now he is one of almost 200 registered physicians, a number that continues to grow, in Virginia who can recommend it to patients. “Recommend” is the key word.
Because CBD is still considered illegal at the federal level, doctors can’t prescribe medical cannabis, they can only recommend it.
Duchin says CBD can offer support, a necessary kick-start when the ECS is struggling to utilize its own endocannabinoids. “With CBD you’re getting the benefits [of marijuana] without the risk,” Duchin says. He believes CBD can treat inflammation, chronic pain and other conditions and hopes that research and clinical efficacy can expose the potential of CBD oils.
He recently recommended the compound to a 75-year-old patient who had smoked marijuana to alleviate pain from spinal stenosis, a condition that can put pressure on the spinal cord and nerves, but the patient had developed chronic pulmonary disease and could no longer smoke. CBD was the solution.
“I don’t want to recommend something to patients if I think its snake oil,” Duchin says. “CBD oil has the potential to be a well-tolerated, safe, effective, natural product that can treat anxiety disorders, and I think [it] has the potential to decrease opiate medications in treating opiate addiction.”
But without FDA guidelines, purchasing CBD products can be akin to purchasing an automobile when the only information presented is from the car’s salesman.
If consumers purchase cannabidiol products online or in other states, the only regulatory oversight applies to manufacturers operating under a state-regulated program. Some products on the market have been tested and contain no CBD, or even high levels of THC, presenting dilemmas for consumers.
Michelle Peace, an associate professor for the Department of Forensic Science at Virginia Commonwealth University and a forensic toxicologist, recently received a call from a CBD e-liquid user claiming he experienced a “harsh high” and intoxicating effects from a product.
Peace and her lab analyzed nine CBD e-liquid vapes. Four of the samples contained a synthetic cannabinoid typically found in the drug “spice”, and the cough-suppressant dextromethorphan (DXM) was present in another. “Without federal oversight, what penalty is there for distributing low-quality products?” Peace says. “When communities police themselves, the opportunity for nefarious activity is higher than what would otherwise be the case.”
She supports robust clinical trials to discover the long-term effects and appropriate dosage of CBD but believes the gray area of legality and lack of regulation is a scary landscape for consumers. Since the study, she says, dozens of people have sent their products to VCU’s lab to be tested, out of concern over what they may contain.
Boketto Wellness health boutique in the Museum District sells CBD products. (Photo by Ash Daniel)
Several merchants selling CBD say they are cautious about where they obtain their products. “A lot of companies and brands, knowing that CBD has become popular, are trying to jump on the bandwagon and cutting corners,” says Allison Walton, an employee of Boketto Wellness health boutique in the Museum District. “We’re particular in sourcing brands, and we get to know them, where they grow it and their process.”
Several doctors who have registered with Virginia in order to recommend the substance say they did so conditionally.
Danielle Noreika, medical director for inpatient palliative care services at VCU, focuses on pain and symptom management for patients with lifelong illnesses and has known about CBD for years. Despite recognizing CBD’s potential and possessing a strong interest in medical interventions for her patients that pose benefits with low risk of harm, Noreika says registering was a proactive measure.
“I don’t know until we have more evidence that I will be in a place of specifically recommending it,” she says. Noreika finds the lack of standardized ingredients in CBD products a concern.
“We can’t recommend a resource without being sure what the ingredients might be,” she says. “Clearly, from our standpoint, it’s much more straightforward to recommend an FDA-approved substance because we know what we’re recommending. This is more challenging.”
Egidio Del Fabbro, program director of palliative care at VCU, says he’s been interested in the possibilities of cannabis, both THC and CBD, in helping with appetite and nausea for his patients with cancer. “I’m intrigued by the prospect of CBD being effective and not having the psychotropic effects of THC,” he says.
Del Fabbro believes in keeping an open mind and exploring alternative medicine, but he says clinical-trial evidence supporting CBD is slim. Although it’s not necessarily being prescribed to patients who have life-limiting illnesses, it is in a variety of other settings. “What’s really striking is CBD is being used in just about everything without any evidence, and I’m surprised there’s not more interest from the federal government in presenting research.”
Click upper-right corner to enlarge image.
Legal Matters/The Gray Area
The most confusing and perhaps most important piece of the CBD puzzle for consumers: Is it legal?
“I have one simple answer,” says NORML’s Pedini. “No.”
CBD is illegal at the federal level, and in Virginia.
The federal government lumps CBD in with Schedule I drugs, considered to have no accepted medical use and a high potential for abuse. Others on that list include peyote, heroin, LSD and marijuana, according to the United States Drug Enforcement Administration.
But states have been flexing their own rights, and so far the feds have turned a blind eye. Regarding CBD, the DEA and federal authorities have issued statements that although it is illegal, it’s tolerated and off their radar. With a raging war on opioids, people snacking on CBD gummy bears to relax or rubbing CBD salve on their arthritic hands is the least of their worries.
The federal legal landscape of CBD could face changes with the passage of the 2018 Farm Bill, which as of press time awaits signature from the president after passing both houses of Congress.
In 2015, Virginia approved use of medical cannabis oil to treat intractable epilepsy and expanded the program last year for use in treating any diagnosed condition. CBD oils can be legally recommended in Virginia with a written certification from a physician registered through the Board of Pharmacy. In early 2018, The Virginia Board of Pharmacy chose five pharmaceutical processors from a group of 51 applicants to launch the state’s first authorized growing facilities — one-stop shops for growing, extracting and dispensing oils derived from marijuana plants. Maryland-based Green Leaf Medical won the initial contract to provide services to Richmond and parts of Southside.
Once the processors are in operation, which is projected to occur later this year, the oils they produce will contain at least 5 milligrams per milliliter of either CBD or tetrahydrocannabinol acid (THC-A), a form of THC that does not produce a high.
Pedini says that while CBD is widely accepted, users should be cautious. People have been arrested for CBD possession in Virginia and other states.
Henrico Commonwealth’s Attorney Shannon Taylor says the county’s focus on CBD is safety, not locking people up. “What we’re trying to do is consumer protection,” Taylor says. “We would support law enforcement reacting to a consumer protection issue by a mislabeled product.”
The bottom line, businesses and consumers should be aware that they are handling a product that is unregulated, and in its infancy, which raises concerns for law enforcement — and consumers, says Mike Feinmel, deputy commonwealth’s attorney in Henrico. “From a law enforcement perspective, nobody wants to see anyone suffering or deprived legally of a product that can help ease suffering, especially if medically recommended,” he says. “But just because a product says CBD oil or puts a pot leaf on the container, it doesn’t mean it has the CBD content that’s contemplated.”
UPDATE, Jan. 21, 2019: With the passage of the 2018 Farm Bill, industrial hemp became legal on the federal level on Dec. 20. Provisions under the Farm Bill remove hemp from its Schedule I classification and broaden the definition to include any part of the plant, including cannabinoids that are not higher than 0.3 percent THC. However, CBD is currently still illegal in Virginia and under the Federal Food, Drug and Cosmetic Act, CBD is still illegal to put in foods or market as a dietary supplement.
