I am a patient of your practice but am unable to use any cannabis products with THC for the next year. I suffer from chronic tendonitis, anxiety and IBS. I am hopeful that using CBD derived from industrial hemp could provide me some relief to my ailments. It is legal to purchase and I can vaporize it, take it sublingually and use it as a salve. Do you know of anyone having success with this CBD oil and how much I should use to reach an optimal therapeutic effect?
Dr. Sulak’s Answer
This question is coming up more often, thanks for asking it on Healer.com.
First of all, I’m sorry to hear that you must abstain from THC for a year, especially if it was working well for you. Perhaps the silver lining is that you will get to know CBD and how to best use it to treat your conditions.
Several companies are now shipping hemp-based CBD across the country. These practices are not exactly legal, because hemp laws apply to food, not medicine, and CBD is still considered a schedule 1 substance by the US Department of Justice. Nevertheless, the DEA has not taken action against these companies, and I doubt they will. Interestingly, the FDA did get involved, and actually penalized several companies for not putting enough CBD in the products to live up to the claims on the label. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm435591.htm
I have a few concerns about hemp-based CBD. True industrial hemp is not an efficient source of cannabinoids – those plants are best for producing seeds and fiber. So to get CBD from industrial hemp, huge quantities of starting material must be used, and the CBD must be extracted using an organic solvent. Usually, the safest solvents like ethanol and CO2 are the most expensive to use, and I worry that large-scale production might lend itself to cheap, toxic solvents that may make their way into the final product. I recommend having your product tested for both cannabinoid content and residual solvents/pesticides.
I believe that some of the “hemp” being grown for this purpose is actually not industrial hemp, but rather CBD-dominant medical cannabis plants that can be considered “hemp” due to their low THC content. This would make more sense from a production standpoint.
For more information, check out Project CBD’s report from last year, though I’m sure some things have changed since then: https://www.projectcbd.org/news-release-project-cbd-issues-special-report-medical-marijuana-inc-hempmeds-and-kannaway
Now, back to your question. For tendonitis, anxiety, and irritable bowel syndrome, I do think that CBD could be a great help. Most patients use a somewhat higher dose of CBD compared to THC, often starting around 5mg sublingually and working up to 50mg, 2-4 times daily. I would expect the anxiety and IBS to respond to a similar dose. Some patients have reported good results with topical CBD for musculoskeletal issues, though I more often hear positive reports about THC or combined THC/CBD topical preparations. I’m curious to hear what you find if you try it.
Please note that like THC, CBD often follows a multi-phasic dose-response pattern, which means more is not always better, and going above your optimal dose may result in decreased efficacy. Please also note that at low doses, CBD tends to be awakening and stimulating, but above a certain dose, CBD can be sedating. While most people with similar conditions to you do well with less than 100mg daily, some people need 500-800mg daily to help with other conditions, such as seizures and schizophrenia.
All the best,
Dustin Sulak, D.O.