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CBD: The Hype and the Reality

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Illustration by Iris Gottlieb

CBD is everywhere these days, but a decade ago it was largely unknown. Martin Lee, one of the founders of the California nonprofit Project CBD, helps us unpack how the CBD craze got started, what makes CBD promising and whether the hype is justified.

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Ann Marie Awad: From Colorado Public Radio and PRX, this is On Something.

Speaker 2: I'm a big fan of CBD. I use CBD frequently, especially when I'm trying to get some deep sleep.

Speaker 3: There are people who I've known in my life, like my piano teacher, who are now rallying in Texas for this usage because of the medicinal use.

Ann Marie Awad: By now, I'm sure we're not breaking the news that CBD is everywhere. It's the new kale. It's the new superfood. It's whatever you want to call it. Here in Denver, between talks at a TEDx event we were attending, we asked a bunch of folks to share their thoughts on CBD with us. And, perhaps not surprisingly, nearly everyone we asked had something to say.

Speaker 4: I mean, I know that it has healing properties, but I'm not all up on all the data.

Speaker 5: Oh yeah. I saw it in Walgreens next to the cough syrup I was going to get for my kids. So my kids were sick, and it was just right next to them, and I was like, "CBD? I thought this was a dispensary thing," but I guess it's everywhere.

Ann Marie Awad: So what is this stuff? And how did it start showing up everywhere? How did something that is made from cannabis, which is still illegal in many states, become part of a never-ending national wellness industry spin cycle? How can something that has such promising research behind it as a medicine be the same stuff that Gwyneth Paltrow is trying to sell in her Goop newsletter, along with yoni eggs and moon juice?

Ann Marie Awad: This is On Something, stories about life after legalization. I'm Ann Marie Awad. On this podcast, we talk about people's relationships with weed. And now that your mom, your sister, and all your in-laws are into CBD, lots more folks in America have a relationship with weed. CBD is one of those examples of the way that pot just captures our imagination. I think the second that we came up with the idea for a podcast about legalization, people started telling us immediately that we needed to be talking about CBD. And so we got to talking with Martin Lee, one of the founders of Project CBD in California. It's a non-profit that aims to promote the scientific research around CBD.

Ann Marie Awad: Martin is a journalist. He's been writing about CBD for almost 10 years now, long before you or I caught wind of all of the CBD hype. He's followed every step in CBD's recent rise, and he's actually got something of an expertise in reporting on drugs. He wrote a book called Acid Dreams, it's all about the history of LSD in America. And another book of his, called Smoke Signals, tells a social history of marijuana in America. He's got bylines in the Washington Post, The LA Times, and Rolling Stone. And to be clear, somewhere along the way, Martin also became a believer in CBD. Actually, as I've gone down the CBD rabbit hole this year, I've found that people who can speak authoritatively on CBD have, for the most part, drunk the Kool-aid, so to speak. But Martin maintains that there is no Kool-aid sipping here.

Martin Lee: We're not cheerleaders for CBD. We're certainly a pro cannabis therapeutics. We feel there's a lot of value there and we feel that CBD, in and of itself, adds immensely to that. But we feel it's also important to ground what we know in science and actual experience. It's pretty obvious that CBD is an impressive molecule. We don't have to exaggerate what it does.

Ann Marie Awad: It was 2006 when Martin remembers first hearing a scientist talk about CBD at a conference in Switzerland. This conference was actually focused on psychedelics, and Martin was riveted by probably the least psychedelic substance being talked about, because you know, CBD doesn't get you high.

Ann Marie Awad: It wasn't until fairly recently that we had an understanding of how CBD works and what it can do, but scientists have known about CBD for quite some time, as far back as the 1940s. And human beings have been using cannabis for centuries, long before anyone had come up with the name cannabidiol. That's what CBD stands for, by the way. But we're not going to dive into all that history right now. No. This episode is about the modern history of CBD, the Kim Kardashianization of CBD, if you will.

Kim Kardashian: I was like, "I can't do another baby shower. I can't do another baby game …

Ann Marie Awad: This is Kim herself, I know we can never get enough of Kim Kardashian, talking with E News earlier this year.

Kim Kardashian: I just want a zen, CBD-themed baby shower. That is the theme.

Speaker 8: Really? Oh, girl, I could help you with that. I got a few phone calls I-

Ann Marie Awad: CBD did not yet have that celebrity cachet when Martin Lee was at that conference in 2006. A few years later though, marijuana growers in Northern California who were supplying California's medical marijuana market, were tweaking their plants. They were trying to breed plants that had higher levels of THC. That's the stuff that gets you stoned. But some of these growers made some mistakes, weed strains that wouldn't get anybody high because instead of THC, these plants were potent in CBD.

Ann Marie Awad: Okay. Before we go on, we need to have a little vocabulary round, because with all of this technical jargon, we might just get lost in the weeds. So CBD, we've already established, stands for cannabidiol. It doesn't get you stoned, but it's the part of cannabis that's responsible for relaxation. It's been approved by the FDA to treat some rare forms of epilepsy. It has anti-inflammatory effects, etc. THC is another compound we've mentioned here. That stands for tetrahydrocannabinol. That's the stuff that gets you stoned, gives you the munchies, might make you paranoid. And THC and CBD sort of work together like two interlocking pieces.

Martin Lee: One of the problems with THC, people can get too high and it can be uncomfortable. It can be, rather than relaxing, it can be anxiety-producing. CBD, if anything, is just the opposite. CBD has an anxiety reducing effect. And that's I think one of the most common uses for CBD is as an anxiolytic, or anxiety-lessening agent.

Ann Marie Awad: A cannabinoid is a chemical that naturally occurs in the cannabis plant. So CBD and THC are a couple of examples of cannabinoids, but more than 100 cannabinoids have been isolated from the cannabis plants. There are also other plants that produce cannabinoids, but not in the quantities that marijuana does. So calm down. Cannabinoids affect our bodies by talking to our endocannabinoid system. That's because dun, dun, dun, our body naturally produces its own cannabinoids. Cannabinoids made by the body are like little messengers that sends signals to the brain, or the gut, or whatever part, to regulate basic bodily functions. The cannabinoids that you smoke, or vape, or eat, those can imitate these little messengers.

Martin Lee: It was only discovered, it actually started in the late 1980s. Let's say in high school, and you studied biology of all the different systems, the skeletal system, the circulatory system, reproductive system, nervous system, etc, etc-

Ann Marie Awad: Yeah, I don't remember the endocannabinoid system in there anywhere.

Martin Lee: No, it would not have been there. And it's, again, one of the reasons why cannabis is very versatile therapeutically, because cannabis very directly affects the endocannabinoid system, and therefore can affect all these other physiological systems as well.

Ann Marie Awad: The endocannabinoid system is still a pretty recent discovery, and it's not totally understood. There's a lot of emerging research though, that suggests it has a major role in regulating our memories, our appetite, our metabolism, how we respond to stress, sleeping, reproduction, pain response, all kinds of things.

Ann Marie Awad: All right, so now that we all know our terms, let's move on. So in the early 2000s, you had these pot growers in Northern California that started accidentally producing this high CBD weed. And Martin says that this moment was like a rediscovery of CBD. Before then, it had been all about THC, but the high CBD strains of weed coming out of California got Martin's attention. And this was the impetus behind Project CBD.

Martin Lee: Well, when CBD was first rediscovered in Northern California, it was during the first year of the Obama presidency. When we look back on it, we might not remember, but Obama wasn't a great friend of medical marijuana in the very beginning. There was a lot of federal pressure. There was raids. There was letters to landlords telling them to shut down dispensaries, and so forth and so on. So there was a lot of pressure on the community.

Ann Marie Awad: In the eyes of the world, the medical marijuana movement was, at its core, still about people getting high. That's because up until then, THC was the name of the game. But Martin thought the new research on CBD would force people to re-evaluate everything they thought about marijuana. This was the stuff that could be medicine. This was the stuff that could challenge marijuana's status as a Schedule One drug. In other words, CBD could change everything.

Martin Lee: One of the criticisms of the medical marijuana phenomenon is, "Oh, this is just a front for stoners. This is not really real. Okay, maybe a few people, it helps. But by and large, this is just an excuse for people getting high." Well, once CBD is part of the mix, you can't use that criticism anymore. It doesn't apply. Why would a person then go to a dispensary specifically to buy a product that's not going to get them high or not get them very high? So that criticism, which was a frontline criticism of the medical marijuana world, no longer had that traction.

Martin Lee: And we thought this would have far-reaching implications, because not only would it be very difficult for the drug war establishment to respond to CBD, to justify keeping it illegal, but at the same time, we thought it would be a huge impetus that would open the door for many people in the United States, and the world, for that matter, who would want to access the benefits of marijuana but who didn't want to get high. We did think it was going to be a big deal, but I don't think anyone realized it would be as big a deal as it has turned out to be.

Ann Marie Awad: After a short break, we'll try to pinpoint the exact moment that CBD became the next big thing. And we'll try to get to the bottom of whether or not all this hype is warranted.

Ann Marie Awad: Can you remember a turning point when, all of a sudden, CBD was just everywhere?

Martin Lee: I think there were a couple of key tipping points. One was in the summer of 2013 when CNN did the special with Sanjay Gupta.

Sanjay Gupta: People are lighting up all over the country. They call it the "green rush."

Ann Marie Awad: The show, simply called Weed, was an hour-long special in which Dr. Sanjay Gupta put medical marijuana under a microscope. And yes, while this special featured the predictable B-roll of lots of pot plants and people puffing away on glass pipes and stuff like that, Gupta actually spent most of his time focused on the family of Charlotte Figi in Colorado Springs.

Sanjay Gupta: What would you do if this were your child? Charlotte Figi had an extreme form of epilepsy. Her body was so frail that any seizure could kill her. With no traditional treatment left to try and the clock ticking away, her parents decided to try marijuana. Charlotte was just five years old.

Ann Marie Awad: The show featured footage of the little girl having a seizure.

Sanjay Gupta: And this might be hard for some of you to watch.

Paige Figi: It's okay, baby.

Ann Marie Awad: She had hundreds of seizures weekly as a result of a rare type of epilepsy called Dravet Syndrome. Charlotte's epilepsy was so severe that all of the normal treatments didn't help. Her mom took her to see a Harvard trained physician in Denver who wrote her a prescription for cannabis high in CBD. And at the time, CBD was still relatively under the radar. And this doctor was an outlier for his willingness, not only to prescribe it, but to prescribe it to a child. After jumping through lots of hoops, Charlotte's mom obtained a liquid solution of CBD with little to no THC in it.

Paige Figi: I measured it with a syringe and squirted it under her tongue. It was exciting and very nerve-wracking.

Sanjay Gupta: Holding Charlotte in her arms, Paige waited. An hour ticked by, and then another, and then another.

Paige Figi: She didn't have a seizure that day, and then she didn't have a seizure that night.

Sanjay Gupta: Did you sit there and …

Martin Lee: To see that kind of transformation is very, very powerful, a real tearjerker. But I think when people saw that on national television, international television, there's two things that came through really powerfully. You remember, we had grown up learning that marijuana was the assassin of youth. And here we have a situation where we're seeing a certain kind of marijuana, the CBD-rich marijuana, was saving the lives of children. And not only that, it was doing it in a way that they weren't getting intoxicated, the kids weren't getting high. And that was just mind-blowing to people in the United States. It was really an eye opener.

Ann Marie Awad: Charlotte's family, with a big assist from CNN, had kicked the door open. They had gotten help from the Stanley Brothers, a cannabis company that started making the liquid solution of CBD that Charlotte needed. And after the CNN special, the Stanley Brothers saw a huge spike in demand. Their CBD was made from a weed strain that used to be called Hippies Disappointment, but after they met Charlotte, they renamed it Charlotte's Web.

Ann Marie Awad: After the documentary aired, you started to hear a lot more about self-described medical marijuana refugees. These were families that moved to Colorado to get their own Charlotte's Web. They, too, had children with epilepsy or other severe, difficult-to-treat conditions. And then came the backlash. Gupta received criticism for painting CBD as this miracle cure when it didn't actually work for every child. If you take nothing else away from this episode, take this. The link between CBD and epilepsy is the only concrete proof that we have of CBD's effectiveness as a treatment for any medical condition. All of those other kids who came to Colorado in search of a CBD miracle cure, they got mixed results. But by then, other cannabis companies had seen an opportunity. So CBD products started showing up in dispensaries all over, and not just in Colorado either.

Ann Marie Awad: Now, here's another big watershed moment in 2018.

News Anchor: Well, the latest Farm Bill legalized industrial hemp as a crop plant, sparking interest for a number of producers looking to capitalize on the new commodity.

Ann Marie Awad: That explosion of CBD that you've noticed recently, you can thank the 2018 Farm Bill. Hemp is a type of cannabis with very low THC levels and much higher CBD levels. It's a plant that can be used to make everything from paper, to fabric, to insulation, to fuel, to food. And it was illegal in America for as long as marijuana has been illegal. But last year, it was legalized, which meant that certain types of CBD extract, which had very low levels of THC, are now legal too. That meant that anyone could get in on this thing, not just cannabis companies in the legal states. CBD was now fair game for vitamin manufacturers, cosmetics companies, and wellness brands.

Martin Lee: I think that there's a lot of value in being open-minded with respect to CBD-rich cannabis, but that doesn't mean one should be sort of taken in by all the marketing hoopla. I think we're at kind of a transition phase here where we're just now, as a culture, welcoming back CBD-rich cannabis, this traditional herb, into the pharmacopeia, into the pantheon of medicinal herbs.

Ann Marie Awad: And to Kim Kardashian's baby shower.

Martin Lee: Which I was not invited to, and I feel personally insulted, because-

Ann Marie Awad: How unfair.

Martin Lee: … we've done so much for CBD that at least they could have invited us. But anyway, we'll give them a pass this one time.

Ann Marie Awad: All right, ha ha at the Kim Kardashians jokes, but she has major cultural clout. If she's talking about it, there are already lots of companies out there trying to make money off of it. Culturally speaking, CBD's seemingly magical healing powers have been fully co-opted by the wellness industry. It's started to occupy this friendly millennial pink corner of our lives as a healing balm for everything from aches and pains to anxiety. And Martin says the CBD explosion is about filling a certain void.

Martin Lee: We're in a situation in the United States where there's a lot of dissatisfaction with the healthcare system. People feel it's broken, it's too expensive. The medical insurance is almost like a joke in the United States compared to other countries. So there's a deep dissatisfaction with the way things are in terms of conventional medicine in the United States. And it's out of that dissatisfaction, I think, comes a longing for non-pharmaceutical approaches to healing, approaches that are gentle, that don't come with a lot of harsh side effects as pharmaceuticals tend to bring. So you might say that the moment was very, very ripe for something like the CBD phenomenon.

Ann Marie Awad: But if you think we've reached peak CBD already, you'd be wrong, according to Martin. He says we haven't even begun to realize its potential. Now, as we mentioned, Martin is a journalist, he's not a doctor or a scientist. But based on the studies that he's seen, he thinks that one day CBD may change the way that doctors treat cancer.

Martin Lee: There's very compelling research that shows that CBD interacts with chemotherapy agents for cancer. And you have the similar kind of situation where if CBD, or THC, for that matter, potentiates a chemotherapy drug, that means-

Ann Marie Awad: You got to help me out here a little bit, "potentiates" is a bit too jargony. I'm not sure what that means.

Martin Lee: Potentiates means magnifies the effect, makes it stronger-

Ann Marie Awad: I see. Okay.

Martin Lee: … so that if you take a CBD and it makes a chemotherapy agent stronger in its effect, that means one could take less of the chemotherapy agent, which tends to have a very damaging effect on the body.

Ann Marie Awad: Oh, yeah.

Martin Lee: It not only kills the cancer cells, it kills everything else. And it really, it can ravage one's health and have longterm damage in one's health. So anything you could do to lower the amount of the chemotherapy agent, and yet still maintain its effectiveness as a chemotherapy agent, is almost like a godsend. Well, I would predict, in the future, we will see combinations of CBD and other cannabinoids with chemotherapy drugs and other kind of drugs in such a way as to maximize the potential of conventional pharmaceuticals so that they will have less … they will be just as effective with less harmful side effects.

Ann Marie Awad: Okay. If it sounds like we are creeping very close to "CBD cures cancer" territory, I'm just going to throw some cold water on this idea. Martin is making a prediction based on a finding that CBD can affect the way that the body metabolizes certain kinds of drugs. By interacting with a certain enzyme in the liver, CBD can cause the body to absorb more of a medication. In one instance, a patient taking CBD and blood thinners absorbed about 30% more of the blood thinner than normal. So it's not out of the realm of possibility. But to be clear, Martin is making a prediction. There is no research we were able to find about CBD being used this way during chemo. And again, we are talking about the same stuff that the barista will put in my latte for an extra $4, CBD.

Ann Marie Awad: In our utopian version of the world where people are listening to this episode before they try CBD themselves, do you have advice for people who are considering giving it a shot for something that ails them?

Martin Lee: Yeah, there's this phrase, "Start low and go slow." I think it does apply to CBD-rich cannabis. Sometimes it's a bullseye for someone. Other times, it requires a lot of trial and error, and experimentation. But know that there is a real basis for why these things can be effective. There's a real scientific basis that's understood.

Ann Marie Awad: So remember when we talked about how CBD can affect the way that the body metabolizes drugs? We have to offer an important caveat here. If you're taking any kind of regular medication, it might be riskier for you to experiment with CBD. So that's a conversation that you should have with a doctor.

Ann Marie Awad: CBD comes from cannabis, which creates big roadblocks when it comes to research. Even in legal states, the federal government restricts cannabis research because cannabis is still a Schedule One drug. So when it comes to CBD, a substance with lots of interest, surrounded by lots of questions, it's easy to feel like all you've got to go on is anecdotal evidence.

Martin Lee: When people are saying time and again, "Oh my God, it's really helped the nausea I was experiencing after chemotherapy like nothing else did," and you hear this time and time again, you hear it from patients, from doctors, that's meaningful. One shouldn't poo-poo anecdotal evidence just because it's anecdotal. One should understand that that has a certain kind of value that's not the same as the randomized double-blind gold standard experimentation.

Ann Marie Awad: The Food and Drug Administration has only recently waded into the CBD waters. Earlier this year, the agency held the first public hearings on CBD, and has been exploring possible ways to regulate CBD products that are already on the market. Because right now, they're largely unregulated. There's little to no check on what companies can print on the labels of CBD products. Even the potency advertised on these products might be far from accurate.

Ann Marie Awad: Also, did you know that most companies that are currently marketing CBD as a supplement or a food are technically doing it illegally to begin with? They're not supposed to be making health claims that haven't been proven about supplements like CBD. For example, the FDA told General Mills years ago that they couldn't claim that Cheerios prevented heart disease.

Ann Marie Awad: It's also real important to mention that just because CBD has been made a bit more legal, it's still very illegal for certain folks. So if you are in the armed forces, for example, you are definitely not allowed to have CBD. And if you're not a citizen of the United States, CBD can cause you a lot of trouble. And that's just the federal government. CBD is still illegal in a few states. And this hand-wringing over how best to regulate CBD, this gets Martin really worked up.

Martin Lee: It should never have been made illegal in the first place. We're still in a legal mess. And it will never be resolved until cannabis, as a whole, is legalized. It should never have been made illegal in the first place. It was made illegal as a result of a racist campaign. And the fact that it is still illegal today, it's like the Confederate statue still standing, is what it is.

Ann Marie Awad: Oh, wow.

Martin Lee: It's a testament to enduring racism in the United States. Racism is what gave us the Controlled Substances Act. Racism gave us the Marijuana Tax Act. And the fact that the Controlled Substances Act still includes cannabis in it, shows that racism still exists in our society. So that's one way to look at it. But racism aside, it's just not workable. It's absurd. And it's not functional.

Ann Marie Awad: Yeah. We're in a situation now where it's something like 33 states have legalized medical marijuana, but the law of the land is still that there is no accepted medical use for marijuana.

Martin Lee: And again, that's absurd. The FDA can sit on its high horse and say, "Marijuana has never been put through double-blind randomized control studies, so it's not a medicine." Okay, if you judge it that way. But all that shows is really that the FDA's way of assessing a medicine is incomplete or inadequate. Clearly cannabis has medical value. That's been known for thousands of years.

Ann Marie Awad: So I've used CBD a few times. I have this chronic back injury, and I got mixed results with CBD. And I guess that's the key thing to know. Well, actually, there's two big takeaways: mileage may vary, and buyer beware. Mileage may vary because this stuff really does affect people differently. Like I said, I didn't have a "whoa" moment with CBD, but I have friends who use it regularly, and they swear by it. So everybody's body is different, everybody's experience is different.

Ann Marie Awad: And buyer beware, as we discussed earlier, a lot of the stuff out there right now is not reliable. Some stuff that's marked as having no THC has tested positive for THC. Lots of stuff promising to contain certain amounts of CBD contain way less than advertised. And there's still a lot we don't know about how CBD can interact with other drugs, as we mentioned earlier. Many studies show that CBD has no known lethal dose, and side effects like changes in appetite, tiredness, or diarrhea have been noted. But pretty much every study emphasizes that there is still so much we don't know. And I guess that's where CBD's appeal comes from, right? The mystery, the hope.

Ann Marie Awad: On Something is a labor of love reported and written by me, Ann Marie Awad. Produced and mixed by Brad Turner and Rebekah Romberg. Our editor is Curtis Fox. Music by Brad Turner and Daniel Mescher. Our executive producers are Rachel Estabrook and Kevin Dale. On Something is made possible by lots of talented people, like Francie Swidler, Kim Nguyen, Dave Burdick, Alison Borden, Matt Hertz, and Iris Gottlieb. Special thanks to actual scientist, Loren Reynolds, for his help with this episode.

Ann Marie Awad: If you've got something to say to us, you can give us a call and leave us a voicemail at (720) 420-6587. That's (720) 420-6587. You can also email us at [email protected]. This program is made possible in part by the Corporation for Public Broadcasting, a private corporation funded by the American people. This podcast is also made possible by Colorado Public Radio members. Learn about supporting Colorado Public Radio at cpr.org. Because with all of this technical jargon, we might get lost in the weeds. I'm sorry.