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Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms

PainSci » bibliography » Moore et al 2023
Tags: harms, pain problems

One article on PainSci cites Moore 2023: Marijuana for Pain

Photo of marijuana plant.

Perhaps the most interesting & controversial plant in the world.

PainSci commentary on Moore 2023: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is an extremely negative review of sixteen studies of CBD for pain.

“You’ve got to ask yourself one question: Do I feel lucky? Well, do ya, punk?”

You’ve got to ask yourself that because, in the wacky world of cannabis products, you never quite know what you’re going to get! CBD products are like a game of roulette: you might end up with a little, a lot, or maybe even none of the CBD that’s promised on the label.

Or is it a game of Russian roulette? Because CBD concoctions also seem to contain a medley of other mysterious chemicals, and they probably aren’t all okay. While verified pure CBD appears to be “largely benign,” trials of commercial products show some evidence of serious side effects, specifically liver stress. That points to toxicity, probably from contamination, but possibly through other mechanisms like adulteration, or interactions with other drugs (see Smith).

But lots of medications are hard on the liver and the rest of the body, and we routinely accept those trade-offs. Is CBD efficacious enough to justify the risk of a funky batch?

Probably not. Of the sixteen trials of CBD in various forms, fifteen concluded, “Not today, CBD!” No more pain relief than a good old placebo.

Many people are quick to claim that they’re just fine with a placebo “as long as it works.” But that rationalization probably cracks under the pressure of liver toxicity.

“There is no good reason for thinking that CBD relieves pain,” Moore et al. write, “but there are good reasons for doubting the contents of CBD products in terms of CBD content and purity.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Cannabidiol (CBD) attracts considerable attention for promoting good health and treating various conditions, predominantly pain, often in breach of advertising rules. Examination of available CBD products in N America and Europe demonstrate that CBD content can vary from none to much more than advertised, and that potentially harmful other chemicals are often included. Serious harm is associated with chemicals found in CBD products, and reported in children, adults, and the elderly. A 2021 International Association for the Study of Pain task force examined the evidence for cannabinoids and pain but found no trials of CBD. Sixteen CBD randomised trials using pharmaceutical supplied CBD or making preparations from such a source and with pain as an outcome have been published subsequently. The trials were conducted in 12 different pain states, using three oral, topical, and buccal/sublingual administration, with CBD doses between 6 and 1600 mg, and durations of treatment between a single dose and 12 weeks. Fifteen of the 16 showed no benefit of CBD over placebo. Small clinical trials using verified CBD suggest the drug to be largely benign; while large scale evidence of safety is lacking there is growing evidence linking CBD to increased rates of serious adverse events and hepatotoxicity. In January 2023, the FDA announced that a new regulatory pathway for CBD was needed. Consumers and health care providers should rely on evidence-based sources of information on CBD, not just advertisements. Current evidence is that CBD for pain is expensive, ineffective, and possibly harmful. PERSPECTIVE: There is no good reason for thinking that CBD relieves pain, but there are good reasons for doubting the contents of CBD products in terms of CBD content and purity.

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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: