Detailed guides to painful problems, treatments & more

Do you feel lucky, punk? CBD product efficacy and toxicity

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

There’s a new and extremely negative review of CBD trials for pain in The Journal of Pain.

“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.”

Please don’t shoot the messenger (who uses cannabis routinely as a sleep aid).

Meme of Dirty Harry’s famous line: “Do you feel lucky? Well do ya, punk?” The screengrab is of Clint Eastwood pointing his gun at the camera.

Interesting how this line is usually deliberately misquoted for clarity, because the “Do I feel lucky?” requires the setup of “You have to ask yourself…” (And it is “ya” in the second line not “you,” I checked for fun.)

“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 these poorly regulated CBD concoctions also seem to contain a medley of other mysterious chemicals, and some of them are probably not 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, likely from contamination.

Many medications are hard on the liver and the rest of the body, of course, and we accept those trade-offs anyway. Drug side effects aren’t usually caused by contaminants, of course, but still… maybe CBD is efficacious enough to be worth the risk of a funky batch?

It doesn’t seem likely. Of 16 trials of CBD in various forms, 15 of them concluded, “Not today, CBD!” No more pain relief than a good old placebo.

Many people will be quick to say that they are fine with a placebo, “as long as it works.” But that rationalization probably cracks under the pressure of liver toxicity.

Welcome to the unpredictable and underwhelming world of CBD products. For much more information, see Marijuana for Pain: The hype versus the science! What does the evidence actually show about cannabis and chronic pain?