Q: "The use of CBD oil has been in the news a lot and I’ve heard it mentioned to help treat Sjögren’s. What is CBD oil, how can it be used to treat Sjögren’s patients and has this treatment been approved to be safe?"
A: With our current opioid crisis along with the increasing approval of the use of medical cannabis in the United States, this is a timely and appropriate question. Cannabis (also known as marijuana) is the most commonly used illegal drug worldwide (at least illegal in most areas). The compound called delta 9-tetrahydrocannabinol (THC) is responsible for its effects that make people feel “high.” Another compound in cannabis is cannabidiol, known as CBD for short. CBD does not have the “high” exerting effects of THC but is thought to have medicinal effects partly due to its attachment to cannabinoid receptors. These receptors are located on the surfaces of cells throughout the body to include the brain, nerves, and cells of the immune system. Therefore, it is not surprising that CBD may potentially have beneficial health properties.
CBD oil is an oil substance that contains CBD. Its medical use has been purported to possibly help with pain, epilepsy, insomnia, anxiety, glaucoma, appetite loss, and muscle spasms. A cannabis extract with THC and CBD called Sativex is approved for use in at least 27 countries, excluding the U.S., to treat the pain and muscle spasm of multiple sclerosis, and the CBD extract called Epidiolex has been FDA approved to treat childhood epilepsy. Upon a careful search of the medical literature, I was unable to find any good research addressing its use in Sjögren’s. Its effects on the immune system in autoimmune diseases, such as Sjögren’s, is currently unknown. There are two types of cannabinoid receptors on immune cells; the activation of one of them can increase inflammation, while activation of the other can decrease it. Clearly, we need good research.
Unfortunately, research into the effects and use of CBD has been greatly hindered because the U.S. government classifies CBD under Schedule I: “high potential for abuse” under the United States Controlled Substances Act making it illegal to possess or use under federal law (though it has been legalized by most states). Unfortunately, this Schedule I classification has kept researchers from truly testing it as you would any medical treatment.
Thus far, side effects have been noted in cannabinoid products to include rash, diarrhea, vomiting, fatigue, drowsiness, low blood pressure, high heart rate, light headedness, worsening of Parkinson’s disease, and dry mouth (important when we are talking about Sjögren’s). They also appear to probably have potential harmful interactions with other medications and supplements to include melatonin, valerian root, SAMe, antibiotics, antidepressants, antihistamines, blood pressure medicines, warfarin, anti-acids, statins used for cholesterol, seizure medicines, and Viagra.
I have had patients with chronic pain use CBD oil and purportedly report good results, especially for nerve pain (which is common in Sjögren’s). However, I am unable to formally recommend it to my patients for several reasons. One big reason is that recently there have been reports of high levels of pesticides and heavy metals (such as arsenic and lead) in many CBD products along with inaccurate amounts of the stated amounts of CBD. This represents one of the biggest problems. Since the federal government makes CBD use illegal, there is no quality regulations imposed on their production and distribution. One of the most important things is that I cannot recommend any treatment unless it has been proven safe plus effective. We just do not have the research to prove either one.
Bottom Line: I do believe that it may have potential health benefits. However, until we have more studies to prove effectiveness that outweighs side effects, studies to know its potential interactions with other medications, and that we have regulatory controls to ensure high quality products (devoid of harmful contaminants), I cannot recommend it.
By Donald E. Thomas, Jr., MD, FACP, FACR, RhMSUS, CCD
This article was first printed in the Foundation's patient newsletter for members. Click here to learn more about becoming a member.