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On CBD Dosing

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 Introduction

Since medical cannabis has been legalized in the majority of states in America, more and more people have realized the health benefits of a cannabidiol (CBD) regimen. CBD has been found to be effective for a plethora of health ailments, from anxiety to sleep disorders and from epilepsy to hypertension. Unfortunately, though, the medical profession has not yet caught up to the growing CBD industry. Although CBD has been proven to help alleviate a number of health issues, medical doctors rarely know much about how it works and how much to take, so consumers are often forced to learn on their own or to consult CBD retail employees, which can sometimes result in wide ranging answers. The following article examines a number of different academic articles that considered studies, or were reports of studies, of CBD use for a variety of ailments. In particular, this article will focus on the amount and numbers of doses that are generally required for a CBD regimen to be effective in a tone for the most part free of medical and academic jargon.

CBD Dosing and Anxiety

An examination of the recent academic literature reveals somewhat confusing results pertaining to CBD dosing amounts for anxiety. Generally speaking, CBD has been shown to be effective in people suffering from anxiety, but studies on animals show a bell curve of effectiveness in regard to dosing amounts. On the other hand, studies also show that higher doses of CBD in humans are conducive for specific activities, such as public speaking.

            Shannon et. al. (2019) discuss in their article the effects of CBD on anxiety in human subjects in a simulated public speaking test. The subjects were administered single doses of CBD at strengths ranging from 300 to 600 milligrams (mgs). The dose would generally take effect in one to two hours, with the subjects demonstrating a significant drop in anxiety without decreased cognitive or speaking abilities. The results of this study echoed an earlier one by Blessing et. al. (2015), which also examined animal subjects over a longer period.

            In addition to considering the same study cited above, the Blessing article examined the efficacy of a CBD regime through a number of published experiments, including ones with rats as subjects.  One of the interesting things the Blessing article noted was that CBD dosing appears to have a bell curve type effect for anxiety – small doses seem to do little, as do doses above 600 milligrams for humans. With that said, higher doses of CBD due not have the opposite effect, as THC often does, by inducing anxiety or making one “paranoid.” Also, smaller doses of CBD will have the effect of inhibiting the anxiety causing effects of THC. The ability of CBD to mitigate anxiety caused by THC was also discussed in an article by Zhornitsky and Potvin (2012).

            Citing some of the same clinical studies that Shannon and Blessing did, namely M. M. Bergamaschi et. al. (2011), Zhornitsky and Potvin reviewed a fair amount of literature and experiments relating to CBD and anxiety. Like the other authors, Zhornitsky and Potvin showed that based on clinical trials on humans, orally administered CBD in doses of at least 400 mgs can reduce anxiety and that higher doses were needed to reduce anxiety when taken in conjunction with THC. On the other hand, there were experiments cited that suggest CBD may prolong the effects of THC, so more research is needed. The authors also point out that while oral doses of CBD in amounts of 150 to 600 milligrams may have the desired effect of reducing anxiety, they may also cause “mental sedation.”

Dosing for Sleep Disorders

Two of the articles that discussed the benefits a CBD regimen for anxiety also covered various sleep disorders. In a crossover study that compared CBD to nitrazepam for sleep disorders, Shannon et. al. (2019) revealed that a 160 mg dose in humans before bedtime increased the duration of sleep. Although nitrazepam and other traditional drugs used for sleep disorders are effective, their toxicity levels are an issue for many people, especially many of those who are partial to CBD. This crossover study was also cited in the Zhorntisky and Potvin (2012) article. Smaller CBD doses of 40 mg and 80 mg were also administered, but the 160 mg dose was the most effective for insomnia. The Shannon article further showed that extremely high doses of CBD, up to 1,500 mg, were well-tolerated by subjects, who showed no signs of toxicity, although Zhornitsky and Potvin noted that the higher doses of CBD reduced dream recall.

            Shannon et. al. also discussed a study done on humans subjects at the Wholeness Center in Fort Collins, Colorado. The final sample of seventy-two subjects were given 25 mg CBD capsules, either in the morning for anxiety problems or at night for sleep disorders. The results of the study indicate a more sustained response for those suffering from anxiety than sleep disorders over an extended period. This of course would follow what was discussed earlier with the bell curve of dosing for anxiety problems.

            Finally, Linares et. al. (2018) examined the effect of CBD on the human sleep cycle in their article. They cited a Brazilian study of twenty-seven human volunteers who were either given 300 mg doses of CBD or placebo, which were both administered orally. The study indicates that higher doses of CBD do not adversely affect sleep patterns, unlike benzodiazepine and other anti-anxiety drugs.

CBD Dosing and Other Ailments

CBD dosing for a number of other health problems was examined in some of the articles already discussed, in addition to some other studies. Kerstian and Gortenhermen (2017) examined a study where rats were administered high doses of CBD to ascertain its possible effects for bipolar disorder. Subject rates were given injections of 15, 30, 60 mg per kilogram with the result being that the higher doses showed effects that were comparable to the antipsychotic drug clozapine. Similarly, in the Zhornitsky and Potvin article already mentioned, they discussed a clinical trial where CBD was administered to a group of twenty-eight schizophrenia patients. The results indicated that patients treated with 300 mg doses of CBD improved more than those given 600 mg doses. The authors, though, point out that more research is needed.

            Perucca (2017) presented findings from clinical trials performed on both mice and human children to ascertain the efficacy of a CBD regimen to mitigate the effects of epilepsy. A survey of children suffering from epilepsy was particularly interesting as it showed that 80% of their parents reported that their children had fewer seizures after being put on a daily CBD regimen of 25 mg doses. In another study Perucca cited, 162 child patients at eleven epilepsy centers were administered does of CBD up to 50 mg combined with clobazam. The result was that 51% of those in the test reported a reduction in seizures, which included patients with Dravet Syndrome and Lennox-Gastaut Syndrome.

            Another useful article by Pamplona et. al. (2018) also presented findings from clinical tests on the efficacy of a CBD regimen for juveniles with epilepsy. Pamplona et. al. analyzed many of the studies cited in Perucca, arriving at some of the same conclusions, while making a few other points. Overall, Pamplona et. al. indicates that CBD products that are CBD rich extracts work better for epilepsy than purified CBD products. One of the more impactful studies cited by Pamplona et. al. was a clinical trial of 670 patients treated with 1-50 mg does of CBD for three to twelve months. The results were positive, with all patients showing improvements, but those given CBD rich extracts versus those on purified CBD did better. It is important to note that the CBD rich extracts were much lower in volume, with 6 mg being the highest dose, as opposed to the highest dose being 25 mg for the purified CBD.

            Hypertension and effectively controlling blood pressure has become a major problem in America in recent decades. A large part of this problem is derived from increasing obesity rates, but other factors also play a role. Blood pressure drugs are routinely prescribed today, but they come with many unwanted side effects, so some researchers are now considering CBD as a viable alternative. In an article by Jadoon et. al. (2018), the beneficial effects of CBD for high blood pressure were examined. A study was cited where nine males with varying ranges of blood pressure were given 600 mg of CBD or placebo after undergoing a stress test. The preliminary results of the test show that those given CBD saw a reduction in their resting systolic blood pressure, while their cardiac output was not adversely affected. The results are certainly encouraging but more research is warranted.

            An article by Gamble et. al. (2018) examines the effects of CBD on arthritis. Numerous studies have shown that cannabinoids, CBD and THC, generally have anti-inflammatory properties and can therefore be conducive for the alleviation of arthritis symptoms. Gambel et. al. profiled a study of CBD’s effects on arthritis sufferers with dogs as the subjects. In the study, four male beagles were given either 2 mg per kg doses of CBD oil or placebo every twelve hours for a four week period. The amount may not seem like much, but if one considers that a fifty-five kilogram person (about 120 pounds) would take doses of about 110 mgs, then the amount is consistent with many of the other studies cited in this article.

            Finally, an article by Corroon and Phillips (2018) examined a general study of CBD users. The study involved a questionnaire completed by 2409 CBD users asking why they used CBD and how effective they believed it was. More than 60% of the respondents claimed they used CBD for a wide range of health reasons, including: chronic pain, arthritis, anxiety, depression, insomnia, headaches, and PTSD. This article confirmed many of the finding of the other articles but did not offer specifics in terms of dosing amounts used by the respondents.

Dosing Amounts and Side Effects

Kerestin and Grotenhermen (2017) more thoroughly defined what are considered high doses of CBD and how it interacts with other drugs. This is important because many people who take CBD for pain, sleep disorders, and/or anxiety are also taking prescribed drugs for those ailments. Kerstin and Grotenhermen consider 1,500 mg to be among the highest dose amounts recorded. They point out that 132 studies of human subjects show that high doses as well as chronic use of CBD is well tolerated in humans with relatively few and minor side effects. They point out that when higher doses of CBD are used with other drugs, such as ketoconazole, itraconazole, ritonavir, and clarithromycin, the result is that the effects of CBD last longer. In contrast, when CBD of any dose is used with phenobarbital, rifampician, carbamazeipine, and phenytoin the benefits are reduced.

            Corroon and Phillips (2018) cite studies where the adverse side effects of higher CBD doses are relatively minor and for the most part consist of dry mouth, increased appetite, and bloodshot eyes. Zhornitsky and Potvin note that in doses between 150 and 600 mgs, some CBD users reported “mental sedation,” while the article by Iffland an Grotenhermen (2017) confirmed that even when doses of 700 mg of CBD were administered to patients few side effects were reported and they were for the most part minor.

CBD Doses and Vaping

Since vaping has become such a popular option for younger people to ingest nicotine, THC, and CBD, it is important to mention an article by Solwij et. al. (2019) that examined CBD dosing amounts administered through vape devices. Solowij et. al. discussed the results of a study where CBD was administered through a vape device to balloons instead of humans. The study revealed that 200 mg of CBD was the highest dose that could be effectively vaporized, with doses more than that resulting in excessive resinous residue. With that said, it is important to remember that 200 mg of CBD placed in a vape device does not mean that all or even most of that will make it into the body. The study showed that of 200 mg CBD vaped, only about 80 mg will make it into the body, with the rest being “burned.”

Conclusion

Determining how much you should dose on a CBD regimen is important, so hopefully this article cleared up some questions you may have had. Based on the available scholarly sources, the dose size of CBD a person takes is largely contingent upon the person’s ailment. Dosing amounts for anxiety seem to have a bell curve of effectiveness, but for the most part larger doses are fine. And most importantly, CBD doses of 600 and 700 mgs are well tolerated with few and only minor side effects.

References

Blessing, Esther M., Maria M. Steenkamp, Jorge Manzanares, and Charles R. Marmar. 2015.            “Cannabidiol as a Potential Treatment for Anxiety Disorders.” Neurotherapeutics 12        (September). Accessed June 7, 2019.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/.

Corroon, Jamie and Joy A. Phillips. 2018. “A Cross-sectional Study of Cannabidiol Users.”          Cannabis and Cannabinoid Research 3 (July). Accessed June 9, 2019.            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043845/.

Gamble, Lauri-Jo, Jordyn M. Boesch, Christopher W. Frye, Wayne S. Schwark, Sabine Mann,     Lisa Wolfe, Holly Brown, Erin S. Berthelsen, and Joseph J. Wakshlag. 2018.     “Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in            Osteoarthritic Dogs.” Frontiers in Veterinary Science 5 (July). Accessed June 13, 2019.         https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065210/  

Iffland, Kerstin, and Franjo Grotenhermen. 2017. “An Update on Safety and Side Effects of         Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.” Cannabis and   Cannabinoid Research 2 (June). Accessed June 7, 2019.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/.

Jadoon, Khalid A., Garry D. Tan, Saoirse E. O’Sullivan. 2017. “A Single Dose of Cannabidiol     Reduces Blood Pressure in Healthy Volunteers in a Randomized Crossover Study.” Journal of Clinical Investigation Insight 2 (June). Accessed June 13, 2019.      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470879/.

Linares, Ila M. P., Francisco S. Guimaraes, Alan Eckeli, Ana C. S. Crippa, Antonio W. Zuardi,    Jose D. S. Souza, Jaime E. Hallak, and José A. S. Crippa. 2018. “No Acute Effects of Cannabidiol on the Sleep-Wake Cycle of Healthy Subjects: A Randomized, Double  Blind, Placebo-Controlled, Crossover Study.” Frontiers in Pharmacology 9 (April).     Accessed June 12, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895650/.

Pamplona, Fabricio A., Lorenzo Rolim da Silva, and Ana Carolina Coan. 2018. “Potential            Clinical Benefits of CBD-Rich Cannabis Extracts over Purified CBD in Treatment  Resistant Epilepsy: Observational Data Meta-analysis.” Frontiers in Neurology 9         (September). Accessed June 12, 2019.            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143706/.

Perucca, Emilio. 2017. “Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?”      Journal of Epilepsy Research 7 (December). Accessed June 11, 2019.            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767492/.

Shannon, Scott, Nicole Lewis, Heather Lee, and Shannon Hughes. 2019. “Cannabidiol in Anxiety and Sleep: A Large Case Series.” Permanente Journal 23 (January). Accessed June 6, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/.

Solowij, Nadia, Samantha J. Broyd, Hendrika H. van Hell, and Arno Hazekamp. 2014. “A           Protocol for the Delivery of Cannabidiol (CBD) and Combined CBD and Δ9     trahydrocannabinol (THC) by Vaporisation.” BMC Pharmacology and Toxicology 15        (October). Accessed June 11, 2019.            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274767/.

Zhornitsky, Simon and Stéphane Potvin. 2012. “Cannabidiol in Humans—The Quest for  Therapeutic Targets.” Pharmaceuticals (Basel) 5 (May).  Accessed June 8, 2019.            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763649/.

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