With all the hype around CBD — particularly in the past year — it’s become increasingly difficult to separate fact from fiction. At first, the non-intoxicating cannabinoid seemed like a promising natural remedy for anxiety, pain, insomnia, and other common health conditions. Research was scant, but the appeal was obvious: who wouldn’t want a safe, effective alternative to overpriced prescription medications? And with just a handful of mom-and-pop companies offering simple, old-fashioned products like tinctures, it was easy to view the trend as a refreshing “back to basics” approach to holistic wellness.
Fast forward to today, and we have now hundreds of CBD brands and thousands of products. And in the face of CBD-infused beer, CBD salad dressing, and CBD pedicures, we can’t help but wonder — have things gone too far?
According to Dr. Jordan Tishler, a Harvard-trained physician and founder of Inhale MD, a medical marijuana practice in Massachusetts (full disclosure: Dr. Tishler is also a medical advisor at cannabisMD), the answer to this question is: yes, yes they most certainly have.
Unlike many medical professionals, Dr. Tishler is no skeptic when it comes to cannabis. He’s the president of the Association of Cannabis Specialists, a contributing author to the medical textbook “Cannabis: A Clinician’s Guide,” and one of the internet’s most widely-cited experts on the plant’s medicinal uses.
He’s also developing a reputation as the guy who doesn’t believe in CBD. And according to Tishler, “It’s not too far off.”
But why’s he so dubious about this massively popular trend? Herewith, Dr. Tischler shares his main arguments against the mega-popular cannabinoid.
According to Dr. Tishler, the vast majority of products on the market simply don’t deliver enough CBD to get the job done (whether that’s relieving pain, reducing anxiety, or anything else). That doesn’t mean CBD itself is useless — but many of the products that contain it might as well be.
“I think that CBD will ultimately be shown to be useful in particular situations,” says Dr. Tishler, “but at a much higher dose than what people are getting now.”
Dr. Tishler draws his conclusions from “successful” studies on three unique groups:
“Across all three of those areas the dosing is consistent,” says Dr. Tischler — about 10 to 20 mg of CBD per kilogram of body weight. For the average adult, that would mean consuming more than 700 mg of CBD per day. Considering how expensive CBD is (and the fact that most bottles of CBD oil contain significantly less than 700 mg of the titular cannabinoid), patients could easily end up paying over $100 a day for their “affordable” alternative remedies.
“No one can afford that,” Dr. Tischler says.
But what about the fact that tens of thousands of CBD users are reporting success with these underpowered products? Here, Dr. Tischler is adamant that while their results might be genuine, CBD probably doesn’t deserve the credit.
As Dr. Tishler says, “The people taking [the CBD products] they find on the shelves at Whole Foods are only getting a few milligrams. It’s the placebo effect, at best.”
In his view, that’s not the only reason to think the CBD hype is overblown.
According to Tishler, we’re making the big mistake of giving CBD all the credit for what cannabis as a whole can do. “It’s lifting the description from cannabis and sticking it on CBD,” he says. And as of this moment, he doesn’t think CBD deserves that credit.
That flies in the face of the current narrative, which attributes most of cannabis’ positive qualities to CBD — and its negative ones to THC, which is responsible for causing the plant’s signature euphoria. However, Tishler says that when it comes to therapeutic benefits, “THC really does the heavy lifting and CBD facilitates.” As a result, he believes “we need to be looking for THC-dominant material that has a trace amount of CBD.”
Hemp CBD proponents probably won’t be happy to hear that. When the 2018 Farm Bill made hemp federally legal, it was hailed as a major breakthrough for increasing access to CBD — since the hemp-derived version contains less than 0.3 percent THC, it can be sold over the counter in the vast majority of states. The problem is that, while it’s legal, hemp CBD isn’t nearly as effective as the stuff derived from marijuana.
“We shouldn’t be selling these hemp-based CBD products because they don’t have enough THC,” Dr. Tischler says.
CBD lovers shouldn’t take his criticisms personally, though. Dr. Tishler feels the same way about hyper-focusing on any single compound found in cannabis — even THC.
“We put THC in a pill and it didn’t work,” he says, referring to the drug Dronabinol, which contains a synthetic form of THC and is absent of any other cannabinoids.
He’s not wrong. Most of the research to this point shows that single-compound cannabis treatments are consistently less effective than those that incorporate other plant compounds. For example, a 2010 study published in the Journal Of Pain Symptom Management tested two types of cannabis medicine on patients with opioid-resistant pain. One contained only THC, while the other had both THC and CBD. The second variety was much more effective.
“For the moment, the plant as it’s found in nature is our best bet,” says Dr. Tishler.
While Dr. Tishler has gained a reputation as a CBD naysayer, his opinion that the whole plant is better than the sum of its parts is shared by almost all cannabis experts — few would disagree that full spectrum extracts are more effective than isolates. The problem is that there’s an awful lot of money to be made by developing “pure” medicines that use proprietary formulations and patentable production processes.
The way Dr. Tishler sees it, this isn’t something unique to cannabis. In fact, it’s a larger trend that applies to the entire pharmaceutical industry. “As a society we’ve spent years developing medications that are based on one compound, which has likely caused us to miss out on a lot of other potential drugs,” he says.
That’s why Dr. Tischler is so opposed to CBD’s growing monopoly over the field of cannabis medicine. Why repeat the same mistakes of the past when we have a golden opportunity to rectify them? “Cannabis could teach us a whole new methodology for developing medicine,” he says.
Now, we just have to be open to learning it.