This summer, a new drink called Aurora Elixirs became the latest beverage infused with a special ingredient called Cannabidiol, better known by its acronym, CBD. After reading numerous stories about this magical extract, derived from the cannabis plant and now being added to everything from lattes to skincare, my curiosity was piqued. My friend also happened to be the founder. I asked if she could send me some samples.
The tonic, which comes in effervescent flavors that you can pair with spirits or drink on its own, contains 15 mg of CBD, one of the many phytochemicals called “cannabinoids” found in the cannabis that gets you high, as well as in hemp, the kind of cannabis that doesn’t. I drank four bottles on separate occasions and tried to gauge my mood. As far as I could tell, nothing had happened. I asked my friend, Aurora’s founder, Victoria Pustynsky, what the desired effect was, and she compared the hemp-derived CBD in her tonics to “a chip off a Valium.”
The comparison helped me put this very trendy cure-all into context. Once the most prescribed treatment for anxiety, Valium was the first prescription drug to reach a $1 billion in sales. Now CBD, which is also used to treat anxiety, is on track to eclipse sales not just for the famous mother’s little helper, but all “benzos” including Xanax. One forecast predicts that the market for hemp-based CBD alone will reach $22 billion by 2022.
That may seem aspirational, but its market is far larger. CBD is essentially available wherever you can connect to the internet (and in seemingly every coffee shop in Brooklyn). Though the plant it comes from is still classified as a Schedule I drug, along with heroin, a Farm Bill, set to pass this month, will redefine hemp as separate from marijuana, freeing farmers across the country to grow it without approval from the DEA, and allow major retailers like Target to start selling CBD products legally. Already the DEA has declassified CBD for one certain use: an FDA-approved drug safe enough to treat epilepsy in children. This is the therapy that popularized CBD in the first place. When CNN filmed a documentary about the way it stopped one Colorado child’s seizures in 2013, its host, Dr. Sanjay Gupta, introduced the acronym to the public.
The potential applications for CBD have mushroomed since. A recent World Health Organization report on CBD cited a 2017 review of all the early studies to date, either on animals or in small-scale human trials, that show CBD’s promise in treating nearly every major ailment, from Alzheimer’s to pain to anxiety to cancer.
With a list of potential benefits that runs so long, and hype this pervasive, it does begin to sound like snake oil. But one thing we do know is that CBD carries no risk of addiction or overdose. Technically it won’t even intoxicate you. So I spent a month experimenting with different formulations and talking to various doctors, growers, producers and friends about CBD, to see how it worked for them, and what, if anything, it might do for me.
CBD for the red-eye
You don’t have to live in a state that has fully legalized pot or be part of a medical marijuana program to realize that our appreciation of cannabis has fundamentally changed. (For starters, the preferred term is cannabis now; marijuana has racist and generally negative connotations.) It’s evolved from something purely recreational but little understood, to a plant that can be cultivated into specialized strains for a better high or medicinal purposes. And increasingly it’s distilled into things you don’t even need to smoke.
The only thing recognizable about the world of cannabis today versus the pot of the past is the stigma that’s still associated with using it. But even that is changing, particularly as more people experiment with CBD, and equate this part of the cannabis plant with healing, instead of a high. Its non-intoxicating aspect is what made me open to trying it in the first place, given that pot generally makes me more prone to the self-doubt that I experience on a good day. So during a trip to Nevada this summer, I did what many visitors to the state now do: I went shopping in a dispensary. Only instead of buying weed, I got CBD.
By this point, I already knew of a handful of women experimenting with it. A few said it helped them cut back on drinking, something I’d been trying to do. I had developed more of daily wine and beer habit in my late thirties than I ever had in my twenties, and now in my forties, I wanted to slow it down.
I emailed about this phenomenon with a mom of three in Brooklyn, Leslie, who I knew had been regularly taking CBD. For a while, she and her husband were drinking a bottle of wine nightly. “It just seemed to help with the evening crunch of handling all three kids and daily stresses,” she said. Still, despite exercising, the alcohol made her feel unhealthy. Then her sister told her about CBD, and how vaping it had helped her deal with the anxiety of school. In the process, she found that her taste for alcohol went by the wayside, too. So Leslie decided to give the same product a try.
“I had started a ‘no drinking on Monday-Thursday rule,’ but it was very difficult and I had to constantly battle myself to stick with it,” she said. “Now it isn’t a struggle at all…In addition to helping with my drinking habit, [CBD] has helped me go to sleep…I’m not sure if it’s just me being more disciplined and forcing myself to go to bed earlier or if I am so relaxed from CBD that I just slip away into the evening,” she wrote by email. But overall, she was sleeping better.
Terrible sleep was also on my fix-it list. On any given week, whether or not I’d had a drink, I would find myself spiraling toward insomnia, unable to turn off my thoughts and drift off, or worse, waking up for a brief moment and then staying awake. I chalked it up to the fact that I was entering perimenopause, when many women start experiencing interrupted sleep. Having two noisy, wheezing dogs and a cat who thinks I should get up with her at 5am didn’t help. So I began regularly drinking Holy Basil Leaf bedtime tea, and stocked my nightstand like a pop-up shop for sleep aids, with a six-month supply of orange, industrial earplugs and an eye mask at the ready.
I entered the Nevada dispensary this summer without a set product in mind, but when I pointed to a vape pen and learned it contained just CBD, I was excited to give it a shot. The CannaHemp pen I bought in Reno contains just 1.6mg of CBD per puff, along with something called terpenes—aromatherapeutic compounds that make apples smell like apples, pine trees smell like pine. The pen contained three different ones: Nerolidol, Myrcene and Linalool, all terpenes found in the sedating strain of cannabis, “indica,” that’s often remembered by its mnemonic nickname, “into the couch.”
After five hits of my pen before my flight back to New York, I did feel a noticeable difference. My entire airport experience, from security to boarding, felt pleasant, a word that doesn’t normally apply to post-9/11 aviation. I also fell asleep immediately on the red eye, and stayed asleep until the lights in the cabin turned on.
It may have helped that I had vaped, as the lungs provide one of the fastest means for any drug to enter the bloodstream. But by the same coin, it also leaves your system the fastest. Taking a CBD oil sublingually, or under the tongue, is the second fastest delivery method. Applying it topically only targets the area you’re treating, while ingesting it, say as a pill, takes longer to hit your system, and can also substantially lower its “bioavailability”—the amount that actually enters the bloodstream and affects you.
As Don Moxley, the director of applied science and brand development of a medical marijuana producer, GrowHealthy, told me, “It looks like the liver just pummels it.” (If you’ve ever had an edible with THC—say a pot brownie or gummy—this runs counter to experience. That’s because the liver transforms the THC in cannabis into an even more psychoactive compound, which is why the effects of eating pot feel amplified, and noticeably different, from smoking it.)
Said Moxley, “My recommendation is, if someone wants to do it orally”—meaning by capsule, not sublingually—“they just have to boost their dose.”
Perhaps that explains what happened after I consumed copious amounts of CBD at a dinner party.
CBD for dinner
For one night this fall, Loosie’s Kitchen & Cafe in Williamsburg invited guests to dine on a three-course vegetarian menu comprised of dishes rich in CBD oil, sourced from a local company called Plant People.
Before the meal began, Gabe Kennedy, a tall outdoorsy-looking guy with a mop of curly brown hair, described his impetus for starting Plant People, whose line of CBD products includes an oil, pills and a balm. Both he and his business partner had sustained back injuries, and they’d lamented the lack of non-toxic, non-intoxicating treatment options that Western medicine provided. Pot had helped, but as professionals, they needed something that would allow them to perform. The answer was CBD.
A cocktail blend of Aquavit and CBD was the first drink passed. I took a seat beside two women in their 30s, one of whom was a regular pot smoker and an accomplished baker of edibles. The other didn’t enjoy smoking, like me, but was curious about this compound that didn’t get you high. We were happily chatting when Gabe’s business partner, Hudson Gaines-Ross, approached our table and offered each of us a dropper of their CBD oil, 10 mg full, to keep under our tongues for a full minute. It tasted herbaceous and pot-like, like distilling stink bud into liquid.
Course upon delicious vegetarian course came out—apple “carpaccio” with enoki mushrooms and a CBD-rich dressing; lightly battered cauliflower fritters dipped in CBD-infused curry; and beet salad drizzled with CBD oil—each paired with wine. I could feel a rising wave of contentedness radiating from my gut, much different than a straightforward alcohol buzz clouding my thoughts. Knowing now that ingesting CBD can reduce its efficacy, this seems implausible. But my friends and I compared notes, and we all agreed we “felt it.” Over the course of the night I had ingested well over that 10 mg Hudson gave me, so perhaps a higher dosage was to thank. Or maybe it was the wine after all.
After the dinner, I called Kennedy to find out more about how his products worked. He was the first to tell me about the innate system in our bodies that creates nearly identical compounds as CBD. Called the endocannabinoid system, it was discovered fairly recently in the 1980s, well after scientists identified cannabinoids in plants. The ones we produce are like the many neurotransmitters in our bodies and operate in concert like our own inner thermostat to maintain a state of homeostasis. If we become upset during an argument, our cannabinoids help bring our mental state back to normal. After our body fights an infection with a fever, the ECS helps brings our body back to a normal temperature. Remarkably, as the author of a book named Healing with CBD, Eileen Kocienzsky, explained, we have more endocannabinoid receptors than any other type in our body.
Sometimes there is a delay though, and the ECS doesn’t tell us when to stop stressing or fighting a cold. This could be the result of a deficiency in our own natural cannabinoids, or an overtaxed endocannabinoid system, a dysfunction that could explain the mechanism of post-traumatic stress disorder.
Since we make these compounds ourselves, it stands to reason that CBD works in conjunction with our innate cannabinoid system, and perhaps replenishes it, or kicks it into gear. THC appears to work this way, and nearly everything I read and many I spoke with made this same connection with CBD.
I was surprised, then, to read a scientific review that says the exact opposite. “A significant area of confusion,” it summarized, “has been the assumption that, being a cannabinoid, CBD acts through the ECS; an assumption that has now been largely dismissed.” As Dr. Kent Hutchison, a neuroscientist at the University of Colorado at Boulder, and the founder of the Center for Research and Education Addressing Cannabis and Health explained on a recent episode of the podcast Science VS, “We don’t even know the mechanism yet in terms of how CBD works in the brain.”
That doesn’t mean it’s not working. But because the very plant it comes from is a Schedule I drug, it makes it difficult to perform the kind of large-scale clinical studies on humans that will advance our understanding of it, and bring everyone who is researching cannabis into agreement. Dr. Hutchison’s University, in fact, is conducting the first 200- to 300-person human trial in the U.S. that pits the efficacy of plant-based CBD vs. THC vs. CBD and THC—findings that won’t be published for another several years.
And yet, it’s very easy to read about CBD right now without hitting a phrase like “may help,” “seems to indicate” or “we don’t know for sure”—cautionary speed bumps that indicate where we are in the research.
Kennedy believes his oil is beneficial not just because it contains CBD, but a whole litany of cannabinoids found in hemp and cannabis with similar acronyms like CBN and CBG. In the industry this is known as a “full spectrum” or whole-plant product, and it plays upon the theory of the “entourage effect.” Research suggests that cannabinoids work best in tandem, and though these studies are often based upon THC being in the mix, combining CBD with phytochemical kin like terpenes could be beneficial, too. For every 10 mg of CBD in Plant People oil, for instance, there is also 2.5 mg of lesser-known cannabinoids, including terpenes. The only cannabinoid it’s largely missing is the intoxicating one, because hemp contains a negligible amount of THC.
Before ordering a bottle to try, I asked how much was the right dose. “Everyone reacts very differently to these compounds, particularly full spectrum,” he said. His advice was to go slow and low and titrate up to see what works best, and above all, to be consistent. He himself took about 10 to 20 mg a day, not to treat any residual back pain, but more as preventive medicine. “It acts as a balancing tool,” he said, like any other daily, healthy practice.
“You can eat a vegetable or meditate now and then,” he said. “The profound shift occurs when you commit to doing it every day. That’s where you start noticing the paradigm shifts.”
We hung up the phone, and I ordered nearly his entire product line to see how it would work on me. While I waited for it to arrive, I decided to ask another friend if she was taking CBD. Two years ago, she was diagnosed with Lyme disease, which led to a host of other neurological conditions including neuropathy and fibromyalgia. She was likely in need of pain relief, and she was probably open to it coming from cannabis.
She texted back immediately. “Yes, in many ways. I will show you my goods… I have a spectrum.”
CBD for pain
Faith’s stash was indeed extensive. She had a box full of CBD tinctures, all of which came from California dispensaries, all of which came from cannabis (not hemp) and contained some amount of THC. Considering the many possible indications for cannabis’ power couple, Dr. Hutchison believes they’re particularly promising for the kind of pain Faith experiences. “Neuropathic pain I think is one of these problems that we’ll eventually clearly find evidence…for the fact that CBD and THC helps. When you talk to people with neuropathic pain, it’s very clear to them that it makes a difference.”
In the right ratios, the two compounds even appear to cancel pot’s intoxicating effects. So during the daytime, for instance, Faith will take a high-CBD formula like 20 parts CBD to 1 part THC. For her, and for friends of hers also using these blends, these daytime formulas cause no psychoactive effects. At nighttime, she switches to a tincture higher in THC, like a 1:1 ratio. All told, this translates into roughly 20-25 mg of CBD a day.
“Pain management is complicated these days,” she said, because “to be a patient in a pain management practice there are not a lot of options.” On the one side are all the alternative therapies, all of which she’s tried, like massage and acupuncture, that don’t help neuropathic pain, whose signals come from the brain. And on the other are all the prescription meds that carry severe dependency risks or side effects. “I tried these terrible ones that I’m now not having to take, like Gabapentin, which is like a nerve deadener…It actually kills your nerve endings, so you don’t feel them.”
CBD, she said, works better, and means that she now takes pharmaceutical drugs only if she’s having an acute issue. “Just the day-to-day CBD is all I need to manage my pain now,” she said. Not only is it more gentle, with no real side effects, “it’s also pure,” she said. “The problem also for somebody like me who has a lot of allergies to things, is when you get a prescription pain medicine, it’s going to be compounded with all kinds of fillers and dyes to make it into a pill form.” With CBD, “the liquid is clear, it floats in coconut oil, and maybe there’s a little mint…but it’s all natural, actual compounds.”
Cannabis vs Hemp CBD
I wasn’t about to acquire a medical marijuana license to try CBD from a dispensary, even if there is one set to open in Brooklyn by the end of this month. I wasn’t in pain, and I didn’t see the point, aside from ensuring that a product actually does contain the natural, actual compounds it claims to.
A doctor that Faith consulted, Dr. Douglas Allen of New York Pain Medicine, was one of the first CBD providers under New York state’s medical marijuana program, and only trusts CBD coming from a licensed dispensary. “All of the CBD I recommend is regulated through New York state,” he said. “The problem with getting everything online that there’s really no assurance that what’s in the product is what you’re receiving. We’ve seen a lot of companies jumping on the bandwagon, claiming that their product has certain percentages of CBD.”
In fact, one study found that as many as 70% of CBD products do not contain the amount advertised on their label, and sometimes include enough trace amounts of THC to cause some to feel high from it. But what also bugged Dr. Allen about the CBD market as a whole, even at the dispensary level, was that his patients were being sold on having to take CBD morning and night, in order for it to have a cumulative effect, “which is unfortunately not true,” he said.
It was all so contradictory. It’s good with THC, but not without. It’s only good if you use it all the time, or fine if you don’t. It’s best from cannabis, and not from hemp—yet another discrepancy I encountered.
The truth is likely a very unsatisfying, “it depends.”
CBD for anxiety
Another friend of mine, Rose, heard that CBD helped anxiety, and brought it up with her psychiatrist, Dr. Karen Hopenwasser, who has been practicing in New York for 35 years. Hopenwasser first began integrating cannabidiol supplements into her therapy around five years ago, when a patient of hers didn’t respond to any other treatment for her severe anxiety.
This makes sense: conditions like anxiety and stress are often connected with inflammation in the body and CBD, Hopenwasser notes, is “highly anti-inflammatory.” It works this way in mice, at least, and there are a number of small human trials that show that CBD lowers anxiety.
“From my perspective as a psychiatrist who does a lot of integrative work—meaning brain, gut, behavior, mood—inflammation is key and I do all sorts of things to get people to decrease inflammation in their bodies.” The supplements are just one of the modalities she uses, along with exercise and diet.
She cautions though, that she’s had many patients for whom it hasn’t worked at all.
“What I’ve learned over the years is probably the majority of the people, the response is mild to moderate,” she said, which essentially echoed Rose’s experience.
“And probably the reason is that the dosage you’re getting in a supplement is really quite low, and this is probably effective at much higher dosing.”
This is one of the least-known aspects of CBD: how much is needed to effective? Epilepsy patients might take upwards of 1000 mg a day. Don Moxley spoke of taking a combination himself of about 175-200 mg of hemp-derived CBD for his own chronic pain after years of collegiate wrestling, in addition to 125mg of cannabis-derived CBD, in part to lower the cost involved in maintaining a cannabinoid cocktail of this size. And yet, Dr. Hutchison pointed out, manufacturers often specify a small dose, like 10 mg.
“We have no idea what the appropriate dose is,” he wrote in an email. “Obviously, companies make a lot more money selling 10 mg a dose.”
CBD for me
In the midst of these many conversations, and my husband often joking about my “snake oil,” I’d begun taking CBD regularly over the course of a month. I found that taking the Plant People oil, and not the capsules, had the most noticeable impact on my mood, and over time I felt that one to three drops, or 10 to 30 mg a day, toward the evening, was optimal. On one particular night when I felt the vice grip of insomnia closing in on me, I took another 30 mg and felt my tension dissolve, quite literally. It became my go-to sleep aid, and unlike melatonin or a sleeping pill, I didn’t feel zonked in the morning.
I even tried smoking a CBD-rich strain of hemp—because you can pretty much order any form of CBD online—and was sent into even more of a stupor than I’d felt from the oil or capsules. I imagine that the heady, pot-like scent of the terpenes was to thank. But smoking it meant being discreet, something I can’t always do at home with kids.
If I felt like reaching for a beer or cocktail on a night when I didn’t want to drink, I would take the drops instead, and feel the urge disappear. There are studies that show CBD can help cravings for opioids and other addictive drugs, but they involve extremely high doses. Perhaps just having a non-intoxicating option in the house had helped—one definitively cooler than, say, a can of La Croix.
Then I ran out of my first bottle of CBD oil and ordered another brand of full-spectrum oil that had positive reviews online. It tasted different, and I didn’t feel as noticeable or as instant an effect. I wondered if I’d gotten a bad batch. I’d just dropped $60 on it, though, so instead of wasting it, I decided I had nothing to lose by having fun with it. On a whim I put around 50mg in a beer one night. Within two hours I felt as if I’d eaten a mild edible. It was disorienting in that “when is this feeling going to end” kind of way, and as I lay in bed, waiting for the effect to wear off, I realized I knew nothing about what these CBD products actually contained, nor how they interacted with other substances in my body. I also thought to myself: this is definitely not placebo.
Because it’s entirely possible that everything up to that point was. As Dr. Hutchison had said to me earlier, “Scientists are a little more skeptical by nature…for good reason, because of course, the placebo effect is huge. I think particularly with CBD, it’s probably really huge.”
The Placebo effect may not be a simple trick of the mind like we think, though. Last month a feature by Gary Greenberg in The New York Times made clear that it’s still not fully understood, and may be “a biological response to an act of caring” by any healer—a doctor, an acupuncturist, even a shaman—and “that somehow the encounter itself calls forth healing and that the more intense and focused it is, the more healing it evokes,” wrote Greenberg. If Placebo has more to do with the person administering it, could a recommendation from a friend or a salesperson or an online review really be influencing my perception of CBD?
When I told Dr. Hutchison about my personal experience with the tinctures I’d bought online, he tempered his skepticism a bit. “When I mentioned CBD didn’t do anything, I was talking more on an acute scale,” like, for instance, CBD added to the occasional latte or tonic. “I think the combination of THC and CBD—this is my hypothesis—may work more in the short term, like you notice effects quickly, and I suspect CBD, if it does anything, it might have more of a long-term effect. So if you think about it as an anti-inflammatory, and dampening down inflammation, it might take some time to notice the effect, and it might be more subtle. So when you were talking about taking it for four weeks, that makes more sense that you might notice some subtle changes.”
It sounded an awful lot like herbalism, which I was already, inadvertently practicing. That Holy Basil Leaf, or Tulsi, bedtime tea really does nudge me to sleep, and if you read this scientific review of its benefits, it sounds a lot like the cure-all capabilities of CBD. The author describes it as an “adaptogen,” or “herb that helps with the adaptation to stress and the promotion of homeostasis,” something that “is not widely used in Western medicine.”
CBD’s popularity is already changing that generalization. It may not be technically classified as an adaptogen, but homeostasis is considered its essential function. Its murky legal status and link to cannabis certainly adds to its intrigue. And its adoption as a proven, non-toxic therapy for a major disease, epilepsy, gives it the shine of credibility, more than any other plant-based medicine I know of. But for people like me who are not taking it for pain or epilepsy, but just to sleep a little better and drink a little less, it seems, at the moment, like any other medicinal herb: helpful to many, but believed by few.
“You won’t notice a difference unless there’s something you have [that] you’re trying to alleviate,” Dr. Hutchison said toward the end of our conversation. For me, this is the only burden of proof necessary.