If a person would like to try CBD to treat a medical condition, what dose would you recommend?
Dose is extremely important and because the CBD market is unregulated, there are no established doses. People might be underdosing and therefore seeing no effect and giving up on potential benefits, or might be taking too much, which can have potential adverse effects. There needs to be some type of understanding, but we are a long way from knowing what a minimal or excessive dose might be.
There is an old adage, “Start low, go slow.” If CBD is ineffective, I recommend that people increase the dose in small increments so long as they do not feel adverse effects, and that they continue increasing until the drug is effective. This is what we do with prescription products—titrate the dose upwards, assess vital signs, assess pain, and raise the dose again if necessary. The caveat is that higher doses may cause adverse effects at any time during use, not necessarily immediately. It is always best to do this under supervision of a physician or pharmacist.
Do you think that CBD is a viable alternative to opioids for pain management?
Some research has shown that people can discontinue opioid therapy and use CBD instead or use CBD or cannabis as adjunct therapy to minimize opioid dose increases.7,8 Unlike opioids, CBD does not have any clear dependency issues when used without THC and, comparatively speaking, has a relatively good side effect profile. If I had chronic pain myself I would consider almost anything before opioids, including CBD. And it is definitely safer than the way we use opioids as a society, where we are seeing rampant opioid use disorder and overdose epidemics. But again, we do not know enough about CBD to offer strong recommendations.
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Metabolic Drug-Drug Interactions between CBD and Enzyme Substrates, Inhibitors, and Inducers
Brown JD, Winterstein AG. J Clin Med. 2019;8(7):989
Drug-Drug Interactions between CBD and Secondary Metabolism or Transport Proteins
UGT = uridine 50-diphospho-glucoronosyltransferase; BCRP = breast cancer resistance protein; BSEP = bile salt export pump
Brown JD, Winterstein AG. J Clin Med. 2019;8(7):989.