Today’s Dietitian
Vol. 22, No. 9, P. 12
CBD is a nonintoxicating cannabinoid found in cannabis and hemp plants. For many, it can provide relief from pain, inflammation, anxiety, muscle spasms, insomnia, inflammatory bowel disease, irritable bowel syndrome, migraines, and more.1-5 There are multiple ways to use CBD, but not all delivery methods are appropriate for every person or for every condition.
Q: What are the different ways to use CBD?
A: The most common delivery methods include tinctures placed under the tongue, softgels and edibles, and topicals applied to the skin. Other options include transdermal patches applied to the wrist or ankle, water-soluble tinctures added to liquids, rectal and vaginal suppositories, and inhalation using a vape pen, joint, or pipe. The different delivery forms have varying times of onset and duration and optimal therapeutic uses.
Q: How can someone determine which method of administration is best for them?
A: With the many different CBD options available, it’s best to advise clients to do their research and speak with a medical professional who has experience with CBD options and dosing.
Generally speaking, inhalation provides the fastest relief for symptoms, with an onset of effect of one to three minutes and a duration of one to three hours. Some may smoke hemp “flower” (ie, the dried plant), but most use a vape pen. It’s important to purchase vape cartridges from a trusted source or dispensary. Clients may be wary of the potential negative health effects from inhalation, especially amid fears of smoking/vaping potentially aggravating COVID-19 complications, so a more popular option is a sublingual tincture. Tinctures are absorbed directly into the blood stream and provide relief in 15 to 30 minutes with a duration of two to four hours.
Another popular way to use CBD is to consume “edibles” (including gummies, mints, and softgels). This ingestible CBD option provides a longer-lasting effect of six to 12 hours and is often recommended for long-term management of inflammation, anxiety, and pain. High doses of ingested CBD may interact with certain medications, particularly those contraindicated with grapefruit and those with a narrow therapeutic window.6
Topical creams may help with pain, inflammation, neuropathy, and muscle soreness. Unlike tinctures, vapes, and edibles that offer systemic relief, topicals aren’t absorbed into the blood stream and provide regionalized relief lasting two to four hours. On the other hand, transdermal patches offer a slow, steady release of medicine into the blood when applied to the wrists or ankles. Patches take effect within 30 minutes with a duration of relief of six to 12 hours.
Rectal and vaginal suppositories may provide relief for some abdominal and gastrointestinal issues, sciatica, and pelvic and menstrual pain, with an onset of 15 to 30 minutes and duration of six to eight hours.
Lastly, clients should be aware that products containing a broad spectrum of cannabinoids, terpenes, and flavonoids—other compounds found in the plant—are more effective than products containing only CBD.7
Q: What is the appropriate dose of CBD?
A: CBD dosing is highly individual. Factors such as a person’s endocannabinoid system (ie, the system of receptors throughout the body that respond to cannabinoids such as CBD), condition, and method of administration all will impact the recommended dose. Some people find relief with as little as 2 mg and others require 50 mg or more. It can take some trial and error to find the right product and dosage for maximum efficacy. “Start low and go slow” is the best way to determine the minimum effective dose. Clients should keep a journal to track how they feel when taking CBD to help determine the best dose and administration method. It’s important to note that it may take a couple of weeks to experience CBD’s full therapeutic effects.
— Janice Newell Bissex, MS, RDN, FAND, is a holistic cannabis practitioner at Jannabis Wellness.
References
1. Grinspoon P. Cannabidiol (CBD) — what we know and what we don’t. Harvard Health Publishing website. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. Updated April 15, 2020.
2. Manzanares J, Julian MD, Carrascosa A. Role of the cannabinoid system in pain control and therapeutic implications for the management of acute and chronic pain episodes. Curr Neuropharmacol. 2006;4(3):239-257.
3. de Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS, et al. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets. 2014;13(6):953-960.
4. Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.
5. Esposito G, De Filippis D, Cirillo C, et al. Cannabidiol in inflammatory bowel diseases: a brief overview. Phytother Res. 2013;27(5):633-636.
6. Devitt-Lee A. CBD-drug interactions: role of cytochrome P450. Project CBD website. https://www.projectcbd.org/medicine/cbd-drug-interactions/p450. Published September 8, 2015. Accessed March 24, 2020.
7. Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-1364.
