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ANALYSIS: ‘Try CBD’? Current research doesn’t back South African newspaper’s claim that cannabidiol relieves stress ‘time and again’

In a post-Covid world, the Citizen newspaper suggests cannabidiol, a natural compound of the cannabis plant, as a way to reduce stress. But available research does not support this.

“Not everyone is keen on experimenting with CBD, but it has proved time and again that it helps to relieve stress,” says the Citizen, a South African newspaper, in a February 2022 article on ways to counter stress after two years of Covid. 

CBD, or cannabidiol, is a natural compound in the cannabis plant. Unlike other cannabis compounds such as tetrahydrocannabinol or THC, cannabidiol does not by itself produce the “high” that many people who use cannabis seek. 

CBD-infused products have become popular in a wellness trend touting them as natural treatments for a range of ailments. But is CBD really a stress-reliever? 

CBD has benefits, but more research needed

As part of the recent boom in medical cannabis research, scientists have begun to investigate the potential therapeutic benefits of CBD. The most promising effects found so far are in treating epilepsy

Rigorous research suggests that CBD may be effective and relatively safe when used to manage the seizures associated with epileptic disorders

Preliminary research suggests cannabidiol might also help treat a range of psychological symptoms. Researchers are studying its use in managing problematic substance use, psychosis, anxiety and the symptoms of mental illnesses. 

But research on CBD as a way to treat stress and anxiety is still in the early stages. Studies are often conducted on animals, on people but only for a short period of time, or without control groups. (Note: Learn what control groups are here.)

The difference between anxiety and stress

Many studies on cannabidiol investigate anxiety or anxiety disorders, which have similar symptoms to stress. But the two are not interchangeable. 

Both anxiety and stress have psychological and physical symptoms such as irritability, anger, muscle pain, fatigue, and sleep or digestive disorders.  

But stress usually relates to a specific trigger in a person’s life, while anxiety is more persistent, continuing even when there is no external trigger.

In medical research, randomised controlled trials are often considered the gold standard. They are designed to reduce the chances of biased results, and allow researchers to be more sure about what causes a particular effect. 

But few of these trials have been done to investigate the potential of CBD in managing stress or anxiety. 

One important part of randomised controlled trials is control groups, which may be relevant when it comes to CBD and anxiety research because of the placebo effect

Studies limited, conclusions premature 

In one study, participants who believed cannabidiol reduced anxiety had decreased anxiety symptoms after they were given a substance they were told was CBD, but was actually an inactive placebo. So it’s important to test whether it’s CBD itself, or just participants’ expectations, that produces results. 

We did find a few trials that investigated CBD’s effect on anxiety. In one study often cited as evidence for the stress-relieving properties of cannabidiol, participants with social anxiety disorder, or SAD, were asked to complete a simulated public speaking test. 

One group received 600 milligrams of CBD before the task, while the control group got a placebo. Those given the CBD had lower levels of anxiety during the task than the placebo group. 

These results look promising, but they are not definitive. The study’s sample size was just 24 people – not nearly enough to conclusively link CBD to the relief of anxiety in most people. And the experiment only looked at short-term effects. It didn’t examine cannabidiol’s interaction with anxiety over the longer term.  

More than this, the study participants had all been diagnosed with an anxiety disorder. None were people experiencing stress. Other studies that used similar methods have similar limitations

A 2020 South African review of the body of evidence for CBD’s therapeutic effects confirmed these gaps in research. In relation to anxiety disorders, among other conditions, the authors concluded that CBD “did not show meaningful benefit” due to “significant limitations” in the study designs. 

Africa Check asked Eric Decloedt, one the review paper’s authors and head of Clinical Pharmacology at Stellenbosch University, if current evidence suggested CBD reduced stress and anxiety.

“It is premature to make such efficacy claims; the data lacks evidence to support this,” he said.

No evidence for CBD effectiveness in doses allowed in South Africa

The research into anxiety and CBD discussed so far was conducted with varying doses of CBD. But the doses are almost always more than 150 mg – usually from 400 to 600 mg.  

The legal status of CBD is important to consider in relation to dosage. Legality and regulations differ by country, but in South Africa CBD is currently unscheduled – it can be bought without a prescription – if it contains no more than 600 mg per product pack and the maximum daily dose is not more than 20 mg.

So even if CBD was effective in reducing stress or anxiety, which is uncertain, there is not even preliminary evidence to suggest its effectiveness at the currently legal doses.  

Despite this, unscheduled CBD oils, CBD-infused goods and other CBD products have become commonplace in health and wellness stores, pharmacies and supermarkets across South Africa.

Some products get around the lack of evidence by making vague health claims. For example, an Adcock Ingram line of CBD products is advertised as stress relief in the Citizen article. One of these products, ADCO CBD Stress, is described on the company’s website as “provid[ing] therapeutic effect with 20mg CBD per dose”, without explicitly saying if this dose can actually reduce stress or anxiety.

Jeffrey Chen, a medical doctor and founder of the UCLA Cannabis Research Initiative, summed up the problem with CBD health claims in a 2019 article

As scientific studies involved much higher doses of CBD, he said, “the 5 mg to 25 mg of CBD per serving in popular CBD products may likely be inadequate”. 

He added that “even if you took dozens of servings to reach the dosage used in these clinical trials, there is still no guarantee of benefit because of how preliminary these findings are”.

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