Cannabidiol (CBD) has become widely available owing to recent changes in federal and state regulations. Although it is marketed for many health conditions, a recent survey found that the most common reason for taking CBD was for the treatment of pain. The endocannabinoid system (ECS) is present at essentially all levels of the anterolateral system, which is responsible for the perception and modulation of pain. In addition to its effects on the ECS, CBD interacts with other important signaling systems involved in the regulation of pain. Thus, there is a physiological basis to investigate CBD for the treatment of pain. Although CBD has been found to reduce pain in several animal models of inflammatory and neuropathic pain, studies to date lack sufficient rigor to provide more than modest evidence for the analgesic activity of CBD. To date, only 1 controlled clinical study has been published evaluating the effect of CBD in the treatment of pain. This study was fraught with numerous deficiencies in design, such that the results are uninformative. Because studies to date have found a high level of variability in the content of CBD products, product quality is a major concern. Although limited preclinical studies suggest that CBD may alter the metabolism of drugs metabolized by cytochromes P450, the lack of clinical studies makes it impossible to assess the clinical significance of these observations. At present, there is insufficient evidence to recommend CBD for the treatment of pain. The safety of the compound in patients with chronic illness remains untested, and pharmacists should caution patients about its use in the absence of clinical supervision.
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