Is CBD nothing more than a placebo effect?

CBD and Placebo Effect

Cannabis and hemp have a long history of making its way into many different preparations that included teas and tinctures all the way through to lotions and poultices. Even as far back as Ancient Egypt, cannabis and hemp was being described in medical papyruses as a treatment for conditions as varied as the treatment of ingrown toenails to a remedy for inflammations of the vagina.

Yet, many scientist find it hard to believe that cannabis, hemp and in particular cannabinoids such as cannabidiol (CBD) can do so much, often chalking up the results to a placebo effect.

What is a Placebo and the Placebo Effect?

In simple terms, a placebo is anything that seems to be a “real” medical treatment but doesn’t actually contain any of the active ingredients that are meant to affect health.

Researchers use placebos as a control condition when studying the effects of pharmaceutical interventions to help them understand what the true effects of a new drug or other treatment might have on a particular condition. This allows them to then compare the effects of the drug and the placebo on the people in the study, determining the effectiveness of the new drug as well as checking for side effects.

However, scientists have noticed that during clinical trials, people can often times have a response to a placebo. For instance, the participant’s symptoms may improve despite not receiving any active ingredients or the person may present with “side effects” from the “treatment”. These responses are what is referred to as the "placebo effect."

How does the Placebo effect work?

Although scientists aren’t exactly sure how the placebo effects works, one of the most widely accepted theory is that the placebo effect is due to a person's expectations. Basically, placebos are thought to work because brain processes related to perception and emotion shape and, ultimately, construct and modulate mental and physical health. In other words, because of the relationship between mind and body, when a person believes something will work, it’s actually possible for the body’s own chemistry to cause the effects the medication is expected to cause.

Ironically enough, the endocannabinoid system actually plays a major part in the placebo effect with the belief that a placebo capsule will help treat symptoms and ailments causing the brain to release the endocannabinoid anandamide, otherwise known as the bliss molecule. Anandamide has been shown to actually stimulate many of the desired effects of the expected treatment. This includes things like pain reduction, reducing inflammation and improving mood with the placebo effect accounting for much of the efficacy of pharmaceutical medications such as opioids and anti-depressants.

However, it is important to understand that the placebo effect is a very real thing. Just because it is tied to expectations, it doesn’t mean it is imaginary or fake. In fact, there are studies that who that the changes that occur with a placebo effect are actual physical changes, often showing that the placebo effect is more effective than doing nothing at all.

To illustrate this, let’s look at a couple of real life examples.

For instance, in one randomised, double-blind study that assessed the effects of cannabinoids on multiple sclerosis (MS) symptoms, scientists used a Visual Analogue Scale (VAS) score for each patient’s most troublesome symptom as a measure of how effective CBD is in reducing the symptoms of MS. Illustrating the power of the placebo effect, the scientists found that in the control group who only received the placebo, their symptom scores dropped from an average of 74.31 (12.5) to and average of 54.79 (26.3) points.

In another randomised, double-blind trial studying the efficacy of CBD in the treatment of Lennox-Gastaut syndrome, the researchers went so far as to actually include and account for the placebo effects in their hypothesis. And they were right. They found an astounding 21.8% drop in the monthly frequency of the participants’ seizures even though they were giving nothing more than glucose.

Interestingly enough, in this same study, one participant in the placebo group also had to withdraw from the study because of “adverse events”. So, it would seem that, just like people can sometimes experience an actual improvement in their symptoms because of the placebo effect, the opposite can also happen due to something called the nocebo effect.

What is the nocebo effect?

The term nocebo effect was coined to give a name to the negative equivalent of placebo and distinguish between desirable and undesirable effects of placebos. In other words, for some people this means that taking an inert pill or even just being informed of a pill or procedure’s potential side effects, is enough to bring on real-life symptoms.

What this means in relation to CBD is that, interestingly enough, placebo and nocebo effects seem to be associated with the same dopaminergic and endogenous opioid pathways, but in opposite ways. So, the same way that people who think CBD is going to work for them may experience increased benefit, so too can people who do not believe in the effects of CBD end up feeling nothing, or even negative effects when using it.

So, Is CBD Oil a Placebo?

Although many scientists still believe that we do not have enough scientific data to make a definitive claim about the true effects and therapeutic efficacy of CBD, there is also an ever growing faction of scientists that believe we do.

One only needs to look at the vast amount of scientific research and studies collected by MyDosage or Project CBD (a non-profit dedicated to promoting and publicizing research into the medical uses of cannabinoids such as CBD) showing that CBD may be therapeutic for many conditions to see that its effects are real.

For example, the discovery of the endocannabinoid system and the integral way in which it affects, regulates and modulates almost every system within the body is very real. Similarly, the fact that deficiencies in this system is now being thought to be responsible for a variety of pathophysiological patterns, symptoms, ailments and diseases that may be suitably treated with cannabinoids such as CBD.

Similarly, as cannabinoid and CBD research is increasingly being funded, the evidence that CBD can help reduce, relieve and treat a variety of specific symptoms as well as the underlying causes of these are also growing exponentially. Conditions for which CBD has been shown to be effective beyond what can purely be due to placebo includes but are not limited to:

Pain

Inflammation

Depression

Epilepsy

Neurodegenerative Disorders such as Parkinson’s disease

Inflammatory Bowel Diseases such as Crohn’s disease and Irritable bowel syndrome

Cancer and tumor reduction

Why Do Some Still Think CBD Is A Placebo?

As mentioned in the introduction, many scientist as well as non-scientists simply think that the extraordinary effects and range of applications are merely due to placebo. But why?

Too good to be true

Unfortunately, CBD’s reputation as being a panacea for so many different symptoms and diseases is doing it more harm that good. Because of this, many prefer to think of CBD oil as either a miracle cure-all, or too good too be true.

It might not work the same for everyone

CBD should be viewed as only one weapon in an arsenal that for some may be a great adjunct therapy to use with their traditional pharmaceutical drugs, while for others, it might work perfectly on its own. The point is, CBD doesn’t work the same for everyone and may not even work at all for some and because of this CBD may become to be viewed as a placebo by some.

It Works Over Time

Another issues that causes many people to think that CBD is a placebo is because, unlike its cousin cannabinoid, tetrahydrocannabinol (THC) which produces immediate effects, CBD simply doesn’t do that. Add to that the fact that CBD tends to work over time, it’s easy to understand why many still consider CBD to be a placebo.

Final Thoughts

It is understandable why some scientists as well as many in the general public are skeptical about the effects and benefits of CBD oil. Although not unique in the world of medicine, it certainly doesn’t work the same for everybody, leaving many people to think that the reports, evidence and tales of its therapeutic benefits are overblown and what effects it does have, is due to placebo.

However, although CBD is by no means a cure-all, an ever growing body of scientific research and evidence from clinical trials are showing that CBD has real effects in the body and that its benefits are very real. The trick is to, just like with any other medication or therapeutic agent, use a pharmaceutical grade product, use it correctly and take the time to let it do its job.