The cannabis-derived compound is popping up in everything from mineral water to bath bombs. We ask experts and users if it actually works
Aaron Horn first came across cannabidiol, or CBD, about three years ago in Glastonbury – the town, not the festival. “I found it at this amazing hemp shop, Hemp in Avalon,” recalls Horn, a musician who is now 35. “It’s run by a guy called Free. His last name is Cannabis. He changed his name by deed poll to Free Cannabis.” Horn bought a tube of high-concentration CBD paste – “it comes out like a brown toothpaste, almost” – and it was recommended he put a tiny dot on his finger and pop it in his mouth.
Horn’s adult life had been spent in the shadow of a horrific accident that took place when he was 22. In June 2006, he had been shooting at a target with an air rifle in the garden of his family home; his parents are the music producers Jill Sinclair and Trevor Horn. Horn didn’t realise his mother was nearby, and a stray pellet lodged in her neck and severed an artery. Sinclair experienced hypoxia, which caused irreversible brain damage, and she spent years in a coma before dying in 2014.
After the accident, Horn did sessions of cognitive behavioural therapy, which he found helpful. He didn’t take antidepressants, because he was concerned about the side-effects; he did smoke cannabis, though he didn’t always like feeling stoned. “I suffered from some PTSD symptoms, flashbacks,” he says. “And some other issues.”
Almost immediately, Horn found using CBD lifted his mood. Cannabidiol is a non-psychoactive chemical found in marijuana and hemp plants. It will be present if you smoke a joint, but is often overwhelmed by one of the other 100-plus cannabinoids found in cannabis: THC (tetrahydrocannabinol). This is the ingredient that mainly has mind-altering properties, but also now has worrying links with mental illness and violence. CBD products are allowed to contain only traces of THC, which makes them legal, and devotees claim that they have many of the benefits of cannabis with none of the drawbacks.
“CBD has helped me across the spectrum,” says Horn. “It definitely helped in social situations, if I was finding it hard to be around people. It brings you more into the moment. I felt more relaxed.”
"CBD will drastically affect the way the world looks in 20 or 30 years, and the way we live "
Horn is bouncy and enthusiastic; for someone who spends a fair amount of time meditating, he seems to have a hard time standing still. Our conversation takes place in his shop, LDN CBD, which he opened in Camden last July with a friend, Joe Oliver. CBD has been available to buy for a while – not only in independent shops such as Hemp in Avalon but also, since early 2018, in nationwide chains such as Holland & Barrett – but Horn contends that this is the elixir’s first dedicated boutique in the UK. It is certainly a long way from the traditional head shop: bongs and Rizlas have been swapped for white walls, reclaimed-wood floors and uncluttered shelves sparsely dotted with CBD oils, pastes and pills, and on-trend houseplants. A 10ml bottle of 3% CBD oil costs £25. Horn sees his target customer as anyone interested in wellness, more than counter-culture stoners. Downstairs are two studios for yoga, reiki and CBD massages.
If LDN CBD is the first, it certainly won’t be the last. Interest in CBD products is exploding: it is 2019’s avocado toast, this moment’s turmeric shot. Except there is a crucial difference. If CBD does what its advocates suggest – or even a fraction of it – this all-natural, side-effect-free, widely available chemical could genuinely be the wonder drug of our age. Adherents claim it is “adaptogenic” – that is, a natural, non-toxic substance that regulates your stress response – and it’s not hard to find people who will tell you it has helped with anxiety, acne, schizophrenia, menstrual pain, insomnia and even cancer. There are also dozens of CBD cosmetics products, CBD juices and coffees are now a thing, and some find it useful as a sexual lubricant. Bizarrely, it has taken off in pet products, too: everything from chews for anxious dogs to treating life-threatening ailments. New products include truffles, bath bombs, moisturisers, ice cream, CBD-infused spring water (available from Ocado) and, naturally, CBD turmeric oil. CBD doesn’t have an especially strong taste – fans call it “nutty”, others “boggy” – which means it can be added to food without overpowering it.
Much of this activity takes place online, so it’s hard to gauge the number of users, but one estimate, from the Cannabis Trades Association UK, suggested that there were 250,000 cannabidiol consumers in this country in 2017, double the number from the previous year. For Horn, CBD is simply the perfect drug for the way we live now. Something to take the edge off. Just as you might find a couple of off-licences on high streets now, Horn believes it won’t be long before there are two shops selling cannabis products.
“CBD will change culture,” he predicts. “People are less interested in drinking in bars, getting really drunk, feeling shit the next day, letting their body down, having issues with their body because of that. The shift is happening: more people are interested in eating healthier, living healthier, and this is part of that. It changes it a lot more than the new iPhone or another pair of trainers, or everything we’ve had since the 90s that’s just different versions.
“It will drastically affect the way the world looks in 20 or 30 years and the way we live.”
But does it work? And does taking CBD do us any good? Philip McGuire is a professor of psychiatry and cognitive neuroscience at King’s College London; he has a special interest in psychosis and started looking into cannabidiol about 15 years ago. One of the first experiments he worked on looked at how cannabidiol works in the brains of healthy people in comparison with the impact that THC has. The results were categoric. “We basically showed that the two compounds have opposite effects on brain function,” says McGuire. “So when THC is making you psychotic, it stimulates certain bits of the brain. And in these areas of the brain, CBD has the opposite effect, essentially, in the same people.” To boil it down: “CBD and THC seem to be pushing in opposite directions.”
In the past five years, McGuire has moved on to do clinical trials of cannabidiol in patients with psychosis, or people who are vulnerable to psychosis. The tests have been done against a placebo, double-blind, and again the results are very encouraging. “We’ve done two phase-two trials and, in both of these, found that cannabidiol reduced psychotic symptoms more than the placebo did,” he says. “So it wasn’t a placebo effect, it really did reduce psychotic symptoms.”
McGuire’s work is ongoing, but he doesn’t hide his excitement about CBD. “It’s the hottest new medicine in mental health by some margin,” he says. “There’s huge interest in it as a potential new treatment.”
Mental health is just one area of investigation for those studying cannabidiol. Perhaps the best-known user of CBD – if you discount Gwyneth Paltrow, who has collaborated through her lifestyle website Goop with the MedMen cannabis store, and a handful of Hollywood actresses who have said they use the oil to reduce the discomfort from wearing high heels on the red carpet – is Billy Caldwell. The 13-year-old from County Tyrone, Northern Ireland, who has epilepsy, made headlines last summer when his cannabidiol medicine was confiscated at Heathrow. After a public outcry, the home secretary, Sajid Javid, intervened and medicinal cannabis oil can now legally be prescribed in the UK. It’s been far from straightforward for the family: Billy recently spent three months in Canada, where medicinal cannabis use is less regulated, but he finally returned home in February.
His medicine is Epidiolex, a purified form of cannabidiol that contains less than 0.1% THC. It has been developed by a UK company, GW Pharmaceuticals, and is recommended for the treatment of two of the rarest and most severe forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. When it was cleared for use in the US last year, the president of the Epilepsy Foundation called it “a true medical advancement”. Treatment does, however, come at an eye-watering cost; in the US, GW estimates $36,000 (£28,000) per patient annually, though the company notes that the potential future price in the UK might be different.
Still, it is hard not to feel that cannabidiol has rare potential as a medicine, and we are only just scratching the surface. McGuire is cautiously optimistic that it’s “as good as it seems to be”. For one thing, in tests so far, CBD does not seem to have produced any major unwanted effects in patients. “In mental health, that’s a big deal,” says McGuire. Another strand is that cannabidiol seems to act on different transmitter systems in the brain to existing treatments. That would make it a new class of treatment, which is significant because it means that, if previous medications or approaches haven’t worked, this one might.
One suspicion about cannabidiol is that it is an impossible panacea: some, for example, claim CBD makes them more relaxed; others that it sharpens their mind to focus on complex work problems. Can it really do both? But, for McGuire, this is less a contradiction and more an indication that we don’t yet know what CBD is capable of and how best to use it. “One of the interesting things about the endocannabinoid system in the body is that it’s not just in the brain but also all over the body,” he explains. “And cannabidiol also appears to have beneficial effects on metabolism, on the immune system and liver function, in addition to its mental health effects.”
McGuire would now like to do a worldwide trial of cannabidiol in large samples to see whether it can be a medicine, not just a research tool. “Patients with psychosis have a life expectancy that’s about 20 years shorter than normal, and that’s because psychosis is associated with poor physical health, especially cardiovascular health,” he says. “And it’s possible that – this has never been tested – but another benefit of cannabidiol in these patients is that it could help with their physical health problems.”
Hearing these testimonies, it would seem perverse, even neglectful, not to use CBD, but where to start? One option is High Tea at Farmacy, a plant-based restaurant in west London. On the menu are a CBD-infused vodka cocktail, CBD truffles (tahini and dark chocolate, and basmati and coconut) and a pot of hemp leaf tea. With extras, it costs £42. “You don’t technically get high from it, it’s just a great play on words,” says Camilla Fayed, who opened Farmacy in 2016. “It definitely draws people in.”
ayed, the 34-year-old daughter of former Harrods owner Mohamed Al Fayed, first came across CBD in the US in an oil made by Charlotte’s Web. The company is named after Charlotte Figi, a 12-year-old with Dravet syndrome, whose story has many echoes of Billy Caldwell’s. Figi, too, found that her seizures were significantly reduced by taking medical cannabis. Charlotte’s Web was developed in 2011 by six brothers (Joel, Jesse, Jon, Jordan, Jared and Josh Stanley) who crossbred a strain of marijuana with industrial hemp to make products that are high in cannabidiol and low in THC. Its oils start with the entry-level “full strength”, which claims 6.65mg of CBD per ml, and go up to “maximum strength”, which has 60mg of CBD per ml.
For Fayed personally, CBD helped with memory and concentration. “And tiredness,” she adds. “I’ve got two kids, I run a business, we all need a boost. I’d rather have that than a big black coffee every two hours or whatever.” And it made a difference? “Absolutely. General concentration, sleeping better, just an all-rounder. From taking it, in about six weeks, I could basically track the difference in the way it made me feel. So I just thought: ‘Let’s introduce this to the commercial market.’”
Farmacy started in April 2017 with cannabidiol cocktails. One of these, OMG, is delivered in a syringe and blends flaxseed oil, grapefruit and “wildcrafted” CBD. When it arrives, it’s not immediately clear whether you decant it into a shot glass or shoot it straight in your mouth. “Well, plenty do,” advises Fayed. “It’s very Instagrammable.”
Fayed – in common with Horn – is not allowed to make medical claims about the cannabidiol products she sells. (Horn also points out that he cannot advise on dosage and would never recommend that a customer comes off prescribed medication to use CBD.) But at Farmacy, Fayed often hears that the CBD cocktails impart a more ambient buzz on the drinker. “We have a lot of repeat customers, so for us that’s definitely a winner,” she says. “And especially with the alcohol, there’s that adaptogenic effect in the alcohol: people feel less drunk or feel their hangover is less brutal the next day if you’re going to have two or three.”
It can be tempting to see CBD as a triumph of hype or marketing, and Fayed advises caution: for starters, it needs to be really high quality. Farmacy’s CBD comes from Spirit of Hemp in Forest Row, on the edge of the Ashdown Forest in Sussex. It uses organic hemp, hand-harvested in Switzerland and Austria, and after the extraction process, it reintroduces steam-distilled terpenes (what Spirit of Hemp calls “the life force, the quintessential fifth element or the spirit of the plant”). “It’s a real shift in understanding of what Mother Nature has given to us,” she says. “The veil has lifted finally on its benefits, and it’s definitely the beginning of something really big in the natural medicine world. So I don’t think it’s a trend, it’s here to stay.”
People will try these homeopathic versions, find that it doesn’t do anything, and assume that cannabidiol doesn’t work
Something, though, is missing from the CBD story: proof. And this is the detail that really worries Professor McGuire. He points out that in the trials on psychosis that he’s been involved in, patients might be given 1,000mg of pure cannabidiol in a tablet; the medication for the pharmaceutical treatment of epilepsy could be 2,500mg. Compare this to a drink advertised as CBD coffee or a brownie, which may contain, for example, 5mg of CBD. And there is the issue of bioavailability: how much of a drug your body actually takes into your gut. “Of that 5mg, you might absorb 1mg or less,” says McGuire. “Or none.”
McGuire sighs. “If you look at the labels of the street products, it’s very difficult to know what’s actually in them. And there’s a huge variety between products, so that’s a really important message to get across: that a lot of what people may be taking in good faith may be having absolutely no effect at all, other than a placebo effect.”
The distinction for McGuire is that CBD is a nutriceutical – in common with minerals and vitamins – not a pharmaceutical product. This is in large part due to its origins. Cannabidiol was not developed as a new blockbuster drug by a pharmaceutical giant or a medicine to which nobody else had access. Instead, the compound has emerged relatively organically, and pretty much anyone can produce a version of CBD without infringing patent laws. (GW can only patent what is called the “formulation” of Epidiolex.) If you’re no fan of big pharma, this has some advantages: CBD can become widely available and competitively priced. But the downside is that cannabidiol products are not subject to the clinical trials and randomised, double-blind assessments that we might expect from a supplement we are taking to improve our health.
I’m not trying to be a killjoy,” says McGuire, “but, especially in mental health, the size of the placebo effect is enormous. That’s not to dismiss it, but that’s why in clinical trials, if you don’t give half the people in the trial a placebo, it’s considered junk. It’s not publishable, it’s not taken seriously because, in mental health, the placebo effect can produce a 40% change in symptoms.
“It’s like Prince Charles and homeopathy, it’s a joke. Some of these products have got such tiny quantities that they could never work.”
McGuire concedes that different CBD products will have varying strengths, and he also acknowledges that he cannot say they don’t have an effect – it’s simply that we don’t know for sure either way. And clearly others share his concern. In February, New York became the first major American city to impose a ban on CBD edibles in restaurants. “Until cannabidiol is deemed safe as a food additive,” said a spokesperson from the New York City Department of Health, “the department is ordering restaurants not to offer products containing CBD.” From July, a fine of up to $650 (£500) could be imposed.
There are clear health risks with any unregulated product. The reason that Epidiolex is really expensive, McGuire explains, is that isolating cannabidiol is “intrinsically difficult to do”. He fears that over-the-counter CBD products could have higher levels of THC than either advertised or desired. A 2017 study in the US looked at 84 samples of CBD oils, tinctures and liquids available online and found that only 26 of them contained the amount of CBD claimed; worryingly, 18 of them had more THC than they said. “THC makes you psychotic and anxious and impairs your cognition,” warns McGuire, “so it’s very important that’s not in anything that’s being consumed.”
A longer-term danger, however, is that people will lose interest in cannabidiol, perhaps because they don’t find it has any effect in the product they try, and it will languish as one of those trends we like to make fun of. “I’m slightly anxious that the confusion will muddy the water,” says McGuire. “People will try these homeopathic versions and find that it doesn’t do anything, and then they assume that cannabidiol doesn’t work. Then it will damage the therapeutic potential of what could be a very useful new medicine. It’s a bit like if somebody sold Nurofen at one-hundredth of the effective dose and then found it didn’t work. You could end up dismissing Nurofen as a useful treatment.”
Anecdotal evidence suggests that CBD use skews towards the young and female, but Horn at LDN CBD hasn’t found a gender divide and he has lots of older customers in his shop. He often hears that CBD oil helps with their arthritis, and sometimes that they have been able to open jars for the first time in years. Horn has even got his granny on CBD. He is currently raising funding for two more stores in London, and he would like to have another 10 stores in the major cities of the UK. “Most towns with a Holland & Barrett could have a shop like this,” he predicts.
Horn’s CBD comes from Lithuania and is sold as “ethical and organic”. He accepts that the doses of CBD in the products are significantly lower than might be used in medication or clinical trials, but he’s not sure how relevant that fact is. “From what they are finding out about the endocannabinoid system, little and often of the right product is probably as effective as a huge amount,” he says.
Alongside Horn is LDN CBD’s store manager, Florence Cannon-Orderly, a 30-year-old yoga instructor. She started using CBD to help with premenstrual symptoms. “It’s got much better now, but for a good half of my month I feel extremely challenged,” she says. “CBD has given me the therapeutic benefit without getting stoned.”
Both of them can reel off customers who have found solace in using CBD – though again, they can’t make any medical claims. (The NHS says: “Some products that might claim to be medical cannabis, such as ‘CBD oil’ or hemp oil, are available to buy legally as food supplements from health stores. But there’s no guarantee these are of good quality or provide any health benefits.”)
“There’s one young lad, he’s come off all of his epilepsy medicine, he hasn’t had a fit for two years,” says Cannon-Orderly. “It’s all through CBD, and he was in here talking about how, if you have epilepsy and you haven’t fitted for two years, you can take your driving test. So he was really excited that he could do that.”
Horn interjects: “But we wouldn’t advise people to come off medicine.”
“These are people coming in telling us about their journey,” adds Cannon-Orderly.
“And anyone on medicine, we wouldn’t advise that you take it if you’re on medication,” says Horn. “We say: ‘Go to a doctor first.’”
As Horn acknowledges, he can only tell his own story of the impact CBD has had on his life, and – whatever doubts exist about cannabidiol products – it is a powerful one. “It has just made me a bit less frayed around the edges,” he says. “I still think that I would have done what I would have done, but it helps that rubbing between me and the universe. It helps to oil whatever problems one has or whatever one comes up against. So definitely, for me, it helped my quality of life.”
He runs a hand through his hair and smiles. “And it does still.”