A growing body of research points to an array of therapeutic uses for cannabidiol ( CBD), one of the most abundant cannabinoids found in marijuana

What is CBD Tincture? 

CBD tinctures are a type of concentrated cannabis extract that is consumed orally. Cannabis flower is soaked in alcohol to slowly extract the cannabinoids. The result is a liquid with a high concentration of medicine. 

Tinctures are meant to be taken in small doses. A few drops of concentrated cannabis product can be added to drinks or foods. Tinctures that are absorbed sublingually (under the tongue) may deliver cannabinoids into the bloodstream quicker. You can absorb the cannabinoids this way by allowing the tincture to sit under your tongue for about a minute.

The belief is that the arterial artery beneath the tongue will absorb the cannabinoids directly into the bloodstream, taking much less time than digestion would to deliver the cannabinoids. 

The extract is usually a derivative from the whole plant, so other cannabinoids and terpenes may also be present in a CBD tincture. CBD tinctures contain a higher concentration of CBD than THC, but products with a range of CBD:THC ratios exist as well. 

Benefits

CBD is often inaccurately lauded as a “miracle medicine” because of the wide scope of conditions it seems to treat and its small side effect profile.

For example, in patients with ongoing excruciating and seemingly intractable cancer-related pain even though they were on a prescribed regimen of opioids, a THC-predominant extract did not seem to make much of a difference.

However, a whole plant extract with both THC and cannabidiol ( CBD) proved statistically significantly better than both. The key difference being the presence of CBD in the latter whole plant extract along with all the other constituents. 

Although recent evidence suggests that THC is just (if not more) important than CBD in obtaining beneficial medical results, research suggests that CBD may be able to treat and/or offer relief from symptoms associated with the following conditions: 

  • Sleep disorders
  • Breast cancer
  • Neuroblastoma 
  • Prostate cancer 
  • Acne
  • Parkinson’s disease
  • Alzheimer’s disease
  • Multiple sclerosis 
  • Neuropathic pain 
  • Seizure disorders
  • Anxiety
  • Psychotic disorders 
  • Viral hepatitis 
  • Addiction 

According to Dr. Ethan Russo, consuming a product that reflects the natural chemical composition of the cannabis plant optimizes its medicinal effects. Russo argues that the synergistic relationship between cannabinoids and terpenoids has the potential to achieve a much higher degree of efficacy than any isolated compound could. This has been referred to as the “entourage effect”. 

The important point is that examples of the aforementioned “entourage effect” demonstrates that it is not a single molecule such as CBD or THC in of itself but the use of the whole plant extract that may offer optimal benefits with the above listed diagnoses.

CBD by itself is known to act in a biphasic manner. This means smaller doses reduce pain until a peak is reached. There’s a ceiling effect, where after a certain point, pain more CBD doesn’t equate to further reduction in pain.

What is remarkable is that if used along with THC, a full spectrum Cannabis extract with equivalent doses of CBD, eliminates the biphasic response in favor of a linear dose-response curve,  that has has no observed ceiling effect at any dose. 

Side Effects

A 2017 review confirmed that CBD’s short-term side effects are mild.

Participants reported:

  • Diarrhea
  • Fatigue
  • Changes in appetite
  • Changes in weight 

There have been no major studies that investigate the long-term effects of medicinal CBD consumption.    

Risks

Another important consideration for patients is whether to trust the labeling of their CBD products. A 2017 JAMA Network study reported almost 70 percent of CBD products were labeled inaccurately. Some CBD-only products were found to contain THC.

The risk is accidental THC intoxication as well as the consumption of too much or too little CBD based on a patient’s treatment plan. The other danger is the use of solvents to extract cannabinoids for making concentrates used in making non-flower products (e.g., edibles, tinctures) can cause respiratory and cardiovascular problems and could also be a cause of increased emergency cases of Cannabinoid Hyperemesis Syndrome because the THC content observed may also be inaccurate and thus sufficient to produce intoxication or impairment.

The Effects of THC in Tinctures

It’s not enough to just focus on CBD? A 2018 study by researchers in Israel showed that even when they used Cannabis strains that had similar and equally high- CBD Cannabis extracts, they didn’t all produce the same effects when it came to controlling seizures and exerting an anticonvulsant effect. 

So what is the take home message with regards to the focus on the two renowned phytocannabinoids (-)-Δ9-trans-tetrahydrocannabinol (Δ9-THC) and cannabidiol ( CBD)?

Do not depend on any single magic molecule(s) despite the hype. Your best bet is the whole plant extract in its varied forms. The fact is that the plant contains over 100 additional phytocannabinoids, and 545 metabolic constituents. In addition, the endocannabinoid system is still being researched and many receptors have been identified. These factors make attributing certain molecules to precise effects very difficult for researchers.  


How to Make a CBD Tincture 

cannabis cbd oil

iStock / OlegMalyshev

One way to have more control over the quality of CBD tincture is to make it yourself. To make CBD tincture, gather these materials: 

  • 1/8 oz of a high CBD strain (try ACDC or Charlotte’s Web
  • 2 ounces of pure grain 190 proof alcohol (do not use rubbing alcohol)  
  • 1 mason jar
  • 1-2 coffee filters
  • A measured eye dropper 

Make the tincture:

  1. Decarboxylate finely ground cannabis flower. 
  2. Combine the decarbed cannabis and the alcohol into one of the mason jars. Cover and let it sit for 3 weeks. Shake the mason jar once each day. 
  3. Use the coffee filter to remove the plant matter from the liquid. Try 1 mL of the tincture at a time. 

Research on the Efficacy of CBD Tinctures 

There is little evidence comparing the relative efficacy of cannabis consumption methods. However, the extremely limited research suggests that CBD tincture can be an effective form of cannabinoid delivery however there are associated risks as we will see below.  

A small 2017 study published in the Israel Medical Association Journal reported that CBD-rich cannabis oil taken sublingually improved overall physical and social functioning and decreased body pain in girls with dysautonomic syndrome after an HPV vaccine.

Another small scale 2019 Journal of Palliative Medicine study on cancer patients visiting one New York dispensary found that cancer patients were most likely to use sublingual tinctures. 

It is impossible to draw firm conclusions based on these two studies. For one, they are too small and lack the diversity of participants needed to create a more accurate representation of the cannabis consuming population. Additionally, they do not compare the perceived symptom relief from tincture with any other product. 

In a first of its kind, a 2019 Scientific Reports observational study by Professor Sarah Stith, et.al. analyzed different product types including dried flower, concentrates, edibles, tinctures, and topicals. Stith collected data from ReleafApp to determine the patient-reported efficacy of these cannabis product types in providing relief.

The results of the study offered a whole host of intriguing pointers including that:

  • Flower provides more symptom relief than any other type of product
  • Higher THC offers greater symptom relief and experiences of both positive and negative side effects
  • Higher THC levels results in larger effects and higher CBD offers no statistically significant benefit
  • Variability in CBD levels in flower was not associated with differences in symptom improvement

Stith notes the limitations of her study, particularly its reliance on patient self-reporting, which can be skewed by biases and lack of non- cannabis using controls. 

Researchers are aware of the urgent need for evidence specifically analyzing cannabis consumption methods, but the federal prohibition of marijuana has made it nearly impossible to collect accurate, representative data on the type of cannabis products most consumers are using. 

The benefits reported on CBD tincture rely heavily on anecdotal evidence, so consult with your doctor and stay current on cannabis research if you are considering this therapy