CBD in Long Covid: Approaches to Symptom Relief

The COVID-19 pandemic is over, but its consequences remain. According to a statement by the German Bundestag in 2024 (1), a six-digit number of people in Germany still suffer from Long Covid or Post-Covid Syndrome (ME/CFS). For some patients, the symptoms eventually disappear, while others suffer for life.

To make everyday life a little easier for those affected, treatment with preparations from the cannabis plant, specifically cannabidiol (CBD), has become established. The goal: less pain and fatigue, improved well-being and a better quality of life for those affected.

However, there are also critical voices. CBD is said to be either dangerous or not to show the desired effects in the fight against symptoms. Study results also point in different directions. We provide an overview and summarize what we really know.

Long Covid is on everyone's lips - and rightly so. Estimates suggest that between 10 and 30 percent of all people develop long-term symptoms after a COVID-19 infection. The symptoms are diverse and often so diffuse that patients initially have difficulty being heard by doctors and their personal environment. Once a diagnosis has finally been made, treatment also proves to be very difficult. There is no cure.

The best-known symptom of Long Covid is certainly the so-called fatigue - a leaden tiredness and exhaustion that makes a normal everyday life impossible for many sufferers. In addition, there are concentration difficulties ("brain fog"), shortness of breath, muscle and joint pain, and insomnia. Many sufferers also report heart rhythm disturbances, dizziness, and a general deterioration in their resilience.

What often makes the situation particularly problematic: the symptoms can occur in waves and can be dramatically exacerbated by physical or mental exertion. Doctors speak of "Post-Exertional Malaise" (PEM). Those affected can feel completely exhausted for days or weeks after even the slightest exertion. In between, there are phases in which patients appear to be well - which is why they are often dismissed as "malingerers" by others.

The consequences are often dramatic. Many patients can no longer work, neglect social contacts, and develop secondary depression or anxiety. While for some the symptoms slowly subside after months, others struggle with the consequences of the original infection for years.

Currently, there is no standard therapy for the treatment of Long Covid that works equally well for all affected individuals. Doctors generally focus on treating the symptoms: painkillers, physiotherapy, psychotherapy, and a gradual increase in activity. CBD can provide supportive effects here, for example, by reducing the need for conventional medications.

The terms Long Covid and Post-Covid Syndrome are often used synonymously, but the distinction is very important - also because the treatment sometimes differs.

Long Covid is colloquially used for persistent symptoms after a COVID-19 infection that last longer than 4 weeks. "Post-Covid Syndrome" is the medical term for symptoms that persist for at least 12 weeks after infection and cannot be explained by other diagnoses. ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) is a condition that can occur as a result of COVID-19. It is characterized by extreme exhaustion and post-exertional malaise - i.e., the worsening of symptoms after physical or mental exertion.

CBD, short for cannabidiol, is one of over 100 active compounds in the hemp plant (cannabinoids). Unlike the better-known cannabinoid THC, CBD is not intoxicating, but has anti-inflammatory, pain-relieving, and calming properties. Interest in CBD for the treatment of Long Covid is correspondingly high.

The key to CBD's potential effect lies in the endocannabinoid system (ECS), a complex network of receptors and neurotransmitters that regulates various functions in the body. The ECS is involved, among other things, in regulating pain, inflammation, sleep, mood, and the immune system - all areas that can be disturbed in Long Covid patients.

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Among other things, CBD interacts with the so-called CB1 and CB2 receptors of the ECS. This could affect several Long Covid symptoms:

For chronic pain, CBD could have pain-relieving effects by activating certain receptors. The anti-inflammatory properties of CBD could counteract persistent inflammatory reactions - possibly one of the main causes of Long Covid.

CBD could also help with sleep problems. Many Long Covid patients suffer from severe sleep disorders, which can also exacerbate other symptoms. CBD can have calming and sleep-promoting effects without the addiction potential of conventional medicines.

Particularly interesting for many affected individuals: Some patients report that their fatigue has decreased with the use of CBD. (2) The so-called "brain fog" also diminishes. Although the exact mechanisms are not yet clear and comprehensive experiments and clinical studies are lacking, CBD seems to have great potential for Long Covid therapy, with very few side effects.

But there are also critical voices here.

Overall, the use of CBD carries a very low risk. This is also the result of a study from 2024. (3) According to the study, CBD is very well tolerated and well accepted by patients - which also suggests very few side effects.

Typical side effects of CBD are fatigue, digestive problems (diarrhea), and changes in appetite/weight. However, these were apparently perceived by the study participants as less problematic, possibly also in relation to the improvement of their symptoms.

However: Patients who are already taking medication should only take CBD after thorough medical consultation. Cannabidiol can, according to a number of studies, influence the metabolism of certain drugs in the liver. These then work more strongly or less strongly - with corresponding consequences for the patients.

There are also critical voices warning against viewing CBD as a "miracle cure" for Long Covid and similar diseases. According to researchers, there is simply a lack of clinical studies, and the addiction potential of long-term CBD use has not yet been definitively clarified. (5) This is contradicted by the fact that the WHO already confirmed in 2018 that CBD is not addictive.

One often reads in connection with Long Covid that it could also be triggered by the vaccination against the coronavirus. And this is also part of the truth: yes, there are documented cases where people showed symptoms of Long Covid after the coronavirus vaccination.

However, the cases are extremely rare: only about 3% of all vaccinated people had side effects lasting longer than a week, and for 1.4%, they lasted longer than a month. However, these figures include not only ME/CFS but all longer-term side effects.

Let's put this into perspective: 4.5% of all people developed ME/CFS or comparable diseases after a COVID 19 infection. Without infection, it is only 0.6%. The risk of Long Covid due to the infection itself is therefore significantly higher than that caused by vaccination.

Only for people who suffered from ME/CFS before the Corona pandemic did (and does) the vaccination pose an increased risk.

If you are a Long Covid sufferer and want to try CBD, you should consider a few points. Most importantly: Be sure to discuss the intake with your doctor. Although CBD is available without a prescription, it can interact with other medications and is not suitable for everyone.

In Germany, CBD products with less than 0.3% THC are legally available. To avoid unwanted effects (e.g. intoxicating effects), it is best to use products with a guaranteed low THC content. Laboratory analyses provide maximum safety here.

Also, make sure to buy only from reputable retailers. Cheap products of unknown origin may contain contaminants or provide false information about CBD and THC content.

There is no standard dosage for CBD in Long Covid. Most studies use dosages between 10 and 100 mg daily. Start with a low dose (about 5-10 mg) and gradually increase it until you feel an effect. Some people need higher doses, others react to even the smallest amounts.

CBD is available as oils, sprays or capsules. We recommend using oils or sprays because they allow for the most individual dosing. Sprays are also very discreet and can be easily used when traveling and in everyday life.

Full-spectrum preparations contain other cannabinoids and terpenes in addition to CBD, which may have synergistic effects (entourage effect). CBD isolate is purer but possibly less effective. The scientific evidence is not yet conclusive.

CBD is generally very well tolerated, but can have side effects. Common problems include fatigue, diarrhea, changes in appetite, and dry mouth. At higher doses, dizziness or drowsiness may occur.

Reduce the dose if you observe strong side effects and consult your doctor if in doubt.

CBD can enhance or weaken the effect of other medications. This is particularly important for blood thinners, antiepileptics, and antidepressants. Always inform your doctor about all medications you are taking.

CBD does not work immediately. Some people only feel an effect after weeks. Small steps are more sensible here than overly great hopes for quick relief. Give the remedy time and keep a symptom diary to document changes.

Pay attention to organic quality and CO2 extraction as a manufacturing process. Reputable suppliers provide comprehensive information and analysis certificates that confirm the CBD content and the absence of pesticides, heavy metals, and other contaminants.

CBD is not a miracle cure. It may relieve your symptoms, but in all likelihood, it will not completely cure them. View CBD as a building block of a comprehensive treatment, not as the sole solution.

CBD products are not cheap and are usually not covered by health insurance. Expect monthly costs of 50-200 Euros, depending on the dosage and CBD concentration.

Cannabidiol (CBD) offers many Long Covid sufferers a promising, albeit not yet sufficiently researched, option for alleviating distressing symptoms such as fatigue, pain, sleep disorders, or anxiety. Initial studies and anecdotal reports suggest that CBD is very well suited to bringing the body back into balance - with significantly fewer side effects than conventional medications.

However, conclusive studies are still lacking. The therapeutic effect of CBD for Long Covid is primarily based on theoretical knowledge, small-scale experiments, and subjective experiences. Furthermore, interactions with other medications are possible, which is why it should always be used under medical supervision.

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