Many readers have asked us about CBD. "It has surpassed all other supplements in history in terms of rapid rise in sales and use in the U.S," according to the Mayo Clinic. But are these products safe? Are they effective? What's the big deal? There is a lot of misinformation about CBD, so here are the facts about what it is—and what it isn't.
You see these pricey little bottles everywhere, from food boutiques, supermarkets, and pharmacies, to hair salons and gas stations, often with large-font notices posted in the windows or aisles, “CBD Oil sold here.”
What Is CBD?
CBD (cannabidiol) is a molecule that occurs naturally and abundantly in the Cannabis sativa plant, the same plant that’s more widely known for delivering the high for people using marijuana.
Early research on CBD suggests it holds promise for chronic pain treatment, particularly in the context of opioid abuse. However, "no rigorous safety studies have been done on phytocannabinoid oils because these products are relatively new." See the full "Clinicians’ Guide to Cannabidiol and Hemp Oils."
Does CBD make you high?
No, CBD does not contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that produces a high. Unlike THC, CBD isn’t psychoactive (affecting perception and consciousness). However, CBD does have bioactive properties (properties that can affect human health), though these aren’t well researched or understood.
Cannabis plants have served many purposes over the centuries. 1. Cannabis sativa plants that contain a high percentage of THC are called "marijuana." 2. Those selected for fiber, food, and hundreds of industrial uses, containing a low percentage of THC, are called "hemp." The CBD you see advertised everywhere comes mostly from the flowers of low-THC hemp.
Is CBD Legal?
Yes, the Federal Farm Bill of 2018 legalized "hemp," defining it as cannabis plants containing 0.3 percent or less of THC. Cannabis plants containing more than 0.3 percent THC, even though they may also contain a large percentage of CBD, are classified as marijuana. Since passage of the 2018 Farm Bill, CBD extracted from hemp is legal nationwide, although individual states may regulate it. CBD from higher-THC cannabis plants is still illegal on the federal level, though it may be legal under some state laws.
In 2018, the U.S. Food and Drug Administration (FDA) approved Epidiolex, a prescription-only CBD medicine for the treatment of two rare and severe forms of epilepsy. Epidiolex is currently the only CBD product approved for sale by the FDA.
Is CBD Regulated?
No, CBD does not have FDA approval for therapeutic use as of this writing. But because production and sale of hemp is now legal, and because it lacks clear regulatory and enforcement standards, CBD sales have soared. Today, it’s being promoted for pretty much any chronic condition affecting either humans or companion animals.
Most CBD is sold infused in oil. But you’ll also find it for sale in capsules, tinctures, sublingual drops, vaping cartridges, bath bombs, shampoos and conditioners, creams, lip balms, lotions, and even toothpastes.
Although the FDA currently prohibits adding CBD to foods or beverages, the marketplace teems with gummy bears, muffins, sparkling water, kombucha, teas, and coffees containing CBD. Even restaurants are adding or offering to add it (illegally) to doughnuts, cocktails, lattes, salad dressings, and more.
Although you’ll find lots of testimonials praising this or that product, there are no nationwide standards regulating the safety, purity, and effectiveness of CBD products. Buyer beware.
It's critical to buy from a reputable seller. Without clinical evidence, vendors can make false claims. CBD has been touted to prevent or treat neuropathy, arthritis, diabetes, depression, cancer, opioid withdrawal, sleep disorders, PTSD, Parkinson’s disease, Alzheimer's, ADHD, and more.
Update: As of 2020, the House Agricultural Committee introduced legislation which would allow the FDA to 1. regulate CBD that comes from hemp as a dietary supplement, 2. require a study and report from the U.S. Department of Agriculture, which oversees the production of hemp, on the regulatory and market barriers for farmers engaged in hemp production. This would also identify barriers to success for hemp farmers, informing growers and policy makers of the challenges facing this new industry. Growers need regulatory certainty.
So What’s the Big Deal About CBD?
It’s profitable! Adding CBD to a food item may double its price. Because of its reputed healing potential, and because the CBD industry operates at the margins of legality, estimates of the current and future size of the overall CBD market are hard to determine and vary widely. Some predict overall sales to hit more than $20 billion in the United States by 2024, up from $591 million in 2018.
But research on human subjects remains sparse.
What Are the Benefits of CBD?
A review in late 2019 by the Mayo Clinic finds that there's a growing body of pre-clinical and clinical evidence to suggest that CBD oils may hold promise.
Specifically, there seems to be potential for treating conditions such as chronic pain and opioid addiction.
Pre-clinical studies suggest CBD and hemp oil have anti-inflammatory effects and may be helpful with improving sleep and anxiety, too.
However, more research involving humans is needed before health care providers can definitely say that they're helpful and safe. Trials in humans are still limited, so it is too early to be definitive about efficacy and safety.
Also, with lack of regulation, research on the products themselves has revealed that many CBD products contain toxic contaminants, synthetic additives, high levels of THC, or no CBD at all. Also, many questions remain about potential harms such as interactions between CBD and other drugs/supplements, as well as the long-term effects of chronic CBD use.
You may see products whose labels or advertising show the test results from labs, certifying their products contains the amount of CBD stated on the label and are free of contaminants. But remember, these labs can’t certify either the product’s effectiveness or its potential for harm. In terms of safety, there has also been growing number of reports of liver injury in patients who have used CBD products. With greatly increasing patient interest in CBD and hemp oil products, it's important that clinical research moves ahead to better understand their efficacy and safety.
If You’re Considering Trying CBD:
If you choose to try CBD, medical professionals offer these suggestions:
Talk it over with your doctor (also your pharmacist, and the senior staff at a state-licensed cannabis dispensary if your state has legalized medical marijuana) before you do. Ask about the potential interactions between CBD and other drugs or supplements you’re taking.
Ask if your doctor can recommend a product from a reputable seller.
Begin with a low dose, and work up slowly to the recommended therapeutic dose.
Stay alert for side effects, especially if you take prescribed drugs or other supplements.
Use extreme caution using cannabis products (or consider abstaining) if you’re pregnant or nursing. There’s very little research on the effects of cannabis compounds on developing brains and other organ systems.