A mother uses CBD to treat her son’s seizures. A veteran hopes it will reduce his anxiety and various aches and pains. A housewife says it helps her sleep through the night. Even a pet owner uses it to calm his anxious Saint Bernard. These are just some of the estimated 64 million Americans who have tried CBD (cannabidiol) in the past two years, according to a recent survey of more than 4,000 Americans. The survey found that more than a quarter of people—spanning all age groups—say they’ve tried CBD, a compound in marijuana and hemp that doesn’t get you “high.” One out of 7 of those people said they use it every day. Most of those who tried CBD reported that it was “effective,” especially among those who used it for anxiety. In some cases, they said CBD allowed them to eliminate over-the-counter or prescription drugs, including pain-killing opioids.
Sold in pill form, oils, tinctures, topical lotions, and even in bottled water, coffee, beer, and cosmetics, CBD is already in hundreds of products on the market. And that could soon rise sharply, in part because of recent changes in federal law that allow U.S. farmers to legally grow hemp. The CBD market from hemp alone is expected to grow to $22 billion by the end of 2022, up from $327 million in 2017.
Meanwhile, some scientists, doctors, and public health officials question what’s really known about the benefits—and risks—of CBD alone.
SO WHAT DO WE KNOW ABOUT CBD ALONE?
Until recently, CBD was an underappreciated compound in cannabis. Growers actually tried to breed it out of plants, seeking strains with higher levels of THC (tetrahydrocannabinol), which is the chemical responsible for most of marijuana’s psychological effects.
Some research suggests that CBD may affect the “endocannabinoid system,” a series of receptors found throughout the body that seem to interact with various compounds in cannabis, including CBD, and some of which are related to feelings of anxiety and pain, or that help regulate the body’s sleep-wake cycles.
CBD’s most far-reaching health effect may be its anti-inflammatory properties throughout the body, including the central nervous system and the brain. In a 2018 review, researchers said such effects could possibly reduce anxiety, depression, and post-traumatic stress disorder (PTSD), and even benefit people who have had a concussion. The best studies of CBD so far, however, have been in the area of epileptic seizures, and the results were strong enough that last year the Food and Drug Administration (FDA) approved a prescription version of CBD, called Epidiolex.
A Consumer Reports’ survey provided some support for CBD’s possible health benefits. Almost three-quarters of people who took CBD said it was at least moderately effective for the main reason they took it, with 48 percent of them saying it was very or extremely effective. CBD seemed to work for some of the most common problems, including easing stress and joint pain, and improving sleep. The survey also suggested that side effects are uncommon; almost three-quarters said they experienced no side effects. Also promising: 22 percent of people who took CBD for one of the health problems they were asked about said it helped them replace prescription or OTC drugs, with more than a third of them saying they used it to replace opioids. And some researchers across the U.S. are now studying whether CBD (alone or in combination with THC) could be a tool in the fight against the ongoing opioid crisis.
One important caveat, however, is that CBD, as used for all these apparently “successful” applications, none has passed the rigorous criteria required by the FDA. The only exception is its use to control of epileptic seizures, as noted above (in which high doses are required in the adult range of 300-400 mg/day). This places CBD otherwise into the general category of “supplements” which are often useless and often rely on their apparent “successes” attributable to the well-known “placebo effect,” that is, a property capable of “tricking” the mind into believing that said nostrum is actually working—especially to combat subjective problems such as pain, fatigue, anxiety, or depression. Moreover, supplements, in general, have not been studied extensively enough to provide a clear picture of all their side effects and dangers. Though it’s often well-tolerated, CBD can cause side effects including dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications such as blood thinners.
CBD’S LEGAL STATUS
The legal status of CBD is still somewhat murky. Forty-seven states have passed laws legalizing it to one extent or another. (If it comes from hemp, THC levels must stay very low—0.3 percent or below compared with the 20 percent or higher concentrations typical in marijuana.) And the 2018 Farm Bill allows farmers to grow hemp and legalizes hemp derivatives like CBD. The bill also removes CBD extracted from hemp from the Drug Enforcement Administration’s (DEA) list of Schedule I drugs such as heroin, which they deem to lack any medical use and to pose a high risk of abuse. (Marijuana and THC remain Schedule I drugs.) But on the federal level, the FDA still has reservations. Although the agency has approved the CBD based anti-epileptic prescription drug—Epidiolex—any product that markets the compound for any other health purpose must go through the FDA’s rigorous official drug approval process. In addition, the FDA notes that when CBD is put into food—say, a cookie, honey, coffee, or water—it is considered a “food additive.” And the agency has not yet approved CBD for that purpose.
As a result, some local health officials have started to crack down on CBD in food and drink. New York City has prohibited adding CBD to food and drink after being advised by the FDA that this was an unlawful act. Regulators in Maine, Ohio, and elsewhere have taken similar steps..
WHERE CAN CBD BE OBTAINED?
One should first decide why he/she would want to use CBD. Though, as noted above, it’s being touted for numerous possible health benefits, for now it’s only clearly proved to help treat only two rare, but devastating, forms of epilepsy.
And even less is known about which forms of CBD—pill, topical, or drop, for example—might be appropriate. Still, experts do have some advice: For very quick relief of, say, muscle cramps or anxiety, inhaling CBD may be most effective, via either a vape pen (think e-cigarette) or cigarette-style. For effects within a few minutes, oil drops under the tongue may be useful. Topical lotions, rubbed onto the skin, vary from person to person—some may feel it right away, others not for several hours. On the other hand, CBD in food products is likely to take longer—30 minutes or more—to be absorbed into the system.
Next, consider how much THC the product contains. This is important, mainly if one wants to avoid the psychological high that comes with marijuana. Some research suggests that in some people, CBD may work better when it’s combined with at least a little THC. This is called the “entourage effect,” the idea that the sum of the two chemicals, plus other related compounds in the plant, is greater than their individual parts. However, that notion is more theoretical than proven. Possibly only a small amount of THC—as low as the 0.3 percent cutoff required for CBD products made from hemp—may be needed to enhance CBD’s therapeutic effect.
So if you want a product that has a little THC but not so much to get you high, look for one made from hemp. Such products have the added benefit of being widely available, including online and in retail stores. Although CBD products should also include THC levels on their labels, many made from hemp don’t. For that, you need to check a product’s test results, if they are available.
If one seeks a CBD product that contains more than 0.3 percent THC, that could be tougher yet, for such products are limited to states that have legalized marijuana, not just CBD. This will necessitate going to a state-licensed dispensary to buy it and, in the 20 states that have legalized just the medical use of marijuana, one will need a recommendation from a physician. In states that have legalized medical and recreational use, there’s no need to see a doctor first, but one must be over 21.
Dispensaries may sell a variety of “CBD-rich” products that are high in CBD and relatively low in THC, including oils, tinctures, topicals, and vaping liquids. For example, the strain “AC/DC” can be just 0.5 percent THC, much lower than the 20 percent or higher THC concentration typical of most marijuana strains. Still, some people are much more sensitive than others to the psychoactive effects of THC. So if one wants to avoid this type of high, it’s better to stick with CBD from hemp.
- FOR PRODUCTS FROM HEMP, FIND WHERE IT WAS GROWN
Many CBD products sold online and in retail stores come from hemp, not marijuana. And the source of that hemp can be important. Most hemp used in CBD products sold in the U.S. comes from Colorado or Oregon (which have long histories with cannabis) or Kentucky (which passed a law to support hemp growers in 2013), or is imported from overseas. Among those sources, Colorado has the most robust hemp program. The state’s agricultural program performs spot-tests of hemp plants while they are still in the field to check THC levels and will investigate the potential use of any illegal pesticides based on complaints. Products made with hemp grown overseas can be more problematic, because they are not subject to any state or federal testing. There needs to be testing results available to consumers, and manufacturers should follow the FDA’s guidance for good manufacturing practices.
For CBD products from hemp, check labels to see whether they say where it was grown, and look especially for those from Colorado. Not all products, however, include that information. So in a dispensary or a retail store, ask the staff whether they know where the hemp was grown. And for products purchased online, check the company’s website to see whether it has that information.
- ASK FOR TEST RESULTS
Always ask to see a product’s COA, or certificate of analysis. That document shows how a product performed on tests checking for CBD and THC levels, and the presence of contaminants. For products made with CBD from hemp, even Colorado doesn’t require testing of the finished product. So any COA for those final products comes from testing that the company arranged on its own. Though not all manufacturers take that step, many do. That includes even some companies that use imported hemp, such as CV Sciences, which makes Plus CBD Oil from hemp grown in Holland. If an online manufacturer or a retail store doesn’t have the information, or refuses to share it, avoid the product and the retailer.
My state, Indiana, has made it easier for consumers to find these COAs. Since July, all hemp-derived CBD products sold in stores in Indiana must include a QR code on their label that lets consumers download a product’s COA to their phone. All CBD products sold at Indiana locations of Fresh Thyme Farmers Market, a Midwest regional chain, now carry those codes.
For even more assurance about a product’s quality, one should check the COA to see whether it says that the lab meets “ISO 17025” standards. That suggests the lab adheres to high scientific standards. Also look to see whether a company uses testing methods validated by one of three respected national standard-setting organizations: the Association of Official Agricultural Chemists (AOAC), the American Herbal Pharmacopoeia (AHP), or the U.S. Pharmacopeia (USP).
Unlike hemp-derived CBD products, those made from marijuana must undergo testing—at least in states that permit medical and recreational use of marijuana. In some of those states, the dispensary staff is supposed to have the COAs available and be willing to share them with you. If they aren’t, or the COA is not available, go to another dispensary or choose another product.
- LOOK FOR PRODUCTS THAT LIST THE CBD AMOUNT
Products should show how much CBD is contained in both the whole bottle but in each dose. Dosages, which are expressed in milligrams (mgs), vary considerably depending on the form of the product, and one should start with products that have relatively low doses. For example, with tinctures, consider a product that has just 10 mg per dose. On the other hand, take extra care with products that list only the amount of total “cannabinoids” they contain, not specifically how much CBD is in them. Those cannabinoids could include not just CBD and THC but dozens of other related compounds. Companies may take that labeling approach because they seem to hope it will attract less scrutiny from the FDA. Little is known about optimum or maximum dosage levels, as used for various assumed indications.
Some of those products, which don’t include the CBD amount on their label, market themselves as “whole plant” or “full spectrum” hemp products, or say they are rich in other compounds from the plant. In those cases, one should check the COA, if they have one, which lists how much CBD or THC they contain.
- AVOID PRODUCTS THAT MAKE SWEEPING HEALTH CLAIMS
Making health claims, even just the ability to treat relatively minor problems like migraines, is legal only for prescription drugs, which undergo extensive testing for effectiveness and safety. And the more dramatic the claim, such as the ability to cure cancer or heart disease, the more skeptical you should be. Since 2015, the FDA has cracked down on dozens of companies selling CBD products online for making unpermitted health claims.
Although being touted for many possible benefits, be aware that little is scientifically proven about health pluses and minuses associated with CBD. So if you wish to try this product, I have provided the various possible benefits and safeguards, and how to obtain it. The rest is up to the reader, but healthy skepticism is advised!