CBD Oil 101: Uses, Benefits, Side Effects, and More
Shannon Donnelly, a 30-year-old entrepreneur in Denver, was going through a difficult time several years ago that led to anxiety and occasional panic attacks. One night when h er heart began beating fast and she felt as if she couldn’t catch her breath, couldn’t think clearly, and couldn’t stand up straight, she knew a life adjustment was in order.
“I realized I really needed to do something different to change my life, that I could do something to stop my anxiety and change my life,” she recalls. That something turned out to be taking cannabidiol, aka CBD.
Google “CBD” and more than 150 million results will pop up, many purporting that this natural chemical derived from cannabis is a magical elixir that can do just about anything from relieving anxiety , pain , insomnia , and menstrual cramps to clearing your skin , staving off aging , and bulking up your bones .
The trouble is there’s scant scientific evidence to support most of those claims, and there’s still a lot of uncertainty about CBD’s potential side effects and even its legality. “Cannabidiol is the No. 1 new treatment people are asking about,” says Susana Galle, PhD , a psychologist, clinical nutritionist, and certified naturopath in Washington, DC. “But although there’s tons of talk about it and lots of products out there, there’s still not much evidence.”
And yet the buzz is so strong that to say CBD-infused products are selling like hotcakes would be an understatement. In 2018 alone, the Hemp Business Journal estimates, more than $500 million worth of CBD-infused oils, creams, patches, beer, coffee — even tampons and pet food — were sold in the United States, a number forecast to hit nearly $2 billion by 2022. ( 1 )
Common Questions & Answers
CBD (cannabidiol) is one of more than 80 active compounds called cannabinoids found naturally in the cannabis sativa plant. CBD can be extracted into a thick, oily paste and mixed with a carrier oil (like hemp oil or coconut oil) to produce CBD oil, which is made with a specific concentration of CBD.
CBD interacts with the endocannabinoid system, a network in the body that helps regulate many functions, including digestion, metabolism, mood, memory, sleep, motor control, pain perception, immune function, fertility, and pregnancy. Pain, anxiety, and depression are the top three conditions for which people report taking CBD. In addition, CBD effectively reduces seizures in two types of pediatric epilepsy. A liquid CBD anti-seizure drug, Epidiolex, was approved by the FDA in June 2018.
The medical consensus is yes. A World Health Organization report published in November 2017 states: “To date, there is no evidence of public health–related problems associated with the use of pure CBD.” Still, it can be harmful if labels aren’t accurate or if people start to treat medical conditions with CBD instead of medication for which there is compelling evidence of effectiveness from well-designed clinical studies. Poor quality CBD can cause symptoms ranging from headaches and nausea to fatigue, diarrhea, and changes in appetite and weight. Widespread CBD use is still in its early days, so long-term effects have yet to be studied.
CBD derived from low-THC hemp is now legal in every state. (Hemp-derived CBD is not derived from high-THC cannabis plants.) The catch: Because CBD was approved as the active ingredient in the anti-seizure medicine Epidiolex, the FDA considers it a drug, making it illegal to sell as an OTC supplement. How that prohibition might be enforced isn’t known. The situation should become clearer over the next year or two, as a regulatory framework is better established.
CBD is not psychoactive, so you can’t get stoned on it alone. Its chemical cousin, THC (tetrahydrocannabinol), is the only cannabinoid that causes a high. Marijuana-derived CBD oil comes from high-THC cannabis plants, which can contain varying amounts of THC. Hemp-derived CBD oil is extracted from low-THC cannabis plants; it’s this nonintoxicating, hemp-derived CBD that is sold over the counter and added to so many products these days.
What Exactly Is CBD Oil?
CBD is one of more than 80 active compounds called cannabinoids found naturally in the cannabis sativa plant, according to a study published in January 2019 in The Permanente Journal. ( 2 ) Extracting it results in a thick oily paste, which is then typically mixed with a carrier oil, such as hemp oil or coconut oil , to produce a product with a specific concentration of CBD. That product is CBD oil.
Condition Kitchen Bites: Cacao Smoothie
How Do You Use CBD Oil?
CBD-infused products fall into four basic categories, according to the book CBD: A Patient’s Guide to Medicinal Cannabis — Healing Without the High : ( 3 )
- Ingested CBD Swallowing CBD oil allows it to pass through the digestive system and be metabolized by the liver, sending its active compounds throughout the body over several hours. CBD oil is usually ingested in drops, tinctures, and capsules, or added to foods and beverages, such as gummy candies and coffee. CBD can also be ingested as a powder made by removing all plant matter to reveal a crystalline powder that has no taste or odor.
- Sublingual CBD Another popular way to take CBD is to place a few drops of the oil or tincture, or a small bit of the powder, under the tongue and hold it there for several seconds. This allows the active ingredients to be rapidly absorbed into the bloodstream through mucus membranes in the mouth.
- Topical CBD CBD-infused products are applied to the skin to relieve pain and reduce inflammation directly where needed. Topical products include creams, salves, patches, shampoos, suppositories, lip balms, bath salts, and personal lubricants.
- Inhaled CBD CBD can be inhaled by vaporizing the oil or by adding the oil or powder to e-cigarettes or tobacco and smoking them. Inhaled CBD enters the bloodstream rapidly through the lungs, avoiding the digestive system. For this reason, “vaping” has been a popular way of using CBD. But a mysterious spate of lung injuries linked to inhaling products has led the Centers for Disease Control and Prevention (CDC) to urge people to refrain from vaping while they investigate. Most of the people in the more than 800 cases reported by the end of September 2019 were in patients who used products containing THC (tetrahydrocannabinol), according to the CDC. Like CBD, THC is a cannabinoid, and the two are often found together in vaping products.
What Are Medical Marijuana and CBD? Everything You Need to Know
Can You Get Stoned (or High) on CBD?
No, you can’t get blissed out on CBD alone. ( 3 ) Its chemical cousin, THC, is the only cannabinoid that causes the high associated with marijuana use. For this reason, it’s important to know exactly what type of CBD you’re buying:
Marijuana-derived CBD oil is extracted from high-THC cannabis plants, which can contain varying amounts of THC. (The ratio of CBD to THC is typically listed on the product label.) Any product with more than 0.3 percent THC is considered a controlled substance and can only be bought in a state where medical or recreational marijuana is legal. ( 4 )
Although the science is scant, the British Journal of Pharmacology reported that some experts believe combining CBD with THC enhances CBD’s pharmacological benefits, a theory known as the “entourage effect.” ( 5 )
Hemp-derived CBD oil is extracted from low-THC cannabis plants. This is the type of CBD sold over the counter in nutrition stores and supermarkets, added to lattes in cool coffee shops, and infused into luxe beauty products.
Because it’s not intoxicating, hemp-derived CBD is what’s fueling the CBD craze. What once was called “hippie’s disappointment” is now being embraced precisely because it can induce the relaxing effects of marijuana without any worry that it will impact your consciousness, explains psychologist Lara Fielding, PsyD, author of Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grown-Up .
“I’ll confess, I tried CBD, and my whole life I’ve been an adamant anti-drug person because people I’ve known and loved have ruined their lives with drugs,” Dr. Fielding says. “And I’ve been converted. It triggered a wonderful feeling of going from tension and pain and distress to feeling fine without altering me in any other way.”
What Does CBD Do in the Body?
In a nutshell, CBD interacts with the endocannabinoid system, a large messaging network in your body that plays a key role in regulating many physiological functions. In fact, cannabinoids are so essential to good health that your brain actually produces its own cannabinoids.
According to a study published online in March 2018 in the International Journal of Molecular Sciences, the physiological functions affected by cannabinoids include: ( 6 )
- Appetite, digestion , and metabolism
- Mood, memory , and sleep
- Motor control
- Pain perception
- Immune function (including inflammation )
- Fertility and pregnancy
Health Conditions for Which Medical Marijuana May Be Beneficial
Doctors React to News That States With Legal Marijuana Prescribe Fewer Opioids
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Marijuana for Rheumatoid Arthritis Pain: Pros and Cons
Crohn’s and Medical Marijuana: What to Know
Is There Any Proof CBD Works?
The strongest scientific evidence of CBD’s efficacy in humans is for reducing seizures in two rare types of epilepsy that occur in children: Dravet syndrome and Lennox-Gastaut syndrome. Based on that evidence, a liquid CBD anti-seizure drug, Epidiolex , obtained approval from the Food and Drug Administration (FDA) in June 2018. (7)
Otherwise, the only disorder for which there is “conclusive or substantial evidence” that CBD is helpful is multiple sclerosis, according to a report published in January 2017 by the National Academies of Sciences, Engineering, and Medicine. (8) The same report found “moderate” evidence that CBD improves sleep in people with chronic pain and certain other conditions, and only “weak” evidence for supporting or disproving all other claims of CBD’s health effects.
8 Medical Conditions CBD Can Help Treat
On the other hand, no studies have shown that CBD is harmful, says Debra Jaliman, MD , author of Skin Rules: Trade Secrets From a Top New York Dermatologist . While research into CBD’s usefulness in skin-care products is admittedly limited, some facts point to its potential benefits. “CBD has been shown to be rich in amino acids , [which] provide nutrients to nourish the hair, skin, and nails ,” Dr. Jaliman notes. “CBD’s also a powerful antioxidant . Antioxidants protect the skin by limiting the production of free radicals, which can damage skin cells. And CBD contains fatty acids , which help in keeping the skin healthy.”
What Do People Most Often Use CBD Oil For?
In a survey published in the July 2018 issue of Cannabis and Cannabinoid Research, almost 62 percent of CBD users reported using it to treat a medical condition, the top three being pain, anxiety, and depression . ( 9 )
Although the FDA has not approved using CBD to treat any of those conditions, there are signs CBD could be beneficial.
1. Pain So far, most of the evidence for CBD’s ability to reduce pain comes from animal-based research, including a study published in December 2017 in the journal Pain, which found that CBD applied on the skin of rats with osteoarthritis significantly reduced joint pain and inflammation. (10) Continued use of CBD also prevented further pain and nerve damage in those same joints.
2. Anxiety While there haven’t been any large-scale clinical trials testing CBD oil as a treatment for generalized anxiety disorder , social anxiety , panic disorder , or phobias , a small study published in January 2019 in The Permanente Journal showed promising results. ( 2 )
During the two-month study, 72 adults in a psychiatric clinic were given CBD oil capsules once daily. Most received 25 milligrams (mg) of CBD with a few receiving doses as high as 175 mg. Within the first month, more than 79 percent of the patients reported feeling calmer, and they continued to feel calmer for the duration of the study. “We saw no evidence of a safety issue that would limit future studies,” the researchers added.
3. Depression Animal studies, including a study on mice in which depression was surgically induced, suggest that CBD is a potential treatment for depression . In this particular study, published in April 2016 in the journal Neuropharmacology, CBD worked “fast” on receptors in the brain to boost levels of serotonin , a chemical messenger thought to play an important role in regulating mood. ( 11 ) More recently, a study published in February 2019 in the journal Molecular Neurobiology showed that CBD induces “sustained antidepressant-like effects in mice.” ( 12 )
“The animal data are very promising for a number of conditions, but rigorous randomized clinical trials have yet to be done,” says Kevin Hill, MD , director of the division of addiction psychiatry at Beth Israel Deaconess Medical Center in Boston and an assistant professor of psychiatry at Harvard Medical School in Boston. “That is one of the frustrating aspects of the current state of cannabis: There are many companies and states profiting from the sale of cannabis and cannabinoids, but those same companies and states are not putting financial resources toward advancing the science.”
For Shannon Donnelly, her own experience with CBD is evidence enough. Since beginning a daily CBD regimen several years ago, she says her panic attacks are gone, as are other health problems, including depression. She currently takes 35 mg of CBD each morning and soaks in a tub of warm water laced with CBD bath salts each night.
“CBD gives me confidence,” Donnelly explains. “It gives me clarity and calm. I am now able to go into situations in which previously I would have used coping mechanisms that were very detrimental to myself, such as catastrophizing, negative self-talk , and overwhelming sadness .”
Donnelly’s experience so convinced her of CBD’s worth that she founded a company, Healthy Honeys , to spread the word — and to combat a particular problem that has plagued the CBD industry: inaccurately labeled products.
What Is CBD Oil?
This cannabis extract may help treat nerve pain, anxiety, and epilepsy
Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman’s World, and Natural Health.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Meredith Bull, ND, is a licensed naturopathic doctor with a private practice in Los Angeles, California.
Cannabidiol (CBD) oil is an extract from hemp plants called Cannabis indica and Cannabis sativa . You might be more familiar with cannabis plants because they are grown for marijuana. However, CBD is not the same thing as marijuana.
CBD oil contains CBD that’s mixed with a base (carrier) oil, like coconut oil or hemp seed oil. These are called tinctures. You can get tinctures in different concentrations. The oil can also be put into capsules, gummies, and sprays.
People who support using CBD oil say that it can treat pain and anxiety; can help stimulate appetite and may help manage some types of seizures.
This article goes over what CBD is used for, the possible side effects, and what you should look for if you choose to buy CBD.
CBD vs. Marijuana
CBD is one component (called a cannabinoid ) that’s found in a hemp plant. Marijuana is a separate plant but it’s from the same species that hemp belongs to. Marijuana has CBD and hundreds of other compounds in it.
The main difference between hemp plants and marijuana plants is how much of a compound called tetrahydrocannabinol (THC) is in them. Hemp is grown to have less than 0.3% THC, while marijuana has more.
THC is what’s responsible for the psychoactive effects of cannabis—in other words, it’s what makes you feel “high.”
CBD oil generally does not have THC in it; however, a very small (trace) amount might be in products sold in certain states.
What Is CBD Oil Used For?
We’re not sure exactly how CBD works. Unlike THC, CBD doesn’t have a strong connection with the molecules in the brain that THC binds to create psychoactive effects. These are called cannabinoid receptors.
Instead, CBD works on other receptors, like the opioid receptors that help control pain. It also affects glycine receptors that control a brain chemical called serotonin which helps control your mood.
People that support the use of CBD claim that CBD oil can treat a variety of health problems, including:
- Chronic pain
- Drug use and withdrawal
- High blood pressure
- Muscle spasms
- Poor appetite
As CBD has gained popularity, researchers have been trying to study it more. Still, there has not been a lot of clinical research to look for evidence in support of these health claims.
CBD is not a safe option for everyone. Talk to your healthcare provider if you want to try it for managing a health condition.
A 2015 review of research that was published in the journal Neurotherapeutics suggested that CBD might help treat anxiety disorders.
The study authors reported that CBD had previously shown powerful anxiety-relieving effects in animal research—and the results were kind of surprising.
In most of the studies, lower doses of CBD (10 milligrams per kilogram, mg/kg, or less) improved some symptoms of anxiety, while higher doses (100 mg/kg or more) had almost no effect.
The way that CBD acts in the brain could explain why this happens. In low doses, CBD might act the same as the surrounding molecules that normally bind to the receptor that “turns up” their signaling.
However, at higher doses, too much activity at this receptor site could produce the opposite effect.
There have not been many trials to look at CBD’s anxiety-relieving effects in humans. However, one was a 2019 study published in the Brazilian Journal of Psychiatry.
For the study, 57 men took either CBD oil or a sugar pill with no CBD in it (placebo) before a public-speaking event.
The researchers assessed the participants’ anxiety levels using measures like blood pressure and heart rate. The researchers also used a reliable test for mood states called the Visual Analog Mood Scale (VAMS).
The men who took 300 mg of CBD oil reported less anxiety than the men who were given a placebo; however, the men who took 100 mg or 600 mg of CBD oil did not experience the same effects.
CBD oil might help people with substance use disorder, according to a 2015 review published in the journal Substance Abuse.
The review looked at the findings from 14 published studies. Nine of the studies looked at the effects of CBD on animals, and five studies looked at the effects on humans.
The researchers reported that CBD showed promise for treating people with opioid, cocaine, or psychostimulant use disorders.
However, the effects of CBD were quite different depending on the substance. For example, CBD without THC did not decrease withdrawal symptoms related to opioid use.
On the other hand, it did reduce drug-seeking behaviors in people using cocaine, methamphetamine, and other similar drugs.
Some experts suggest that CBD could help treat cannabis and nicotine dependence, but more research is needed to provide this theory.
High Blood Pressure
A 2017 study found that CBD oil may reduce the risk of heart disease because it can lower high blood pressure in some people.
For the study, nine healthy men took either 600 mg of CBD or the same dose of a placebo. The men who took CBD had lower blood pressure before and after experiencing stressors like exercise or extreme cold.
The study also looked at the amount of blood remaining in the heart after a heartbeat (stroke volume).
The stroke volume in the men who took CBD was lower than in was in the placebo group, meaning their hearts were pumping more efficiently.
The study suggested that CBD oil could be a complementary therapy for people with high blood pressure that is affected by stress and anxiety.
However, there is no evidence that CBD oil can treat high blood pressure on its own or prevent it in people at risk. While stress can complicate high blood pressure, it does not cause it.
In June 2018, the U.S. Food and Drug Administration (FDA) approved a CBD oral solution called Epidiolex.
Epidiolex is used to treat two rare forms of epilepsy in children under the age of 2: Dravet syndrome and Lennox-Gastaut syndrome. These are very rare genetic disorders that cause lifelong seizures starting in the first year of life.
Other than for these two disorders, CBD’s effectiveness for treating seizures is not known. Even with Epidiolex, it’s not clear if the anti-seizure effects are from CBD or another factor.
However, there is some evidence that CBD interacts with seizure medicines like Onfi (clobazam) and raises their concentration in the blood. That said, more research is needed to understand the link.
Possible Side Effects
Clinical research has shown that CBD oil can cause side effects. The specific side effects a person has and how bad they are varies from one person to the next and from one type of CBD to another.
Some common side effects people report from using CBD include:
- Changes in appetite
- Changes in mood
- Dry mouth
CBD oil may also increase liver enzymes, which is a marker of liver inflammation.
People with liver disease should talk to their healthcare provider before taking CBD oil. They may need to have their liver enzymes checked regularly if they are using CBD.
Can You Use CBD If You’re Pregnant?
You should not use CBD oil if you’re pregnant or breastfeeding. Even though the effects of CBD are not fully understood, it does pass through the placenta.
The American Academy of Pediatrics (AAP) further states that pregnant people should not use marijuana because of the potential risks to a developing fetus.
Do not drive or use heavy machinery when taking CBD oil—especially when you first start using it or switch to a new brand. Remember that some products do contain THC, even in small amounts.
CBD oil can interact with medications, including many that are used to treat epilepsy. One of the reasons for this has to do with how your body breaks down (metabolizes) drugs.
Cytochrome P450 (CYP450) is an enzyme your body uses to break down some drugs. CBD oil can block CYP450. That means that taking CBD oil with these drugs could make them have a stronger effect than you need or make them not work at all.
Drugs that could potentially interact with CBD include:
- Anti-arrhythmia drugs like quinidine
- Anticonvulsants like Tegretol (carbamazepine) and Trileptal (oxcarbazepine)
- Antifungal drugs like Nizoral (ketoconazole) and Vfend (voriconazole)
- Antipsychotic drugs like Orap (pimozide)
- Atypical antidepressants like Remeron (mirtazapine)
- Benzodiazepine sedatives like Klonopin (clonazepam) and Halcion (triazolam)
- Immune-suppressive drugs like Sandimmune (cyclosporine)
- Macrolide antibiotics like clarithromycin and telithromycin
- Migraine medicine like Ergomar (ergotamine)
- Opioid painkillers like Duragesic (fentanyl) and alfentanil
- Rifampin-based drugs used to treat tuberculosis
Always tell your healthcare provider and pharmacist about all the medicines you take, including prescription, over-the-counter (OTC), herbal, or recreational drugs.
The interactions between these medications and CBD are often mild and you might not have to change your treatment.
However, in some cases, you might have to change medications or space out your doses to avoid a reaction. That said, never change or stop medication without talking to your provider.
Dosage and Preparation
There are no guidelines for using CBD oil. Each product works a bit differently, depending on the form.
For example, putting the oil under your tongue can produce effects more quickly than swallowing a capsule that needs to be digested.
Here are a few ways that you can take CBD oil:
- Placing one or more drops under your tongue and holding it there for 30 to 60 seconds without swallowing. You can also use a spray that is spritz in your mouth/under your tongue.
- Taking a capsule or chewing a gummy
There’s no “correct” dose of CBD oil. How much you take and the form you choose will depend on your needs and what you hope to get for effects. The average dose range is from 5 mg to 25 mg.
Most oils come in 30-milliliter (mL) bottles and include a dropper cap to help you measure.
That said, it’s hard to figure out the exact amount of CBD per milliliter of oil. Some tinctures have concentrations of 1,500 mg per 30 mL, while others have 3,000 mg per mL or more.
How to Calculate CBD Dose
To determine an exact dose of CBD, remember that each drop of oil equals 0.05 mL of fluid. This means that a 30-mL bottle of CBD oil will have about 600 drops in it.
If the concentration of the tincture is 1,500 mg per mL, one drop would have 2.5 mg of CBD in it. The math to figure that out looks like this: 1,500 mg ÷ 600 drops = 2.5 mg
What to Look For
CBD oil comes in different forms: isolates, broad-spectrum, and full-spectrum.
- Isolates contain only CBD
- Broad-spectrum oils nearly all of the components of the plan (e.g., proteins, flavonoids, terpenes, and chlorophyll), but does not have THC oils have all the compounds including THC (up to 0.3%)
Alternative medicine practitioners believe that the compounds provide more health benefits, but the is a lack of evidence to support these claims.
Remember that CBD oils are unregulated. There’s no guarantee that a product is what it claims to be on its packaging. You also can’t know for sure that it’s safe and effective.
A 2017 study reported that only 31% of CBD products sold online were correctly labeled. Most had less CBD in them than was advertised, and 21% had significant amounts of THC.
If you are interested in buying CBD products, here are a few tips to keep in mind:
- Buy American: Domestically produced CBD oil might be a safer option than those that have been imported.
- Go organic: Brands certified organic by the U.S. Department of Agriculture (USDA) are less likely to expose you to pesticides and other harmful chemicals.
- Read the product label: Even if you choose a full-spectrum oil, don’t assume that every ingredient on the product label is natural. CBD products can also have preservatives, flavorings, or thinning agents in them. If you don’t recognize an ingredient, ask the dispenser what it is or check online.
Hemp plants can be grown for different purposes. Some species are made for marijuana but others are used to make CBD products.
Unlike marijuana, CBD oil does not “get you high.” Instead, it may help relieve stress, anxiety, drug withdrawals, and nerve pain.
While there are many claims about the health benefits of using CBD oil, the evidence is lacking. A lot of studies were done with animals, not humans.
If you want to try CBD oil, you should learn about the different dosages and preparations first.
You should also know that the products are not regulated, which means you can’t know for sure that a product will work and be safe.
Before you use CBD oil, talk to your provider. If you take certain medications or have a health condition, you may not be able to use these products.
Frequently Asked Questions
It would be hard to overdose on CBD oil. Research has shown that human tolerance for CBD is very high. One study reported the toxic dose would be about 20,000 mg taken at one time.
It depends on where you live, the type of product, how it was sourced (e.g., is it from hemp or marijuana), and its intended purpose (medical or recreational). In many states, you must be 18 or 21 to buy CBD oil. Check your state’s laws.
Not necessarily. While the names are sometimes used interchangeably, hemp oil can also refer to hemp seed oil, which is used for cooking, food production, and skincare products.
CBD oil is made from the leaves, stems, buds, and flowers of the Cannabis indica or Cannabis sativa plant. It should contain less than 0.3% THC.
Hemp oil is made from the seeds of Cannabis sativa and does not have TCH in it.