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CBD: What Parents Need to Know

Parents are giving it to kids to combat anxiety and other problems. But there are risks, and little research to support it.

What You’ll Learn

  • Is CBD safe for kids?
  • What are the risks of giving kids CBD?
  • Can CBD help kids who have mental health disorders?
  • Quick Read
  • Full Article
  • What do we know about CBD?
  • Concerns about CBD
  • Is CBD safe?
  • CBD oil for anxiety
  • CBD and autism
  • Research boom

Quick Read

These days, you can find CBD everywhere. Some people believe that it can treat everything from chronic pain and cancer to anxiety and ADHD. But is it safe for kids?

CBD is still pretty new, so there’s very little research about its safety or how well it works, especially for children. So far, there’s only one marijuana-derived medication that has been approved by the Food and Drug Administration. It’s called Epidiolex, and it’s used to treat a rare form of epilepsy in patients who are at least two years old.

Because CBD is so new, there also aren’t a lot of rules about what can and cannot be included in CBD products. So, there’s a huge variety in the quality of products. You may even find different amounts of CBD in different packages of the same product.

Since there isn’t a lot of research about CBD, doctors say there are some risks with using CBD for kids. For example, CBD products may contain things other than CBD, and those things could be harmful. Plus, we don’t yet know if CBD works well with other medications or how much you should give your child.

Although a few studies have found that CBD oil might work for anxiety, they only looked at healthy people who were put in situations that made them anxious. There are no studies yet on people with chronic anxiety. Researchers are also exploring CBD for kids with autism spectrum disorder. The results are good so far, but more research needs to be done before we can know if it’s safe and effective.

CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better.

Though CBD — full name cannabidiol — is extracted from marijuana or hemp, it doesn’t contain THC, the chemical in marijuana that has psychoactive effects, so it doesn’t make you feel high.

Available in the form of vaping, oils, lotions, cocktails, coffee, gummies — you name it — CBD has been touted as a treatment for complaints as far-reaching as chronic pain, cancer, migraines, anxiety and ADHD. You know it’s gone mainstream when even Consumer Reports has issued guides on how to shop for CBD and tips for safe CBD use.

Not only are adults experimenting with CBD for whatever is bothering them, increasingly parents are turning to CBD to help their kids focus, sleep, calm down and more.

But popular use of CBD is blowing up with very little research into its safety or its efficacy, especially in children. The first and only marijuana-derived drug approved by the Food and Drug Administration, Epidiolex, is used to treat a rare, severe form of epilepsy in patients two years of age and older. And since cannabis is in the early stages of legalization and regulation, there is a huge variety in the quality and dosage of products — risks associated with using products that have not been vetted by the FDA.

What do we know about CBD?

For millennia, hemp plants have been used for medicinal purposes around the world. In 1851 marijuana was classified by the United States Pharmocopeia as a viable medical compound used to treat conditions like epilepsy, migraines and pain. But since marijuana and cannabis-related products were made illegal in the US in 1970, there has been a dearth of research about either marijuana or CBD. Its classification as a Schedule 1 drug made it nearly impossible to get federal funding to study cannabis.

“The biggest problem is there’s a lot that we still need to know, especially in kids,” says Paul Mitrani, MD, a clinical psychiatrist at the Child Mind Institute. “In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.”

Dr. Mitrani, who is a pediatrician and child and adolescent psychiatrist, says it’s an area worthy of investigation but recommends that parents wait until further research is done before giving a child CBD.

Concerns about CBD

While anecdotal evidence of the benefits of CBD is common, there are risks associated with using these products, especially in children. Some of the concerns:

  • Products are unreliable in delivering a consistent amount of CBD. They could have less, or more, than advertised, and most do not offer independent verification of active contents. Analysis of products for sale show that many do not have the amount of CBD that they advertise. “So you can’t depend on the quality of what you’re getting,” notes Dr. Mitrani.
  • How much is absorbed? Very little is known about how much CBD is actually delivered to the brain in a given product. Various delivery systems — vaping, taking it orally, eating it in baked goods, etc. — have different rates of delivery. Even the oils that the CBD is dissolved in can result in varying effects. “Effects can vary a lot based on the delivery system used and the amount people are exposed to can be inconsistent,” Dr. Mitrani says.
  • Products may contain things other than CBD, and they could be harmful. Lab testing — which provides information about CBD levels, THC levels (if any), and contaminants in the product — isn’t mandatory for CBD products in every state. Without a CoA (Certificate of Analysis) it’s that much harder to verify the safety of the product. Bootleg CBD may be connected to recent lung illnesses and deaths that have been attributed to vaping. The CDC and the American Medical Association recommend avoiding vaping entirely while the cause of these illnesses is determined.
  • CBD may be safe itself, but it may interact with other medications a child is taking, that are also metabolized in the liver.
  • If it’s used for sleep, Dr. Mitrani worries that while it may potentially help with sleep, “your child may become tolerant to it and possibly experience worsening sleep problems if stopped.”
  • Since CBD use — especially for kids — is a still so new, few people are familiar with dosing for children, so determining how much to give your child would be tricky. Clinical doses versus what you might find at a coffeehouse could vary dramatically.
  • The legality of cannabis products and CBD is still murky. CBD derived from hemp is federally legal, while CBD derived from marijuana plants is subject to the legal status in each state — and remains federally illegal. Meanwhile, the FDA issued a statement making clear that products that contain CBD — even if they are derived from legal, commercial hemp — cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use.

Is CBD safe?

Last year the World Health Organization, acknowledging the explosion in “unsanctioned” medical uses of CBD, reviewed the evidence for its safety and effectiveness. The WHO report concluded that “CBD is generally well tolerated with a good safety profile.” Any adverse effects could be a result of interactions between CBD and a patient’s existing medications, the WHO noted.

The report found no indication of potential abuse or dependence. “To date there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”

As for effectiveness, the WHO noted that several clinical trials had shown effectiveness for epilepsy, adding: “There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”

CBD oil for anxiety

In 2015 a group of researchers led by Esther Blessing, PhD, of New York University, investigated the potential of CBD for treating anxiety. In a review of 49 studies, they found promising results and the need for more study.

The “preclinical” evidence (ie from animal studies) “conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders,” Dr. Blessing wrote. Those include generalized anxiety disorder, PTSD, panic disorder, social anxiety disorder and OCD.

The review notes that the promising preclinical results are also supported by human experimental findings, which also suggest “minimal sedative effects, and an excellent safety profile.” But these findings are based on putting healthy subjects in anxiety-producing situations and measuring the impact of CBD on the anxiety response. Further studies are required to establish treatment with CBD would have similar effects for those who struggle with chronic anxiety, as well as what the impact of extended CBD use may be.

“Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders,” Dr. Blessing concludes, “with need for further study of chronic and therapeutic effects in relevant clinical populations.”

CBD and autism

A group of Israeli researchers have been exploring the use of CBD to reduce problem behaviors in children on the autism spectrum. A feasibility study involving 60 children found substantial improvement in behavioral outbreaks, anxiety and communication problems, as well as stress levels reported by parents.

The researchers, led by Adi Aran, MD, director of the pediatric neurology unit at Shaare Tzedek Medical Center, went on to do a double-blind, randomized, placebo-controlled trial with 150 participants with autism. In this trial, just completed but not yet analyzed, patients were treated CBD for three months.

Research boom

In the US, research has been given a boost by changing guidelines and laws. In 2015 the DEA eased some of the regulatory requirements that have made CBD, as a Schedule 1 substance, difficult to study. “Because CBD contains less than 1 percent THC and has shown some potential medicinal value, there is great interest in studying it for medical applications,” the DEA said in announcing the change.

And in approving the first CBD-based drug, Epidiolex, last year the FDA expressed enthusiasm for the research boom that is sure to come, paired with stern words for the flood of marketers of products claiming unsubstantiated health benefits.

“We’ll continue to support rigorous scientific research on the potential medical uses of marijuana-derived products and work with product developers who are interested in bringing patients safe and effective, high quality products,” the FDA pledged. “But, at the same time, we are prepared to take action when we see the illegal marketing of CBD-containing products with serious, unproven medical claims.”

CBD Dosage: How Much Should You Take?

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Table of Contents

  • Determining the Best CBD Dosage for You
  • How to Calculate CBD Dosage
  • How to Take CBD

Cannabidiol (CBD) is growing increasingly popular, thanks to its many purported health benefits and non-intoxicating properties (most CBD products contain less than 0.3% tetrahydrocannabinol, or THC). In fact, 60% of U.S. adults have tried CBD at some point and believe it has medicinal benefits, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll. As research evolves and sheds light on CBD’s efficacy, especially for pain relief, more and more people are adding it to their daily wellness regimens.

Consumers can choose from a variety of CBD products, from oils to gummies to vapes to capsules. But figuring out the safe and effective CBD dose for an individual is a complex decision.

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Here’s how to find the right CBD dosage for you and how to consume it safely.

Determining the Best CBD Dosage for You

With the exception of one CBD product, a prescription drug used to treat seizures associated with particular syndromes, the Food and Drug Administration (FDA) doesn’t regulate the use of CBD. (In fact, it’s illegal to market CBD as a supplement or add it to food.) Therefore, it’s best to consult a doctor with experience in CBD administration to determine your ideal dosage.

Expressed in milligrams (mg), CBD dosage largely depends on the conditions and symptoms you’re trying to treat and your unique endocannabinoid system, which is associated with motor control, behavior, emotions, the nervous system and homeostasis. CBD dosage remains an area of active research—more large, high-quality studies are needed in different populations to determine appropriate dosing, efficacy and safety guidelines.

“It’s best to start small and gradually increase your dose up to a level that gives you the desired effect,” says Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine. Your starting point might look like half a CBD gummy or a drop of oil. Ideally, navigate this process under the guidance of a qualified physician.

If you’re still not sure where to start, mydosage.com offers a questionnaire and CBD calculator to help you based on your specific symptoms and usage goals.

How to Calculate CBD Dosage

When you consume CBD gummies, capsules or softgels, dosage is typically expressed per unit. For example, there may be 50 milligrams of CBD in each individual gummy. These products don’t offer much dosage flexibility since you can’t split up capsules easily. For instance, if one softgel capsule didn’t provide your desired result, you would have to take another full capsule, doubling the total dose.

CBD oil, on the other hand, makes it easier, to begin with a small dose. But calculating CBD oil dosage can be less straightforward. Oils and tinctures tend to come in a dropper bottle and, typically, only the total liquid volume and CBD contents are listed on the label. For example, the label might simply state there’s 1,500 milligrams of CBD in the 30-milliliter bottle.

But what does 1 milliliter look like? Due to the current lack of regulation of CBD, this calculation can be tricky. Start by figuring out the volume of a single drop in your dropper, which is usually 0.05 milliliters, according to Dr. Bugailiskis. If you’re unsure, ask the company.

Here’s where math comes in. Let’s continue with the 30-milliliter bottle with 1,500 milligrams of CBD and 0.05 milliliters in a single drop as our example.

1500mg÷30mL = 50 mg/mL

This bottle contains 50 milligrams of CBD per milliliter. Let’s see how many milligrams are in a drop:

50mg/mL ×0.05mL/drop = 2.5mg/drop

Each drop contains 2.5 milligrams of CBD.

Next, you can calculate how many drops you need to reach your goal dosage. Let’s say you want to consume 25 milligrams each day.

25mg÷2.5mg/drop = 10 drops
10 drops ×2.5mg = 0.5mL

With this CBD oil dosage calculator as your guide, you would find that you needed to consume 10 drops, or 0.5 milliliters, to reach 25 milligrams. And if you intend to consume 25 milligrams daily, you can expect this particular bottle to serve as a 60-day supply.

Some CBD products do some of this math for you and illustrate how many milligrams are in a milliliter, some even marking these points on the dropper so you know exactly what you’re taking.

CBD Dosage for Different Ailments

Without FDA approval, there is little guidance in the U.S. on how much CBD a person should consume for various conditions.

In many medical studies on CBD, you see administered doses reach hundreds of milligrams a day, which sounds severe compared to our starting dosage example of 25 milligrams. However, Steven Phan, founder of Come Back Daily, a CBD dispensary in New York, points out that patients in these studies are often dealing with serious flare-ups and pain-inducing conditions compared to everyday dispensary customers.

Below are clinically-studied CBD dosages based on different ailments and conditions. Note: Some of the formulations studied contained THC as well—not all available dosage research sticks strictly to CBD.

Condition Dose* Anxiety 300mg–600 milligrams a day [1] Linares, Ila M. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test . Brazilian Journal of Psychiatry. 2019;41(1):9-14. [2] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients . Neuropsychopharmacology. 2011;36(6):1219-1226. Select forms of epilepsy Starting at 2.5 milligrams per kilogram of the person’s body weight twice daily [3] EPIDIOLEX- cannabidiol solution. DailyMed. Accessed 7/4/2021. Central neuropathic and cancer-related pain A maximum of 30 milligrams a day (or 12 sprays) [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021. Opioid addiction 400 or 800 milligrams a day [5] Hurd YL, Spriggs S, Alishayev J, et al. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Psychiatry. 2019;176(11):911-922. Arthritis A maximum of 30 milligrams a day (or 12 sprays), or 250 milligrams applied topically [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021.

*Dosages are based solely on small, short-term clinical study results where CBD proved significantly successful over placebo. Much larger studies are needed to further strengthen the evidence.

FDA-approved Epidiolex administers CBD orally as a liquid to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. The dosage of Epidiolex is determined by taking the patient’s weight in kilograms (kg) into account.

Several countries, including Canada and those in the U.K., have approved the use of Sativex, an oral spray with equal amounts of CBD and THC, to treat pain stemming from multiple sclerosis. Canada has also approved it for treatment of cancer pain.

The medical and research community still has a long way to go before figuring out what dose works best for each condition. At an individual level, consumers can experiment with caution until they find what works best for them.

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How to Take CBD

Popular ways to take CBD include:

  • Oils and tinctures (extracts of plant material dissolved in ethanol): A liquid that comes in a bottle with a dropper
  • Gummies: A soft, chewable candy that’s often fruit-flavored
  • Sprays: A liquid that comes in a bottle with a nozzle for spraying into the mouth
  • Capsules: Tablets or softgels that are ingested by mouth
  • Vapes: CBD oil that’s heated without ignition, resulting in an inhalable vapor
  • Flower: Dried hemp plant that’s often ignited and smoked
  • Edibles: Any food that CBD oil has been added to, such as brownies or chips
  • Drinks: Any beverage that’s infused with CBD, often in the form of hemp extract

Your CBD product of choice will largely depend on your personal preferences, as well as your budget since prices vary depending on the potency of ingredients and manufacturing processes. Different mediums also offer varying levels of bioavailability—or how much of what you take is actually absorbed into your bloodstream to have an effect. For example, if you ingest 10 milligrams of CBD via 1 milliliter of liquid, your body might absorb about 60% of it, or about 6 milligrams.

Cannabinoids generally have a low bioavailability compared to other substances, according to Jordan Tishler, M.D., a physician specializing in cannabis treatment in Massachusetts. However, “products that contain emulsifiers like egg yolk (brownies) or lecithin (some gummies) do better,” he says.

With that said, ingesting CBD via gummies or other edibles may take longer to take effect since the CBD has to travel to your digestive system to be broken down and absorbed.

Can You Take Too Much CBD?

Like with any substance, you can take more CBD than your body can handle. Studies show doses up to 1,500 milligrams a day have been well-tolerated, but every person is different [7] Bergamaschi MM, Costa Queiroz RH, Zuardi AW, Crippa JAS. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current Drug Safety. 2011;6(4):237-49. . Ingesting too much CBD can cause unpleasant side effects, such as dry mouth, nausea, diarrhea, upset stomach, drowsiness, lightheadedness and general disorientation. While rare, liver damage can also occur.

What’s more, CBD can have serious interactions with certain medications. In evaluating available information on five prescription CBD-based medications, researchers found 139 medications could have a potential drug-drug interaction with CBD [8] Kocis PT, Vrana KE. Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Medical Cannabis and Cannabinoids. 2020;3:61–73. . People who take certain blood thinners, heart rhythm medications, thyroid medications and seizure medications need to be particularly careful.

At the end of the day, not all supplements are created equal, which is why it’s important to work alongside a health care provider when adding CBD to your wellness regimen and research reliable brands. And while emerging research and anecdotal evidence is promising, more large, randomized-controlled trials are needed to further understand the benefits of CBD and its dosing.