Cannabidiol (CBD)-what we know and what we don’t
Cannabidiol (CBD) is often covered in the media, and you may see it touted as an add-in booster to your post-workout smoothie or morning coffee. You can even buy a CBD-infused sports bra. But what exactly is CBD? And why is it so popular?
How is cannabidiol different from marijuana, cannabis and hemp?
CBD, or cannabidiol, is the second most prevalent active ingredient in cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. One of hundreds of components in marijuana, CBD does not cause a “high” by itself. According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”
Is cannabidiol legal?
CBD is readily obtainable in most parts of the United States, though its exact legal status has been in flux. All 50 states have laws legalizing CBD with varying degrees of restriction. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. In 2018, the Farm Bill made hemp legal in the United States, making it virtually impossible to keep CBD illegal – that would be like making oranges legal, but keeping orange juice illegal.
The Farm Bill removed all hemp-derived products, including CBD, from the Controlled Substances Act, which criminalizes the possession of drugs. In essence, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) – even though it is the exact same molecule. Currently, many people obtain CBD online without a medical marijuana license, which is legal in most states.
The evidence for cannabidiol health benefits
CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, stop them altogether. Epidiolex, which contains CBD, is the first cannabis-derived medicine approved by the FDA for these conditions.
Animal studies, and self-reports or research in humans, suggest CBD may also help with:
Studies and clinical trials are exploring the common report that CBD can reduce anxiety.
- Insomnia. Studies suggest that CBD may help with both falling asleep and staying asleep.
- Chronic pain. Further human studies are needed to substantiate claims that CBD helps control pain. One animal study from the European Journal of Pain suggests CBD could help lower pain and inflammation due to arthritis when applied to skin. Other research identifies how CBD may inhibit inflammatory and neuropathic pain, which are difficult treat.
- Addiction. CBD can help lower cravings for tobacco and heroin under certain conditions, according to some research in humans. Animal models of addiction suggest it may also help lessen cravings for alcohol, cannabis, opiates, and stimulants.
Is CBD safe?
Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level of blood thinning and other medicines in your blood by competing for the liver enzymes that break down these drugs. Grapefruit has a similar effect with certain medicines.
People taking high doses of CBD may show abnormalities in liver related blood tests. Many non-prescription drugs, such as acetaminophen (Tylenol), have this same effect. So, you should let your doctor know if you are regularly using CBD.
A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot be sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other unknown elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
How can CBD be taken?
CBD comes in many forms, including oils, extracts, capsules, patches, vapes, and topical preparations for use on skin. If you’re hoping to reduce inflammation and relieve muscle and joint pain, a topical CBD-infused oil, lotion or cream – or even a bath bomb — may be the best option. Alternatively, a CBC patch or a tincture or spray designed to be placed under the tongue allows CBD to directly enter the bloodstream.
Outside of the US, the prescription drug Sativex, which uses CBD as an active ingredient, is approved for muscle spasticity associated with multiple sclerosis and for cancer pain. Within the US, Epidiolex is approved for certain types of epilepsy and tuberous sclerosis.
The bottom line on cannabidiol
Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer or COVID-19, which it is not. We need more research but CBD may prove to be a helpful, relatively non-toxic option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies, we can’t pinpoint effective doses, and because CBD currently is typically available as an unregulated supplement, it’s hard to know exactly what you are getting.
If you decide to try CBD, make sure you are getting it from a reputable source. And talk with your doctor to make sure that it won’t affect any other medicines you take.
Every Question You Have About CBD—Answered
Does CBD get you high? What are the actual benefits? Will it show up on a drug test? Here’s everything you need to know about the product that’s suddenly everywhere.
An article by ‘Health.com Editorial Team’ indicates a collaborative effort from our in-house team. Sometimes, several writers and editors may contribute to an article over the years. These collaborations allow Health.com editors to provide you with the most accurate, up-to-date, and comprehensive information available. The editors at Health.com are a dedicated team of experienced health editors, writers, and other media professionals who strive to bring trustworthy and responsible health and medical content to their readers. As a team, we have decades of experience in health journalism, and have worked at legacy publishers and some of the biggest news and media companies in the U.S.
There’s no question that CBD is the buzzy wellness product of the moment. If you live in a state where it’s currently legal, you might feel like CBD has gone from being sort of around to absolutely everywhere all at once. Coffee shops sell CBD lattes, spas offer CBD facials, beauty companies are rushing to release lotions with CBD or hemp oils in their formulas. And everyone from your anxious coworker to your arthritis-suffering dad wants to get their hands on some CBD gummies.
But even though it’s infiltrating pretty much every corner of the wellness world (hi, vegan CBD brownies!) many people still find CBD a little confusing—especially when it comes to figuring out the right way to use it and how to make sure the stuff you’re buying is, you know, actually legit. Below, we asked experts to answer the most pressing questions about CBD.
OK, first things first. What is CBD?
CBD, short for cannabidiol, is a chemical compound from the Cannabid sativa plant, whish is also known as marijuana or help, according to the US National Library of Medicine.
It’s a naturally occurring substance that’s used in products like oils and edibles to impart a feeling of relaxation and calm. Unlike its cousin, delta-9-tetrahydrocannabinol (THC), which is the major active ingredient in marijuana, CBD is not psychoactive.
So you’re saying CBD won’t get me high?
Nope. The cannabis plant is made up of two main players: CBD and THC. “CBD is the non-psychoactive portion of the plant, so what that means is you won’t have any effects like euphoria,” says Junella Chin, DO, an osteopathic physician and a medical cannabis expert for cannabisMD. “You won’t feel sedated or altered in any way.”
There are two possible exceptions to this. The first is that some people, for unknown reasons, just react differently to CBD. According to Dr. Chin, about 5% of people say they feel altered after taking CBD. “Usually they’re the same people who have side effects from Advil or Tylenol,” she says. You never know how your body will react to any new supplement, so when taking CBD for the first time, do so safely under supervision.
It’s also crucial to buy third-party-tested CBD for quality assurance (more on this later). Because the FDA doesn’t regulate CBD, it is possible to buy a product that is more or less potent than advertised, or even contains small amounts of THC.
Where does hemp come in to all this?
You’ve probably heard the terms cannabis, marijuana, and hemp all tossed around in relation to CBD. The plant Cannabis sativa has two primary species, hemp and marijuana. Both contain CBD, but there’s a much higher percentage in hemp, which also has very low (less than 0.3%) levels of THC compared to marijuana.
When people talk about hemp oil, they’re referring to oil extracted from the seeds of the hemp plant. There are no cannabinoids—CBD or THC—in hemp oil. This ingredient is packed with healthy fats and often appears in beauty products for its moisturizing benefits.
What are the health benefits of CBD?
The only CBD medication that is currently FDA-approved is Epidiolex, which the agency approved last year for the treatment of certain types of epilepsy. But many people swear CBD has helped with a slew of other health conditions, including back pain, osteoarthritis, even cancer.
“My practice has patients walking in every day asking about CBD,” says Houman Danesh, MD, director of integrative pain management for the Mount Sinai Hospital in New York City. But while there’s lots of anecdotal evidence, he says, “it’s still very difficult to say” what the real benefits are due to a serious lack of research.
“Right now, you just have pharmacies trying to make some sort of sense out of it and say, ‘Yes, it works for this,'” he says, “but that’s not the way medicine is practiced—it should be based on evidence, and there’s not a lot of evidence to really support these claims.”
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Still, is CBD worth trying for pain management?
There are two main types of pain, Dr. Danesh says: musculoskeletal and nerve. “There could be benefit for both conditions,” he says.
The tricky part is that there’s some evidence suggesting CBD works best for pain when combined with a little THC, says Dr. Danesh. “Depending on what type of pain you have, you might be able to do just CBD, but sometimes you need CBD and THC.” This makes accessing a product that will actually help you more difficult due to different regulations in each state. In New York, where Dr. Danesh practices, for example, CBD is available over the counter. But as soon as you add THC, you need a prescription.
Figuring out how much you should take is challenging as well; the dosage that alleviates one patient’s pain might do very little for someone else. “And until we can study it, it’s the wild west,” Dr. Danesh says.
The takeaway? “I think CBD is a safe thing to try,” says Dr. Danesh. But he urges patients to push for more research by putting pressure on representatives to get national bills passed that allow scientists to look closer at CBD and the conditions that respond to it.
What about my anxiety—can CBD help with that?
CBD might be worth trying to manage symptoms of anxiety. “[CBD] tells your body to calm down and reminds you that you’re safe,” Dr. Chin says. “It mellows out the nervous system so you’re not in a heightened ‘fight or flight’ response,” she says, so people with anxiety may find it helps them feel more relaxed.
Still, one of the biggest misconceptions about CBD is that it’s a wonder drug. “A lot of times people think CBD is a cure-all, and it’s not,” Dr. Chin says. “You should also have a healthy lifestyle with plenty of exercise and good nutrition—CBD is not going to fix everything.”
I’ve heard of edibles, tinctures, vape pens. What’s the best way to take CBD?
It really depends on what your goal is and why you’re taking CBD in the first place.
Some people don’t want to ingest anything and therefore prefer a topical CBD cream or ointment. “You can apply it to muscles, joints, and ligaments and still get a nice, localized release,” Dr. Chin says.
The biggest differences between tinctures, edibles, and vape pens are speed of delivery and how long the effects last. Vape relief is faster but wears off faster too—usually in about two hours, says Dr. Chin. “Say you wake up in the morning and pulled your back out, you might want to take CBD through a vape pen, which delivers in 10 minutes.”
Tinctures and edibles take longer to work but last four or five hours. “A tincture looks like a little liquid that you put under your tongue, and you feel relief within half an hour,” Dr. Chin says. “If you prefer to taste something, you choose an edible, whether it’s a capsule, gummy, or baked good.”
What should I look for when shopping for CBD products?
“There are literally hundreds of CBD brands at this point,” says Brandon Beatty, founder and CEO of Bluebird Botanicals and an executive vice president of the U.S. Hemp Roundtable. Here are a few things you should keep in mind when shopping.
What does the label look like?
We don’t mean the color or millennial font. If it’s a dietary supplement, it should have a back panel with an FDA disclaimer and warning section, according to Beatty. “Ideally, it would be preferable to have access to their third-party lab testing results too.”
Speaking of which: Has it been third-party tested?
Nearly every expert Health spoke to agreed that your CBD products should be tested by a third party to confirm the label’s accuracy. This is a real concern in the industry—take the 2017 Journal of the American Medical Association study, for example, which tested 84 CBD products and found that 26% contained lower doses than stated on the bottle. Look for a quality assurance stamp or certificate of analysis from a third party (aka not the actual brand) or check the retailer’s website if you don’t see it on the product’s label.
What’s the dosing?
This is a confusing one for many people. “A lot of brands don’t do a good job of clearly instructing their consumer on the dosing,” says Chris Roth, CEO and co-founder of Highline Wellness. When thinking about dosing, also consider whether your CBD is full-spectrum or isolate: Full-spectrum could include other cannabinoids like cannabidivarin or cannabigerol (this is important, since “there’s something called the ‘entourage effect’ when all together, they’re more effective than any one of them alone,” Roth explains), while isolate is 100% CBD. “Some people might only need 10 milligrams of full-spectrum CBD, but with isolate, even taking 80 or 100 milligrams might not have the same effect,” he says.
Does it claim to cure any diseases?
If so, hard pass. “You should avoid any company that makes disease claims,” says Beatty. “If so, it means they’re either willing to break the rules or they’re not aware of the rules.”
Is there a batch number?
You know how you check your raw chicken or bagged lettuce every time there’s a recall to make sure the one you bought isn’t going to make you sick? You should be able to do that with CBD products too. “This is a huge indicator as to whether they are following good manufacturing practices,” says Beatty. “There should be a way to identify this product in case it was improperly made so the company can carry out a recall.”
Are there additional ingredients in there?
As with any supplement, you want to know everything you’re ingesting in addition to the main event. For example, “sometimes I notice that [CBD manufacturers] will add melatonin,” says Dr. Chin.
Are you buying it IRL?
You can find CBD products in shopping malls, convenience stores, even coffee shops in many states right now. But when in doubt, natural grocers are a safe brick-and-mortar place to buy CBD, Beatty says. “Typically they have a vetting process that does some of the legwork for you.”
That all sounds good, but is it legal?
First, a little background. Industrial hemp was legal in the United States until Congress passed the Marihuana Tax Act in 1937. (“Some of our early presidents grew hemp,” notes Sarah Lee Gossett Parrish, a cannabis industry attorney based in Oklahoma.) Nearly 80 years later, the 2014 Farm Bill took the position that states can regulate the production of hemp and, as a result, CBD. Then last year, President Trump signed a new Farm Bill that made it federally legal to grow hemp.
This means that “consumers everywhere, if they’re compliant with their state, can grow hemp and use hemp products,” Parrish explains, “and among those will be CBD.”
In other words, the latest bill removed hemp from the Drug Enforcement Administration, or DEA’s, purview. “Hemp can now be grown freely under federal law, which, of course, is huge,” Parrish says. “But while it’s legal under federal law, it’s up to each state to set their own policy.”
These policies vary widely. Marijuana and CBD are currently fully legal for both medicinal and recreational purposes in Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, Washington, and Washington D.C. In 23 states, it’s legal in some form, such as for medicinal purposes. Another 14 states permit just CBD oil. But both are illegal in Idaho, Nebraska, and South Dakota. For more information, the organization Americans for Safe Access has a helpful guide to the specific laws in each state.
“It’s kind of ironic,” says Parrish. “With marijuana, we have got the federal government saying ‘No’ and a bunch of states saying ‘Yeah, it’s OK’—but with hemp, the feds say ‘Yeah, it’s OK,’ but we still have some states saying it’s not.”
Can you travel with CBD?
That same 2018 Farm Bill means you can now travel between states with legit CBD products. “Flying with CBD should pose no issues now,” Parrish says. However, if you’re traveling with a tincture, be mindful of TSA limits on how much liquid you can carry on an airplane, she adds. (You can also mail CBD products, just like “companies that comply with the Bill can ship their hemp-derived CBD products anywhere in the U.S.,” Parrish notes.)
Will CBD show up on a drug test?
It should not, as long as you’re buying third-party tested CBD with no added THC, says Dr. Chin. But she does point out that athletes, who often are required to take drug tests that are more sensitive, “could potentially test positive” for trace amounts of THC if they’ve been using CBD products.
Last question: Can I give it to my dog?
Tempted to give your pup one of those CBD dog biscuits? “Generally we expect CBD products to be safe, and they could show some benefit for anxiety in pets,” says John Faught, DVM, a veterinarian based in Austin, Texas.
But the challenge when considering CBD products for pets is the same as with people: lack of research. “I believe there are good products out there today, but I also don’t know how to distinguish them at this time,” Faught says.
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