The structure of cannabidiol (CBD) displayed over a photo of Cannabis sativa.

Cannabidiol, or CBD, is the latest natural cure-all for everything from cancer to anxiety. You can buy it almost anywhere, from the local gas station to a health food store. It is available as a tincture (oil solution), nasal spray, lotion, capsule, powder, or even lip balm or shampoo. As with any new health or wellness craze, there can be a lot of misleading claims and false hope. Let’s take a second to explore what the science really says!

What is CBD?

CBD is one of more than 100 cannabinoid compounds produced by the plant Cannabis sativa, commonly known as marijuana or hemp, and it accounts for about 40% of the plant extract. The other well-known cannabinoid is delta-9-tetrahydrocannabinol, or THC, the compound responsible for the psychoactive effects of marijuana. It is a common misconception that hemp (source of CBD) and marijuana (source of THC) are separate species or strains of C. sativa. Hemp and marijuana are more accurately described as chemovars, or varieties of C. sativa that produce different amounts and ratios of cannabinoids depending on growth conditions and climate. There is also a legal distinction between hemp and marijuana.

Is CBD legal in the US?

Yes, with restrictions. Hemp has existed in the US since the early days of colonization, but at the turn of the 20th century, racial and political factors led to its criminalization.  Despite this, scientific research on cannabinoids was progressing, and CBD was first isolated in 1940. Under the 1970 Controlled Substances Act, C. sativa was made illegal, and CBD was designated as a Schedule I drug (drugs with high abuse potential and no medical use). In 1980 the first medical benefit of CBD (seizure reduction) was discovered, and scientific interest greatly increased. Mounting evidence of the medical benefits of CBD and other cannabinoids eventually led to the Hemp Farming Act of 2018. Under this act, hemp was legally defined as any C. sativa variety that produces less than 0.3% THC and reclassified as an ordinary agricultural commodity. This has allowed more production of hemp, although restrictions still apply. Any CBD product derived from hemp grown under the current guidelines is legal, otherwise, CBD remains a Schedule I drug. Therefore, it is important to research companies supplying CBD products online or in stores. Furthermore, marketing CBD products as a dietary supplement or making claims that they can prevent, diagnose, treat, or cure disease is illegal. The Food and Drug Administration (FDA) has issued warning letters to companies for such violations. Research on CBD continues, and the National Institutes of Health (NIH) supports a wide variety of projects evaluating its therapeutic potential. 

Is CBD safe?

CBD is generally safe, however, there are a few considerations to keep in mind, since the CBD products available online or in stores are not FDA regulated drugs. The FDA monitors them for general product safety, but there are no guarantees that the formulation is effective at delivering CBD or that the dose is effective. There are also no regulations on product quality or whether the actual amount of CBD in a product matches the label. Reputable companies often opt to have their products verified by a third party.

Few side-effects have been reported from CBD use and the compound is generally well-tolerated, but some drug-drug interactions have been reported. CBD can interact with a variety of common medications including, but not limited to, statins and other heart medications, antidepressants, Aleve, opioids, and immunosuppressants.  For this reason, make sure to tell your doctor or pharmacist about ALL medications and supplements you are taking before trying CBD.

CBD does not produce intoxication or euphoria (a “high”) and has low abuse potential. The World Health Organization (WHO) in their 2017 report on cannabidiol stated that there is “no evidence of recreational use of CBD” and “no public health problems (e.g. driving under the influence of drugs cases, comorbidities) have been associated with the use of pure CBD.”

Does CBD work?

Cannabidiol has been tested for a wide variety of therapeutic applications, and the most clinical success so far has been in the treatment of epilepsy. Epidiolex®, a liquid formulation of pure cannabidiol, is FDA-approved for the treatment of three severe childhood seizure disorders – Dravet and Lennox-Gastaut syndromes and tuberous sclerosis complex. Epidiolex® is the only pure CBD drug approved by the FDA. However, there are some CBD drug formulations in development. Arvisol®, a tablet formulation of pure cannabidiol, is currently in Phase 2 clinical trials for schizophrenia. ZygelTM is a topical CBD formulation currently in clinical trials for Autism Spectrum Disorder and a few other rare neuropsychiatric conditions. Finally, Sativex® is an oral mist containing an almost equal ratio of THC and CBD. It has been approved in the EU and Canada for treating multiple sclerosis symptoms and cancer pain and is currently being evaluated for approval in the US by the FDA.

There is promising evidence of the therapeutic benefit of CBD for other conditions, such as depression, anxiety, rheumatoid arthritis, nausea, cancer, inflammatory bowel diseases, and neurological diseases, although further study in humans is needed. There is also mounting evidence to suggest that CBD could be effective in the treatment of chronic pain and addiction. Hopefully, scientific research in the coming decades will address these questions. 

So should I try CBD?

That’s up to you (after you’ve talked to your doctor and researched the product), but it depends on what you are taking CBD for. If you want to take CBD because it might help you relax after a stressful day, then go for it. A tincture or nasal spray with CBD is the best option, followed by edible forms such as hemp teas. There is a very low likelihood that the CBD in a lip balm, lotion, or makeup will be absorbed through your skin and have any effect. 

If you are considering using CBD to treat a medical condition, then you are much better off trying medications that have been scientifically tested first. However, scientific research is ongoing, so more CBD treatments for specific medical conditions could be approved in the future. Stay posted!

A CBD tincture.

Peer edited by Laetitia Meyrueix  and Mackenna Wood

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