CBD is being promoted as a natural remedy for a wide range of ailments
There are decades of research into cannabinoids, but CBD research is early stage
1 in 8 Americans have tried CDB and most believe it has health benefits
Potential CBD users need to be aware of safety considerations, dosage guidelines and how to choose from the hundreds of products being sold today
CBD is the "new kid on the block" in the cannabinoid family
Cannabidiol (CBD) comes from cannabis. The cannabis plant produces two chemicals in abundance. The most abundant and best known is tetrahydrocannabinol (THC). THC causes the psychoactive intoxication or "high" associated with cannabis. The second most abundant chemical is CBD, which doesn't cause a "high".
Our bodies naturally produce cannabinoids involved in many bodily functions including appetite, pain sensation, mood, and sleep. The current thinking is that CBD interacts with these existing cannabinoids and increases their effect.
Decades of research have found THC can help treat various ailments, such as chronic pain, anxiety, depression, nausea and vomiting, and insomnia. The research on CBD is much more recent.
Many Americans are touting the benefits of CBD
Today, CBD is being promoted as a natural remedy for ailments ranging from aches and pains to anxiety and sleep disorders. Chances are you've heard someone you trust share how CBD oil has helped them.
In 2019, almost 80% of Americans familiar with CBD oil credited CBD with having health benefits. In fact, a full third of people familiar with CBD oils say they have "a lot of health benefits" and another 45% say they have "some" benefits, according to a 2019 Gallup survey. The Gallup survey also noted that confidence in CBD is much greater the more people know about it.
14% of Americans say they use CBD, and almost all of them use it for its health benefits
We explore below the most commonly cited health benefits of CBD and discuss the state of the science for each.
From Pain to pets: How people are using CBD today
20% of CBD users have taken it for anxiety, and there is significant buzz around the use of CBD for anxiety relief.
The research into the potential of CBD as a natural approach to alleviating anxiety is encouraging. For example, a review of 49 primary preclinical, clinical, or epidemiological studies conducted by researchers at the New York University School of medicine concluded that "evidence from human studies strongly supports the potential for CBD as a treatment for anxiety disorders". This review demonstrated that there is evidence that CBD is useful in treating generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
More recently, a 2019 study looking into the potential of CBD to reduce anxiety and improve sleep observed a reduction in measured levels of anxiety for almost 80% of the adults studied. As the research into CBD as a treatment for anxiety is largely preclinical, more research into this area is required.
The use of cannabis to treat epilepsy and other neurological conditions has been studied for years. In 2018, the FDA approved an oral CBD solution for the treatment of some forms of epilepsy in people two years of age or older.
There is significant scientific research into the use of CBD to treat inflammation, commonly implicated in the progression of neurodegenerative diseases like Alzheimer's and MS.
CBD offers a natural option to consider for treating different types of chronic pain, such as arthritis. Research into the use of CBD for pain includes a study in the European Journal of Pain showed that CBD applied on the skin could help lower pain and inflammation due to arthritis.
CBD for Pets
Scientific research from Cornell University and also from Colorado State University provide early support for the use of CBD for pain relief and epilepsy in dogs. Beyond the scientific research, there is a building body of anecdotal evidence in support of the use of CBD to treat canine anxiety, pain, nausea, inflammation, and other ailments.
The scientifically proven anti-inflammatory properties of CBD are making it a natural "go-to" to relieve muscle soreness and promote muscle recovery.
Early research suggests that taking CBD before bed improves sleep time in people with insomnia.
...but is CBD safe? What you need to know
In 2018 the World Health Organization (WHO) published a critical review report on CBD that concluded that CBD is "generally well tolerated with a good safety profile". The report also notes that, in light of the emerging research in support of CBD, several countries have made changes to their national controls to accommodate CBD as a medicinal product.
FDA Consumer Update on CBD
The U.S. Food and Drug Administration issued a consumer update in November 2019 about products containing cannabis and cannabis-derived compounds that stated, among other things, the following:
The FDA has seen only limited data about CBD’s safety and these data point to real risks that need to be considered
Consumer use of any CBD products should always be discussed with a healthcare provider
Consumers should be aware of the potential risks associated with using CBD products
Quality and Purity Concerns
In general, one of the most significant safety concerns with CBD is the challenge of ensuring the quality of CBD products. This challenge comes from CBD being marketed and sold as a supplement, not a medication, which means that the FDA does not regulate the safety or the purity of CBD products.
Chose your CBD carefully
Since it is difficult to know for sure that the product you buy has active ingredients at the dose listed on the label and that it does not contain other unknown elements, it is important to carefully choose the CBD that you buy.
Side effects and contraindications
Although CBD is generally well tolerated, reported side effects include:
Drowsiness and fatigue
CBD can also interact with other medications you're taking, such as blood thinners.
The FDA and others advise against the use of CBD in any form during pregnancy or while breastfeeding.
CBD legislation: staying on the right side of the law
Marijuana-derived CBD Products
If you live in one of 10 states that have legalized the recreational use of marijuana, marijuana-derived and hemp-derived CBD products are legal in your state. Many states have legalized medical marijuana, and the use of marijuana-derived CBD will generally follow the laws that govern the use of medical marijuana in those states (e.g. permissible if the patient has a qualifying condition).
Hemp-derived CBD Products
Hemp became legal at the federal level through the Agriculture Improvement Act of 2018 (“Farm Bill”), which removed hemp from the Controlled Substances Act. Hemp regulations are now under the purview of the U.S. Department of Agriculture (“USDA”). The Farm Bill also granted the Food and Drug Administration (“FDA”) the authority to regulate products containing cannabis or cannabis-derived compounds
Nonetheless, each state has its own set of laws and regulations related to CBD, and in many cases, these laws are under review. We've listed here the states where hemp-derived CBD is still either illegal or where the legislation is still not clear.
Most CBD products being marketed today are from hemp and are legal in the U.S. federally. But, it's still illegal to buy or possess hemp-derived CBD in some states.
California: Legislation to legalize hemp-derived CBD in foods, beverages, and cosmetics is in progress
Hawaii: Laws prohibit adding any cannabis-derived substances to food, beverages or cosmetics for manufacture, distribution or sale
Idaho: Any products containing any level of THC are illegal
Iowa: The law does not discern between CBD and medical marijuana, however, that is expected to change in 2020
Massachusetts: The sale of food containing CBD, CBD products that make medicinal claims, animal feed with hemp, and the sale of unprocessed or raw plant material to consumers is prohibited
Missouri: The law does not discern between CBD and medical marijuana
Nebraska: Possession of CBD can be treated as possession of a controlled substance
South Dakota: All forms of CBD are illegal
Since the laws and regulations around CBD are not always entirely clear and because they are evolving quickly, it's important to check the laws in the states where you live or travel before purchasing or possessing CBD in those states.
CBD dosage: Cutting through the confusion
There is no universally recommended dosage for CBD. Studies have shown that CBD is safe and effective in treating various ailments low, moderate and also very high doses.
A 2018 study on cannabis dosing conducted by researchers from the University of British Columbia and the International Cannabis and Cannabinoids Institute in Prague noted that "many patients obtain benefits with much lower does, starting with 5-20mg per day".
Unfortunately, there haven’t been sufficient scale clinical trials to provide specific CBD dosage recommendations.
"Start low, go slow and stay low"
The generally accepted approach to CBD dosing is to start with a low dose and adjust it slowly over time to one that you determine is effective for you. This approach is supported by research such as the 2018 study above and by the Canadian Pharmacists Association's safe and effective dosing guide.
Factors to consider to arrive at an appropriate and effective CBD dose include:
The concentration of CBD in the product being used
Your unique body chemistry and metabolism
Everyone metabolizes differently. If you know you are generally sensitive to medications or other natural remedies, you should take that into consideration when working to establish the right dose of CBD for you.
Specific CBD dosage guidelines
A number of CBD vendors provide dosage charts that follow the "start low, go slow and stay low" philosophy. For example, the stepwise procedure and charts provided by CBD vendor Green Flower Botanicals to easy to follow for CBD products that are clearly labeled and contain proven (e.g. lab certified) amounts of CBD.