CBD products are everywhere. But do they work?

Experts say cannabidiol products are likely a good choice for some conditions, but evidence is lacking for others.

By now, you've probably run into a product containing cannabidiol, also known as CBD. It's in everything from drinks and pet products to lotions and chewable gummies. Even major drugstore chains have announced they will start carrying CBD products in certain states.

But many people still don't really know what CBD is. Is it marijuana? Is it legal? Does it actually work? Is it safe?

The answers to those questions aren't necessarily straight-forward. The only thing that is clear at this point: "The marketing has gone way ahead of the science and the law when it comes to CBD products," says Donald Levy, medical director at the Osher Clinical Center for Integrative Medicine at Brigham and Women's Hospital and assistant clinical professor of medicine at Harvard Medical  School.

That said, CBD is thought to be a safe and effective option for certain conditions. Below, we sort through the confusion by answering some of the most common questions about CBD.

Is CBD marijuana?

Yes and no. Cannabidiol is one of the two best-known active compounds derived from the marijuana plant. The other is tetrahydrocannabinol, or THC, which is the substance that that produces the "high" from marijuana.

CBD does not get you high, but Dr. Levy says the idea that it's not psychoactive is something of a misconception in his opinion. "It does change your consciousness. You feel mellow, experience less pain, and are more comfortable," he says. In addition, some CBD products do contain small amounts of THC.

While CBD can come from marijuana, it can also be derived from hemp. Hemp is a related plant with 0.3% or less of THC. This plant is often used to make fabrics and ropes. As of 2018, Congress made hemp legal in all 50 states, and consequently CBD derived from hemp is also legal. The rules around marijuana-derived CBD, however, are far less clear.

Is marijuana-derived CBD legal?

Again, yes and no, depending on where you live. In some states marijuana is legal for both recreational use and medical use. In other states, it's legal only for medical use. And in some areas, it's not legal at all. When it comes to CBD products, the FDA is still trying to get its arms around the issue. The agency is just starting the process of hashing out some rules regarding CBD sales. Officials recently formed a working group to create guidelines that could allow companies to legally market CBD products. Currently, CBD products are considered supplements, which aren't FDA-regulated, and it is illegal for companies to make health or therapeutic claims about the products in their marketing. In announcing its effort to set CBD marketing rules, the FDA also signaled that it is cracking down on CBD companies that are using "egregious and unfounded claims" to market their products to "vulnerable populations."

Currently there is only one CBD product that has FDA approval: a prescription medication called Epidiolex, used to treat two severe seizure disorders in children. The bottom line is that in order to understand whether CBD is legal where you live, you'll need to consult your state health department website or professionals in your community.

Does CBD work?

Yes, there is evidence that CBD works for some conditions, but certainly not all the conditions it is being promoted for these days. There's no evidence, for example, that CBD cures cancer. There is moderate evidence that CBD can improve sleep disorders, fibromyalgia pain, muscle spasticity related to multiple sclerosis, and anxiety.

"The most benefit I have seen as a physician is in treating sleep disorders, anxiety, and pain," says Dr. Levy. "Many people report a definite response when it comes to anxiety." CBD also appears to have fewer side effects than other anxiety medications. However, the same may not be true for a host of other CBD products on the market today, in particular those that are rubbed on the skin. It's hard to know whether these have any clinical benefit, because they haven't been tested sufficiently, says Dr. Levy. Testing also shows that many products don't contain what's claimed on the label. For example, they may have less CBD than advertised. So, buyer beware.

Where should you purchase CBD products?

If you are interested in trying a CBD product, it's best to seek one through a dispensary, which is an establishment legally licensed to sell marijuana, if they are available in your state. Dispensary products must be labeled so you can see exactly how much CBD is in the product and whether it also contains THC. A small amount of THC in a CBD product isn't typically problematic. But larger amounts could cause a "high" and may present a risk if you are going to drive, says Dr. Levy.

Also, keep in mind that CBD products aren't standardized and will vary. It helps to keep a journal recording what type of CBD product you took, how much, and your response to it. This will help you track what works and what doesn't for your condition, he says.

The safest way to take CBD is orally,  as a tablet, chewable, or tincture (a concentrated liquid typically administered with a dropper). "I never recommend smoking any product," says Dr. Levy. Steer clear of any illegally sold synthetic CBD products, sometimes called "spice" or "bath salts." These products have induced psychotic reactions in some people and pose a major health risk.

Is CBD safe?

For adults, CBD appears to be a very safe product. CBD does produce side effects for some people, including nausea, fatigue, and irritability. It may also interact with certain medications, so always check with your doctor before use.

But for children under age 21 it's a different story. "I don't suggest that anyone under age 21 use marijuana regularly," says Dr. Levy. "It's also not clear what the appropriate CBD dose is for children, and more research is needed in this area."

Evidence regarding CBD is still building. Now that some states have legalized recreational and medical use of marijuana products, including CBD, scientists are finding it easier to conduct research. More will be known in the next 10 years, including whether there are yet undiscovered problems associated with long-term use.

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