After an accident at his workplace that saw Rick Simpson suffer from dizzy spells and tinnitus, Simpson saw a documentary highlighting the positive benefits of using cannabis. He approached his doctor about using cannabis as a treatment, however, his doctor refused. Undeterred, Simpson sourced it for himself. After a short time, he started seeing an improvement in his symptoms and continued to use cannabis as a treatment.
To make matters more confusing, nine states (including California, Washington, and Colorado) let residents buy cannabis-based products with or without THC. Nearly two dozen other “medical marijuana states” allow the sale of cannabis, including capsules, tinctures, and other items containing CBD or THC, at licensed dispensaries to people whose doctors have certified that they have an approved condition (the list varies by state but includes chronic pain, PTSD, cancer, autism, Crohn’s disease, and multiple sclerosis). Sixteen more states legalized CBD for certain diseases. But because all these products are illegal according to the federal government, cannabis advocates are cautious. “By and large, the federal government is looking the other way,” says Paul Armentano, deputy director of the Washington, DC–based National Organization for the Reform of Marijuana Laws (NORML), but until federal laws are changed, “this administration or a future one could crack down on people who produce, manufacture, or use CBD, and the law would be on its side.”
CBD—or cannabidiol—is a type of cannabinoid, a family of molecules typically associated with marijuana, but in fact, also found in other plants and even humans (in us, they’re called endocannabinoids). There are hundreds of different cannabinoids in marijuana. The best known is tetrahydrocannabinol, or THC, a chemical in marijuana that targets and binds to certain receptors in the brain to give you a high. CBD is non-psychoactive and non-addictive, and it seems to bind to multiple target sites, thereby affecting a range of systems throughout the body.
Given CBD’s reputation as a popular, artisanal remedy, one would think that Epidiolex would command a lot of “off label” attention. After all, physicians often prescribe pharmaceuticals off label to treat conditions that were not the actual focus of clinical trials. But the costly price tag for Epidiolex (more than $30,000 annually) precludes off label prescribing as well as affordable access for tens of millions of Americans without health insurance.
Keep in mind, too, that CBD product companies use different CBD sources, extraction methods and production techniques – and not all resulting products are created equal. You'll have to do your own research to determine which companies you're willing to trust, Asquith says. Plus, how the products are packaged and consumed – be they in oils, creams or capsules – affect how they're absorbed in the body. Edibles, for example, are well-absorbed, while oils taken under the tongue are "baloney," Tishler says. And of course, salespeople at herb shops don't have the same mission, knowledge, training or oversight as physicians and pharmacists. "We have spent the last 100 years or so developing the pharmaceutical system because it works," Tishler says.
Tetrahydrocannabinol is the most abundant cannabinoid in most medical and recreational marijuana strains. However, in hemp THC is a minor constituent and appears only in trace amounts under 0.3% by dry weight, as required by the U.S. government for hemp products. THC mimics the action of anandamide, a neurotransmitter naturally produced in the human body, and binds to CB1 receptors in the endocannabinoid system found mostly in the brain. The extremely low levels of THC in hemp make hemp oil non-psychoactive and safe for all ages to use.
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The most abundant cannabinoid in hemp oil, making up over 90% of the cannabinoid content, cannabidiol or CBD is non-psychoactive and is the focus of the benefits from hemp oil. CBD has little affinity for CB1 or CB2 receptors, the main points of interaction for cannabinoids in the endocannabinoid system, and instead acts as an indirect antagonist of cannabinoid agonists, possibly allowing CBD to temper the high caused by THC. Our Gold Label RSHO™ is almost 25% CBD, making up most of oil’s weight. All other cannabinoids come in under 0.4% by weight.
Quality is a particular concern, because cannabis plants easily soak up heavy metals from pesticides and other contaminants, Marcu says. If you are buying online, look for a company that documents how it tests its products. (If the website doesn’t indicate this, call and ask.) “Buying from a reputable manufacturer is crucial, because it matters how the plant is cultivated and processed,” Dr. Maroon says. One clue that a company is cutting corners: too low a cost. Good CBD is pricey—a bottle of high-quality capsules is sold in Cohen’s office for $140. But for many, it’s worth the money. Roth spent $60 on her tiny bottle. But when her energy returned the day she started taking CBD, she decided that was a small price to pay.
So, many of CBD's popularized benefits aren't well-proven. But are there any harms in trying CBD-containing products? In a word, yes. While any reported side effects from CBD alone are minor (think dry mouth and dizziness), they can be serious if the CBD products interact with other medications, experts say. Since CBD is metabolized by the same enzyme in the liver that metabolizes many conventional medicines and supplements, the chemical can cause the levels of other drugs in the system to rise; in some cases – like for those taking a drug to prevent their bodies from rejecting a donor organ – to a deadly level, Tishler says.
CBD isolate is pure CBD, extracted and purified until none of the plant’s other constituent compounds remain. It has been isolated down to just the CBD molecule. This purity and potency is why it’s the preferred treatment for patients needing unadulterated doses of CBD and nothing else. It has no other active ingredients and its purpose is simply to deliver therapeutic doses of CBD. CBD isolate products often come as a white powder or a mix with a oil.
Miller, whose clients include patients referred by physicians, uses CBD in a variety of delivery modalities that she has found effective. “Patches can be worn for pain or anxiety management. Capsules or concentrated drops can be taken orally for pain, inflammation, sleep, and anxiety. Balms and creams can be used on the hands and feet to manage arthritic pain. Vaping is another delivery method,” she says.
Do the right thing for your body and ensure that you only purchase high-quality products from trusted sellers. Once you’ve decided between full spectrum vs regular CBD, you now need to make the choice of picking the right seller. Choose someone with a great reputation and independent lab testing results available on the site for all to see. You certainly want to make sure you get what you pay for!
At least one benefit of CBD is well-supported by science: It can be effective in treating children with rare, genetic seizure disorders. Adults, children and even animals with epilepsy have been shown to benefit from the chemical too, the World Health Organization reports. There's also some evidence that CBD can help with anxiety, says Dr. Robert Carson, an assistant professor of neurology and pediatrics at Vanderbilt University who focuses on children with epilepsy. "In children, especially those with autism spectrum disorders, this may manifest as improved interactions with others," he says. Other preliminary research shows CBD holds promise for conditions including Alzheimer's disease, cancer, psychosis and Parkinson's disease – and is pretty much impossible to abuse or become addicted to, WHO says.