Recently, CBD supplements have become very popular. People have begun taking CBD for chronic pain, insomnia, anxiety and many other issues. Lately it seems as though people look at CBD as a miracle cure for all types of things. Unfortunately, because CBD is considered a supplement and not a drug, it is not regulated in the same way as medications. What is CBD, how does it work, what is the evidence for using it and how can you make sure you are choosing a quality product?
CBD is a cannabinoid from the marijuana plant that works in the human body through the endocannabinoid system (ECS). The human body produces some of its own cannabinoids, and they are used to regulate sleep, immune system responses, and pain. CBD may possibly stop the body from absorbing anandamide, which is a compound associated with regulating pain. The less anandamide in the body, the lower the level of pain. It also may limit inflammation in the brain and nervous system. It is this proposed mechanism of action that leads to the anecdotal evidence of its use for improving sleep and lowering pain. CBD also binds to the CB1 and CB2 receptors in the ECS which may alter the level of serotonin leading to an anti-anxiety effect.
In 2018, the Agriculture Improvement Act removed hemp from DEA regulation as a controlled substance. Marijuana plants that contain less than 0.3% THC are qualified as hemp. THC is the psychoactive part of marijuana that produces a high. CBD, in contrast, reacts with different receptors in the brain and does not produce that effect. CBD actually seems to counteract the psychoactive effects of THC.
So how do you go about picking a product from all of the non-FDA approved ones on the market? The first thing to consider is where the product is grown. It should be grown from one of the 33 states where CBD is legal. The following is a table of the amount of regulation per state.
CBD Laws by State
Here’s an overview of the legal status of CBD in each state, as of January 2020. We provide details on each state’s laws below, including any qualifications about the approved use cases for medical CBD.
State
Hemp-sourced CBD for any use
Marijuana-sourced CBD for medical use
Marijuana-sourced CBD for recreational use
Alabama
Legal
Legal
Illegal
Alaska
Legal
Legal
Legal
Arizona
Legal
Undecided
Illegal
Arkansas
Legal
Legal
Illegal
California
Legal
Legal
Legal
Colorado
Legal
Legal
Legal
Connecticut
Legal
Legal
Illegal
Delaware
Legal
Legal
Illegal
Florida
Legal
Legal
Illegal
Georgia
Legal
Legal
Illegal
Hawaii
Legal
Legal
Illegal
Idaho
Illegal
Illegal
Illegal
Illinois
Legal
Legal
Legal
Indiana
Legal
Illegal
Illegal
Iowa
Legal
Legal
Illegal
Kansas
Legal
Illegal
Illegal
Kentucky
Legal
Illegal
Illegal
Louisiana
Legal
Legal
Illegal
Maine
Legal
Legal
Legal
Maryland
Legal
Legal
Illegal
Massachusetts
Legal
Legal
Legal
Michigan
Legal
Legal
Legal
Minnesota
Legal
Legal
Illegal
Mississippi
Legal
Ilegal
Illegal
Missouri
Legal
Legal
Illegal
Montana
Legal
Legal
Illegal
Nebraska
Illegal
Illegal
Illegal
Nevada
Legal
Legal
Legal
New Hampshire
Legal
Legal
Illegal
New Jersey
Legal
Legal
Illegal
New Mexico
Legal
Legal
Illegal
New York
Legal
Legal
Illegal
North Carolina
Legal
Ilegal
Illegal
North Dakota
Legal
Legal
Illegal
Ohio
Legal
Legal
Illegal
Oklahoma
Legal
Legal
Illegal
Oregon
Legal
Legal
Legal
Pennsylvania
Legal
Legal
Illegal
Rhode Island
Legal
Legal
Illegal
South Carolina
Legal
Ilegal
Illegal
South Dakota
Unclear
Illegal
Illegal
Tennessee
Legal
Ilegal
Illegal
Texas
Legal
Illegal
Illegal
Utah
Legal
Legal
Illegal
Vermont
Legal
Legal
Legal
Virginia
Legal
Legal
Illegal
Washington
Legal
Legal
Legal
Washington, D.C.
Legal
Legal
Legal
West Virginia
Legal
Legal
Illegal
Wisconsin
Legal
Legal
Illegal
Wyoming
Legal
Legal
Illegal
CBD from these states tend to have more testing for impurities, like pesticides and heavy metals. Also, look for a Certificate of Analysis which will show an independent laboratory assessment of potency and the presence of contaminates. Check out the dosage of CBD on the bottle to see the exact amount you are getting. Finally, look for the Hemp Authority Seal, which means that the product is legal and the manufacturer is adhering to quality standards.
There is one FDA approved medication that contains CBD. The product is Epidiolex and it is approved for treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. In addition, there are ongoing studies of a drug called Sativex that contains THC and CBD and is used in over 25 countries worldwide in the treatment of MS.
One of the most common OTC uses for CBD is the treatment of chronic pain. There are no large randomized placebo controlled studies that confirm the efficacy of CBD in treating pain, but there is quite a bit of anecdotal evidence. To date, the only study that showed CBD to help relieve pain was a 2016 study by the European Journal of Pain which involved the topical application of CBD to rats and measured the effect on inflammation. There are many topical CBD creams on the market so this may support their use. There have been several studies that showed that CBD in combination with THC to be promising in the treatment of pain, but that may be because the CBD allows for a higher dosage of THC by blocking its euphoric effects. Products that contain both CBD and THC are not be available for over the counter purchase.
CBD has also been studied in the treatment of anxiety. One study showed that a 300 mg oral dose of CBD can reduce anxiety for public speaking if the person doesn’t suffer from social anxiety, and a 400-600mg dose was needed if the person did have social anxiety. Use these dosages as a reference point if you want to try treating your anxiety with CBD.
Early research also shows that 160mg of CBD before bed improves sleep time in people with insomnia, but it does not help them fall asleep faster. This does lead to an improvement in quality of life because of the increased amount of rest.
Other conditions that CBD has been studied for include Crohn’s disease, Parkinson’s, diabetes, MS, heroin withdrawal, schizophrenia, quitting smoking and bipolar disorder. There has been some evidence that CBD can help reduce the number of cigarettes smoked in people who want to quit smoking. It also seems to help with the cravings and anxiety associated with heroin withdrawal over the first 3 days. There have been conflicting results in the treatment of Parkinson’s, MS and schizophrenia. Evidence does not seem to support the use of CBD in the treatment of Crohn’s disease, Type 2 diabetes or the treatment of manic episodes in bipolar disorder.
There are several things to be aware of when taking CBD oil. The first thing to be aware of is that it may contain trace amounts of THC, which may result in a positive drug screening for marijuana. Be sure to check the Certificate of Analysis to see the THC content of any product you use. CBD is metabolized by the liver so it may have some effects on certain drugs. Be particularly cautious if you are taking it with blood thinners or anything that can depress the central nervous system such as certain muscle relaxers, anti-anxiety medications or pain medications, because it can result in an increased effect from these drugs. Speak with your pharmacist if you are unsure of how CBD might affect your medications.
Side effects from CBD include sedation, decreased appetite, fatigue, dry mouth, dizziness and and increased risk of liver damage. When taking CBD you should have your liver enzymes monitored, as well as your cognitive function. It is not be advisable to use CBD in situations where it is important to be extremely alert. CBD is also found in breast milk, so it should not be used by nursing mothers or in pregnancy.
Lastly, how do you figure out the dosage of CBD that is right for you with the product you choose? CBD is commonly sold as a tincture and the amount of CBD listed will be the total amount in the bottle. In a 30ml bottle of CBD oil there are approximately 600 drops. You can use this ratio to calculate the amount of CBD in each drop and figure out a dosage from there.
CBD is an extremely popular supplement right now and you can find it in many forms including tinctures, creams and even gummies. I think there is evidence to support taking it orally for the treatment of anxiety and some kinds of insomnia, and topically for pain. If you want to give it a try, be sure to research the product you choose and consult with a pharmacist if you are taking any other medications. Give the product a try for at least 2 weeks at an adequate dosage. Be aware of the side effects and drug interactions. Through my job as a pharmacist I do hear of a lot of positive reports from people taking CBD, but as with any medication your milage may vary!
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