En español | Twice a day, Joe Tanko puts a drop of CBD tincture under his tongue — and waits for the active ingredient to be absorbed. “Golfing makes my back sore,” says Tanko, 62, of Pelham, Alabama. “It's pretty miserable waking up through the night with the pain.” But he says that since he started using CBD this year, his back feels fine and his sleep is undisturbed. “It also helps me to concentrate better,” he notes, which he says has helped improve his golf game.
CBD (cannabidiol) is the trendy cannabis compound with a supersized health halo and market presence. While some states still restrict or ban CBD products, and their legal status remains murky and confusing, they are increasingly available at retailers and online.
Conventional CBD products include oils to take internally or vape, as well as topical creams, balms and lotions. But CBD is also turning up in bottled water, pet treats, breath mints, as well as jelly beans and lollipops, coffee and cupcakes, pizza and beer — even hair pomade. Whoopi Goldberg and Montel Williams hawk their own CBD products. You can pick up CBD at a CBD store, order it online or grab some at gas stations, supermarkets and — in some states — at CVS, Rite-Aid and even the cosmetics counter of the high-end department store Neiman Marcus.
Thanks to all that hoopla and some eye-watering prices — like $179 for a one-ounce bottle of CBD oil — cannabis industry watchers predict the CBD market could hit $22 billion by 2022.
At least 64 million Americans have tried CBD — including more than 1 in 6 boomers. The top reasons: pain, anxiety, depression and insomnia; in one recent study, two-thirds said it helped their health issue all by itself, and 30 percent said CBD helped when combined with conventional medications.
Here's what you need to know.
CBD alone won't get you high
CBD products generally have no more than a minute amount of tetrahydrocannabinol — better known as THC, the main psychoactive chemical in marijuana — and it's not enough to make you feel euphoric.
It's hard to know what's in the bottle
CBD is a largely unregulated product, warn Utah Department of Health researchers, who say synthetic cannabinoids marketed as CBD likely caused 52 poisonings in Utah in late 2017 and early 2018. A recent Virginia Commonwealth University study found a dangerous synthetic, as well as the cough suppressant dextromethorphan, in one manufacturer's CBD vaping products. And a 2017 study of 84 CBD oils, tinctures and vape products found that just 31 percent contained the amount of CBD specified on the label. About 1 in 4 had less, and 43 percent had more.
Before trying CBD
1. Consult your doctor. Talk to your primary care physician and any specialists you may have, as there may be drug interactions with blood thinners, chemotherapy drugs and other medications.
2. Find a quality product. “Don't just grab a bottle off the shelf at the convenience store,” says Maroon. Go to the product's website and look for information about third-party testing for purity, safety and CBD and THC levels.
3. Start small. Try a low daily dose of CBD for several days before making any decisions about increasing the amount you use.
"Currently, the FDA [Food and Drug Administration] doesn't regulate the safety of dietary supplements. And most CBD is marketed as a supplement or added to foods and drinks,” notes Peter Grinspoon, a medical marijuana researcher, primary care physician at Massachusetts General Hospital and Harvard Medical School instructor. “You cannot know for sure that the product you buy has active ingredients at the dose on the label."
CBD seems to work for some conditions, but not for others
Anecdotally, CBD appears to work for pain. Neurosurgeon Joseph Maroon, a professor at the University of Pittsburgh Medical Center, says his patients with joint and back pain get relief with over-the-counter CBD. “Any time there's inflammation, CBD may help,” he says. “There's some data it helps with peripheral neuropathy, a growing problem for people with diabetes — especially as they age. I recommend it along with other natural anti-inflammatories like fish oil, curcumin and boswellia.”
But there are strong indications that “having some THC in a CBD product” works best, says Bryan. For instance, a 2019 German study of a drug with equal parts THC and CBD eased severe chronic pain. Even a little may make a difference — though that calls into question the effectiveness of over-the-counter, CBD-only products, which lack what are considered therapeutic amounts of THC. Scientists suspect CBD works by latching onto receptors in the body's endocannabinoid system, an internal regulating system that plays a role in pain, sleep, mood, inflammation, stress and more. Still, it is not even close to being a cure-all. “People think it helps nearly everything, but that cannot be true,” notes Kent Hutchison, a professor of psychology and neuroscience at the University of Colorado Boulder. “It will likely be good for some things; we just have to find out what they are. We need good human studies.”
CBD has been researched most for seizure disorders. In one recent study, CBD reduced seizures in kids and adults, ages 2 to 55. In 2018, the FDA approved Epidiolex — the nation's first drug derived from CBD — for rare, severe forms of epilepsy that don't respond to other treatments.
CBD is not a treatment for serious medical conditions like cancer, diabetes and Alzheimer's disease. Since 2015, the FDA has sent dozens of warning letters to CBD companies that made “egregious” or “unsubstantiated” claims, including, in July, to Curaleaf for online CBD health claims the FDA says amounted to selling unapproved drugs. (The company says it has removed the claims and supports the FDA's enforcement efforts.)