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CBD Oil Is Everywhere, But Is It Really Safe and Healthy?

Y ou might have seen it in your neighborhood health store, your local spa or your corner coffee shop. CBD, aka cannabidiol, is getting mixed into cocktails, lotions and drinks.

But what is CBD, exactly? Does it have real health benefits? Is it even safe?

To get a better understanding of the compound, TIME spoke to two scientists on the cutting edge of CBD research: Dr. Esther Blessing, an associate professor of psychiatry at New York University, and Margaret Haney, professor of neurobiology at Columbia University Medical Center and director of the university’s Marijuana Research Laboratory.

Blessing and Haney agree that the current evidence suggests that CBD shows promise for helping to treat some illnesses. In June 2018, the Food and Drug Administration (FDA) approved the first cannabis-derived drug — Epidiolex, which contains purified CBD — to treat certain rare childhood seizure syndromes. However, much of the research on CBD is only in very early stages, and scientists still don’t know a lot about it — including whether it has negative long-term effects.

On top of that, the CBD that is available in shops and online is not regulated by the government — which means it might contain other ingredients, or not even any CBD at all, Blessing says. Haney warns that much of the CBD on the market could be “snake oil.”

Here’s what you need to know about CBD.

How is CBD different from marijuana?

The drug marijuana, which is also known as weed or pot, is the leaves and flowers of the cannabis plant.

Cannabidiol is a naturally occurring compound that is found in cannabis plants. CBD can be extracted from the same plant as marijuana, or from hemp — another cannabis plant that is now legal in the United States.

Hemp has very low levels of another cannabis compound, tetrahydrocannabinol (THC) — the main psychoactive compound in marijuana. Evidence suggests that THC — not CBD — causes the symptoms people associate with getting high on marijuana, Blessing says. Unlike marijuana, which the CDC argues is addictive, CBD also doesn’t seem to be, according to the World Health Organization.

What is CBD oil?

In theory, CBD oil should consist of two main ingredients: the compound cannabidiol dissolved in an oil made from hemp seeds or coconut.

However, all CBD products on the market (besides Epidiolex) are almost completely unregulated. Products might not contain the amount of CBD that is advertised, and might even contain undesirable ingredients, such as THC, Haney says.

Patients who take CBD without knowing what they are getting are “just throwing their money away,” Haney says.

“It’s unfortunate that there aren’t many options for consumers to ensure that CBD they buy is safe – or even has any CBD in it,” Blessing says.

Does CBD oil have health benefits?

Companies that market CBD oil make a wide variety of claims about it. However, scientists and doctors emphasize that the research on CBD is limited, and has been slowed in the United States by federal restrictions.

Scientists say that there’s a growing body of evidence that CBD can treat other illnesses besides seizure syndromes, but they emphasize that scientific research is in its very early stages.

CBD is in early clinical trials for treating post-traumatic stress disorder (PTSD) and schizophrenia, says Blessing, who is currently studying whether CBD could be used to treat PTSD in people with alcohol use disorder.

Blessing says that CBD shows a lot of promise, and that she is frustrated that the federal government makes it so difficult for scientists to obtain different strains of CBD. “It’s my opinion that the government should step up, so we can do clinical trials and get this out to people,” Blessing says.

Blessing says that she first became interested in CBD because she saw it being used in early trials to treat people with psychosis. She explains that unlike FDA-approved antipsychotic medications, which can cause weight gain and other side effects, CBD doesn’t seem to have any major side effects.

Other evidence suggests that CBD could also be used to treat anxiety, but it has been tested only in animals and in very early clinical trials on humans.

Haney says she believes that CBD shows promise to help treat the cognitive symptoms associated with HIV and Alzheimer’s, and to treat neuropathic pain (pain from damage to the nervous system, which can be caused by diabetes, chemotherapy or HIV). Research is ongoing in all of these areas.

However, Haney emphasizes that a lot still isn’t known about CBD — including the effects of long-term use, how it acts on the brain or its impact on brain development.

Why do people use CBD products?

Scientists are looking into a wide range of uses for CBD. However, Haney and Blessing say that except for the medicine Epidiolex, there’s only been a limited amount of research to suggest that CBD can be used to treat other illnesses.

Although most scientists agree that a lot more research is needed before CBD can be prescribed to patients, for some people who are selling CBD, personal experience and word of mouth is enough to convince them that it is effective.

Lisa Richards of Denver, Colorado is a longtime yoga teacher and the co-founder of L’eela CBD Body Care, which sells CBD capsules and serums. Richards says that her own experience with CBD has convinced her that it is effective.

“I’m a believer, obviously. I can say, absolutely, for myself this works,” Richards says. “I have arthritis in my knee. If I don’t take CBD, I’m going to feel it come back in a day or two.”

Richards says that she prefers to use products in which she can actually identify the ingredients.

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“In my mind, simpler is better. If I can’t pronounce it, if I can’t tell what it is, I stay away from it,” Richards says.

Haney, however, warns that consumers should be careful about the personal testimonies and anecdotes companies offer. “It’s important to be aware of the enormous placebo effect,” says Haney. The claims marketers make are “not based on science.”

Is CBD legal?

CBD is in a legal grey area. CBD that is extracted from hemp (which must have an extremely low level of THC) has only been legal nationwide since the Agriculture Improvement Act — better known as the Farm Act — was passed in December 2018.

CBD that is extracted from other cannabis plants is still illegal on the federal level, but may be legal under state law.

However, businesses can run into trouble when they make false claims about the health benefits of CBD, or when they add CBD to food.

In recent months, both cities and states have moved to control how CBD is sold. Maine and New York City have moved to crack down on edible products containing CBD. New York’s health department confirmed to the New York Times that it has started ordering restaurants to stop selling CBD-laced food because it has not been “deemed safe as a food additive.”

Companies also can’t legally make unproven health claims about CBD.

Blessing says she’s concerned that some people buying unregulated CBD have a “real medical need” and won’t seek proven methods of treatment.

“They might be taken for a ride by people who are marketing unregulated forms of CBD and not get the treatment they need,” Blessing said.

What are the risks of using CBD oil?

The current evidence suggests that the active ingredient in CBD oil is safe, says Blessing, although it could have serious interactions if it is taken with other medications.

Haney says that more research is needed to determine whether there are long-term effects, or if it affects brain development.

“There’s nothing damning; we really just don’t know,” Haney says.

However, Blessing and Haney emphasize that products that are being sold as CBD are almost completely unregulated. Some products might even contain THC, which can interfere with medications and cause unwitting users to get high.

Should you try CBD?

While Blessing and Haney both say that CBD shows a lot of promise, they agree that the CBD products on the market (excluding the seizure drug Epidiolex) are suspect.

Blessing says that anyone considering trying unregulated CBD should definitely talk it over with a doctor, and be as well informed about it as possible.

“Take the time to get the best information you can. It’s a complex subject. The details really matter,” said Blessing.

Blessing emphasizes that there are many factors that can impact CBD’s effects. Too little CBD may have no effect at all. Additionally, the way it’s administered — as a cream, oil, pill or tab under the tongue — could weaken its effects.

Available CBD products meant to be taken orally (besides Epidiolex) generally have poor “bioavailability,” says Blessing, “so only a small fraction of CBD you swallow makes it into your bloodstream.”

Haney warns that people should approach companies that sell CBD with skepticism.

“Because it’s not regulated, nobody is really checking what it contains,” Haney says. “There is no source of CBD I can recommend.”

A Beginner’s Guide to CBD: What Is It and How It Works

The supposed miracle elixir is popping up in everything — here’s what you need to know about the buzziest ingredient on the market.

CBD is everywhere these days: You can get it in dispensaries and drug stores or at your local bar and corner store. You can drink it, eat it, vape it, and slather it on your skin. One thing you can’t do? Get stoned on it. While CBD comes from the same plants that produce pot, it’s more about healing than about getting high.

The enthusiasts who have made CBD a $1 billion business claim it calms anxiety, eases pain, soothes sleep problems, and more. The theory behind how it works seems promising: CBD — which stands for cannabidiol, a compound found in cannabis plants — is similar to compounds the human body produces naturally, called endocannabinoids, which help regulate stress, sleep, metabolism, memory, inflammation, and immunity. Some think CBD is so similar to these naturally occurring molecules that it can work the same kind of stress-relieving, sleep-inducing, and pain-reducing magic.

But here’s the catch: There’s no definitive scientific evidence that shows exactly how CBD works — or even if it works at all — says Mark Wallace, MD, a professor of anesthesiology at the University of California San Diego, who’s been studying medical cannabis for more than 20 years. “There’s a lot of hype around CBD that’s completely unsubstantiated,” he says. “While there are a lot of theories, we don’t have the proof yet, because it’s been hard to study.” After all, until CBD was legalized on the federal level in 2018, if was difficult for researchers to get any samples to test out.

Before you see for yourself if CBD has healing super powers or is just a scam, here’s important info about how it may work, what researchers do and don’t understand, and what that all means for you.

First, here are some terms you should know before trying CBD.

How CBD might work

While scientists are still figuring out exactly how CBD works, the best theory is that it impacts the endocannabinoid system (ECS) — a complex cell-signaling system that’s thought to regulate a number of important functions in your body, such as stress, sleep, digestion, immunity, memory, and the release of hormones.

The ECS in a nutshell: There are cannabinoid receptors all over your body, though they’re primarily located in the central nervous system and brain (where they’re called CB1 receptors) and in the immune system and inflammatory cells (where they’re called CB2 receptors). Your body produces billions of natural chemicals called endocannabinoids every day, which bind to these receptors to help you do things like sleep, eat, remember where you put your purse, and start the healing process when you cut your finger. When these endocannabinoids are done with their various jobs, enzymes pop up to destroy them.

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In the brain, these endocannabinoids act like neurotransmitters — they transport messages from one neuron to another. But rather than send messages with directives to do things, they actually slow down the brain’s signaling, says Mohini Ranganathan, MBBS, associate professor of psychiatry at Yale University and a CBD researcher. “When there’s too much neurotransmission going on — which you might experience as a racing mind, high anxiety, or even an increase in pain — endocannabinoids in the brain help pump the brakes,” says Ranganathan, which might explain why so many people swear by CBD’s anti-anxiety and anti-inflammatory effects.

Another theory, adds Wallace, is that while a healthy ECS is able to make its own endocannabinoids to balance out the experience of anxiety or pain signals in the brain, some people don’t produce enough cannabinoids—or if they do, the enzymes destroy them before they have a chance to do their important work. “We think CBD binds to those CB2 receptors to inhibit the release of pain signaling,” says Wallace. Finally, it may be that that CBD allows the body’s naturally-produced cannabinoids to stay in the brain and body longer, prolonging their calming effect.

What can CBD actually do?

Here are the most common medical conditions that prompt people to try CBD, and what the science says so far:

Control Seizures

Right now, the only CBD treatment that has strong enough evidence to become FDA-approved is for treating childhood epilepsy, particularly the cases that typically don’t respond to anti-seizure medications. In a number of studies, pure CBD administered orally via an oil was shown to reduce the number of seizures and in some cases, stop them altogether. In 2018, the FDA gave its stamp of approval to Epidiolex, the first cannabis-derived medicine for seizures.

Calm Anxiety

There are only a handful of small studies showing that CBD can help you chill. One 2019 study of 72 adults with anxiety and poor sleep found that CBD helped alleviate both conditions within a month. Another recent study of 60 men and women found that while clonazepam (a medication used to treat panic disorders) consistently reduced anxiety better than both CBD and placebo, 300 mg of CBD was shown to significantly reduce anxiety compared to the placebo group. (Interestingly, the same wasn’t true when study participants were given 100 mg or 900 mg of CBD, proving more research is needed to figure out the right dosing, says Ranganathan.) However, other studies have found that CBD had no effect on anxiety, leaving experts in agreement that more research is needed understand how CBD might play a role in treating an anxious mind.

Relieve Pain

One study on animals published in the European Journal of Pain found that CBD applied topically could help lower pain and inflammation due to arthritis. Another study done on rodents found CBD injections prevent inflammatory and nerve pain. Yet the evidence is still pretty slim: When Australian researchers analyzed 104 studies, including more than 10,000 patients, they found that just 29% of patients experienced a 30% reduction in pain after using CBD — not much higher than the 26% who found the same relief using a placebo.

Treat Schizophrenia

Preliminary research indicates that CBD may reduce some of the symptoms of schizophrenia without the side effects that come along with most anti-psychotic drugs. “However, the data is mixed,” says Ranganathan, who has authored studies that show CBD might have some benefit when it comes to treating this mental illness, as well as other studies that have found no effect at all.

But wait — is CBD even legal?

Until recently CBD products (with the exception of the FDA-approved epilepsy drug Epidolex) were lumped into the same category as heroin, according to federal drug laws. However, when Donald Trump signed the Farm Bill into law in December 2018, it legalized CBD that is derived from hemp and contains no more than 0.3% THC. CBD that comes from the marijuana plant is still illegal, since marijuana still has Schedule 1 drug status. Even the TSA recently announced it would allow people to fly with hemp products, including CBD produced within the regulations defined by the new law. “However, we’re still waiting for the USDA to create the final rules regarding the legality of hemp products, which means CBD isn’t yet legal in every state,” says Cristina Buccola, an attorney who specializes in the cannabis industry. “While we wait for federal-level guidance, you should check your own state’s laws. That said, any kind of enforcement we’re seeing as it relates to CBD has been targeted toward the manufacturers and distributors — not the customers.”

The side effects of CBD

It’s possible you will notice drowsiness, dry mouth, and lightheadedness when taking CBD. The FDA strongly advises against using CBD if you are pregnant or breastfeeding. The FDA also notes that CBD can cause liver injury and interact negatively with other medications, so it’s important you speak with your doctor before trying a CBD product.

The Dos and Don’ts of buying CBD

Ready to see if CBD can work its alleged magic on you? Proceed carefully with these tips:

DON’T trust labels. A 2017 study published in the journal JAMA found that of 84 CBD products researchers bought online, 43% had more CBD than indicated, 26% had less, and some even had unexpected THC.

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✘ DON’T hunt for bargains. “Good CBD is expensive,” says Wallace. “CBD manufacturers have to do a lot of extraction to get CBD oil from hemp plants, and while they’re getting more efficient at that process, it’s time-consuming and expensive.” That’s why most quality CBD products can cost upwards of $50 to $100 for a 1-ounce bottle of oil. However, thanks to the new Farm Bill that legalized hemp, CBD production will likely ramp up, which should drive the costs down.

✘ DON’T believe the hype about the ideal dose. There is absolutely no evidence proving you should take a specific amount for specific result (other than childhood epilepsy — the only medical condition for which CBD is FDA-approved). “We are working on dose studies and trying to figure out how, exactly, CBD is metabolized and absorbed,” says Ranganathan. “We simply don’t have definitive information yet.”

✔ DO look for a “Certificate of Analysis” (CoA) when you order. This document provides lab results of the actual CBD used in the product. If the company website doesn’t include a CoA, call and ask about it — but keep in mind that CoAs aren’t mandatory in every state.

✔ DO choose products made with organic American hemp, which makes it easier to find out if the soil it was grown in has been properly tested. (Hemp is a bio-accumulator, which means it absorbs everything in the soil — including herbicides, pesticides, metals, and fungus, says Wallace.) Better yet: Buy from a state such as California or Colorado that has some sort of cannabis control in place, adds Wallace; this offers another layer of protection against buying a contaminated product.

✔ DO talk to your doctor if you’re going to try CBD. While research on drug interactions with CBD is in its infancy, we do know it has the ability to either stimulate or inhibit the enzymes that metabolize other drugs you might be taking, which could impact the effectiveness of those medications. While the doses in consumer CBD products are typically so low that the risk is likely minimal, says Wallace, it’s still a good idea to talk to your doc about any supplement you’re taking — including CBD.

How to take CBD

Not sure where to even start when it comes to trying CBD? That’s understandable, says Wallace. “This is a very complicated therapy, because there are so many different modes of delivery.” Here, the different ways you can take CBD and how each works:

Edible

WHAT IT IS: CBD oils and tinctures mixed into chocolate bars, gummies, soft drinks, coffee, popcorn, and salad dressing.

HOW IT WORKS: When CBD travels through your digestive system, only a small percentage gets absorbed, says Ranganathan. “If you ingest 100 mg of CBD only about 5 mg may end up in your bloodstream,” says Ranganathan. While scientists are working on increasing bioavailability, there’s another issue to keep in mind: Different people absorb different amounts of the same dose of CBD. “Even the same person taking the same dose on two different days means it may be absorbed differently,” she adds.

Sublingual

WHAT IT IS: Oils and tinctures that are designed to be held under your tongue before swallowing.

HOW IT WORKS: The CBD passes through a permeable membrane under your tongue, bypassing your digestive system and going right into your bloodstream — meaning you will absorb more than you would by simply eating it. It’s not clear exactly how much CBD is absorbed, though, and a good amount of what you put in your mouth will still be swallowed, just as if you’d taken an edible.

Topical

WHAT IT IS: A CBD-infused cream you rub on sore areas like a bum back or arthritic hands.

HOW IT WORKS: A few animal studies have found that transdermal CBD products, which penetrate the skin deep enough to enter the bloodstream, can reduce inflammation and pain-related behavior in rats with arthritis. But we don’t yet know if this translates to humans. Some CBD creams include ingredients such as arnica, menthol, and camphor, which are known to provide an immediate cooling sensation on the skin that distracts from pain — meaning it might not be the CBD at all that soothes the pain in these products.

Should you vape CBD?

When you inhale CBD, it bypasses your digestive system and heads straight for your lung tissue. (One study found that about 25% of the dose of vaped CBD was absorbed, compared with about 5 percent of edible CBD.) But hearing about the dozens of deaths and hundreds of illnesses that have been attributed to vaping may have you rethinking that plan.

While most of the vaping-related deaths have been linked to bootleg products containing THC, that doesn’t mean vaping CBD is safe, says Daniele Piomelli, PhD, professor of anatomy and neurobiology at the University of California Irvine School of Medicine and director of the UCI Center for the Study of Cannabis. “The only info we have about CBD is from clinical trials where CBD is given orally,” he says. “And we haven’t studied the materials in the vaping gadgets. What happens after a certain amount of use at a certain temperature? Could those materials leak into what is vaped and inhaled?”

“We know even less about the health risks of vaping CBD than THC or any of the other marijuana products,” adds Suchitra Krishnan-Sarin, PhD, director of Yale University’s Tobacco Centers of Regulatory Science. “We don’t know what concentrations of CBD come in most products and what they do to pulmonary and cardiovascular health.”Until we learn more, both the CDC and the American Medical Association have recommended that people avoid vaping entirely while the cause of vaping-related illnesses and deaths is determined.