What is CBD and is it Safe to Use?

Step aside Vitamin C. Move over fish oil. Stand down, Echinacea. There is a new "it" cure-all in town, and it is taking the marketplace by storm. The U.S. hemp CBD market has exploded and is projected to total $22 billion by 2022.¹

But what exactly is CBD, and is it safe to use for its many touted health benefits?

Christine Roussel, PharmD, BCOP, BCSCP, Director of Pharmacy at Doylestown Health, and sought-after expert in the clinical and legal considerations regarding cannabis, weighs in on the safety of CBD.

What is CBD?

Cannabidiol (CBD) is one of many active ingredients in the Cannabis sativa plant. CBD does not alter perception, mood, consciousness or cognition, nor is it associated with addiction. The molecule in cannabis that usually gets the most attention is tetrahydrocannabinol (THC). THC gets people "high" and is the primary molecule for pain relief, according to Dr. Roussel.

Not all Cannabis sativa plants contain the same amount of THC and CBD. Plants with high amounts of THC are commonly known as marijuana, while those with lower amounts are called hemp. CBD is found in marijuana and hemp; and thanks to the Farm Bill of 2018, growing hemp has become as conventional for farmers as growing corn. The more hemp that is grown, the more CBD products have flooded the market.

CBD: The Good News and the Bad News

"CBD is shown to have several effects on the immune system and reduces seizures in children," explains Dr. Roussel. "For this reason, there is one FDA-approved CBD drug for rare types of epilepsy. Like all prescriptions, it is illegal to use a prescription outside its intended use. Therefore, in the eyes of the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA), the countless over-the-counter CBD products available today are not federally regulated."

In addition, there are other concerns consumers should be aware of when considering over-the-counter CBD products:

• There are no regulations for cannabidiol products, as they do not qualify as dietary supplement.
• In a study of products on the market, only thirty percent of the products actually contained the amount of CBD in them as was listed on the label,² "which is very concerning," say Dr. Roussel. The FDA has sent warning letters to many CBD companies for making false claims, including selling "CBD" products with no CBD in them at all.
• Forty percent of products in the study had way more CBD in it than was listed. High doses of CBD can cause liver problems.
• One in five CBD products is contaminated with THC.³ Loss of function and light-headedness become a concern, as does impaired driving, fall risk and the likelihood of failing a drug test.
• It is unknown how CBD interacts with many prescriptions and other drugs. The more CBD a person ingests, the greater the impact on drug interactions. It is known that CBD can affect blood thinners, which increases the risk of bleeding, as well as changes in blood levels and the way medications work for certain cancer and HIV medications.
• Side effects of CBD include diarrhea, headache, appetite suppression and sleep disruption.⁴

The Bottom Line

"CBD is an amazing chemical with great clinical potential, but it must be respected as a powerful drug that belongs behind a pharmacist’s counter," says Dr. Roussel. While CBD creams and lotions are less of a concern, she warns against ingesting CBD. "If a person wants to test the waters, they must know and trust the manufacturer and be sure about the quality and consistency of the product. Patients should speak to their doctors first if they are taking other prescription medications."

1. Cannabis market researcher Brightfield Group
2. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA 2017;318:1708-1709.
3. US Food and Drug Administration (FDA). Warning letters and test results for cannabidiol-related products. April 2, 2019. www.ismp.org/ext/247
4. World Health Organization: Cannabidiol Critical Review