420 FILE--There’s a reason cannabidiol (CBD) is becoming a ubiquitous product nationwide. At the end of last year, health authorities removed hemp — a species of cannabis that doesn’t contain psychoactive qualities — from the controlled substance list, meaning the plant is no longer considered illegal under federal law. Since most CBD products are derived from hemp, that change meant new products could flood the market. And they did.
The CBD and cannabis market research firm Brightfield Group says the market for hemp-derived CBD products was about $591 million in 2018 and is on pace to grow into a $22 billion market by 2022.
You can now buy CBD-laced cookies at bakeries and CBD face masks at the pharmacy. It’s sold as tinctures at farmers markets and bougie wellness boutiques and infused into cocktails at bars. Walgreens and CVS announced in March they will begin selling CBD sprays, creams, and patches at hundreds of their stores.
“There are a million different products that didn’t exist a year ago,” says Anja Charbonneau, the founder and creative director of Broccoli, a print magazine focused on cannabis culture.
CBD is closely related to another active phytocannabinoid, tetrahydrocannabinol (THC), and there’s evidence it could provide relief for a range of conditions, including anxiety, insomnia, chronic pain, and arthritis. “Could” is the key word. “The enthusiasm for CBD has outpaced the hardcore scientific evidence in humans,” says Dr. Peter Grinspoon, a primary care physician in the Boston area.
Preliminary research and ample anecdotal evidence suggest CBD may tamper down inflammation in the body and quell anxiety, but randomized clinical trials studying the health benefits of CBD in humans are few and far between. That hasn’t stopped companies from connecting the dots anyway.
The U.S. Food and Drug Administration (FDA) sent warning letters in April to three companies — Advanced Spine and Pain LLC, Nutra Pure LLC, and PotNetwork Holdings Inc. — for falsely claiming their products could cure cancer, neurodegenerative conditions, autoimmune diseases, and opioid use disorder.
The wider the disconnect grows between vertiginous expectations and science-backed evidence, the higher the probability that CBD will disappoint. The compound is being painted as a cure-all, says Jason DeLand, an advertising executive and the co-founder of Dosist, which makes vapes with CBD and THC. “It’s not.”
Which isn’t to say you shouldn’t try it. As chemical compounds go, pure CBD is relatively safe. According to the World Health Organization, CBD does not “appear to have abuse potential or cause harm.”
Here’s a guide to navigating the CBD market without getting scammed.
What CBD is actually good for
The literature on CBD’s effects on humans is sparse. That’s largely because studying cannabis remains a major challenge. While hemp-derived CBD is legal, cannabis remains a Schedule 1 drug, which means the U.S. government restricts its availability for research.
The FDA has only approved one drug derived from CBD. Epidiolex from GW Pharmaceuticals was approved in June 2018 to treat rare and severe forms of epilepsy. GW Pharmaceuticals is working on cannabinoid-based treatments for a range of other conditions, including epilepsy, autism, and schizophrenia.
The way CBD could be effective for these conditions is how it binds to receptors in the endocannabinoid system — a network in the brain involved in the regulation of functions such as mood, pain, inflammation, and movement — without producing a high. That’s the working theory for now, even though hard evidence is scant.
“It depends on what you consider as evidence,” says Grinspoon. “A lot of people swear by it and say it helps them with sleep, anxiety, and pain.”
But there is little clinical evidence to back up these anecdotes. While research on animals suggests CBD could be beneficial for anxiety, sleep, pain, and addiction, results in animals don’t always translate to results in humans.
Drew Todd, one of the co-founders of the CBD startup Feals, says his company conducted a survey of 5,000 people about their product and amassed plenty of anecdotal evidence that CBD was helping his customers. “If you have anxiety, that feeling of anxiety isn’t there anymore,” he says. “Same for pain or inflammation.” On its site, the company describes its CBD tinctures as “helping people manage anxiety, pain, and sleeplessness.”
Now that hemp-derived CBD is legal, Todd says he’s optimistic the company’s marketing will be backed up by clinical research. And according to Grinspoon, such studies are underway. Research into the long-term effects of CBD will have a longer lag time, however.
What to look out for
Unlike marijuana-based products — which are subject to state regulations that often require laboratory testing — hemp-derived CBD has little oversight, leaving the onus on the customer. Federal health officials released a report in 2018 that showed 52 people were sickened with nausea and seizures in Utah over a four-month period from synthetic products that were falsely labeled as CBD.
Charbonneau, the editor of the cannabis magazine, advises online shoppers to start by visiting companies’ “About” pages on their websites and reading up on them with an eye for information about their farm, where the product is coming from, and who is growing the plant.
Products ideally should list on the label the exact amount of CBD as well as a breakdown of any other ingredients. Cannabis plants can absorb heavy metals and pesticides through soil and water; they also might contain THC or other unknown substances. In a 2017 study published in the Journal of the American Medical Association, researchers purchased and tested 84 CBD products sold online and found that 26 percent contained less CBD than labeled.
Grinspoon recommends only purchasing CBD products from companies that verify the purity of their products through an independent lab and can provide a certificate of analysis detailing the results.
If you’re purchasing CBD from a store or coffee shop, ask questions, says Raeven Duckett, co-founder of Community Gardens, a cannabis dispensary in Oakland, California. “The people who are serving it to you should be able to tell you that or direct you on where you can find it.”
If you live in a state where cannabis is legal, Duckett recommends visiting a licensed dispensary because most have regulations around quality control in place. “Budtenders are usually pretty knowledgeable about the CBD products carried in their store,” she says.
What form to take it
If you’re looking to try CBD, there’s a dizzying array of options to choose from, including vapes, joints, gummies, chocolate, tinctures, face masks, and infused lattes.
Inhaling CBD is the fastest-acting, according to those familiar with the products, and oil tinctures are a close second. Diluting a tincture by adding it to food or a drink will likely increase the onset period. CBD-only gummies as well as gummies with a high CBD-to-THC ratio are also popular ways to ingest CBD. In general, Duckett says CBD that’s ingested via edibles takes about 90 minutes to activate.
There’s also a suite of topical CBD products, including soaps, face masks, and creams. Unlike the other forms of CBD, topicals aren’t absorbed into the bloodstream. Instead, they work by binding to cannabinoid receptors receptors in the skin. While less risky than the other methods, it’s still a good idea to verify that these products contain the amount of CBD they say they do.
How much to take at a time
Unfortunately it’s hard to get granular on how high to go; the research on dosing is slim. Experts advise to start with a dose of CBD of around five milligrams or less and slowly work up from there because, like coffee and alcohol, CBD affects everyone differently.
Very high doses are often used in animal studies, says Grinspoon, the Boston-area physician. This is also true in the limited published research on humans. One small study found that 300 milligrams of CBD outperformed a placebo in treating anxiety, and an ongoing study on CBD’s effects on anxiety has people taking up to 800 milligrams a day. Both studies have small sample sizes, and without knowing the long-term side effects of CBD, taking anything approaching that amount is likely unwise.
What to know about the health risks
CBD is nonpsychoactive and nonaddictive, and there is no “abuse liability,” says Sumner Burstein, a professor emeritus of biochemistry and molecular pharmacology at the University of Massachusetts Medical School. However, there is evidence CBD affects the way the body metabolizes drugs, which could alter the effects of other medications, like blood thinners. It may be worthwhile to mention to your doctor that you’re taking CBD.
Like coffee and alcohol, CBD affects everyone differently.
The bottom line
Since CBD is relatively benign and there’s a dearth of scientific-backed advice on dosage, if you’re interested in trying the compound, your best bet is careful experimentation.
It’s also wise to temper your expectations. If it helps relieve pain, anxiety, insomnia, or any of the other conditions people use it to treat, that’s great. But experts are skeptical that CBD can actually get rid of any of these health problems on its own.
Grinspoon says CBD offers exciting potential, particularly given how safe it appears to be and especially compared with other available treatments for anxiety, insomnia, and pain. “I’m very eager for the science to catch up,” he says.
(Laura Entis is a Medium member and a freelance journalist on health, business and science. Former associate editor at Fortune.)