CBD Oil: What's Behind the Hype?

If you're at all plugged into trendy health and wellness culture, you've probably heard of CBD oil, the cannabis extract that doesn't get you high, but has been touted as a potential remedy for everything from anxiety to aches and pains and insomnia. At your local health food store or on the internet, you can find it in the form of drops, capsules and edible gummies. Some baristas are using it as an ingredient in lattes, and hip bars are even mixing it with alcohol to serve up CBD cocktails. There's even CBD toast and CBD facial masks in spas.

But there's more to CBD than hipster hype. Epidiolex, a drug containing CBD, recently was approved by the U.S. Food and Drug Administration for treatment of seizures related to two rare forms of epilepsy, and a growing number of studies suggest that it may be useful in treating other disorders as well.

And remarkably, that's all happening, even though CBD — with the exception of the epilepsy medication mentioned above — remains technically illegal at the federal level, though that prohibition, at least for now, isn't being aggressively enforced. At the state level, CBD's legality varies.

So, underneath all the hype, what is CBD oil, anyway? Cannabidiol, or CBD, is a chemical compound that can be extracted from the cannabis plant. Unlike delta-9-tetrahydrocannabinol, or THC, the chemical ingredient that may lead a pot smoker to get the giggles or play interminable air guitar solos while listening to the Grateful Dead's "Europe '72" album, CBD doesn't get a user stoned.

CBD vs. THC

THC and CBD have vastly different effects, according to cannabis researcher Joshua Kaplan, an assistant professor in the behavioral neuroscience program at Western Washington University. Unlike THC, which gets its effect from acting upon certain cannabinoid receptors in the nervous system, CBD has 65 known targets in the brain and body, Kaplan says.

For example, CBD activates the same serotonin receptors that are acted upon — though in a different manner — by selective serotonin reuptake inhibitors (SSRIs), a frequently-prescribed class of antidepressant medications. "If you're trying to treat anxiety, the serotonin system seems to be important," Kaplan explains.

CBD's effect on multiple systems in the brain and body make it a potentially useful treatment for a wide range of different conditions, from inflammation and migraines to spasticity caused by multiple sclerosis, Kaplan says.

But that doesn't necessarily mean that CBD is a panacea. While there have been large, well-designed studies on CBD as a treatment for certain types of epilepsy, much of the information about other possible uses comes from anecdotal reports, case reports, case series and small studies, according to Timothy Welty, a professor of pharmacy practice and chairman of the Department of Clinical Sciences at Drake University in Des Moines, Iowa, and author of a recent article about CBD in The Conversation.

While those sources can provide interesting information, they're also prone to placebo effects, Welty explains via email. "They are often not reproducible," he said. "The situations that are described are usually not well-controlled to demonstrate the effect of CBD and eliminate potential confounding factors. For this reason, they are not considered as strong evidence for the efficacy of a drug."

Additionally, the limited scale of that CBD research makes it difficult to detect side effects, drug interactions and other potential problems, because there are too few patients involved, Welty says.

But many people out there aren't content to wait for more scientific studies or FDA approval of medications containing CBD. Instead, they're experimenting with CBD on their own, to see if it works for whatever ails them.

Dosing

That's a concern to researchers such as Kaplan, who explains that different conditions might call for very different dosages of CBD. "The dose range can be quite narrow," he says.

For example, in a Brazilian study published in 2018 on CBD's effect in relieving anxiety associated with public speaking, researchers gave different doses of CBD to 57 male subjects. They found that a dose of 300 milligrams significantly reduced anxiety for subjects, but those who took 150 milligrams or 600 milligrams showed no significant difference.

Additionally, CBD may not work for everything that people want to use it for. Though some are using it as an insomnia remedy, for example, there's little evidence that CBD helps people whose sleeplessness isn't caused by an impairing symptom, such as anxiety or chronic pain, Kaplan says.

For anyone using CBD, "the best onboarding strategy is to go slow, and slowly build up," Kaplan says.

But dosing can be tricky, because CBD products of the sort sold in health food stores or online aren't regulated by the FDA. A study published Journal of the American Medical Association in 2017 found that nearly 70 percent of CBD products from those sources either had lower or higher doses than the labels indicated.

Is It Totally Legal?

For something that's so widely available in stores and on the internet, CBD's legal status is murky. Even though it doesn't get anyone stoned, the U.S. Drug Enforcement Administration (DEA) classifies it as a Schedule I controlled substance, just like marijuana, according to DEA spokesperson Katherine Pfaff. The agency doesn't distinguish between CBD extracted from a high-THC cannabis plant of the sort grown to produce marijuana and CBD that comes from hemp, a form of cannabis that contains only a tiny amount of THC. (The CBD that's available in health food stores is the hemp variety.)

In September, the DEA did announce an exception for Epidiolex, the FDA-approved seizure medication containing CBD, which it classified as Schedule V, the category for medications with a low potential for abuse. Pfaff says the DEA would do the same thing for other CBD drugs that come up through the FDA pipeline. That didn't change CBD's overall classification.

But although CBD technically remains a controlled substance, DEA isn't going out of its way to enforce the prohibition, and isn't targeting CBD users. "We're more focused on major drug traffickers and the opioid crisis," Pfaff explains.

That leaves CBD up to individual states, whose laws vary. According to Justin Strekal, political director and federal lobbyist for the National Organization for the Reform of Marijuana Laws, CBD is definitely in the clear in the nine states (plus the District of Columbia) that have legalized cannabis use by adults, while in the 31 states that have legalized medical cannabis, CBD is legal if a person has an authorization from a physician. Two other states, Indiana and Kansas, have passed laws legalizing CBD from hemp, even though they don't allow medical or recreational use of cannabis. (CBD Hacker, a website that reviews CBD products, provides this handy interactive map of state CBD laws.)

There have been "very few" instances of consumers actually facing criminal charges for purchasing CBD derived from hemp, Strekal says.

Meanwhile, the Brightfield Group, a market research firm, predicts that CBD will be a $22 billion industry by 2022.