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CBD is seemingly everywhere and in everything, from CBD-infused creams to CBD-infused oils, tinctures, gummies, juices, and lollipops. But does it work, and is it safe? We’ve got your questions covered.

I n case you haven’t heard, CBD is a cure for whatever ails you, from insomnia and inflammation to pandemic angst. Or at least that’s what retailers, supermarkets, mini-marts, beauty stores, and coffee and smoothie shops across America would have you believe. There are CBD-infused creams. CBD-infused oils. CBD-infused tinctures, gummies, juices, lollipops, lattes, nutritional supplements, and even a CBD oil–infused pillow! What’s next, CBD-infused tampons? (Actually, that already exists. Really.)

According to the Brightfield Group, a market research firm, CBD sales were estimated to exceed $4 billion at the end of 2021, and by 2025, the industry’s total market value could reach a whopping $16 billion.

Put that in your pipe and smoke it.

But does CBD work?

That’s a question worthy of a Talmudic scholar, because the CBD world is complicated.

Some believe that it may have an important role to play in certain health outcomes.

Raphael Mechoulam, PhD, a professor of medicinal chemistry at Hebrew University in Jerusalem, Israel, has been studying the health benefits of cannabis and CBD since the early 1960s. Long considered the grandfather of cannabis research, Dr. Mechoulam and his team developed a process for synthesizing certain acids found in the cannabis plant. These acids — otherwise known as cannabidiolic acid (CBDA), and a methylated version of CBDA (CBDA-ME) — have been since studied for a variety of purposes, and might ultimately be used to develop new drugs for everything from arthritis and anxiety to inflammatory bowel disease and psoriasis.

Others believe CBD is unproven and risky.

The U.S. Food and Drug Administration (FDA) continues to investigate its potential harms, noting that while it recognizes the potential opportunity that cannabis-derived compounds (like CBD) can offer, it remains concerned about CBD products being marketed as supplements. (According to the FDA, THC and CBD products do not fit the definition of a dietary supplement.)

“FDA is aware that some companies are marketing products containing cannabis and cannabis-derived compounds in ways that violate the Federal Food, Drug, and Cosmetic Act (FD&C Act), and that may put the health and safety of consumers at risk,” the Agency wrote in its 2021 update, noting that it’s illegal to market CBD by adding it to a food or labeling it as a dietary supplement.

Among a number of problems with CBD, the FDA says, is that it can cause liver damage and diarrhea, it may impact the metabolism of other drugs, and it may cause male reproductive toxicity in humans, as has been found in animal studies.

Still, many consumers continue to believe CBD’s potential benefits. A report (PDF), also from the Brightfield Group, that analyzed 2,400 members of an online community of medical cannabis users found that 59 percent of CBD users say they use it for insomnia and 66 percent for anxiety, while 44 percent have taken it for depression and 49 percent for joint pain and inflammation.

With so much CBD noise out there, we’re feeling a little overwhelmed and confused about CBD. We want to know the real deal. For starters, is CBD the same as cannabis? Should we spend our hard-earned money on the stuff, or is it a scam? Is there any science to back up the claims that CBD is helping people sleep better, feel better, look better, or be an all-around better human? If so, is that in the form of CBD oil, tinctures, lotions, or should we vape it? But wait — isn’t vaping bad for you?

Relax. We’ve got you covered. Herewith, the real scoop on CBD. (Buyer beware: Abbreviations ensue.)

Common Questions & Answers

Endocannabinoids are molecules produced by the body to maintain homeostasis — stability — in response to changes in the environment. The endocannabinoid system interacts with all of the major systems and organs in the body to enable and restore optimal functioning.

The word “cannabinoid” usually refers to a chemical found in the cannabis (marijuana or hemp) plant. “Endo,” in this context, refers to substances produced inside the body. Endocannabinoids are, in effect, the body’s own source of cannabis-like substances.

CBD and THC are plant cannabinoids, which operate much as endocannabinoids do, by attaching to certain receptors on the outsides of cells and altering the behavior of those cells or the bodily systems they are a part of.

Cannabinoids and endocannabinoids can affect pain perception, memory, mood, appetite, and many other bodily systems. The endocannabinoid system regulates the release of other neurotransmitters — that’s how it maintains homeostasis — and helps the body heal from any damage it sustains. Plant cannabinoids can similarly enhance feelings of well-being, but they can have undesirable side effects as well, particularly in young people.

Research suggests that endocannabinoids can be boosted by certain foods, such as those containing essential fatty acids, chocolate, herbs, spices, and teas, as well as by stress-reducing activities.

CBD: The Good, the Bad, and the Confusing

Before we get too much into the, er, weeds, it’s important to understand what CBD is and where it comes from.

Cannabis refers to a group of three varieties of marijuana plants with psychoactive properties: Cannabis sativa, Cannabis indica, and Cannabis ruderalis.

Cannabis contains more than 400 compounds, known as cannabinoids (pronounced keh-NAB-eh-noyd). The most well-known and researched are cannabidiol (CBD), and delta-9-tetrahydrocannabidiol (THC). Other lesser known components — THCA, CBN, CBC, and CBG — play different roles and have different effects in the body. (See our CBD glossary for details.)

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The component in cannabis that is linked to its intoxicating effects (in other words, the “high,”) is THC. Conversely, CBD won’t get you high. Depending on your goals, this is either a good or a bad thing.

“Hemp” (which incidentally, is considered part of the CBD family) refers to non-intoxicating varieties that are high fiber or high seed-yielding and often used for rope, clothing, or sails. (Cocktail party fact: “The word ‘canvas’ comes from ‘cannabis,’ as it was made from cannabis fiber varietals,” says Will Kleidon, the CEO of Ojai Energetics in Ojai, California..)

In the United States, the legal definition of hemp is any cannabis plant whose delta-9 THC is below 0.3 percent.

What’s the Endocannabinoid System and How Does It Work?

The endocannabinoid system (ECS) is a biological system first described in the 1990s, and it plays a big role in brain, endocrine, and immune function. Its main role, however, is to maintain homeostasis, the internal biological balancing mechanism of the brain and body.

Two main elements of the system are endocannabinoid receptors, classified as CB1 and CB2. The body makes its own cannabinoids, known as endocannabinoids, that can act upon these receptors. But other varieties of cannabinoids, such as CBD, can interact with them, too.

What Are Cannabinoid Receptors?

Cannabinoid receptors are laced throughout the body, brain, and nerves.

  • Cannabinoid 1 (CB1) Receptors Most of these are in the central nervous system, especially neurons (nerve cells) in the brain.
  • Cannabinoid 2 (CB2) Receptors These are located mainly on immune cells but are also found in the central nervous system.

Both receptor types are activated by cannabinoids, which can be generated naturally inside the body (known as endocannabinoids) or can be introduced through a form of cannabis.

What’s the ‘Entourage Effect’?

The entourage effect refers to a theory that the whole is more effective than each part — or that the various compounds of the cannabis plant work best synergistically.

“It’s the theory that the cannabinoids, flavonoids, terpenes, and fatty acids all work together like an orchestra, in which all the instruments complement each other so you get the maximum effect of the plant,” says the cannabis researcher Monica Taing, PharmD. “CBD by itself can be a pain reliever, and THC can be a pain reliever by itself, but when combined, they work better for pain relief. That’s the entourage or ensemble effect.”

Now that that’s out of the way, let’s get into the nitty-gritty.

What Are the Legal Implications of Using CBD?

The legality of CBD is confusing.

In 2018, the Agriculture Improvement Act of 2018 (aka that year’s Farm Bill), legalized CBD derived from hemp — with the important caveat that it could only contain 0.3 percent of THC by dry weight, to be grown legally. This type of CBD is legal in 47 U.S. states with some restrictions, but totally illegal in Idaho, South Dakota, and Mississippi. Plants with more than 0.3 percent of THC are considered marijuana, which is legal for recreational use in 19 states, Washington, DC, and Guam.

Despite state laws legalizing the sale of cannabis for recreational or medicinal use, the Drug Enforcement Administration (DEA) (PDF) still classifies it as a Schedule 1 drug: “substances or chemicals [that] are defined as drugs with no currently accepted medical use and a high potential for abuse.” So, while marijuana is illegal on a federal level, states have different laws regarding marijuana and CBD.

Only one cannabis-derived drug product has been FDA approved: cannabidiol sold under the brand name Epidiolex, which contains a purified form of high-dose CBD to treat a rare, hard-to-treat form of epilepsy in children ages 1 and up.

How Do I Find Safe CBD Products? How Do I Know What I’m Getting?

Short answer: You often don’t.

The situation is not unlike that of dietary supplements, except for in the case of supplements, the FDA has defined a very clear set of restrictions — and the Federal Trade Commission, strict reinforcement of health claims. While the FDA has sent warning letters to certain companies selling CBD products, many products slip under the radar. In addition, state and Federal CBD regulations are at odds, so oversight can be difficult. What’s more, every state where medical or recreational marijuana is legal has its own testing rules and regulations, so something that passes muster in Massachusetts might not in California.

People often buy their products online or at the local drugstore or gas station, meaning that they often don’t know what they’re getting.

“Some CBD products don’t contain CBD, but they contain THC and heavy metals, so we need strong regulations,” says Dr. Taing. Indeed, as of May 21, 2022, poison control centers have managed 2,652 cases related to CBD, per the American Association of Poison Control Centers.

Some people have failed drug tests because they’ve unwittingly taken THC that was in a product that was supposed to contain only CBD. A study published in the Journal of the American Medical Association (JAMA) in November 2017 found that 21 percent of CBD products derived from hemp and sold online contained THC, even though THC wasn’t listed on the packaging.

A more recent study in JAMA Psychiatry showed that even a high-quality, high-potency cannabidiol product labeled as carrying as much as tenfold less than the legal limits of THC permissible under law might still result in positive urine drug tests.

Findings from another study, published June 2022 in the Journal of Cannabis Research, showed that of the 80 products evaluated, 37 contained CBD concentrations that were at least 10 percent higher or lower than the concentration listed on the label: 12 products contained less than 90 of what was listed, while 25 products contained more than 110 percent.

Even more worrisome, a study published in January 2019 in Forensic Science International examined nine liquids that were advertised as 100 percent natural CBD extract and found they contained potentially problematic compounds. One contained dextromethorphan, which is used in over-the-counter cough medication and is considered addictive when abused. Four others had a synthetic cannabinoid that can cause, among other things, anxiety, psychosis, and even death.

“As with any other product you would ingest, you have to be smart,” says Jahan Marcu, PhD, the editor in chief of the American Journal of Endocannabinoid Medicine, and the cofounder and chief science officer at the International Research Center on Cannabis and Mental Health.

What’s more, he says, every product should have a certificate of analysis, or COA — a document generated by a laboratory certifying its legitimacy and also listing the ingredients.

The Mayo Clinic uses the following checklist to identify high-quality products, as described in a 2019 issue of Mayo Clinic Proceedings:

  1. Does it meet the following quality standards? These include Current Good Manufacturing Practices (CGMP) certification from the FDA; European Union (EU), Australian (AUS), or Canadian (CFIA) organic certification; National Science Foundation (NSF) International certification.
  2. Does the company have an independent adverse event reporting program?
  3. Is the product certified organic or eco-farmed?
  4. Have their products been laboratory tested by batch to confirm tetrahydrocannabinol levels below 0.3 percent and no pesticides or heavy metals?

For more information, Project CBD, Certified Kind, Clean Green, and WeedMaps offer information on dispensaries, cannabis products, and brands.

Does It Matter if the CBD Is Organic?

In theory, yes, because without an organic label, there’s a potential for ingesting pesticides and chemical fertilizers. If you have a COA, then you’ll know what’s in the product.

But here’s the rub: Organic products are regulated by the U.S. Department of Agriculture (USDA), which is a federal agency. Since cannabis is considered a Schedule 1 drug, technically, medical cannabis couldn’t be designated as “organic,” unless it’s made from hemp.

In May 2018, Palmetto Grow became the first company to have USDA Organic certification for hemp flower and seed. Since then, other organic growers have joined the market. You can find a list of some of the best organic CBD products from EcoWatch and The Honest Consumer.

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