Cannabidiol (CBD), a compound found in cannabis, has experienced a huge surge of public interest and media attention over the past five years. Indeed, this once relatively unknown compound is now so popular – perhaps even ubiquitous – that it can be found in a dizzying array of consumer products, ranging from wellness supplements and smoothies all the way through to bath salts and bacon-flavored dog treats. This boom in popularity has led to massive growth in the CBD market, which is predicted to reach 20 billion dollars in the US alone by 2024 (Dorbian, 2019).

Despite the popularity of CBD products, however, some experts fear that the media and marketing hype surrounding these items has far outpaced research on the medicinal properties of CBD (Eisenstein, 2019; Stith et al., 2019). This is not to say that CBD offers little or no therapeutic value to its users; rather, the medicinal properties it possesses have yet to be fully researched and understood. To dispel some of the confusion surrounding this topic, the following sections address the most commonly asked questions about CBD with regards to its sources, legality, safety, usage and effectiveness.

What is CBD, and how does it differ from cannabis?

CBD is one of many naturally occurring compounds found in cannabis (aka marijuana). Unlike the plant’s main psychoactive compound, tetrahydrocannabinol (THC), CBD does not produce feelings of euphoria or intoxication (Pertwee, 2004). You cannot get ‘high’ from CBD alone, despite the fact that it is often derived from marijuana plants.

What are the differences between CBD, cannabis and hemp?

CBD is a compound found in both cannabis and hemp plants. In legal terms, hemp is defined as cannabis containing no more than 0.3% THC by dry weight in accordance with the Agricultural Improvement Act of 2018. CBD can, therefore, be derived from either cannabis or hemp, as both plants contain this compound and differ only in terms of THC content.

Is CBD legal?

Hemp is legal in all 50 states, as is CBD derived from hemp plants. When it comes to cannabis-derived CBD, however, the situation is not so clear-cut because cannabis’s legal status varies considerably by state. In some states, cannabis is legal for recreational and medical purposes whereas in others, it may only be used medically. States such as Idaho and Nebraska have not legalized either recreational or medical use of cannabis.

Restrictions that apply to cannabis therefore affect the legality and usage of cannabis-derived CBD products in the various states. The most lenient states allow residents to purchase CBD products irrespective of how the CBD has been sourced or its intended usage while the strictest do not allow cannabis-derived CBD to be used for any purpose. Always check your state’s laws before purchasing any cannabis-derived CBD product to avoid potential possession charges and fines.

Is CBD safe?

Current research indicates that CBD is generally safe and well-tolerated by most people (Iffland and Grotenhermen, 2017). No drug is completely safe, however, and adverse drug events (ADEs) have been reported in medical studies. Indeed, according to a recent review of studies by Brown and Winterstein (2019), nearly 50% of CBD users experienced ADEs, including sedation, anemia, sleep disturbances and infections. These ADEs followed a general dose-response relationship, meaning that adverse effects associated with CBD depended on, among other factors, the dose administered in the reviewed studies. Potential interactions between CBD and other medications were also highlighted in Brown and Winterstein’s article. Although medically vulnerable people (i.e. people with complex underlying conditions) may be more at risk of experiencing ADEs, general consumers should be aware of potential side effects and consult with a physician before using CBD products.

How do people use CBD?

Excluding cannabis-based items sold in licensed marijuana dispensaries, the general consumer has many different options available when it comes to purchasing and using hemp-derived CBD products. Dried hemp buds, for example, can be smoked like regular cannabis or steeped in hot water to drink as a tea. Oils and tinctures containing CBD extracts are another popular option for oral consumption, as are CBD oil-infused edibles (e.g. gummy bears and lollipops) and capsules. Lotions and gels containing CBD can also be applied to the skin for those who prefer to consume it topically rather than orally.

Why do people use CBD?

Aside from recreational use, many people use CBD to treat or manage a wide variety of symptoms and illnesses. According to a recent study published in the Journal of Cannabis Research (Moltke and Hindocha, 2021), the top reasons for using CBD given by the study’s survey respondents were as follows:

• Self-perceived anxiety (42.6%)
• Sleep problems (42.5%)
• Stress (37.5%)
• General health and well-being (37%)
Although the survey’s respondents were primarily based in the UK, other surveys conducted in the US and Canada have reported similar results. A survey undertaken in the US by Chicago-based Aclara Research in June 2020, for example, found that anxiety (58%) and pain relief (58%) were the top reasons cited by respondents for using CBD, with relaxation (48%), sleep (37%) and general wellness (30%) following closely behind (Drotleff, 2020).

How effective is CBD?

Research on the medicinal properties of CBD is very much in its infancy, and consequently, the full therapeutic potential of the substance is simply unknown at this point. On the other hand, the compound does seem to possess many useful properties that could make it an ideal pharmaceutical drug target, as “CBD has shown promise as an analgesic, anticonvulsant, muscle relaxant, anxiolytic, antipsychotic and has shown neuroprotective, anti-inflammatory, and antioxidant activity, among other currently investigated uses.” (National Center for Biotechnology Information, 2021, p.2).

CBD could, therefore, be used to treat or manage a wide range of conditions, including epilepsy, anxiety, pain, insomnia, multiple sclerosis, inflammation and neurodegeneration. However, although CBD could treat many of these disorders and promising results have been reported in some studies, especially for anxiety (Skelly et al., 2020), the evidence in favor of its benefits is generally weak and incomplete (White, 2019). Much additional study of CBD’s effects on these conditions will be required before any firm conclusions can be drawn about its potential as a therapeutic agent.

A notable exception in the current evidence base is the research examining CBD’s effectiveness as a treatment for Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), two devastating childhood-onset epilepsy disorders. Several clinical trials have demonstrated that CBD has anti-seizure properties that help limit the number of seizures experienced by sufferers of DS and LGS (Silvestro et al., 2019). On the back of the promising research conducted in this domain, the Food and Drug Administration (FDA) approved the drug Epidiolex in 2018, which remains the only FDA-approved CBD medication to date.

The bottom line…

Despite the immense popularity of CBD as a consumer product, research on its medicinal properties and safety remains limited. Although CBD has potential for broad therapeutic application, the evidence for its effectiveness in treating many conditions has yet to catch up with the media and marketing hype that often surrounds commercially available CBD products. Potential consumers should, therefore, be aware that CBD products are not a magic cure-all but rather a promising new wellness trend that could help many people once the full risks and benefits have been studied at length. If you are planning to use CBD either recreationally or for medical purposes, please consult with your physician.

References cited

Brown, J.D. and Winterstein, A.G. (2019). Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol (CBD) use. Journal of Clinical Medicine, 8(7), pp.989-1002.

Dorbian, I. (2019). ‘CBD Market Could Reach $20 Billion By 2024, Says New Study’, Forbes, 5/20/19. Available at:
forbes.com/sites/irisdorbian/2019/05/20/cbd-market-could-reach-20-billion-by-2024-says-new-study/?sh=64b2ecec49d0. (Accessed 5/5/21).

Drotleff, L. (2020). ‘Study: During coronavirus pandemic, American consumers turn to CBD for stress relief, wellness’, Hemp Industry Daily, 11/10/20. Available at: hempindustrydaily.com/study-during-coronavirus-pandemic-american-consumers-turn-to-cbd-for-stress-relief-wellness/. (Accessed 5/5/21).

Eisenstein, M. (2019). The reality behind cannabidiol’s medical hype. Nature, 572(7771), pp.S2-S4.

Iffland, K. and Grotenhermen, F. (2017). An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis and Cannabinoid Research, 2(1), pp.139-154.

Moltke, J. and Hindocha, C. (2021). Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. Journal of Cannabis Research, 3(1), pp.1-12.

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 644019, Cannabidiol. PubChem. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Cannabidiol. (Accessed 5/10/2021).

Pertwee, R.G. (2004). The pharmacology and therapeutic potential of cannabidiol. In: Di Marzo, V. (ed). Cannabinoids. (New York, NY: Kluwer Academic/Plenum Publishers), pp.32-83.

Silvestro, S., Mammana, S., Cavalli, E., Bramanti, P. and Mazzon, E. (2019). Use of cannabidiol in the treatment of epilepsy: efficacy and security in clinical trials. Molecules, 24(8), pp.1459-1483.

Skelley, J.W., Deas, C.M., Curren, Z. and Ennis, J. (2020). Use of cannabidiol in anxiety and anxiety-related disorders. Journal of the American Pharmacists Association, 60(1), pp.253-261.

Stith, S.S., Vigil, J.M., Brockelman, F., Keeling, K. and Hall, B. (2019). The Association between Cannabis Product Characteristics and Symptom Relief. Scientific Reports, 9(1), pp.1-8.

White, C.M. (2019). A review of human studies assessing cannabidiol’s (CBD) therapeutic actions and potential. The Journal of Clinical Pharmacology, 59(7), pp.923-934.