Cannabidiol (CBD) is one of the most studied compounds of the cannabis plant. CBD drew attention when it was shown to stop seizures in a group of patients with a form of epilepsy that does not respond to conventional therapies. Potential benefits of CBD might include anti-inflammatory, immune system, and anti-anxiety effects. A great deal more scientific investigation is needed. A CDC report found that synthetic products sold as cannabidiol (CBD) had sickened dozens of users in the state, including so-called "Yolo CBD Oil."
CBD Products Do They Work?
Cannabidiol (CBD) is one of the most studied compounds of the cannabis plant. CBD drew attention when it was shown to stop seizures in a group of patients with a form of epilepsy that does not respond to conventional therapies. Potential benefits of CBD might include anti-inflammatory, immune system, and anti-anxiety effects. A great deal more scientific investigation is needed.
The Full Story
There is a term of Greek origin, panacea, that means all-healing. Vitamin D, magnesium, turmeric, and recently cannabidiol (CBD) are some of the products that have enjoyed time in the public eye as the panacea we are all missing. CBD is a chemical compound from the cannabis plant. CBD is not tetrahyrdrocannabinol (THC), which is the main psychoactive substance in cannabis that causes intoxication and is potentially habit forming.
The idea that the cure lies in plants and natural medicine is alluring. After all, humans have relied upon natural medicines much longer than tightly-controlled pharmaceuticals. When drugs are created, a common method is to find a receptor in the body and make a compound to act on that receptor. Cannabinoid-sensitive receptors exist in our bodies (primarily in the central nervous and immune systems), and the cannabinoids that act on them already exist in abundance in the cannabis plant.
CBD does not cause people to become intoxicated or “high” and, so far, has not been shown to be addictive like THC. Cannabis plants today have been cultivated to contain high levels of THC. Hemp plants are cannabis plants that have been cultivated to have low amounts of THC (although not zero) and higher amounts of CBD. Hemp plants are the source of the flood of CBD products on the market, from skincare to latte add-ins.
In America, hemp plants are now legal to grow. However, extracted CBD from hemp plants is a pharmaceutical ingredient according to the United States Food and Drug Administration (FDA). Because of this, CBD cannot be sold or marketed as a dietary supplement or food in the United States. However, Epidiolex, an FDA-approved, prescription CBD medication is available and has been shown to help some people with rare types of epilepsy that are not controlled by other medications.
Supplements and non-pharmaceutical CBD products are not regulated by the FDA. This means that there is no oversight from the FDA assuring that these products are made in an appropriate environment, are free from contamination, or even contain what they advertise on the label. This has become an important issue in major sports where athletes take supplements or try to use natural products instead of pharmaceuticals. There have been cases in which athletes used CBD products and, during drug screens, tested positive for THC. It might be that the athletes were not telling the truth, or it might be that they unknowingly used an unregulated CBD product contaminated with THC. Because of the lack of FDA regulation, CBD products may be contaminated with THC or other chemicals such as pesticides or heavy metals. In one study from 2017, an analysis of 48 CBD products revealed that less than one-third of the products had accurate labeling about their CBD concentration, and 21% contained THC. People who use CBD products should know that these products may contain potentially dangerous ingredients that can have negative or unwanted medical and legal consequences.
Much of the research on CBD has searched for anti-inflammatory and targeted immune system effects. Steroids are the most commonly used anti-inflammatory agents, but a steroid substitute could be very helpful, because steroids have extensive side effects. However, there are many inflammatory diseases for which chronic steroid therapy is one of the only effective treatments.
Common side effects reported from swallowing CBD products are generally mild and may be related to other components or contaminants present in the product. Drowsiness is the most common side effect, and decreased appetite, nausea, and diarrhea can also occur. Contamination with myrecene, another chemical found in in both cannabis and hemp, may be responsible for some of the sedating effects of CBD. CBD is metabolized by a major enzyme system in the liver and can have drug interactions. In animal studies, chronic CBD use also suppressed male fertility.
Research is ongoing, so more compounds of interest from the cannabis plant are sure to follow. But there are many unanswered questions. Can individual chemicals such as CBD alone provide a benefit, or is the entire plant needed (entourage effect) to realize the full effects? Additionally, studies on safety and use in children need to be pursued. Will CBD users develop tolerance and potentially experience withdrawal? These questions will not be answered until large groups of people taking CBD have been studied.
For now, there is no panacea.
If you are worried about a CBD exposure, check the webPOISONCONTROL ® online tool for guidance or call Poison Control at 1-800-222-1222. Whether you log on or call, expert assistance is available 24 hours a day.
Pela Soto, PharmD, BSHS, BS
Certified Specialist in Poison Information
Call 1-800-222-1222 or
- Over-the-counter CBD products (topical, oral, or otherwise) have not been studied in children and should not be used by children or adolescents.
- Tell your doctor about any strange or unwanted side effects that occur after use of CBD products.
- Ask your pharmacist to check for drug interactions involving regular medications and CBD-containing products.
This Really Happened
A 13-year-old boy was feeling anxious at school. A friend offered him a gummy thought to contain CBD. He went to the school nurse who called the boy’s parents and Poison Control. Poison Control indicated that if it truly was CBD alone, the boy should have no significant symptoms beyond mild sedation or dizziness. With increasing availability of THC-containing products, the school nurse was also informed of symptoms that would be expected with THC in his age group including excitation (anxiety, paranoia) and sedation. When Poison Control followed up on the boy several hours later, he had confessed that the ingestion was actually several days previously and that he had no effects. He was nervous about the exposure and wanted to be sure he was okay.
Fake CBD Poisoned At Least 52 People In Utah Last Winter, Officials Say
According to the Centers for Disease Control (CDC), synthetic products marketed as cannabidiol (CBD) sickened at least 52 people in Utah last winter, sending 31 of them to emergency rooms.
This week, the agency released a report on a poisoning outbreak that occurred in the state between December 2017 and January 2018, and which it linked to one or more synthetic cannabinoids being sold as the genuine article. Users reported that they had purchased such products as “Yolo CBD oil” at regular smoking and/or head shops, or acquired them from friends.
Unlike the many poisoning victims of K2 and other chemicals sold as ‘synthetic marijuana’ (a.k.a. synthetic cannabinoids), all of the patients identified in the report believed they were consuming legally derived CBD, which experts maintain has little to no potential for psychoactive effects. The cannabinoid chemical is found in varying amounts in both marijuana and hemp, and has been shown to have significant potential applications (and some outright proven ones) in medicine.
As CBD’s reputation in certain areas has grown, many new users have sought out the chemical for an effective but benign way to help with pain, anxiety, or recovery from substance abuse, among other things.
Over the past several years, however, a growing range of unregulated products claiming to contain CBD have also been flooding state and national marketplaces, putting consumers at risk of wasting their money, or worse. Last year, the U.S. Food and Drug Administration moved to crack down on four CBD manufacturers and distributors, particularly focusing on the companies’ claims around cancer treatment.
The market surge on so-called CBD has also meant that would-be safe users of effective, actual cannabidiol are finding they need to do a lot of time-consuming research about each product (and often still cross their fingers) before swallowing companies’ claims.
Eliezer, a 38 year old homeless heroin addict, smokes a K2 cigarette in the Bronx on May 4, 2018 in . [+] New York City. Eliezer often snorts his heroin instead of injecting as he feels it lessens the chances of overdosing on the drug. The Bronx was the borough with the highest number of overdose deaths in 2016 with 308 residents dying. (Credit: Spencer Platt/Getty Images)
In Utah, the CDC reported, “By the end of January 2018, suspected cases [of synthetic cannabinoid poisoning] were identified in 52 persons. Nine product samples (including one unopened product purchased by investigators from a store and brand reported by a patient) were found to contain a synthetic cannabinoid, 4-cyano CUMYL-BUTINACA (4-CCB), but no CBD.”
Roberta Horth, an officer with the CDC’s Epidemic Intelligence Service, and the report’s lead author, pointed out for Gizmodo that the range of easily tweak-able synthetic cannabinoids available in recent years seem to pose significantly more (and more unexpected) risks so far than organic cannabinoids such as THC, which can also produce negative psychological and physical side effects. She also noted that fatalities following the use of this particular formulation, 4-CCB, have already been reported in Europe.
Among the 52 people the CDC was able to identify as being part of the outbreak, t he top three symptoms experienced were altered mental status, nausea or vomiting, and seizures or shaking — symptoms or side effects which have not been linked to CBD, incidentally, but which CBD has been variously used to treat.
Regarding the recent Utah poisonings, the CDC report continued,
Eight of the tested products were branded as ‘Yolo CBD oil’ and indicated no information about the manufacturer or ingredients. Blood samples from four of five persons were positive for 4-CCB. Press releases were distributed to media outlets December 19–21, 2017, with a warning regarding the dangers of using the counterfeit product . The number of reported cases peaked during this outreach and dropped shortly thereafter.
Thirty-four suspected cases were reclassified as confirmed if the person reported use of a Yolo product or laboratory testing found 4-CCB. Approximately one quarter of persons were aged
Rapid identification and a coordinated response among state and local agencies contributed to control of the outbreak. This investigation highlights the hazards of consuming unregulated products labeled as CBD. States could consider regulating products labeled as CBD and establishing surveillance systems for illness associated with products labeled as CBD to minimize the risk for recurrences of this emerging public health threat.