Cannabidiol (CBD), a component of the marijuana plant, has garnered some serious attention, which is no surprise given its supposed health benefits. Proponents of CBD use claim it can help relieve pain, lower cancer risk, treat epilepsy, prevent Alzheimer's disease and reduce anxiety.
The US Food and Drug Administration (FDA) even approved the first prescription medication made with CBD taken directly from the cannabis plant, not made synthetically. The drug, Epidiolex, has only been approved to treat Dravet syndrome and Lennox-Gastaut syndrome, two rare forms of childhood epilepsy.
"CBD does seem to do some very interesting things to the brain, which can be helpful for medicinal purposes," say Esther Blessing, MD, PhD, a psychiatrist and researcher at New York University in New York, New York.
The World Health Organization (WHO) has been public about their stance—"cannabidiol does not appear to have abuse potential or cause harm”—but also stresses that more research is needed before they can consider recommending CBD for treatment of seizure disorders. The organization does not recommend cannabidiol for general medical use.
Some CBD products can be applied topically to treat conditions like acne. Others, like those designed to treat anxiety, depression, Alzheimer's disease and epilepsy are ingested, and often sold as oils, capsules or treats, like candy. Some anecdotal research and animal studies suggest CBD could be a safe and effective treatment for anxiety disorders, like generalized anxiety, social anxiety, post-traumatic stress disorder and the symptoms related to those disorders, including trembling, restlessness, increased heart rate and hyperventilation. However, the verdict remains inconclusive.
Do you mean medical marijuana?
Not exactly. Marijuana, even the medical-grade stuff, is not the same as cannabidiol. Although marijuana has hundreds of active components, two of the most studied are tetrahydrocannabinol (THC) and CBD. THC is the psychoactive component responsible for giving users a "high." "Things that cause euphoria or make people feel noticeably different are referred to as psychoactive," says Dr. Blessing.
CBD doesn't have those psychoactive properties, but research suggests it might stimulate various processes in the body, which may explain the potential benefits. Anecdotal evidence suggests cannabidiol might have mood enhancing benefits, but the mechanism is unknown.
Is it safe?
Cannabidiol, in a "pure" state, doesn’t appear to cause bodily harm—it's generally tolerated well and has a low toxicity level—and research seems to support this. A 2017 update of a human and animal study originally published in 2011 suggests CBD ingestion is safe for adults, though most studies are short and the effects on different bodily functions have not been well studied. There is very little research on the safety of unregulated CBD supplements in children, though, Epidiolex has been approved for use in children ages 2 and up. In general, CBD supplements are not recommended for medical use in children, and parents should always consult their doctor before giving a CBD product to a child.
There is a potential for side effects, including fatigue, diarrhea and changes in weight and appetite. The perceived health risks of taking CBD are low, but it's important to remember there is always an element of uncertainty when taking supplements not strictly regulated by the FDA. Unregulated CBD supplements can contain any number of other substances, including THC.
What about the legality of CBD?
CBD supplements are widely available, so they must be legal, right? Not quite. The legality of CBD remains murky—it varies by state and continues to change. As of May 8, 2018, 17 states have specific CBD laws, which differ from medical marijuana ordinances. Many laws authorize the possession and consumption of cannabidiol, with low levels of THC, for people with conditions like epilepsy, but the substance, with the exception of Epidiolex, has not been legalized at the federal level.
Does it really help with anxiety?
"There's evidence that CBD can be useful for treating neurological and psychiatric disorders, like anxiety," Blessing says. But the well of research is far from full. Cannabis is a Schedule I drug, a category of drugs that lack approval for medical use and have a high likelihood of physical or psychological dependence and abuse. The ability to research CBD is often hindered by regulatory requirements. CBD products also may not fit the quality requirements for human trials. Although more research is needed, results from some small or preliminary studies suggest a link between CBD and a reduction of anxiety symptoms. However consuming unregulated substances can still be risky for anyone suffering from anxiety disorders. For some, THC can trigger or amplify anxiety and paranoia, and it can be near impossible to determine which unregulated supplements may contain the substance.
A 2015 review of 49 human and animal studies, for which Blessing was an author, suggests CBD can be effective in alleviating symptoms of anxiety conditions like generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and panic disorder.
These findings are hardly conclusive, but they lay a preliminary framework upon which researchers hope to build a stronger link between CBD and a reduction in symptoms for various conditions.
Blessing does note that there have been no clinical trials in humans comparing the effectiveness of CBD versus a placebo on any measure of anxiety.
A word of caution
In the last number of years, the FDA has issued warnings to those in the market for CBD-containing products, cautioning not all products contain the level of the compounds they claim.
"CBD, when it's sold as a medication that the FDA is going to approve, is purified and doesn't contain anything other than CBD," Blessing says.
A 2017 study published in The Journal of the American Medical Association analyzed 84 CBD products bought online, and found just 30 percent contained the amount of cannabidiol listed on the label. Approximately 70 percent of the 84 products sold by 31 companies contained more or less CBD than the label claimed and some even contained elements not listed on the package, like THC.
Currently these products have little to no oversight or testing standards. Supplements aren’t held to the same standards as approved drugs, and products can vary widely. To help ensure you get what you pay for, choose supplements that have been tested by a state-certified facility for potency and safety—if your state law allows possession of the substance. Results should:
- Be made available upon request
- Contain the amount of CBD in the product
- List the amount of THC in the supplement
- Show no presence of mold or other toxins
CBD has not yet been approved to treat anxiety, or any condition outside of a few rare forms of epilepsy, but researchers are moving forward in the hopes that one day it will be. Although preliminary data suggests adverse reactions to CBD are a rarity, it's best to speak with your healthcare provider before taking CBD or any supplements for anxiety or other conditions.
