Hemp CBD oil is a liquid extract from Cannabis sativa plants that contain 0.3% delta-9 THC or less by dry weight. CBD stands for cannabidiol. It does not cause intoxication at doses used in studies. One CBD product has FDA approval: Epidiolex, a prescription drug for three seizure disorders. For anxiety, sleep, pain, and inflammation, evidence is mixed and comes from small trials. FDA has not approved any nonprescription CBD product for any health condition.
What the product contains
Hemp seed oil and hemp CBD oil are different products. Hemp seed oil comes from seeds and holds little to no CBD. CBD oil comes from flowers, leaves, and stalks. Bottles list milligrams of CBD per milliliter. Lab tests find errors. A 2017 JAMA study tested 84 CBD products sold online and found CBD amounts above or below the label in most samples. Some samples contained THC.
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Seizure disorders
FDA approved Epidiolex in 2018 for Lennox-Gastaut syndrome and Dravet syndrome in patients age 2 and older. Approval for tuberous sclerosis complex came in 2020. The drug is purified CBD in an oral solution. Dosing starts at 5 mg per kg per day, split into two doses, then moves to 10 mg per kg per day. Trials showed fewer seizures than placebo. Side effects include sleepiness, diarrhea, fatigue, and higher liver enzymes. The label requires liver blood tests.
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Anxiety and sleep
NCCIH reports that human trials of CBD for anxiety and sleep are small and short. Doses in those trials ranged from 300 mg to 600 mg. Results differ across studies. No trial has shown that CBD cures an anxiety disorder. Sleep data comes from studies of people with anxiety or pain, so the effect on sleep alone is unclear.
Pain and inflammation
Reviews of CBD for chronic pain mix purified CBD with products that also contain THC. That mix makes it hard to separate the effect of CBD. Topical CBD trials for arthritis and skin conditions are small. FDA has sent warning letters to companies that claim CBD treats pain or disease.
Side effects and drug interactions
Reported effects include sleepiness, diarrhea, appetite loss, and liver injury. CBD blocks the CYP2C19 and CYP3A4 enzymes, so it changes blood levels of other drugs. Drugs of concern include clobazam, valproate, warfarin, and some antidepressants. Talk to a pharmacist before combining CBD with a prescription.
Legal status in the US
The 2018 Farm Bill removed hemp from the Controlled Substances Act. Hemp means cannabis with 0.3% or less delta-9 THC on a dry weight basis. FDA still regulates CBD in food, drinks, and supplements and has not set rules for those uses. State laws differ. Some states ban CBD in food.
What is not known
- Long-term safety beyond a few years of study
- Effects during pregnancy and breastfeeding
- Best dose for any condition outside the approved drug
- Effects of daily use on the liver in healthy adults