CBD's Path to Health Care Legitimacy Christina Badaracco, MPH, RD
Updated: Nov 14, 2019
As a registered dietitian and modern consumer, I am well aware of the growing popularity of cannabidiol (CBD) and the growing trend of adding it to seemingly any product on the market. And, as the co-author of a recent book about the farm bill, I am also well aware that the passage of the 2018 bill legalized hemp production across the country. But I must admit that I struggled to comprehend the issues surrounding CBD’s legality, and I didn’t truly know the extent of evidence that exists for its health and mental benefits. What follows is an attempt to distill what I’ve learned for the benefit of American consumers. What is CBD? The body’s endocannabinoid system is a component of the nervous system that involves neurotransmitters that bind to cannabinoid receptors on cell surfaces throughout the body. It regulates various processes, including appetite, mood and pain sensation. Endocannabinoids can be produced internally, like anandamide, or come from an external source, like CBD. While CBD comes from the same type of plant as tetrahydrocannabinol (THC), it typically doesn’t have a detectable psychoactive component and is incorporated into foods and medications for its purported health and relaxation benefits. How is CBD grown? CBD is one of many different cannabinoid molecules found in cannabis plants. This family, known as Cannabaceae, contains about 170 species that have differing levels of THC and CBD. Cannabis plants that have less than 0.3% THC (and therefore a higher concentration of other molecules) are called hemp, while cannabis plants that contain more than 0.3% THC are called marijuana. Both contain CBD.
In the US, marijuana is grown discretely indoors, either in soil or hydroponic systems, or on public lands along the West Coast or parts of Appalachia. This production is legal in some states, such as California, but not in others, such as Kentucky.
Hemp is grown in at least 19 states across the northern United States, but is still primarily imported from other countries (such as Canada and China) with more lax production policies. Harvested for the seeds and fibers that are both nutritious and useful in manufacturing, its popularity has grown in recent years. Hemp production was first allowed in the US for research purposes in 2014 and has expanded since then, although China remains the leader in global production. How is CBD used medically? CBD has been suggested to improve insomnia, inflammation, anxiety, seizure disorders, pain and a number of other conditions. The scientific evidence to support its benefits, however, is still quite limited. At the end of 2018, the FDA approved the first prescription drug that includes CBD derived from natural marijuana. It is used to treat pediatric epilepsy and it became legal to sell at the end of 2018. CBD is now being studied for potential benefits in treating cancer, Alzheimer’s disease, Crohn’s disease and other conditions. Evidence continues to emerge for CBD’s potential health benefits in many areas; indeed, it is currently being studied in 457 clinical trials, according to NIH’s database. Additionally, synthetic forms of THC are being used as appetite stimulants for malnourished patients (CBD doesn’t have this appetite-stimulating effect). What products contain CBD? The applications of CBD have skyrocketed in recent years; it is now expected to reach a global market of $3 billion by 2021. Outside of the medical field, it can be found in cosmetics, foods in restaurants and grocery stores, extracts, drinks, gums and candies, baked goods, dog treats and more.
The 2014 farm bill (the Agricultural Adjustment Act of 2014) legalized the growth and cultivation of hemp plants “for purposes of research” and in states with applicable laws and approved production plans, creating a complex system since states have vastly different laws about how hemp and CBD can be processed and used. In 2018, for example, California’s Department of Public Health prohibited the use of hemp-derived CBD in foods and supplements that would be sold by non-licensed retailers (marijuana-derived CBD would continue to be available in dispensaries within the state). It remains to be seen how this will be enforced and how it will affect the market now that the 2018 farm bill (the Agriculture Improvement Act of 2018) legalized commercial hemp production at the federal level. How is CBD regulated? Marijuana-derived CBD is currently legal for medical and recreational use in 10 states, while the passage of the 2018 farm bill made hemp-derived CBD (and all hemp production) legal nationwide. Hemp is no longer listed as a Schedule 1 substance under the Controlled Substances Act. Production is expected to increase drastically, which was a goal of policymakers in opening up new growing opportunities for farmers struggling as a result of the current trade war. For now, it remains to be seen how many states will supersede their own bans on hemp production. The FDA will continue to regulate products that contain CBD to ensure public safety. Companies seeking to make health claims, such as curing or preventing diseases, will need approval by the FDA (although companies, unfortunately, do sometimes make such statements illegally). Hulled hemp seeds, hemp seed protein, and hemp seed oil have been “generally recognized as safe” (GRAS) and can be marketed without additional regulation. This is great news because these components can provide excellent plant-based sources of omega-three fats, fiber and protein in the diet. According to FDA regulation, CBD supplements and food products containing CBD may not currently be sold in interstate commerce. Even though the farm bill legalized hemp production nationwide, it does not preempt state law. The FDA has thus far not gone after the individual states that have legalized marijuana, much less CBD, so manufacturers and consumers don’t yet know what to expect in the remainder of 2019. A 2017 study from Penn Medicine showed that about 70% of CBD-containing products were mislabeled, containing amounts other than what was advertised. The authors attributed this to a lack of regulation and oversight, meaning that standards for production, testing and labeling are needed to ensure customers get the products they purchase. Also, THC was detected in more than 20% of the samples, indicating illegal contamination. Why are some people concerned about increasing consumption? There are valid reasons to be concerned about the growing use of marijuana, ranging from increasing rates of psychoses and crime to high spending and rising costs of real estate in states and cities that have made it legal. CBD itself is not psychoactive or addictive, however, and doesn’t carry these concerns. In fact, when derived from hemp, it coincides with the production of a crop that has real benefits for health and industrial uses. A few people, however, have reported adverse side effects, such as nausea and fatigue, after using products containing hemp-derived CBD. The legality of sales and marketing remain complicated, and the FDA will need to improve oversight over labeling claims and product contents. Is it appropriate for me? For most of us, there is neither a need nor a proven benefit of adding CBD in the diet. However, if you have a disease state that has been demonstrated to benefit from CBD, your doctor may suggest complementary treatment with a CBD product to ease pain, insomnia or other symptoms. Most experts believe there isn’t much harm in the emerging supply of food and personal care products containing CBD; however, they may not be worth the extra expense. If it’s relaxation you’re after, herbal tea, magnesium supplements and deep breathing remain excellent options. NB: This article’s research is up-to-date as of February 2019, however, the legal status of CBD is expected to continue to change.
Bonn-Miller MO, Loflin MJE, et al. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017; 318(17):1708-1709.
California Department of Public Health. “FAQ: Industrial Hemp and Cannabidiol (CBD) in Food Products.” Revised Jul 5, 2018. https://bit.ly/2N9agTE
DEA Museum and Visitor’s Center. “Cannabis, Coca, & Poppy: Nature’s Addictive Plants.” US Department of Justice. Accessed Jan 15, 2019. https://bit.ly/2H2uvDA
Doheney, K. “Marijuana, Hemp, CBD Oil: What's Legal and Where.” Jan 10, 2019. WebMD. https://wb.md/2suHyEt
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US National Library of Medicine. Accessed January 11, 2019. https://bit.ly/2U6YAIl
US FDA. “FDA and Marijuana: Questions and Answers.” Updated Dec 20, 2018. https://bit.ly/2wQf6O3
US FDA. “Statement from FDA Commissioner Scott Gottlieb, M.D., on signing of the Agriculture Improvement Act and the agency’s regulation of products containing cannabis and cannabis-derived compounds.” Released Dec 20, 2018. https://bit.ly/2QGnihE
Christina Badaracco, MPH, RD
Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook.
Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency’s Office of Water. She has also enjoyed contributing to children’s gardens, farmers’ markets and a number of organic farms.
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