3

HOW IT WORKS

WHERE CBD COMES FROM, HOW IT AFFECTS OUR BODIES, PLUS COMMON MISCONCEPTIONS AND THE TRUTHS YOU SHOULD KNOW.

 IN THIS CHAPTER 

5 Things You Should Know About CBD

3 CBD Myths Explored

What cannabidiol is and how it works in the body is a complex topic that science is just starting to understand. Even experts who’ve devoted their lives to the study of the subject have trouble fully explaining the processes and mechanisms at work and why CBD has the effect that it does.

Fortunately, this is not a textbook and there will be no exam. On these pages, don’t expect dizzying descriptions of complex physiological responses and theories that require a medical degree to decipher. Instead, this book takes a different tack. First, it’s helpful to understand the basic science of CBD so you can feel informed. This knowledge may help guide you if you decide to delve deeper into the world of cannabidiol. Or it just may make you sound smart the next time you’re talking to friends, family, or colleagues and the subject of CBD arises, as it often does these days. One common thread of such conversations: misconceptions about cannabidiol. To help you see through the fog and enhance your understanding of this much-discussed plant extract, this chapter is devoted to five things you should know about CBD, plus three common CBD myths.

Later, Chapter 4 provides practical advice to help you understand how CBD works with various conditions. Chapter 5 is a useful guide to various product types of CBD, with the best wisdom for being a smart consumer.

1

My Take

I have a patch of psoriasis on my head that appeared a couple of years ago. I was really distressed with it so my daughter drove me an hour from my home to a health food store that sells CBD cream. It cost over $45 for a 2 ounce jar. In addition to cannabidiol, ingredients include: “coconut oil, water, beeswax, and essential oils of juniper berry lavender, rosemary, blue tansy, and hellichysm.” This jar says it contains 200 milligrams of cannabidiol (CBD). The short story is that is does nothing for my skin condition. A little vaseline does just as much. I have put it on other skin problems on my face, and it is just another oil. This product is an expensive ripoff!

—Jane VomSteeg, Diamond Springs, California

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5 THINGS YOU SHOULD KNOW ABOUT CBD

At this early stage of its development, how CBD interacts with the body and its effects are not fully known. Too many questions remain unanswered—to be decided through years of future lab study and clinical observation. Still, there are plenty of important things to understand—about the cannabis plant, how CBD works in your body, where it comes from, and what comes along with it.

THE PLANT

Cannabidiol is extracted from the cannabis plant—formally known as Cannabis sativa L—which has various strains. As described in Chapter 1, the longtime star of the cannabis family is called marijuana, known for its psychoactive effects brought on by the compound THC, which is found in the plant’s flowers. It is widely grown in greenhouses and other controlled environments to maximize its yield of potent flower.

Its sibling strain, called hemp, or industrial hemp, is much more workmanlike, known for its commercial uses. Its seeds and stalks have long been used in many products. The Dutch painter and printmaker Rembrandt sketched his drawings on paper made from hemp, and European shipbuilders centuries ago used it to make sails. It’s a tall, sturdy plant that is grown like other agricultural crops in an open field. It can do well in a variety of regions. China produces more hemp than any other country.

In good conditions, a hemp plant can grow to a foot high in just three or four weeks. At full maturation, it can be 15 feet or taller. Contrary to a common misconception, hemp is not the male version of the female marijuana plant. For both marijuana and hemp, it is the female plant that is cultivated and harvested, ideally before it is fertilized by the male pollen. As the hemp flower (or bud) reaches full bloom, it secretes certain cannabinoids and resin to attract the pollen from the male plants and produce seeds. This secretion is where CBD comes from.

Another misconception is that CBD is the medicinal part of the cannabis plant, while THC is the recreational part. It doesn’t work that way. Both THC and CBD, which are found in various strains of the cannabis plant, have medicinal qualities. They can work well together, but also apart. Both compounds are found in marijuana, while hemp features little or no THC. Today, to be legally considered hemp, a plant must contain less than 0.3 percent of THC, which is about 30 times less than even a weak marijuana plant. Almost all marijuana plants have CBD but no legal hemp plants have more than a tiny trace amount of THC.

THE ENDOCANNABINOID SYSTEM

In the 1990s, scientists—led by Lisa Matsuda, Ph.D., at the National Institute of Mental Health—were trying to figure out why marijuana gets people high. As part of their research, they discovered the endocannabinoid system (ECS), an internal network that had never been understood before. Its job inside the body of all animals is to use neurotransmitters to maintain a stable internal environment for health, mood, temperature, pain modulation, and more.

This system has receptors within the cells of the intestines, liver, pancreas, reproductive organs, and bones, as well as the brain and central nervous system. (The ones located in the brain and central nervous system are called CB1 receptors. The ones in the organs and elsewhere in the body are CB2 receptors.) Every day, enzymes within the human body create billions of beneficial natural chemicals that bind to these receptors, which helps keep the body well regulated and on an even keel. That’s the main purpose of the ECS—to keep your body in a stable state of homeostasis. But while the enzymes produce these chemicals all day long, scientists believe they also reappear to destroy those same chemicals, creating the need for more. There is no storage—the body is constantly using and destroying these natural chemicals. It’s a never-ending cycle.

This discovery was amazing enough. But what really astounded the scientists was figuring out how substances in the cannabis plant could play a positive role with these receptors—in the brain and body. As described in Chapters 1 and 2, within cannabis are compounds known as cannabinoids that, according to the scientists, mimic or improve the performance of these internal chemicals in a remarkable way and play a key role to boost this cellular system. These cannabinoids, including CBD, had been discovered decades earlier but were not fully understood. Without them, the body is forever depleting and restoring those beneficial enzymes that keep the system stable. But scientists began to understand that by consuming CBD, the system may be disrupted, stopping the depletion and allowing the benefits to linger.

The naming of the endocannabinoid system underscored the connection between plant and animal. Scientists named the newly discovered system after the cannabinoids that they had earlier found in cannabis. For the new system, they added a prefix, “endo,” that means “internal”. The beneficial chemicals that bind naturally to those receptors around the body were dubbed endocannabinoids, while the ones that come from plants, such as CBD, received the prefix, “phyto” meaning “relating to plants” and became phytocannabinoids.

The effect of this signaling system on the body and brain is wide and deep. “The ECS helps us to eat, sleep, relax, forget what we don’t need to remember, and protect our body from harm,” says Jahan Marcu, Ph.D., of the International Research Center on Cannabis and Mental Health in New York City. It’s a natural mechanism that helps the body deal with stresses, including extreme exercise. “We always thought the ‘runner’s high’ was due to the release of dopamine and endorphins,” says Joseph Maroon, M.D., clinical professor and vice chairman of neurosurgery at the University of Pittsburgh Medical Center. “But now we know the euphoria is also from an endocannabinoid called anandamide.”

While that’s an example of an internally produced endocannabinoid, the most famous of the plant-based phytocannabinoids is THC, which causes the psycoactive effects of marijuana by binding with those CB1 receptors in the brain, where there are more CB1 receptors than even opioid receptors.

CBD doesn’t bind to the receptors themselves. Rather, it improves their performance, probably by allowing the body’s natural production of key enzymes to keep going without their otherwise inevitable self-destruction. This positive effect occurs in CB1 receptors in the brain as well as in the CB2 receptors throughout the body, which is one reason so many people are excited by the potential of CBD. Unlike THC, which primarily affects the brain, CBD promises a body and brain benefit. While science has yet to figure out all the details, it is known that the ECS affects almost every physiological process, including sleep, hunger, mood, pain, inflammation, the nervous system, and memory. For this reason, the hope is that the phytocannabinoid CBD can bring relief for many conditions, though much human study is still needed to prove the case.

HOW CBD IS MADE

Yes, the CBD found in products comes from the hemp plant, but how? It begins with the growing and harvesting of hemp plants that have been cultivated to contain a high amount of CBD and almost no THC. The amount of cannabinoid in various hemp varieties can vary widely, but CBD growers use the type of hemp that produces the most CBD. Since hemp is a field crop, generally planted in high numbers, the plants are usually harvested using a combine harvester—a huge piece of machinery well known on farms for simultaneously reaping, threshing, and winnowing crops. Once harvested, the extraction process begins, with the aim to separate and collect the essential oils and compounds from the flower of the hemp plant. It can be done with a variety of extraction solvents; the cleanest involves a nontoxic fluid form of carbon dioxide that is used extensively by the food industry. The FDA gives the process GRAS categorization, meaning “generally regarded as safe.”

The solvent is forced through the plant, pulling out the CBD, essential oils, lipids, and other compounds. At this point, the solvent and any other undesirable elements are removed by filtration, leaving an oil that is naturally high in CBD. (For more about the extraction process and how it impacts CBD products, see this page.) To further purify it, the product is heated—a process known as decarboxylation—which transforms the cannabinoids into a form that’s ready to interact with the body’s cannabinoid receptors. The oil can then be used in a wide variety of products.

The most popular type of products are tinctures. In the 2019 Prevention survey of CBD users, 57 percent said they used them. A tincture is a tiny, concentrated drop of CBD oil that goes under the tongue, where mucous membranes quickly absorb it, bypassing the digestive system and liver to reach the bloodstream fast. The CBD is whisked to the carotid artery and directly to the brain’s endocannabinoid receptors. The elapsed time between taking the drop and feeling any effects can be as little as 15 minutes or less, depending on the dose.

Tinctures are the most common way to take CBD, but not the only way. In the 2019 Prevention survey, 35 percent of CBD users said they applied topical lotions, balms, or patches, and 21 percent had ingested their CBD through chewable gummy candies. For 19 percent of users, vaping oil was their delivery method, while 13 percent took capsules. (For a helpful, detailed guide to each of these product types, see Chapter 5.)

ALL ABOUT TERPENES

Spend enough time poking into the world of CBD and soon you’ll come across a word that you may not have encountered before: terpenes. Unless your interest runs heavily to botany, you may not know that these natural compounds found in the essential oil of plants may play an important role within the cannabis plant and ultimately, if you ingest CBD, within your body. As with all parts of the endocannabinoid system, much still needs to be learned about the effects of terpenes, especially when combined with phtyocannabinoids such as CBD. But for consumers of CBD, terpenes are an important element to understand.

Science knows there are many types of terpenes, found in herbs, fruits, and other plants. In cannabis they ooze from the sticky resin glands, the same glands that produce CBD, THC, and other cannabinoids. Among their duties: to provide plants with their aroma and flavor. When you smell a fragrant pine tree, you’re smelling terpenes. Marijuana plants are steeped with many terpenes and have the fragrance to prove it. Hemp, which is generally considered nonaromatic with little flavor, has fewer terpenes, but many believe it’s still enough to have an effect in the body.

One major example is myrcene, which is the most common terpene in cannabis. In some cases, more than half of the terpenes within a hemp plant may be myrcene. It’s also found in lemon-grass, which has long been used in folk remedies, as well as in hops (giving beer its distinct aromas). In marijuana plants, the myrcene level plays a role in whether the plant is considered “indica” (producing a more relaxing high) or “sativa” (producing a more uplifting high). Plants with more myrcene terpenes tend to be classified as the relaxing indica strain, and studies with rodents have shown that myrcene does produce a sedating effect. This leads some experts to speculate that when CBD users report calming and sleep-inducing benefits, myrcene from within the hemp plant may be contributing to that effect. But the study of CBD is new enough that many of these questions are still unanswered. Is it the cannabidiol itself that calms you? Or is it the myrcene within the plant? Or is it a mix of the two, and if so, what’s the perfect combination? Science still isn’t sure.

And with dozens of terpenes to study, the possibilities are vast. For instance, another cannabis terpene, linalool (which is found in lavender, too), is also purported to produce relaxing effects. And then there’s caryophyllene, which is found in black pepper and many herbs and spices, as well as in cannabis. Caryophyllene is a unique terpene in that it’s the only one that has the ability to act like a cannabinoid, binding to the CB2 receptors in the body’s organs, where, some believe, it may work through the endocannabinoid system to provide anti-inflammatory benefits. Again, no one knows for sure how all these ingredients work together, which is one reason most CBD users hedge their bets and buy “broad-spectrum” CBD that comes combined with terpenes, too.

THE ENTOURAGE EFFECT

In some products CBD is presented in its most independent form, known as “CBD isolate.” In these cases, everything else the hemp plant offers is stripped away. A CBD isolate means there’s 0 percent of THC and no other cannabinoids. Isolate often comes as a powder to be used for homemade CBD products and also can be found in oils, edibles, capsules, and other products.

But while solo CBD may sound ideal, many people believe there’s a better way. They put forth the theory that CBD is more effective when it arrives in your body accompanied by terpenes and other natural parts of its native plant. After all, they reason, CBD is just one of many active compounds and beneficial ingredients in cannabis. And while hemp doesn’t have all the compounds found in other strains (most notably, it does not produce THC), it still has more than 100 cannabinoids and other ingredients, including helpful fatty acids, vitamins, proteins, and terpenes.

These proponents also believe that when interacting together in a synergistic way, CBD and other components of cannabis produce a stronger effect than any of the single ingredients could on their own. In other words, one plus one equals three. They call this “the entourage effect.” When shopping for CBD, you will often see the phrase “full spectrum,” “whole spectrum,” or “broad spectrum.” These marketing terms mean the product is promising that the CBD won’t come solo but rather will ride with its whole helpful crew. (The difference between the terms? Full- or whole-spectrum products usually feature everything from the hemp plant, including trace amounts of THC, while broad-spectrum products have undergone an extra step to ensure that all THC is removed. For more details, see this page.)

Most researchers consider the entourage theory plausible, but as with all things CBD, they want to see more research before getting fully on board. For some, the idea of the entourage effect only muddies the waters of their exploration—it’s harder to study the effectiveness of CBD if its true power only comes when combined with hundreds of other ingredients. Some, however, give some credence to the general concept. They point to medical marijuana as an example of the ultimate entourage effect. When pure synthetic THC first became available in the 1980s, some thought it might provide the same medicinal effects as the full cannabis flower. But patients reported more relief from full-flower, whole-spectrum products. It became clear to many that dozens of the other cannabinoids and ingredients in cannabis—including CBD—were working in conjunction with the THC to produce medicinal results.

In fact, some experts believe—putting aside legalities and psychoactive effects—that CBD seems most effective when it’s teamed with a full range of terpenes and cannabinoids, including a hefty dose of THC. After all, they say, marijuana (including THC, CBD, and many other cannabinoids and terpenes) has been used as a healing substance for centuries by various cultures. Today, new strains of medical marijuana are being bred and marketed with even more CBD in the mix. (While marijuana strains traditionally might be, say, 18 percent THC and less than 1 percent CBD, new medicinal products are now popular in dispensaries at all kinds of THC:CBD ratios, including 1:1.) And fans are reporting relief for pain, anxiety, and sleeplessness from such products.

For people who hold a state-sanctioned medical marijuana card or live in a state where marijuana is fully legal, these kinds of products may be an option. However, they come with complications, most notably psychoactive effects and the certainty that you won’t pass a drug test. With broad-spectrum CBD, which includes many of the potentially beneficial side ingredients but no THC, there are none of those complications.

While it’s accepted that CBD plays a role in medical marijuana, the question is, how effective is CBD when the THC isn’t there? Does cannabidiol keep its medicinal profile when it’s on its own or teamed with only the nonpsychoactive elements of its native plant?

Early testing has shown that full-spectrum CBD seems to have a more sustained effect than isolates and may provide a wider medicinal potential within the body. But for experts, more research is warranted to understand how these different ingredients work together and which combinations are best for various conditions and effects. In the meantime, since other parts of the hemp plant are safe and considered generally beneficial, the consensus for those interested in CBD is that it’s a good idea to shop for broad-spectrum products.

1

My Take

I sought out CBD oil for the fatigue, body pain, sleep deprivation, and anxiety I was experiencing living with stage IV metastatic breast cancer. My hope was to receive relief from the side effects I was experiencing from my meds and the disease. I heard CBD could help with my pain, and I bought some from a local store, but did not receive the results I was looking for.

I later found a producer that manufactured their own products from organic Wisconsin hemp. I decided to purchase from this manufacturer after getting a full understanding of how they process the CBD oil through their unique extraction methods, allowing them to get the greatest benefit from the hemp. I started using the new product and felt the effects of it almost immediately!

I’ve continued using the CBD oil and it allows me to enjoy a good quality of life while living with a terminal illness, which is priceless! I have no derogatory interactions with my meds. I am pain free. I have achieved a level of calmness and I sleep well. I’ve also used CBD body balm and lotion to eliminate any areas of inflammation when it appears. I have experienced a better quality of life since I’ve incorporated CBD oil into my daily wellness program. I encourage anyone seeking the benefits of CBD oil into their wellness program to research what is available before running to their local market and buying any CBD oil off the shelf.

—Linda Lambrecht, Mosinee, Wisconsin

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THREE CBD MYTHS

With the outlaw history of cannabis (detailed in Chapter 2) and the scientific mysteries of cannabinoids, it’s easy to see why CBD is subject to misunderstandings and misconceptions. Add in a zealous CBD industry making all kinds of promises and critics spreading ill-informed objections, and it’s easy for wrong-headed notions to take root. Here, we take a look at three stubborn ones and clear the air.

MYTH 1: TAKING CBD COULD GET ME IN TROUBLE.

Some people worry that CBD might cause them to fail a drug test. The truth is, drug tests only measure one cannabinoid from the cannabis plant—the psychoactive compound THC. (To be precise, tests look for a compound created by the body when it metabolizes THC.) One thing drug tests don’t measure is the amount of CBD in your system. By definition, the THC level in cannabidiol is less than one third of 1 percent—just a trace at most, which is much less than could ever cause a failed drug test.

It’s kind of like drinking a nonalcoholic beer, which often contains less than one half of 1 percent of alcohol by volume, while a regular beer might contain 4 to 6 percent. Yes, there may be tiny amounts of alcohol in the nonalcoholic product, but not nearly enough to cause inebriation or a failed sobriety test, unless someone drinks dozens of bottles in the same sitting. Similarly, marijuana is often 15 percent THC or more, which means it may contain more than 50 times the amount of THC than what is the top limit for CBD products. It’s likely you would need to ingest thousands or tens of thousands of milligrams of CBD to fail a drug test—much more than almost anyone would ever use at one time.

But remember, there is no FDA control over the ingredients in a CBD product. As discussed on this page, studies have repeatedly shown that the bottle sometimes contains surprises. In most cases, the discrepancies revealed in those studies involved mislabeling the amount of CBD in the product (sometimes it was more than what was on the label; sometimes less.) But in some cases, a full-spectrum CBD product contained a little too much of the spectrum—including levels of THC that are above the magic 0.3 percent cutoff. In an often-quoted study published in JAMA, researchers bought CBD online and found that 18 of the 84 samples tested contained detectable levels of THC, at levels as high as 6 percent (less than half of what’s in marijuana, but 20 times more than what CBD products are supposed to have).

This can cause problems, especially for CBD users who face drug tests as part of their employment. In 2019, a Phoenix woman named Tammy Allen, who had been taking CBD that she bought online to help with her seizures and migraines, told ABC News, “I tested positive for THC, and I ended up being put on administrative leave.” Eventually, Allen said she lost her job due to the violation. She was told that after the test, her employers believed she had recently smoked marijuana. While many share the fear of the same fate, among the millions currently using CBD, such cases are relatively rare.

In addition to some incidence of mislabeled products, there’s also potential variability in how THC is measured. First, the 0.3 percent is based on the dry weight of the cannabis plant, not the finished CBD product. Plus, each state has its own way of figuring this number. (Some collect the top 6 inches of the plant, others collect more or less.) And there’s no uniformity on testing for THC in finished products. This raises the possibility of THC unexpectedly appearing where it shouldn’t be. But experts suggest the chances are low.

Confusion about CBD can also cause problems for travelers. In May 2019, Lena Bartula, a 71-year-old grandmother, was arrested at Dallas/Fort Worth International Airport when CBD oil was found in her travel bag after she arrived from Mexico. Bartula, who said she relied on the CBD for the aches and pains of aging, was handcuffed and jailed for two nights on felony drug charges. The charges were eventually dropped, and Texas law was later clarified to allow CBD. If there had been more than traces of THC in her oil, however, the outcome may have been much worse. Meanwhile, the Transportation Security Administration (TSA) changed its policies in 2019 to allow passengers to travel with CBD products. But if the CBD somehow contains more than the critical 0.3 percent THC, such legal protections disappear—which means, it pays to know what’s in your bottle.

To improve your odds, experts suggest buying from reputable companies, the kind whose websites post the product’s “certificate of analysis” (showing the exact purported amounts of CBD and THC, as well as how it was tested.) Some users who are especially concerned about drug testing only buy CBD isolate. This is cannabidiol in its purest form, which makes contamination by THC extremely unlikely (For more on this, see this page.) For other helpful tips for buying CBD safely, see Chapter 5.

MYTH 2: TAKING CBD IS RISKY.

Some people wonder if cannabidiol is safe for long-term use. Others question whether it will affect their mind and get them high or worry that it’s addictive. Since CBD is newly popular, some fear unforeseen drug interactions or side effects.

The reality is that even experts who don’t advocate cannabidiol generally consider it remarkably safe. At common doses it is considered nontoxic, although the FDA says there is limited data so there could be risk. That said, with only trace amounts of THC, it doesn’t cause a psychoactive high. And no one has died from overdosing on any cannabis product.

But fears remain. A 2019 Harris Poll found that a third of Americans are concerned about how CBD interacts with prescription drugs. To date, however, there have been no serious problems with CBD mixing badly with medications, except for a couple of very specific exceptions. The National Library of Medicine recommends not taking it with the seizure medication clobazam (Onfi and Sympazan) since CBD may slow the liver’s work to break down the drug, which could change the effect of the drug or cause side effects. With another seizure medication, valproic acid (Depakene), CBD is not recommended because it could cause liver injury.

For some sedatives, it’s a good idea to check with your doctor to ensure that CBD’s interaction with the drug doesn’t cause too much sleepiness. In fact, some experts recommend checking with your doctor before starting CBD if you’re using any drug that is broken down and changed by the liver, which includes more than half of the pharmaceuticals on the market, everything from ibuprofen to Prevacid to Paxil to Xanax. While taking CBD with these drugs is not considered dangerous, the interaction may change the effects and side effects of the medication. More studies are needed to fully understand these interactions.

There are many health experts who believe cannabidiol is completely safe, no matter what the dose. Even an incredibly huge dose such as 5,000 milligrams a day can be well tolerated, says Jahan Marcu, a pharmacological expert. Overall, the World Health Organization has stated, “there is no evidence of public health related problems associated with the use of pure CBD.”

At the same time, experts are looking closely at the plant extract’s effect on the liver, especially at extremely high doses. A study by the University of Arkansas found that after ingesting high doses of CBD, mice experienced liver damage and in some cases died as a result in just a few days. In fact, as part of the clinical trials for the CBD epilepsy drug Epidiolex, researchers discovered liver toxicity in some patients, with 5 to 20 percent experiencing some kind of liver issue. “The FDA identified certain safety risks, including the potential for liver injury,” the agency concluded. It’s important to note that Epidiolex treatments contain a megadose of CBD that’s much higher than what’s typically used by other CBD users. While the National Institutes of Health (NIH) notes that such liver injury is rare, more study is currently underway, and doctors do monitor liver enzymes when using Epidiolex to treat children.

NIH researcher and endocannabinoid expert Pal Pacher, M.D., Ph.D., is leery of much of the positive hype around CBD, but liver damage is one thing he doesn’t worry much about. He says many common over-the-counter medications have the same risk, and for CBD, the only amounts that have caused any problems are so big that for the average user, they would be what he calls “nonsense doses.”

In the Harris Poll, 38 percent of Americans said they were concerned that CBD might have unknown side effects. As with any plant extract, CBD affects each body differently. Some people feel nothing at all—no side effects, no positive benefits. In those cases, proponents often suggest experimenting with higher doses. If that doesn’t work, the most painful side effect may be financial more than physical. At as much as $60 or more for a 500 milligram tincture bottle, CBD isn’t cheap.

Other people experience a variety of effects, including, in some cases, unwanted symptoms. According to the NIH, side effects can include dry mouth, low blood pressure, lightheadedness, and drowsiness. (In cases where CBD is being taken to help with insomnia, that sleepiness, of course, switches from side effect to desired effect.) Others have experienced headaches, irritability, diarrhea, nausea, decreased appetite, red eyes, hunger, rashes, or in a positive twist, euphoria. Since CBD is unregulated, some of these reported effects may have come from other substances incorrectly marked CBD. In any case, according to a 2018 study published in Cannabis and Cannabinoid Research, one in three CBD users had experienced an unexpected effect. “I’m reasonably certain new kinds of side effects will emerge,” says J. Michael Bostwick, M.D., a psychiatrist at the Mayo Clinic. To date, however, most of cannabidiol’s unexpected effects have been minor and relatively rare.

One effect no one should worry about, according to experts, is addiction. “In humans, CBD exhibits no effects indicative of any abuse or dependence potential,” says the World Health Organization. This is often seen as one of CBD’s potential strengths. Unlike opioids and other pharmaceuticals, which often bring the high risk of potentially disastrous addiction, experts say CBD may provide relief without that danger.

The biggest risk of CBD may be taking it instead of a medication that you need. “Misleading and false claims associated with CBD products may lead consumers to put off getting important medical care, such as proper diagnosis, treatment, and supportive care,” the FDA has warned. The agency has cited CBD companies for claiming that it can treat serious diseases such as cancer, Alzheimer’s disease, and diabetes. Such claims are not backed by verifiable evidence.

MYTH 3: CBD IS A WONDER DRUG.

By standard pharmaceutical definitions, cannabidiol is not even a drug at all. It’s a plant extract—a naturally occurring compound. For many people, this is a major part of the appeal. CBD’s fast rise in popularity has brought hope and excitement that there’s now a natural, nonaddictive solution for a wide variety of issues, with no serious side effects—what some might call a wonder drug. For others, this all seems a bit too good to be true. They are skeptical about the lack of indisputable human research and dubious of the hype.

Such skeptics point to the beauty industry, which, based largely on the anti-inflammatory promise of CBD, now markets cannabidiol as if it is some kind of miracle elixir. CBD has become a featured ingredient in moisturizers, shampoos, conditioners, mascaras, soaps, antiwrinkle serums, antiacne formulas, muscle rubs, sleeping masks, face lotions, body creams, and more.

The fiercest CBD advocates believe there’s almost nothing cannabidiol can’t help. There are even products that feature CBD in tampons—to help treat menstrual cramps. Online it’s easy to find CBD touted as a treatment for brain cancer, lung cancer, breast cancer, leukemia, heart disease, Crohn’s disease, Alzheimer’s, autism, ALS, neuropathic pain, obesity, obsessive compulsive disorder, schizophrenia, and much more. For much of the serious medical community, these claims are problematic.

“I don’t have a problem until it is hurting someone,” says Dr. Pacher, NIH investigator and past president of the International Cannabinoid Research Society, a medical organization of professionals devoted to the study of medicinal cannabis. “People can take CBD and I don’t care. They may spend lots of money for it, but it won’t induce harm. But there are so many unsupported claims. For example, there is zero human evidence that it is working to treat cancer patients. But I worry about desperate people giving up chemotherapy thinking that CBD could help them. I have a problem with that, because many of these people may die and their best chance right now, chemotherapy, will be lost because of false hope.”

Dr. Pacher compares the CBD boom to the hype around resveratrol and red wine two decades ago. This compound found in grapes was first isolated in 1939 (almost the exact same time that the compound cannabidiol was first discovered in the cannabis plant). Sixty years later, it gained enormous popularity, spurred by some intriguing research suggesting that perhaps the compound could reduce inflammation, help fight cancer, and improve longevity. The ingredient was heavily marketed and pharmaceutical companies poured money into research. Resveratrol appeared in more than 20,000 research papers in the past 20 years and was studied in more than 130 clinical trials. But it was found to be poorly absorbed when taken and never gained acceptance in the medical community. The product is still available as a niche supplement, and some advocates still believe in its power. The hype, however, is over.

“There were lots of benefits attributed to red wine,” Dr. Pacher says. “Resveratrol was seen as the key ingredient in red wine, much like CBD is seen as the key medicinal ingredient in medical marijuana. But for resveratrol, that was speculation. And with CBD, it’s not so simple, either. We know that cannabis has medicinal effects, but there’s no proof that CBD is the medicinal part. There are terpenes and other minor cannabinoids, plus THC. At the time, you could buy resveratrol everywhere and people were taking it for everything. It was overhyped. It was the new magic bullet to prevent aging. And ultimately, in my view, it was a deception.”

Complicating the issue today, according to Dr. Pacher, are unscrupulous CBD companies who are trying to profit on the boom, with some having little knowledge of their own products. “There is lots of money involved. Billions of dollars. And some of these companies, they make claims, but they have no idea,” says Dr. Pacher, who has coauthored more than 300 peer-reviewed publications and has been a part of the NIH since 2003. “It’s kind of the wild, wild West.”

In the normal life cycle of a new medication, research and development is followed by clinical trials, a patent, government approvals, and finally marketing to the public. But because CBD is a natural part of a plant that anyone can access, cannabidiol itself cannot be patented. What is proprietary for a company are the delivery vehicles (oils, creams, and more) and the sourcing and extraction of their cannabis. This is one of the things that has made CBD a grassroots sensation. To many, it is the underdog health product that comes from nature, not from a lab. While many advocates love this about CBD, it does allow irresponsible companies into the industry, which means consumers need to be especially vigilant about product quality. Even within the best companies, results can be difficult to predict and standardization is hard to achieve since the main ingredient is a plant compound rather than a man-made formula.

Further research will ultimately define the scope of cannabidiol’s full benefits. A common expectation among experts is that it will be useful for some issues and some people, but not a panacea by any means. Whether it’s a wonder drug depends on your perspective. For the epilepsy sufferers and their families who have gone from hundreds of seizures a day to zero, CBD feels like a miracle. For an anxiety, insomnia, or pain sufferer who finds that CBD works well enough that they can stop using opioids or other heavy medication, CBD may seem like a natural wonder. For someone expecting that it will solve all their health problems instantly, that’s unlikely.

“CBD is not a scam,” Yasmin Hurd, director of the Addiction Institute of Mount Sinai Hospital, told the New York Times, after leading a study of 42 recovering heroin addicts and finding that CBD reduced cravings and anxiety. “It has potential medicinal value, but when we’re putting it into mascara and putting it into tampons, for God’s sake, to me, that’s a scam.”