By Kathleen Gray and Kristen Jordan Shamus Detroit Free Press
WWR Article Summary (tl;dr) CBD is an extract derived from the flowers and buds of hemp. It is legal in the United States as long as it contains less than 0.3% THC, the psychoactive component of marijuana, which gets people high.
Tai Ayala's dependency on prescription medications to control both anxiety and irritable bowel syndrome still left her anxious about holding on to a full-time job.
The 25-year-old Royal Oak resident was never sure that she would be able to make it to work without having an accident or a flare-up. So two years ago, she turned to a product that is becoming more and more ubiquitous in the marketplace -- CBD or cannabidiol, the non-psychoactive element of the cannabis plant -- and has weaned herself off the prescription meds.
"I have a medical marijuana card, but I was more interested in the whole CBD aspect of it because I wanted something that was going to help with my IBS, so I could do my job without feeling impaired mentally," said Ayala, who is a budtender at the Greenhouse medical marijuana dispensary in Walled Lake. "When I made that switch to CBD, it definitely improved my way of life."
While the research on the benefits of CBD is scarce, there is a plethora of anecdotal evidence of how it has helped treat everything from chronic pain from such conditions as arthritis, multiple sclerosis and cancer; anxiety, depression and insomnia; addiction to tobacco and opioids; muscle spasticity and other health problems associated with multiple sclerosis and Parkinson's disease; acne, and seizures among those with epilepsy.
As a result, the market is flooded with products for humans and pets. BDS Analytics, a Colorado-based company that tracks the cannabis industry, has projected that CBD sales will reach $20 billion by 2024.
"We're witnessing CBD maturing from a cannabis sub-category into a full-blown industry of its own," attracting 15% of adults in the United States, said Roy Bingham, co-founder and CEO of BDS Analytics.
Other than one prescription drug, Epidiolex, which is used to treat severe forms of epilepsy, the U.S. Food & Drug Administration has not approved CBD products and does not test them.
That means there's no federal oversight to ensure that what you think you're buying is what you are actually getting, said Dr. Peter Grinspoon, a Harvard Medical School professor and a primary care doctor at Massachusetts General Hospital who wrote a memoir called "Free Refills: A Doctor Confronts His Addiction," about his recovery from opioid addiction.
The American Medical Association says more well-controlled studies are needed on the use of marijuana and CBD for patients who have serious conditions before more states legalize pot for adult recreational use. The organization also has called on the federal government to review the status of marijuana as an illegal controlled substance "so clinical research and development of cannabinoid-derived medicines can take place."
It also supports research that would help to determine the consequences of long-term cannabis use, especially among young people, pregnant women, and women who are breastfeeding.
Despite the warnings from the AMA, 11 states have legalized marijuana for adult recreational use and 33 states have approved medical marijuana, and CBD is all the craze. You can buy it online in lotions, creams, oil, patches and tinctures. It's at your local health food stores, gas stations, video stores and even at the Kroger around the corner. Products containing CBD are practically everywhere.
What is CBD and how much is it regulated? An extract derived from the flowers and buds of hemp, CBD is legal in the United States as long as it contains less than 0.3% THC, the psychoactive component of marijuana, which gets people high.
Hemp and marijuana are both cannabis plants, but hemp has much lower concentrations of tetrahydrocannabinol, or THC. Since 1970, all cannabis has been categorized as a controlled substance and, as such, considered illegal by the federal government. But the 2018 farm bill legalized hemp and provides for regulating the growth of the plant.
But even though it's legal and there's easy access to CBD products, it's very much a matter of buyer beware, Grinspoon said "You could get pesticides or heavy metals in the product," said Grinspoon, an expert on medical marijuana who serves on the board of directors for the Doctors for Cannabis Regulation. "And some of the CBD samples that have been tested even had (higher than legally allowed levels of) THC in them."
"I'm not against THC. I am a medical cannabis provider. But the last thing you want is THC when you're not expecting THC," he added. "You could be driving home (after using such a product) and that is profoundly dangerous. The fact that it's unregulated and you don't know what dose you're getting or if you're getting something else on top of CBD is dangerous."
Michigan's Department of Licensing and Regulatory Affairs does not regulate CBD products with less than 0.3% THC. Those hemp-based products are handled by the Michigan Department of Agriculture and Rural Development, which issues licenses for the hemp growers and processors.
After starting a pilot program earlier this year, MDARD has registered and licensed 541 hemp growers in the state who are expected to plant more than 32,000 acres. Additionally, 389 processors who transform the hemp into other products have also been licensed.
The growers will have to have their hemp plants tested, either at the MDARD labs or labs licensed by the state to test medical marijuana, to make sure the plants contain no more than 0.3% THC. Once the hemp is transformed into CBD products, it becomes the U.S. Food and Drug Administration's responsibility.
But the FDA hasn't been testing CBD products, either. At Greenhouse and other retail outlets where CBD is sold, the products don't have stamps of approval, like what you might see on vitamins. However, Angie Roullier, the dispensary's team leader, said all the products it sells have been tested and those results are available to customers, who can buy the products without a medical marijuana card in a room next to the dispensary.
Any product with more than 0.3% THC is regulated in Michigan as marijuana, which now is legal for medicinal use and will be commercially available for sale by late this year or early in the new year for recreational use to anyone 21 and older. Those products are regulated by the state's Marijuana Regulatory Agency.
What are the concerns about CBD products? Grinspoon said the concerns about the CBD products on store shelves include no one checking that the products and dosages listed on the CBD labels are accurate.
"Assuming you are getting the right dose of CBD and it's just CBD," Grinspoon said, the two things consumers need to be concerned about are:
-- It could raise the levels of certain other medications in your blood in exactly the same way that grapefruit juice does. ... So if you're on blood thinners, you're certainly going to want to tell your doctor that you're on CBD so he or she can check the level of your blood thinners more carefully.
-- Your doctor might want to keep an eye on your liver enzymes because some of the trials of CBD elevated the level of liver enzymes.
"But overall, it's a lot safer than anything else you'd be using if you're using it instead of opioids for pain or Ambien to help you sleep or instead of benzodiazepine for anxiety," Grinspoon said. "It's a lot safer than those. But there is no free lunch in medicine, so you have to keep an eye on certain things."
Does CBD really work? Beyond those risks is the question of whether CBD works at all for conditions other than epilepsy, and what dosage is ideal for the best effects.