What you need to know about CBD
The buzz around CBD is at an all-time high. CBD, or cannabis-based products, are hailed by devotees as natural cure-alls for all sorts of health conditions — everything from chronic pain to anxiety, insomnia, and more. And the number of products you can get your hands on feels like it grows more and more every day. There are CBD beauty products, CBD foods, CBD drinks, CBD pills, and even CBD pet products.
So, should you get that CBD massage? Or eat those CBD chocolates? Here, Ebonie M. Vázquez, MD, a psychiatrist and addiction medicine specialist at Kaiser Permanente in Southern California, breaks down what we do and don’t know about CBD products.
What is CBD?
CBD stands for cannabidiol. It’s a natural chemical found in the cannabis sativa plant, more commonly known as marijuana or hemp. 1
“CBD doesn’t contain THC (tetrahydrocannabinol), the major psychoactive ingredient in marijuana that makes you feel high,” says Dr. Vázquez. As a result, CBD products are sold as a way to enjoy the calming effects of marijuana without the high.
Does CBD get you high?
“Pure CBD doesn’t contain THC, so it shouldn’t make you feel high,” says Dr. Vázquez. “But the keyword there is ‘pure.’” It’s hard to know if you’re really getting pure CBD in current products, which aren’t screened for purity or safety.
In fact, over the last few years, the Food and Drug Administration (FDA) tested several CBD products and found that many contained different levels of CBD than they claimed. Some products actually had THC in them, and some are suspected of containing unsafe toxins like pesticides and heavy metals. 2 In general, if your CBD product doesn’t have any other additives, it shouldn’t make you high.
What do we know about the health benefits of CBD?
There’s a lot of buzz around CBD helping with anxiety, pain, stress, and insomnia. But there’s not enough research to prove the hype. “There’s currently research underway to see if CBD can help with Parkinson’s disease, schizophrenia, multiple sclerosis, insomnia, and anxiety,” says Dr. Vázquez. “But it’s too soon to know whether or not CBD effectively treats these conditions.”
Right now, the only CBD health benefit we have scientific evidence for is epilepsy treatment. The FDA has only approved one CBD product — Epidiolex — a prescription drug used to treat 2 severe and rare forms of childhood epilepsy (Dravet syndrome and Lennox-Gastaut syndrome). 2,3
Are there any health risks associated with CBD?
Some potential side effects of CBD are nausea, fatigue, and irritability. But the bigger risk with CBD is with drug interactions.
“CBD may react with a lot of common medications people take,” Dr. Vázquez says. “For example, pain medications, psychiatric medications, blood thinners, antihistamines, and more.” If you’re taking CBD, let your doctor know so they can review your medications to help you avoid a bad reaction.
In addition, some CBD products may contain harmful impurities in them (like pesticides and bacteria) which can put you at additional risk. As a result, pregnant and breastfeeding women shouldn’t use CBD products. 4
Is CBD regulated?
CBD products aren’t regulated or evaluated by any government agency. And aside from the prescription epilepsy drug Epidiolex, the FDA hasn’t approved any CBD products. This includes cosmetics, foods, dietary supplements, and pet products.
CBD products that claim to prevent, treat, or cure diseases (like cancer and Alzheimer’s disease) also haven’t been approved by the FDA. To try to protect the public’s health, the agency has actually warned companies to stop selling CBD products that claim to cure diseases. 5
“Due to this lack of regulation, there’s a lot of variation in product quality,” Dr. Vázquez explains. “There’s no guarantee you’re getting what the label says you’re getting.” And dosage is also murky territory. Since the FDA hasn’t evaluated CBD products for proper dosage, there are no clear guidelines yet on how much CBD is safe to take — whether it’s in pill, oil, or topical form. 6
Will CBD show up on a drug test?
CBD shouldn’t show up on a drug test. But it’s possible. “If your CBD product happens to contain THC,” Dr. Vázquez explains, “it may result in a positive drug test.”
Is it safe to try CBD?
“At this point, I don’t recommend the use of CBD products,” Dr. Vázquez says. “We just don’t have enough evidence right now on the health benefits, and a big concern is the lack of regulation and possible health risks.”
If you’re going to try CBD, it’s important to be cautious and know the risks. And whether you’re interested or already using CBD, Dr. Vázquez encourages you to talk to your doctor about it. “Please don’t hide it from your doctor because you think they might be anti-CBD. We want to hear about your experience and make sure you’re safe,” she says. At the very least, your doctor can review your medications with you to help make sure you’re not at risk for any drug interactions.
And over time, if CBD products are found to be effective and safe, they’ll eventually come under FDA regulation. “Then doctors may feel more comfortable with patients using CBD products,” she says. “But right now, it’s just too new.”
Not sure about CBD?
Reach out to your doctor. They can help explain the potential benefits and risks of CBD.
1 “Cannabidiol (CBD),” U.S National Library of Medicine, November 13, 2019, accessed February 6, 2020.
How to get a CBD oil prescription or medical cannabis prescription
There are four ways to get a prescription for CBD oil or other medical cannabis products:
- From your doctor or specialist
- From a cannabis nursing service
- From a cannabis clinic (“canna clinic”)
- From a cannabis telemedicine service
Here’s what you can expect from each of these approaches.
Your doctor or specialist
Very few doctors and specialists are readily prescribing cannabis, for a variety of reasons. Many will simply refer you to a cannabis clinic, or even suggest you go buy it from a retail store.
If your doctor is knowledgeable and willing, count yourself lucky. That said, they are unlikely to have time to educate you on all of the ins-and-outs of medical cannabis, or help you decide which licensed producer to register with. Nor are they likely to have staff at their clinic who can help.
Some doctors may have a single licensed producer that they have a relationship with. They will forward your prescription to that producer, who will then call you to help you choose a product. It’s convenient for the doctor, but it doesn’t leave the patient with any choice of producer. This is unfortunate because no single producer can meet the diversity of needs that patients have.
[By the way, Wayfare works with quite a few doctors who are prescribing cannabis but count on us to provide educational support to their patients. We can even help prepare documents you can take to your doctor.]
Cannabis nursing service
You can think of this service as a mobile clinic. The nurse will come to your home, provide education, take a medical history and connect with a doctor or Nurse Practitioner to obtain the authorization. She will also help you select an appropriate product and develop a detailed treatment plan and dosing schedule. She will then help register you with a licensed producer so you can order products by phone or on-line, and will follow up with you semi-weekly while you work toward your goal.
The cost for this service is usually fully-covered by insurance as a home nursing expense.
Wayfare falls into this category, although we do often work with patients’ own doctors, and there are some cannabis clinics who refer to us to provide extra support for patients. We are now also providing a telehealth option as well.
Over the past few years a number of specialized cannabis clinics have opened up. These are typically staffed by doctors who work there on a part-time basis. These doctors may come from specialties including psychiatry, surgery, and anesthesiology. This means that some patients may see a heart surgeon for their arthritis! But really, bless these doctors for making time to learn about cannabis and help people.
The educational portion of your visit, where you select a licensed producer and product, is quite often handled by a lay person who may have the title of “cannabis educator”, “canna counsellor”, or “patient educator”. These people rarely have medical training, although they may be knowledgable about particular strains, the pricing programs of the various producers, and how to use a vaporizer.
Cannabis telemedicine services
You can get on a video conference with a doctor or Nurse Practitioner, who will assess you and provide an authorization for medical cannabis. Some of these services are stand-alone whereas others are provided by cannabis clinics as described above.
The educational component of the service may again be handled by a lay person, sometimes via a separate video call or by telephone through a call centre.
Do You Need a Prescription for CBD Oil?
You will find CBD infused into everything from candy to bath salts these days. However, CBD oil is one of the most popular ways of taking the substance. A growing number of companies are springing up offering their take on CBD oil, but the legality of this is somewhat hazy.
In 2018, the updated Farm Bill ensured that the cultivation of Cannabis sativa L. plants containing less than 0.3% THC became federally legal. Following this, hemp was removed from the Controlled Substances Act, and the market exploded unprecedentedly.
Yet, while CBD companies and consumers celebrate this important change, there is just one small catch. The Farm Bill also preserved the rights of the Food and Drug Administration (FDA) to regulate all cannabis-based products under the Food, Drug, and Cosmetic Act. So, while many companies state that their CBD is legal in all 50 states, this is not necessarily the case.
This article explores the confusing laws surrounding cannabis-based medicine and whether you need a prescription for CBD oil. Read on to find out more.
Is CBD Oil Legal?
Technically, the 2018 Farm Bill didn’t legalize CBD or any other cannabinoids. Instead, it permitted the growth of industrial hemp containing a maximum THC content of 0.3%. Therefore, CBD is not a federally legal substance, but hemp is.
Consequently, states are free to set their own CBD laws. In general, most locations follow the lead of the 2018 Farm Bill and tolerate the sale of low-THC CBD products derived from hemp.
However, a couple of states have different rules. In Idaho, CBD products must not contain any THC whatsoever. In Kansas, such items can’t include more than 0.1%. Every other state seems to allow the sale and use of hemp-derived CBD oil with an upper limit of 0.3% THC by dry weight.
To confuse matters, some states have medical marijuana laws that permit patients to access low-THC oil with a doctor’s recommendation. Products can contain more than 0.3% THC in these locations but less than a specific percentage. Let’s find out more below.
Do You Need to Get a Prescription for CBD Oil?
At the time of writing, a significant majority of states have medical marijuana laws in place. If you are lucky enough to live in one of these states, you can apply for a medical card and get access to a whole range of different cannabis-based products.
However, if you are in one of the remaining states, CBD oil may be your only option.
It is not usually necessary to obtain a prescription or a recommendation from a doctor for hemp-derived CBD that contains less than 0.3% THC (see above for exceptions). However, in some states, patients can use CBD oil that contains more than 0.3% THC if they have a medical marijuana card or exception.
For example, in Georgia, the Low THC Oil Registry allows qualifying patients to possess CBD oil with a THC content of up to 5%. In Tennessee, the maximum THC limit is 0.9%.
However, please note that various states’ CBD and MMJ laws change regularly. If you want to know whether you need a written recommendation for CBD oil in your area, we recommend that you contact your local health department for further information.
How to Get a CBD Prescription Legally
Both hemp and marijuana come from the Cannabis sativa L. plant. The main differences relate to THC content and legality, with one dictating the other. While hemp is no longer a controlled substance, marijuana still is.
Any cannabis plant that contains more than 0.3% THC is considered marijuana and is, therefore, federally illegal. Consumers can only use such products in states where recreational marijuana is legal or if they live in a state with a medical marijuana program and have a valid MMJ card.
Obtaining an MMJ card varies depending on where you live. The type of product you can get may also vary.
The MMJ application process varies according to where a person lives. However, in most cases, the process begins with a doctor’s consultation. They ask questions about the person’s health and determine whether marijuana will help them. It is only possible to proceed with an MMJ card application once the individual has received the physician’s certification.
Most states enable patients to apply via an online registry. If their application is approved, the state’s Department of Health sends them a medical marijuana card. Then, they can finally buy CBD products containing more than 0.3% THC, otherwise known as marijuana products.
If the above sounds long-winded, remember that consumers don’t need a prescription for hemp-derived CBD with 0.3% THC or less!
Can Doctors Prescribe CBD Oil?
No. Doctors in the United States are not allowed to prescribe any CBD product. It is the same situation as medical marijuana. Neither CBD nor THC are federally legal substances. Therefore, a physician can recommend CBD oil or MMJ but isn’t permitted to write a prescription for either.
They can also recommend a certain dosage in states where the maximum marijuana limit isn’t set in stone. Some states also permit doctors to recommend increasing a patient’s marijuana dosage depending on the medical condition.
Which CBD Products Are Approved by the FDA?
The only cannabidiol product that the FDA currently approves is Epidiolex. GW Pharmaceuticals developed this medicine. It is approved to treat drug-resistant forms of epilepsy such as Dravet syndrome, Lennox-Gastaut syndrome, and also tuberous sclerosis complex (TSC). As the product has undergone rigorous testing, the FDA has deemed it safe and effective. Sadly, this is more than can be said for other forms of CBD.
Thanks to the illegal status of cannabis for the last century, research into the plant has been severely lacking. Its use as a supplement or food additive is also currently unapproved.
The FDA does allow the use of CBD in cosmetic products, although this is also subject to strict regulations. The actual legality of CBD depends on how it is labeled and marketed, which is where many companies fall foul of the law.
Aside from the dubious legality of many CBD products, customers are presented with another significant problem. Until the FDA fully approves CBD oil as a medicine or supplement, the market will remain completely unregulated. This lack of scrutiny leaves manufacturers free to produce low-quality oils, which at best may have no effect, and at worst, might damage consumer health.
Therefore, if you intend to use CBD, be sure to find a reputable source.
Where Can You Buy CBD Oil Over the Counter?
While CBD oil is widely available online, consumers in select states can purchase over-the-counter CBD at drugstores such as CVS and Walgreens. However, many stores play it safe by only stocking topical products that comply with the FDA’s stringent guidelines.
If you live in a more liberal state, you may also find CBD in specialist stores. There have even been reports of the cannabinoid being sold at gas stations in some states! Whether these products are reliable or not is an entirely different matter, though.
Remember to buy CBD from a reputable brand and not get sucked in by low prices. You get what you pay for in the CBD world, and if the cost of a product seems too good to be true, it probably is.
For some of our top-rated CBD oils, check out this article on the Top CBD Oil Brands for 2021.
All the answers in one post…
Can You Order Cannabis Oil Online Without a Prescription?
The answer is ‘yes’ if the oil in question contains a maximum of 0.3% THC and is deemed to come from industrial hemp. In that case, top-rated brands such as PureKana have you covered as they ship CBD products to most states.
Things get more complicated regarding cannabis oil classified as marijuana products. If consumers can legally buy marijuana in their state, they can purchase it online from a licensed dispensary within the same state. Some dispensaries offer curbside delivery, while others allow online orders for pick-up only.
As marijuana is federally illegal, it remains a crime to transport it across state lines. It doesn’t matter if a person is traveling from one legal state to another. Therefore, ordering high-THC cannabis oil from a vendor in another state could result in federal criminal prosecution.
However, there are cannabinoids offering an intoxicating high that aren’t yet federally illegal. For instance, there is no federal regulation of delta-8-THC, although numerous states have banned it. Delta-8 provides approximately half the level of intoxication as the delta-9-THC found in marijuana. Brands such as Premium Jane are considered among the most reputable sellers of Delta-8.
Further examples of cannabinoids offering varying levels of intoxication that aren’t yet federally illegal include:
If interested in any of the above, Binoid is regarded as one of the most trustworthy vendors.
However, please note that there are calls to ban all of the above federally. Already, there’s a decent chance that for some readers, their state has already made some, if not all, of these cannabinoids illegal. Make sure to check your state’s laws before considering a purchase.
Do You Need a Prescription for CBD Oil? Final Thoughts
Although CBD and cannabis-based medicines are becoming more widely available, residents of certain states may still have some difficulty accessing them. For example, if you reside in a state with a CBD oil registry, you will need to have one of the listed qualifying conditions and get approval from your doctor.
However, most Americans can now enjoy easy access to CBD oil, either online or in retail stores. While this news is undoubtedly positive, it does highlight the need for caution when choosing products. Some brands offer high-quality CBD in a largely unregulated market, while others fail to make the grade.
Until the FDA relaxes its stance on cannabis-based products, this situation is unlikely to change. So, however you get hold of your CBD, be sure to choose a brand that you can trust. Don’t get lured in by flashy packaging or low prices. Instead, look for a well-established, reliable company with positive customer reviews.
Finally, ensure that you are familiar with your area’s CBD rules and regulations. There is a lot of misinformation out there, so do your own research and stay on the right side of the law.