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By Steven Voser

The CBD boom has made headlines all across the globe. Whether it's mixed into a smoothie, taken as an oral tincture, or consumed in the form of chewable gummies, CBD is believed to deliver all kinds of wellness benefits. But when it comes to the safety of cannabidiol and understanding how it acts in the human body, we know far less than CBD retailers like to lead on.

In what follows, we explore the current information on CBD’s safety profile, mechanism of action, legality, and more.


Is CBD Safe?

CBD is often marketed as a safe, non-toxic compound. Indeed, to date, most research suggests that CBD is very well-tolerated by most people. On the off chance that it might cause adverse effects, these tend to be fairly mild, and include dry mouth and diarrhoea, among others. CBD may also compete for metabolism with blood thinners or other medications in the liver, and may therefore affect the half-life of these drugs—which is a very serious relationship for consumers and health professionals to consider.

At the same time, there is still a lot we don't know about CBD and the mechanisms via which it acts in the body. Hence, more research is needed to help us understand how it works before we can make informed conclusions about CBD’s safety.

A growing interest in cannabinoids and their potential benefits, as well as changes to cannabis laws in various regions of the world, has given rise to a larger body of research aimed at understanding cannabis and its major active ingredients. CBD, in particular, has been the focus of numerous preclinical and clinical studies. Here's what these studies[1] have taught us so far regarding CBD's safety:

  1. Animal studies and clinical trials suggest that CBD is generally well-tolerated and safe.
  2. CBD can cause side effects. The most common include tiredness, diarrhoea, and weight/appetite changes. Other side effects may include irritability and dry mouth.
  3. CBD may compete for metabolism by liver enzymes and thereby affect the metabolism and half-life of prescription medications. More research into this relationship is needed to fully understand the safety of CBD and cross-drug interactions.

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How Is CBD Used?

CBD is commonly used in the form of CBD oil or liquid tinctures (which are partially absorbed via mucous membranes in the mouth and via the digestive tract), in the form of gummies or other infused edibles (which are processed by the digestive tract and liver), or as topicals that act directly on receptors in the skin. Vaping CBD is also growing in popularity.

Unlike THC, CBD doesn't seem to have a high affinity for the main cannabinoid receptors CB1 and CB2. Instead, it is believed to act on a combination of:

  • Serotonin receptors (5-HT1A)
  • Capsaicin receptors (TRPV1)
  • Gamma receptors (PPAR)
  • Orphan receptors (GPR55)

CBD is also believed to work as a reuptake inhibitor for the endogenous cannabinoids 2AG and AEA[2], meaning it can interrupt their metabolism and temporarily increase concentrations in the brain.

Such diverse mechanisms of action only contribute to the complexity of making broad statements about CBD’s relationship with the body, and its overall safety. Furthermore, different methods of administration may provide distinct outcomes, as each has a different bioavailability, onset and duration of effects, and unique ingredients.

The popularity of CBD has risen dramatically in recent years, and in many regions around the world legislative powers have been playing catch-up to properly regulate this burgeoning industry. Obviously, CBD legislation varies from one region to another. Below we summarise some of the biggest legislative moves regarding CBD's legality in Europe and other parts of the world.

2018

The WHO concluded[3] that CBD is effective in the treatment of refractory epilepsy (particularly in children) in certain cases, and has no potential for abuse or dependence, and should therefore not be controlled in the same manner as THC.

The same year, the 2018 US Farm Bill addressed grey areas[4] regarding the legality of CBD in the United States. The bill confirmed that hemp (cannabis plants with less than 0.3% THC) and hemp-derived products were legal, though it maintained THC as a Schedule I controlled substance under federal law.

2020

The European Court of Justice stated that CBD is not considered a narcotic drug under European drug laws[5] and could be qualified as a "novel food" given that the form in which it is sold meets EU food safety regulations.

What About CBD in Sport?

By the look of it, CBD has a wide variety of potential applications. And while many of these haven't been confirmed or are still being studied, a growing number of athletes (both professional and amateur) have begun using CBD as part of their diet and supplementary routine to help with recovery and training. Since CBD is derived from cannabis, a prohibited substance under world anti-doping laws, the use of CBD by professional athletes quickly raised discussions among anti-doping agencies.

As of 2018, the World Anti-Doping Agency has removed CBD from its list of prohibited substances[6]. However, other cannabinoids, such as THC, remain prohibited. Since CBD products may contain trace amounts of THC that could potentially trigger a positive drug test, anti-doping bodies such as USADA and UKAD have warned about the risks of professional athletes using CBD.

What Are the Biggest Concerns Regarding the Safety of CBD?

Many legislative powers have concluded that CBD is generally safe, regardless of the fact that we still don't completely understand how it acts in the body. Nonetheless, there are still some real concerns facing CBD. These include:

⚖️ Reliability

While CBD is often marketed as a wellness supplement, most CBD products aren't assessed as rigorously as other supplements or medications. That's usually because legislative powers don't recognise CBD as a medicine or supplement in the first place. In the US, for example, the only CBD medication approved by the FDA is Epidiolex, which can be prescribed to treat rare forms of treatment-resistant epilepsy. In the EU, on the other hand, CBD is considered a "novel food", and therefore isn't tested or regulated in the same way as medications or supplements, and isn't accepted for therapeutic use.

⚗️ Chemical complexity

Cannabis is an extremely complex plant that contains close to 500 different chemical compounds. Each has unique and complex ways of interacting with the body, as well as the potential to synergise with other compounds and produce distinct reactions (a theory known as the entourage effect). CBD products may contain varying concentrations of these compounds, which only adds to the difficulty of understanding the way these products may act in the body.

📝 Drug testing

Moreover, the fact that CBD products may contain trace amounts of THC and other cannabinoids can prove problematic for anyone subject to drug testing. Most legal CBD products should not contain enough THC to trigger a positive result, but it is not unheard of.

💊 Black market products

Black market CBD products are sold in various parts of the world. These products are subject to zero testing or quality control, and therefore we never recommend buying CBD on the street or from any other unreliable source.

What's the Future for CBD?

The demand for CBD has grown exponentially in recent years. And while there are clear challenges to properly regulating CBD and ensuring the safety and reliability of all CBD products, we will likely see these challenges addressed as our understanding of this complex cannabinoid develops.

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