What is CBD and why are so many people using it?

From oil tinctures to gummies, cannabidiol (CBD) can be found just about everywhere these days, in a stunning array of products used by millions of people in the United States. In fact, more than one-third of adults questioned for the 2023 U.S. National Survey on Drug Use and Health had used CBD at some point.

While people take CBD for a multitude of medical issues, research into how much it actually helps is ongoing. In some cases, it may even pose safety risks. That’s why health care providers (HCPs) must be careful about the information they relay to patients—and why patients should let their HCPs know if they’re taking CBD.

So, what is CBD, exactly? Do the purported health perks really live up to the hype? And what potential problems should patients keep in mind?

The basics of CBD

CBD is a cannabinoid, a chemical compound that comes from the cannabis plant. There are more than 100 known cannabinoids, including CBD and tetrahydrocannabinol (THC), the substance that creates a high when you use marijuana. Unlike THC, CBD has no psychoactive effect, which is part of its mainstream appeal.

CBD interacts with the body’s endocannabinoid system (ECS), which can influence pain perception, inflammation, and relaxation.

Certain varieties of the cannabis plant have lower amounts of THC and higher amounts of CBD. These types are commonly known as hemp, and they’re often used to make CBD products, including oils, sprays, creams, and pills.

Currently, the legal status of these and other CBD products is complicated. Though the U.S. Agriculture Improvement Act of 2018 legalized hemp production on a federal level, state and local regulations vary widely. This means that what’s readily available in Colorado may be unlawful next door in Nebraska.

The U.S. Food and Drug Administration (FDA) also restricts how CBD can be advertised and sold. It’s against the law, for example, and to transport CBD across state lines. It’s also illegal to push a CBD product as a prevention, treatment, or cure for any disease without FDA approval.

That said, the general enforcement of CBD rules may vary based on many factors. The substance remains widely accessible in much of the U.S., especially once online retailers are taken into account. In many states, there are brick-and-mortar stores dedicated entirely to CBD goods.

Does CBD really have health benefits?

People take CBD for a wide variety of physical and mental health issues, often without the recommendation of an HCP. It’s commonly used as an alternative treatment for pain, anxiety, Parkinson’s disease, and a number of other health concerns.

Some research hints that CBD has potential for treating chronic pain, multiple sclerosis symptoms, appetite-related HIV/AIDS symptoms, and the side effects from cancer treatments like nausea and vomiting. It’s also been studied as a therapy for many other health issues, including anxiety, sleep disorders, post-traumatic stress disorder, and inflammation disorders. However, CBD isn’t approved by the FDA to treat any of these conditions.

In addition to promising research, there’s widespread anecdotal support for CBD. No matter the illness, many people report that taking CBD simply helps them feel better. This may be true for some, and it may hint at a possible placebo effect for others—the idea that if people believe something works, it just might help.

Much more CBD research is needed, and there’s currently little concrete scientific proof that it’s an effective therapy for most conditions. The FDA has only approved CBD for the treatment of three rare seizure disorders: Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex.

Companies may illegally try to market CBD specifically as a cure for serious chronic health problems, including illnesses like cancer and Alzheimer’s disease. But patients must understand it will not prevent, treat, or cure these conditions. Companies making these claims may be putting patient lives at risk, because sick people may use CBD instead of seeking proven medical care.

Other possible downsides of CBD

In general, CBD is considered safe to use in the short term for most people, including older adults. There’s little evidence you can abuse or become dependent on it. But there are risks of side effects, including:

• Nausea
• Fatigue
• Irritability
• Low blood pressure
• Sleepiness
• Dry mouth
• Lightheadedness
• Slowed breathing

CBD may also interact negatively with other medications, supplements, and even foods. Fattier meals and snacks can increase its absorption and effects. What’s more, CBD’s effects on certain populations are still being studied, including pregnant people, children, and older adults. The FDA strongly advises those who are pregnant or nursing to avoid CBD.

Due to ongoing research into its effects, many experts have unresolved questions and concerns about the compound, including the following.

Long-term safety

CBD’s effects over time remain unclear. For instance, there are some indications it can lead to liver injury and may affect the male reproductive system in certain people. The ways it could affect children’s brain development is also unclear.

Lack of dosing guidelines

There’s little professional medical guidance regarding how much CBD to take for any given condition and how the amount might vary depending on the form of CBD.

Labeling inaccuracies

Since the FDA doesn’t generally police the purity and safety of CBD products, labels are often inaccurate. There may be unlisted additional ingredients, including THC, or the listed amount of CBD may be incorrect. In fact, a 2024 study published in Frontiers in Pharmacology found that 74 percent of products tested were mislabeled, with the listed amount of CBD off by at least 10 percent.

To combat these issues, some states now require CBD products to include a label that confirms ingredients, a certificate of analysis from a lab outside the company, and a QR code or website directing consumers to this information.

CBD safety recommendations

Despite these risks, many people decide to go ahead with CBD anyway. In these cases, it’s best to exercise caution and take a conservative approach. Start with a low dose, slowly work up to a dose that’s effective, and monitor your progress as you go—ideally with consultation from an HCP.

In other words, if you're taking it for pain, keep a log to record how your pain improves—or doesn’t. If you're using it for sleep, document how many hours you're sleeping. If you're using it for anxiety, keep track of how the intensity of your anxiety changes over time.

To really know what you’re getting, you can also ask manufacturers to provide a third-party evaluation of the content of the product. Reputable companies should have no problem with such a request.

In addition, the FDA recommends keeping CBD products out of the reach of children and pets to prevent accidental ingestion.

Ultimately, CBD requires plenty of additional research to more fully understand its capabilities and drawbacks. For these reasons, it’s always best to speak with an HCP before trying any CBD product. It’s perfectly reasonable to be curious about CBD. Just be sure to educate yourself about the products and have an open dialogue with your HCP.