CBD oil has emerged as a promising therapy for many chronic conditions such as pain and anxiety. Given the recent legalization of both medical and recreational cannabis across several U.S. states, it’s likely you’ve seen readily available CBD products lining your local shelves.
Despite all the buzz, many people are still wondering what CBD oil is, how it can help, and whether it’s even legal. If you’re interested in CBD oil but aren’t sure where to begin, we’ve created this guide to help answer your questions, and clear up any misconceptions you may have about CBD oil and its uses.
What is CBD oil?
Cannabidiol (CBD) is one of at least 100 cannabinoids found in the resinous flowers of the Cannabis sativa plant, including both hemp and marijuana. Cannabinoids are active chemical compounds that endow the cannabis plant with its remarkable therapeutic profile.
You may be familiar with delta-9-tetrahydrocannabinol (THC), which is the major psychoactive cannabinoid found in Cannabis sativa. It is responsible for the plant’s mind-altering effects and “promiscuous” reputation. CBD, on the other hand, is a non-psychoactive cannabinoid. In other words, CBD doesn’t produce the “high” commonly associated with marijuana. In fact, CBD can lessen the psychological effects of THC.
CBD oil is attracting a great deal of attention from scientists, health professionals and medical marijuana patients due to its vast medical applications. According to the British Journal of Clinical Pharmacology, both preclinical and clinical trials have shown that CBD is an effective analgesic, anti-inflammatory, anti-anxiety, anti-oxidant, anticonvulsant and anti-tumor.
CBD oil is extracted from the resinous flowers of the Cannabis sativa plant, and then mixed with a carrier oil, like coconut or hemp seed oil.
Is CBD Legal?
Yes and no. The legal status of CBD is complicated as it depends on whether the oil is extracted from hemp or marijuana. Both marijuana and hemp are Cannabis Sativa plants, although the distinction between these two classes is critical. Why?
Under the 2018 Farm Bill, the cultivation of hemp for commercial purposes, such as textiles, paper, and skin care products, is legal throughout the United States. However, marijuana remains classified as a Schedule I Drug under the Controlled Substances Act and is, therefore, an illegal narcotic at the federal level.
According to the United States government:
- Hemp refers to Cannabis sativa plants that contain less than 0.3% THC. These plants cannot cause psychoactive effects due to their negligible concentration of THC.
- Marijuana refers to Cannabis sativa plants that have been selectively bred to contain greater than 0.3% THC and therefore have the potential to cause psychoactive effects.
Consequently, CBD oil derived from hemp is legal in all 50 states, whereas CBD derived from marijuana is generally not. If recreational marijuana has been approved in your state, CBD oil derived from marijuana may be legal. However, even if medical marijuana is legal in your state, obtaining CBD oil derived from marijuana is illegal for those who do not hold a current medical marijuana identification card. Therefore, the safest option for many is hemp-derived CBD oil.
How Does CBD Oil Work?
CBD exerts its therapeutic effects through our endocannabinoid system; a neuromodulatory system present in all vertebrates at birth that regulates appetite, inflammation, mood, sleep cycles, immune response, memory and more. It’s comprised of cannabinoid receptors, endocannabinoids (cannabinoids produced by the body), and enzymes responsible for creating and degrading endocannabinoids.
When CBD is absorbed into the bloodstream, it interacts with cannabinoid receptors located throughout the central nervous system and peripheral nervous system. This interaction can stimulate the release of endocannabinoids, which modulate synaptic transmissions and ultimately regulate a range of biological processes to restore “homeostasis” or balance within the body.
Benefits of Taking CBD Oil?
CBD oil may benefit a person’s health in several ways. As mentioned earlier, several preclinical and some clinical studies show that CBD can effectively reduce inflammation, nausea, vomiting, seizures, and anxiety. Many Americans are prescribed pharmaceutical CBD to treat an array of chronic conditions, although CBD oil derived from hemp is an effective option for those who don’t have access to medical marijuana. Some of the most common symptoms people use CBD oil for include:
According to several well-controlled clinical trials, CBD reduces the frequency of seizures and is shown to be a safe, well-tolerated treatment option for children and young adults with epilepsy.  Due to the level of evidence to support its efficacy and safety, the U.S. Food and Drug Administration approved Epidiolex, a purified form of CBD for the treatment of two rare forms of childhood epilepsy in 2018.
Doctors across the United States can now prescribe Epidiolex to children aged two years or older with Lennox-Gastaut syndrome or Dravet syndrome. These two forms of epilepsy are characterized by frequent seizures that are difficult to control and don’t respond to regular anti-seizure medications.
Nausea and Vomiting
After researching the safety and efficacy of cannabis in the prevention of nausea and vomiting, the FDA also approved Marinol and Syndros for patients with cancer and AIDS. These medications contain a synthetic form of THC, which is very effective at reducing nausea and vomiting, while also stimulating appetite.
However, new research now shows that low doses of CBD oil may also help to reduce vomiting and nausea. Scientists believe CBD may indirectly activate 5-HT1A receptors, which are located throughout the central nervous system and known to suppress vomiting. 
Inflammatory and Neuropathic pain
Chronic pain is one of the main reasons people use CBD oil. Although THC is shown to be more effective at reducing nociceptive pain, CBD appears most effective for alleviating neuropathic or inflammatory pain. In other words, CBD helps address the underlying inflammation causing the pain, rather than reducing your perception of pain.
Neuropathic pain arises from damaged or dysfunctional nerves and can be the result of trauma, surgery, chemotherapy or an underlying inflammatory disease, such as diabetes or multiple sclerosis. CBD is believed to alleviate neuropathic pain by indirectly activating 5-HT1A receptors, which play an important role in regulating immune responses and inflammation . These findings are particularly important for cancer patients, for whom neuropathic pain can be so severe that it often prevents them from continuing chemotherapy.
However, according to reviews of the research literature, a combination of CBD and THC appears to be the most effective way to reduce neuropathic pain.  As a result, both the United Kingdom, Canada, and Australia have approved Nabiximols, a nasal spray containing a combination of THC and CBD in a 1:1 ratio for the treatment of multiple sclerosis.
Arthritis is a debilitating condition affecting over 50 million Americans. The two most common types include rheumatoid arthritis (an autoimmune disease) and osteoarthritis (a degenerative condition). Both conditions are characterized by swollen, stiff and painful joints.
As CBD is an anti-inflammatory agent, many people who suffer from arthritis are using the cannabinoid oil to gain relief from their painful symptoms. In 2016, researchers found that topically applied CBD reduced pro-inflammatory markers and pain-related behaviors in mice with arthritis.  Another study in 2017 demonstrated that locally administered CBD reduced pain and prevented the development of nerve damage in arthritic mice. 
Anxiety and Insomnia
CBD is also commonly used to manage symptoms of anxiety, particularly patients who suffer through the misery of insomnia—and with good reason. Clinical trials show that CBD has a calming effect on the central nervous system that can provide relief from various anxiety disorders, including:
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
In a recent study, 72 adults with anxiety and insomnia were given 25-75 mg of CBD per day for one month. Anxiety levels significantly decreased in 79% of patients, while 67% of patients improved their sleeping habits.  In another study, patients with Social Anxiety Disorder were given 60mg of CBD or a placebo before participating in a simulated public speaking test. Pre-treatment with CBD was shown to significantly reduce anxiety-related symptoms, including reduced blood pressure, heart rate, skin flushing, speech discomfort, and cognitive impairment. 
While there’s still a need for more research to determine precisely how CBD reduces anxiety, scientists have confirmed that it blocks the enzyme FAAH. By blocking FAAH, CBD can help increase your levels of anandamide, an endocannabinoid named after the Sanskrit word for bliss, joy or happiness, because it naturally increases our serotonin levels.
How Long Does it Take for CBD to be Effective?
This is a valid question asked by most first time CBD users. Like other supplements and medications, CBD takes some time to see effects. Before CBD’s benefits are felt, it must be absorbed into the bloodstream. Once in the blood, CBD can exert its effects through the endocannabinoid system by interacting with cannabinoid receptors located throughout the brain and body.
The length it takes for CBD to be absorbed and take effect varies according to several different factors, including the administration route, product potency, your body weight, and metabolic rate. However, the administration route is the most significant variable. As a rough guideline:
- Topical CBD in the form of lotions, ointments or patches is absorbed slowly through the skin and takes approximately 25-45 minutes before effects are felt. These are often used to locally treat muscle and joint pain, as well as inflammatory skin conditions.
- Oral CBD in the form of capsules, edibles or drinks must be digested before being absorbed into the bloodstream. As a result, it takes around 30-45 minutes before the effects are felt. These are often used to treat seizures and inflammatory digestive disorders.
- Sublingual CBD involves placing one to two drops of CBD oil from a tincture beneath your tongue where it’s absorbed directly into the veins. It takes effect relatively quickly, within 15-25 minutes.
- Inhaling vaporized CBD, like e-cigs for CBD, produces rapid effects. The compounds are absorbed directly into the bloodstream via the lungs and are typically felt within 10-20 minutes.
It’s important to note that the jury is still out concerning the safety of vaporized CBD, due to the inherent risk of lung damage.
CBD Oil Side Effects?
Unlike smoking marijuana, CBD oil won’t leave you in a fit of giggles, with the munchies, or even with those tell-tale bloodshot eyes. It can, however, make you feel very sleepy.
The most common side effects are:
- Decreased appetite
- Mild allergic reactions, such as hives. However, allergic reactions are commonly due to the carrier oil, not CBD.
Overall, CBD oil has very few adverse side effects, which are considered mild compared to other treatments used for conditions like anxiety or epilepsy. CBD also poses no potential for addiction and is non-toxic, meaning you cannot overdose on CBD oil. However, we don’t recommend taking CBD for the first time and then operating a vehicle. It’s not illegal to drive with CBD in your system, although there is a risk that you might feel drowsy.
Can CBD Oil Interact with Other Medications?
CBD is generally considered very safe, although, like all supplements and medications, it has the potential to interact with conventional pharmaceuticals. At high doses, CBD can inhibit cytochrome P450 enzymes, thereby reducing your body’s ability to metabolize certain medications. Interestingly, many other common foods can affect drug metabolism this way, including grapefruit and watercress.
By blocking P450 enzymes, CBD can increase the concentration of other medications in your system. This can not only reduce the effectiveness of your medications but also lead to unpleasant side effects.
Although not an exhaustive list, the following medications may cause interactions when taken with CBD oil:
- Blood pressure medications (like warfarin)
- Tricyclic antidepressants (like Amitriptyline, Doxepin, and Desipramine)
- Antipsychotics (like Haldol)
- Allergy medications (like antihistamines)
- Sleeping pills (like Benzodiazepines)
- Immunosuppressants (like cyclosporine)
- Macrolide antibiotics (like erythromycin, roxithromycin, azithromycin, and clarithromycin)
- Antiarrhythmics or Beta Blockers
- Opioid pain medications (like oxycodone and codeine)
- Calcium channel blocks
- HIV antivirals
If you’re taking a medication that may interact, we recommend speaking with your doctor to make sure it’s safe for you to supplement with CBD oil and determine a safe dosage regime.
CBD Oil Dosage
Due to legal issues surrounding cannabis, the FDA has not issued a recommended daily dosage for CBD. It’s also difficult to determine a universal dosage as there are countless variables to take into consideration, including an individual’s weight, metabolism, and genetics.
However, the FDA has provided dosage advice for Epidiolex, a synthetic form of CBD. It recommends starting with 2.5 mg/kg taken twice daily (e.g. 5 mg/kg/day). After one week, you can increase your dosage to 10 mg/kg/day. Further increases can be made in weekly increments as tolerated. However, a daily dose should not exceed 20 mg/kg/day.
While there are no official guidelines for CBD oil, we recommend starting with a low dosage and paying close attention to the product’s CBD content, as the percentage of CBD varies significantly from one oil to the next.