The Food and Drug Administration (FDA) hasn’t approved any over-the-counter (OTC) or consumer CBD products and has only approved one prescription drug called Epidiolex, which is used to treat seizures associated with certain forms of epilepsy and tuberous sclerosis complex, a rare genetic disease.
In fact, the FDA has issued warning letters to several CBD manufacturers, finding that many products don’t contain the levels of CBD listed on their labels. The letters also addressed companies’ illegal claims that their CBD products can prevent, diagnose, alleviate, treat or cure certain diseases, as well as their marketing of CBD products as dietary supplements.
With those FDA warnings in mind, consumers can take certain steps to ensure they’re using CBD as safely as possible. Most potential CBD benefits are based primarily on anecdotal reports because human clinical data is limited, says Dr. Chen, who stresses the importance of CBD dose.
“Most consumers are taking well under 100 milligrams of CBD a day, and although the effectiveness of CBD in this dose range hasn’t been well studied, CBD appears to be safe at the serving sizes recommended by most consumer product manufacturers,” he says. The risk is low, but possible side effects of CBD at these lower doses may include diarrhea and lethargy, he adds.
“In general, my advice on dosing any product is to find the lowest dose that is effective and doesn’t cause any intolerable side effects,” says Dr. Chen. “Consumers should start at a low dose and gradually increase, paying close attention to possible effectiveness and side effects.”
CBD may also interact with certain drugs, including antidepressants, antipsychotics and opioid medications, potentially causing adverse or side effects.
“Consumers should avoid taking CBD with medications that carry a grapefruit warning, such as certain blood thinners and anti-seizure medications, since CBD and grapefruit interact with similar medications,” says Dr. Chen. “CBD should also be avoided by anyone with liver disease or during pregnancy.”
Consumers can go one step further to investigate individual CBD products by checking the certificate of analysis (COA) for the lot number of that particular CBD product. If the manufacturer offers access to the product’s COA, it may be posted on its website.
The COA lists what’s contained in a CBD product based on an analysis performed by a third-party laboratory. Generally, the COA includes hemp extract concentration, percentage of THC and other cannabinoids, and whether the product contains yeasts, molds, bacteria, pesticides or residual solvents.
Because the FDA has approved only one prescription product containing CBD, most health care providers have minimal formal education on CBD, says Dr. Chen. However, many holistic health practitioners, such as naturopathic doctors, are experienced in CBD and its effects on their clients.
“There are ‘cannabis clinicians’ in states that have legalized cannabis who have undergone additional training and/or have significant experience overseeing cannabis use in their patients, including the use of CBD,” he says. “You can find such clinicians through organizations like the Society of Cannabis Clinicians.”
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