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.
Does CBD Oil Require a Prescription?
When reading about all the health benefits of CBD oil, you may be tempted to try it yourself — which is probably why you’re reading this article.
Many questions can start popping up in your head, such as:
Is CBD legal?
Do you need a prescription for CBD oil?
CBD’s safety profile has been acknowledged by numerous international health agencies, including the World Health Organization (WHO) — according to which CBD oil is “safe and well-tolerated by humans.”
Its legal status depends on the source plant because CBD can be extracted from hemp and marijuana (more on that later).
When it comes to getting a prescription for CBD oil, this may not be necessary — at least not in most cases.
Let’s look at different types of CBD products, their legality, and how to buy them.
Is CBD Oil Actually Legal?
People wonder if they need a prescription for CBD oil because many misconceptions are floating around its legal status.
In essence, CBD oil is legal on a federal level as long as it contains 0.3% of THC or less.
In 2018, the federal government declassified hemp from controlled substances, making a clear distinction from marijuana.
The new law allowed American farmers to grow and sell hemp for commercial use, including paper, clothes, biofuel, construction materials, food, and health supplements such as CBD oil.
Do You Need a Prescription for CBD Oil?
Whether you need a prescription for CBD oil or not depends on its source.
Different Sources of CBD
As mentioned, hemp-derived CBD oils are legal on a federal level, and you can buy them over-the-counter. But, CBD can also be extracted from marijuana, which is where its legal status becomes less obvious.
Marijuana-derived CBD Oil
In contrast to hemp, marijuana-derived CBD oil is legal only in certain states. If your state has a medical marijuana program, your doctor can prescribe it to you. These CBD oils are sold in cannabis dispensaries.
You can buy marijuana-derived CBD oils from adult-use dispensaries without prescription in states with a legal recreational market.
States Where Medical-grade CBD Is Available Only for Prescription
Nearly every state has a medical marijuana program. In these states, you need a prescription for marijuana-derived CBD oil. However, if you want to buy CBD that contains only trace amounts of THC, you can buy it without prescription in many local stores, such as pharmacies, wellness stores, vape shops, and online stores.
States, where medical marijuana is legal but recreational use remains illegal include:
- New Hampshire
- New Mexico
- North Dakota
- Rhode Island
- West Virginia
States That Legalized Marijuana for All Adults
These states have legalized marijuana for recreational use as long as you’re 21 or older and can prove it with a valid ID:
- District of Columbia (D.C.)
- New York
- New Jersey
- North Dakota
In these states, you don’t need a prescription for CBD oil, no matter the source.
What CBD Medications Can Doctors Prescribe On a Federal Level?
Marijuana remains a Schedule I substance on a federal level, meaning that doctors can’t prescribe it as an official treatment.
Because Schedule I substances are thought to have no medicinal properties at all.
Does it stay in stark contrast with the current state of knowledge about marijuana?
Yes. And worse yet, doctors have their hands tied to these backward laws because they can’t prescribe marijuana as the first-choice treatment.
That being said, there is one CBD-based medication that the FDA has approved after passing a series of clinical trials.
The medication is called Epidiolex, and doctors prescribe it to treat drug-resistant forms of childhood-onset epilepsy.
The paradox is that the FDA supports the use of synthetically isolated CBD while refusing to investigate the efficacy of whole-plant extracts, which have been highlighted in preclinical human studies as more effective than products made from single cannabinoids.
For now, the consensus is that hemp-derived products are health supplements.
Do You Need a Prescription for Hemp-Derived CBD Oil?
Health supplements are available over-the-counter, meaning you don’t need a prescription for hemp-derived CBD oil.
However, many mislabeled, sometimes dangerous products are churned out by sketchy companies since the market is unregulated. These products may contain significantly less CBD than advertised or be contaminated with toxic chemicals like pesticides, heavy metals, and residual solvents.
That’s why we always underline the importance of third-party lab testing. Third-party laboratories ensure unbiased results of the product’s chemical analysis, including its potency, cannabinoid profile, and purity.
At Royal CBD, we test all our products at different production stages. As a result, our CBD oils come with batch-specific certificates of analysis that prove their quality and safety.
Where Can You Buy CBD Oil Over the Counter?
The federal legalization of hemp resulted in the birth of a booming industry. Since hemp was declassified, many aspiring entrepreneurs have been entering the market to get their fair share of the cake.
However, making CBD oils requires a lot of skill and knowledge, both from manufacturers and lab workers. It also calls for serious investments in high-tech equipment that is required for extraction.
Everybody wants to capitalize on the booming market, but not everybody has the right assets to make high-quality CBD oil.
The best way to buy high-quality CBD products is to find a trustworthy online retailer. Buying CBD oil online makes it easier to research your potential vendors regarding their hemp source, extraction methods, and third-party testing, so you don’t rely solely on the store owner’s assurance.
CBD Oil for Prescription: Wrapping It Up
Generally speaking, you don’t need a prescription for CBD oil as long as it comes from hemp. Hemp-derived CBD products are legal on a federal level, and the FDA does not regulate them. You can find them over-the-counter, just like any health supplement.
Marijuana-derived CBD, on the other hand, is legal only in certain states. If your state allows the medical use of marijuana, you can buy such CBD oils if your doctor prescribes them. Those living in states where recreational use is legal can buy all types of CBD oil without prescription.
When shopping for CBD products — whether near you or online — make sure to tick off some important points on your quality checklist, including the hemp source, extraction, third-party testing, transparency, and the company’s reputation.
Doing so will help you make a well-informed decision and pick the right type of CBD for your situation.
At Royal CBD, we offer shipping to all 50 states so that you can enjoy premium quality from any place in the US.
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.