CBD & Hemp Extract Supplements, Lotions, and Balms Review

Find the Best CBD at the Lowest Price! Learn How Much CBD (and THC) Is Really in Products and Which Are Our Top Picks.

Medically reviewed and edited by Tod Cooperman, M.D.

Last Updated: 09/17/2021 | Initially Posted: 09/05/2020Latest Update: Help for Arthritic Hands?

Table of Contents

Summary

· What is CBD? CBD (cannabidiol) is a compound derived from hemp and marketed as a supplement despite the U.S. FDA's position that CBD is not a dietary supplement.

· Does CBD work? CBD taken orally has been shown to reduce the frequency of certain types of seizures, and preliminary evidence suggests it may also help with anxiety, schizophrenia, and other conditions. However, most of these effects have involved large doses of CBD — hundreds of milligrams per day, which is more than in many marketed CBD supplements and products. CBD applied to the skin (such as CBD creams, gels, and lotions) may modestly reduce some forms of pain (See What It Is and What It Does).

· What did CL's tests of CBD products find? ConsumerLab found significant amounts of CBD in all of the products (ranging from 2.5 mg to 51.3 mg per serving) but the cost to obtain an equal amount of CBD from each product ranged more than 10-fold, from just 24 cents to $2.67 per 10 mg. Interestingly, there were many good, lower cost products available on the market than ConsumerLab found in its last Review in 2018. Levels of THC (tetrahydrocannabinol, a psychoactive compound) also tended to be much lower, with THC not detectable in most products. (See What CL Found and use the Results table to compare the amounts of CBD, THC, and other cannabinoids in products).

· Best CBD Oil? Based on quality and value, ConsumerLab selected several Top Picks including an overall Top Pick as well as high, medium, and low-dose picks for oral use, a Top Pick among topical lotions and balms, and a Top Pick for Pets based on top quality and value.

· How to choose a CBD product? If you seek CBD, look for products that list the amount of CBD or cannabidiol per serving (and don't confuse that with the amount per entire bottle). If a product lists only "cannabinoids" it may contain some CBD but you won't know how much. Products may still have significant amounts of CBD if they list "hemp extract" as an ingredient, but don't expect much CBD if "hemp oil" is the only ingredient. Hemp extracts are more likely to contain a range of cannabinoids in addition to CBD (although it's not clear if this provides added benefit) and this is what is meant by the term "full-spectrum" on labels — but full-spectrum products may or may not contain THC. If you want to avoid THC, look for products that claim to be "THC-free." (See ConsumerTips™)

· How much CBD should I take and when? Most of the research with CBD has involved high doses (several hundred milligrams daily). However, many CBD products on the market are lower dose and it is not clear if this dosing is effective. Nevertheless, to greatly increase CBD absorption, take it with or shortly after a fatty meal. (See ConsumerTips™: Dosage)

· CBD safety, side effects and drug interactions: High-dose CBD can cause a range of side effects (particularly gastrointestinal) and affect certain medications. For details, see Concerns and Cautions.

What It Is:

Cannabidiol (CBD) and its precursor compound CBDa are dominant "cannabinoid" compounds found in hemp and cannabis (a hemp plant also known as marijuana). When CBDa gets converted to CBD, most of it becomes CBD; consequently, 87.7% CBDa in a product can be "counted" as CBD. Unlike tetrahydrocannabinol (THC), which is another cannabinoid compound, CBD is not believed to be a psychoactive compound affecting perception and behavior.

What It Does:

NOTE: The effects described below are primarily based on daily doses of hundreds of milligrams of CBD. Many CBD products on the market contain much lower amounts (providing tens of milligrams or less per day), and it is not known if these low doses are as effective as higher doses.

Epilepsy and seizure disorders
Much of the research with CBD has focused on the reduction of certain types of seizures. A placebo-controlled clinical trial found a high daily dose of CBD (20 mg per kg of body weight, i.e., hundreds of milligrams) to reduce the frequency of convulsions in a rare form of epilepsy known as Dravet syndrome in children and young adults, although it was also associated with a higher rate of adverse effects including diarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liver-function tests (Devinsky, New Eng J Med 2017). Similarly, the same high daily dose reduced the number of drop seizures among people with treatment-resistant Lennox-Gastaut syndrome in a 3-month study. Seizures per month decreased 44% with CBD compared to 22% with placebo; however, again, those taking CBD also had a higher rate of adverse effects including diarrhea, somnolence, fever, decreased appetite, and vomiting (Thiele, Lancet 2018).

Both studies noted above were funded by GW Pharmaceuticals, the maker of the prescription oral solution of cannabidiol Epidiolex. It should be noted that after reviewing these studies, the United Kingdom's National Institute for Health and Care Excellence rejected Epidiolex as a drug for treating these seizures in its draft guidance. The agency raised concerns about the trials, particularly their short duration, because other antileptic drugs are known to lose their effectiveness over time (Dijk, BMJ 2019).

A study in Nashville among 108 children with refractory epilepsy who had been treated with commercially marketed CBD preparations found that CBD could be as effective as the anticonvulsant drug clobazam when used as add-on therapy. A reduction in seizure activity of at least 50% occurred in 33%, 38%, and 44% of those who received, respectively, CBD, clobazam, and CBD+clobazam. Relative to clobazam, CBD seemed to increase alertness and increase verbal interactions. Sedation, which was common among those taking clobazam, did not occur among those taking only CBD. The average daily dose was about 3 mg of CBD per kilogram of body weight: e.g., 100 mg per day for a 73 lb child. (Porcari, Epilepsy & Behav 2018).

Parkinson's disease and movement disorders
CBD does not appear to improve motor symptoms of Parkinson's disease, such as tremor and difficulty initiating movement, or involuntary movements (dyskinesia) associated with the use of the anti-Parkinson's drug levodopa. However, CBD may be helpful for non-motor symptoms of Parkinson's disease, such as psychosis, mood and sleep disturbances — although more research is needed (Crippa, Eur Arch Psychiatry Clin Neurosci 2019).

For example, there have been some preliminary reports of CBD oil (150 mg to 400 mg) improving symptoms of psychosis, with no worsening of motor function, in individuals with Parkinson's disease and psychosis who were taking levodopa (Zuardi, J Psychopharmacol 2009). In three older men with Parkinson's disease and REM sleep behavior disorder (RBD) (characterized by intense dreams and behavior such as laughing, yelling, kicking and punching during sleep) who experienced disruptive sleep episodes between two and seven times per week, none experienced these symptoms during a six-week period of daily dosing with 75 mg of CBD. A fourth man, who took 300 mg of CBD daily for the same time period had a reduction in episodes from two to four times per week to once per week (Chagas, J Clin Pharm Ther 2014). A small, double-blind, placebo-controlled study in Brazil found no improvement in motor function in men and women with mild to moderate Parkinson's disease without other psychiatric conditions (average duration of disease 8 years) who took CBD oil (75 mg or 300 mg) daily in addition to their regularly prescribed anti-Parkinson medication for six weeks -- but those who took the 300 mg dose had significant improvements in Parkinson's Disease Questionnaire-39 total scores, and measures of quality of life such as activities of daily living, "stigma" and emotional well-being. No adverse effects were associated with the use of the CBD oil (Chagas, J Psychopharmacol 2014).

A preliminary trial found modest, dose-related improvements in symptoms of dystonia (involuntary muscle contractions) in five individuals taking between 100 mg and 500 mg per day of cannabidiol; however, at the highest dosages (300 mg to 500 mg) there was a worsening of tremor and the ability to initiate movement in two of the individuals who also had Parkinson's disease (Consroe, Int J Neurosci 1986).

Although the cause of essential tremor (ET) is still unknown, laboratory research has shown that cannabinoid receptor type 1 (CB1) antagonists can reduce tremors in animal models of ET (Abbassian, Br J Pharmacol 2016). Because cannabidiol acts as a CB1 antagonist and has shown some, although mixed, evidence of benefit for other types of tremors, there has been interest in using it to reduce symptoms of ET. However, a small study that included 19 people with ET, all of whom were undergoing drug treatment, found that a single dose of 300 mg of cannabidiol did not reduce the severity of upper limb tremors compared to placebo (Santos de Alencar, Parkinsonism Relat Disord 2021). It is unclear if long-term treatment with cannabidiol would be beneficial.

Schizophrenia and psychosis
Results in people with schizophrenia have been mixed. A study of high-dose CBD (500 mg taken morning and evening) among adults with schizophrenia found that adding CBD rather than placebo to existing treatments for six weeks reduced psychotic symptoms and caused a trend, although not statistically significant, toward improved performance on cognitive tasks. In this study, CBD was well tolerated with no increase in adverse effects (McGuire, Am J Psy 2017). Another 6-week study, however, found that 300 mg of CBD taken twice daily did not improve cognitive or psychotic symptoms in adults with schizophrenia on stable doses of medication; in fact, only those taking a placebo experienced a (modest) improvement in symptoms. Twenty percent of CBD-treated patients experienced sedation (mostly mild) compared to 5% of those on placebo (Boggs, Psychopharm 2018).

CBD seems to "partially normalize alterations" in areas of the brain that are implicated in psychosis (i.e., severely impaired thoughts and/or emotions). This was shown in a small, placebo-controlled study that measured activation of areas of the brain (based on blood flow measured with MRI imaging) during a verbal learning task. Brain activity in people at high risk of psychosis given a single dose of 600 mg of CBD more closely resembled that of people not at risk of psychosis than of people at risk of psychosis who were given a placebo. Interestingly, THC in marijuana can have the opposite effect and has been associated with the development and relapse of psychosis (Bhattacharyya, JAMA Psych 2018). A possible mechanism for an antipsychotic effect of CBD is that, at a dose of 600-800 mg per day, it seems to elevate natural levels of the endocannabinoid anandamide by moderately inhibiting its degradation (Rohleder, Front Pharmacol 2016).

Anxiety, PTSD, and sleep
CBD may reduce anxiety and symptoms of PTSD (post-traumatic stress syndrome). It may also improve sleep in people with such disorders and those with insomnia, but does not appear to be helpful as a sleep aid in healthy individuals.

Studies in animals as well as several small studies in people suggest CBD may help reduce anxiety. For example, a small placebo-controlled study in young healthy men found that a single 400 mg dose of CBD taken as a capsule reduced self-reported anxiety (but also increased feelings of mental sedation) one hour after ingestion (Crippa, Neuropsychopharmacology 2004). Studies have also found CBD to reduce anxiety with social speaking when given 90 minutes before speaking at a dose of 300 mg, while a lower dose (150 mg) was not effective and there were mixed results with a higher dose (600 mg) (Bergamaschi, Neuropsychopharm 2011), Zuardi, J Psychopharmacol 1993, Linares, Braz J Psychiatr 2018). A study among Japanese teenagers with social anxiety found that 300 mg of CBD (which contained no THC and was in a base of MCT oil) daily for four weeks led to a modest decrease in symptoms while there was no significant change in symptoms among those given placebo (olive oil) (Masataka, Front Psychol 2019).

Case reports from an outpatient mental health clinic in Colorado suggested that even lower doses of CBD might be helpful with anxiety and related sleep disorders. (Bear in mind that case reports are not controlled studies, so these benefits remain to be proven.) In a group of 72 men and women treated with CBD daily for two months, anxiety scores decreased within the first month in 79.2% of patients and remained decreased during the study duration. Sleep scores improved within the first month in 66.7% but fluctuated over time. It's important to note that 15.3% reported a worsening of anxiety and 25% reported a worsening of sleep, and similar percentages were reported in the second month of supplementation. Most of the participants took one capsule daily containing 25 mg of CBD oil (provided by CV Sciences Inc., makers of PlusCBD Oil, although it was not a sponsor of the study), and continued taking their regularly prescribed medications. For anxiety, CBD was taken after breakfast, while, for sleep, it was taken after dinner. CBD was generally well-tolerated, although two patients discontinued treatment within the first week because of fatigue and three noted mild sedation that appeared to abate after a few weeks of treatment. CBD was discontinued for one patient with a developmental disorder in whom treatment appeared to cause disinhibition in the form of inappropriate sexual behavior (Shannon, Perm J 2019).

Another series of case reports from the clinic in Colorado suggested that CBD may help relieve symptoms of post-traumatic stress disorder (PTSD). In a group of 11 adults with diagnosed PTSD, overall symptoms decreased by an average of 28% over a 2-month period of CBD supplementation. The average daily CBD dose was 33.4 mg at the start, increasing to 44.6 mg by the end of the study. The participants took CBD as 25 mg capsules and/or an oral spray (1.5 mg of CBD per spray) (Elms, J Altern Complement Med 2019). Separately, the same clinic reported that CBD appeared to be helpful to a 10-year old girl with anxiety and sleep disorder due to PTSD caused by sexual abuse. She took 25 mg of CBD at bedtime and 6 mg to 12 mg of CBD from a sublingual spray as needed throughout the day for 5 months. Her anxiety and sleep improved to the extent that they were no longer classified as disorders (Shannon, Perm J 2016). Although no side effects were observed, it is important to note that there is concern that cannabinoids may affect brain development in children (see Concerns and Cautions).

Preliminary research suggested that CBD may affect the sleep-wake cycle, although this may depend on the dose and the condition for which it is taken. Low-dose CBD (15 mg) may have a stimulating effect, while moderate and higher doses can be sedating and may improve sleep in people with anxiety (as in the case report above) and in those with certain sleep disorders (Babson, Curr Psychiatry Rep 2017). For example, a small study among 15 men and women with a history of insomnia found that 160 mg of CBD taken as a capsule 30 minutes before bedtime for one week significantly increased self-reported duration of sleep compared to placebo. Ten participants reported sleeping more than 7 hours after taking this dose of CBD, but when the same participants took a placebo, only six reported getting more than 7 hours of sleep. However, there was no decrease in the amount of time it took to fall asleep. Lower doses of CBD (40 mg and 80 mg) did not increase sleep time or reduce the amount of time it took to fall asleep (Carlini, J Clin Pharmacol 1981). None of the participants reported increased difficulty in waking or feeling sleepy upon awakening, compared to placebo.

On the other hand, an even greater dose of CBD -- 300 mg taken 30 minutes before bedtime, had no effect on the time it took healthy men to fall asleep. It also had no effect on the amount of time spent in each stage of sleep (such as REM sleep) or the amount of time participants stayed asleep (as measured by polysomnography), and it did not affect self-reported sleep quality, compared to placebo. CBD was not found to impair cognitive function when evaluated the following morning (Linares, Front Pharmacol 2018).

A study among 65 healthy, overweight men and women in the U.S. found that 15 mg of CBD from 60 mg of hemp oil extract (PlusCBD Extra Strength Hemp Extract, CV Sciences) taken as a softgel once daily with breakfast for six weeks did not improve sleep quality, mood, or ability to cope with stress compared to placebo. CBD supplementation modestly increased blood levels of "good" HDL cholesterol, but there were no changes in total or "bad" LDL cholesterol, body weight, blood pressure, or bodyweight compared to placebo. No increases in liver enzymes or serious adverse events were reported (Lopez, J Diet Suppl 2020). The hemp extract used in the study closely resembles that in Plus CBD Oil Hemp Softgels (60 mg hemp oil) tested and approved in this review.

A study in Brazil gave 118 physicians, nurses and physical therapists caring for patients hospitalized with COVID-19 high-dose oral CBD drops (150 mg taken twice daily) for 28 days in addition to standard care (motivational and instructional videos on physical exercise and weekly consultations with psychiatrists) or standard care alone. Compared to those given only standard care, the CBD group had a slightly greater reduction in symptoms of emotional exhaustion (by 4.14 points on a 54 point scale) and anxiety (a 30% decrease in symptoms vs only 2%). Although symptoms of burnout decreased among those who took CBD compared to baseline, the change was not statistically significant. Those who took CBD were more likely to report increases appetite (23,7% vs 8.5%). Four participants who took CBD experienced an increase in liver enzymes (including one severe case) and one experienced a severe adverse skin reaction, while there were no adverse reactions in the control group. The extract used in the study was 99.6% CBD, dissolved in medium-chain triglyceride oil (by PurMed Global, which funded the study. Unfortunately, a placebo was not given to the control group, which would have made the results more meaningful.) (Crippa, JAMA Netw Open 2021).

Substance use disorder
High-dose CBD (400 mg or 800 mg of the prescription CBD oral solution Epidiolex) was shown to reduce drug cravings in a placebo-controlled study among 42 men and women with heroin use disorder, most of whom had been abstinent from heroin for less than one month. CBD was taken once daily for three days. CBD reduced cue-induced drug craving and anxiety and also reduced physiological measures of cue-induced craving such as increased heart rate compared to placebo one to two hours after the first dose of CBD as well as on the seventh day. Both doses of CBD equally reduced craving. There were no significant effects on cognition and no serious adverse events; mild side effects such as diarrhea, headache and fatigue were reported in both those taking CBD and placebo (Hurd, Am J Psychiatry 2019).

CBD may have helped a 17-year old male in Vienna, Austria with multiple substance use disorder (cannabis, MDMA, cocaine, ecstasy), severe depression, social phobia and narcissistic personality disorder. After unsuccessful treatment with the antidepressant sertraline for 6 months, he was started on a dose of 100 mg CBD (50 mg in the morning and evening), which, after 3 weeks, was gradually increased to 600 mg (300 mg twice daily), for a total treatment period of 8 weeks during which he also received, in a day clinic setting, group and individual psychotherapy, social cognition training, occupational therapy and physiotherapy, and his parents had weekly meetings with the treating psychiatrist. He reported no side effects from the CBD. He improved regarding depressive as well as anxiety symptoms and quit abusing illegal drugs without showing withdrawal symptoms (Laczkovics, Neuropsychiatr 2020).

The use of CBD to treat cannabis use disorder appears to require a fairly high dose. A 4-week placebo-controlled clinical trial that included 82 people (average age 26) with cannabis use disorder showed that taking 100 mg of CBD twice daily was not effective, but 200 mg twice daily provided a modest benefit, which was marginally better than a higher dose of 400 mg twice daily. At 200 mg twice daily, cannabis users abstained from use about half a day more per week than those given a placebo. The reduction in cannabis use was confirmed by a decrease in urinary excretion of a THC metabolite (Freeman, Lancet Psychiatry 2020).

Glaucoma
Although there is some preliminary evidence that THC and, possibly other cannabinoids could potentially help to reduce interocular (eye) pressure in people with glaucoma, one study found that, four hours after ingestion, a single, sublingual dose of CBD (which also contained about 1 mg of THC) had no effect on interocular pressure, while a 40 mg dose of CBD (containing about 2 mg of THC) temporarily increased interocular pressure (Tomida, J Glaucoma 2006; Health Canada 2013). There do not appear to be longer-term studies, or studies investigating the effects of cannabidiol alone for glaucoma.

Pain
Preliminary research suggested a role for CBD in pain management but, in most cases, studies used combinations of THC with CBD rather than CBD alone or with minimal CBD. When given without THC, there is currently no evidence that CBD reduces low back pain, arthritic pain, or other pain conditions.

A study in Australia among 100 men and women (median age 47) treated in a hospital emergency room for acute low back pain (not due to trauma) found that taking a single, high dose of CBD (400 mg in MCT oil) in addition to standard treatment (1,000 mg paracetamol (Tylenol) + 400 mg ibuprofen) did not reduce pain any better than giving a placebo (MCT oil alone) with the same standard treatment. In addition, the CBD did not reduce the need for rescue medication (oxycodone) or shorten the length of hospital stay compared to placebo. The occurrence of side effects such as sedation, light headedness, diarrhea and nausea were similar in both groups (Bebee, Med J Aust 2021).

A study showed promise with CBD for people (ages 39 - 70) with chronic pain who had been on opioids for at least one year; however, the study lacked a placebo control, so it is not possible to know if the effects were due to CBD. Study participants were given softgels of hemp extract (15.7 mg CBD and 0.5 mg THC per softgel, from Ananda Professional, which funded the study. For eight weeks, most participants added two of the CBD softgels (a total of 31.4 mg of CBD) to their daily medication regimens. Among 94 patients who completed the study, 94% reported quality of life improvements and 53% reduced their use of opioids (three of whom completely eliminated opioids). CBD appeared to modestly reduce pain intensity and improve sleep quality. Although there were trends toward improvements in pain-related disability and overall health, these were not statistically significant. No significant adverse events were reported, but a small number of participants experienced nausea, heart burn, dry mouth, and/or nighttime anxiety, and two people did not complete the study due to drowsiness (Capano, Postgrad Med 2019).

One study found that an oral spray containing THC and CBD reduced pain in people with rheumatoid arthritis (Blake, Rheumatology (Oxford) 2006); however, a review of four short term clinical studies (including this one) investigating the effects of cannabinoids for the treatment of rheumatic diseases, including fibromyalgia syndrome, back pain, osteoarthritis and rheumatoid arthritis, concluded that there is "currently insufficient evidence to recommend cannabinoid treatments for management of rheumatic diseases pending further study." (Fitzcharles, Schmerz 2016). Furthermore, a three-month study in Denmark among 129 men and women with moderate chronic pain due to hand osteoarthritis or psoriatic arthritis found that a daily dose of CBD that started at 10 mg for two weeks and then increased to 20 or, eventually, 30 mg (taken as a 10 mg tablet with meals, up to three times daily), did not decrease pain or improve self-reported sleep quality, depression or anxiety compared to placebo (Vela, Pain 2021).

A review of several experimental pain studies (using heat or pressure) on healthy people found that cannabis (marijuana) and cannabinoids may not reduce the intensity of pain, but may make pain feel less unpleasant and more tolerable. Although none of the studies tested CBD exclusively, the products containing CBD (in addition to THC), such as cannabis extracts, were shown to be more effective than those containing exclusively THC or THC analogues (De Vita, JAMA Psych 2018). However, a subsequent experimental pain study found that CBD alone did not reduce pain threshold, tolerance or severity compared to placebo, and suggested that a reduction in pain "unpleasantness" may largely be due to the placebo effect — the expectation that CBD will reduce pain. In the study, participants who were given 50 mg of CBD orally as a liquid (99.46% CBD in coconut oil with no detectable THC) but were told they were taking a placebo, 30 minutes before a pain-inducing heating element was applied to the forearm, reported a similar reduction in "unpleasantness" as those who were given a placebo (coconut oil) but told they were given CBD (De Vita, Exp Clin Psychopharmacol 2021).

A few studies suggest that a combination of THC and CBD may be helpful for cancer-related pain; however, there do not appear to be studies on the effects of CBD alone for cancer-related pain (Blake, Ann Palliat Med 2017).

Cancer
Preliminary evidence suggests that CBD may have anti-cancer properties and enhance the immune response to cancer. Although clinical studies have not been conducted, a case was reported in the UK of a man in his early 80s with lung cancer (biopsied as adenocarcinoma) who, after declining traditional therapies, had a dramatic reduction in tumor size after self-administering low-dose CBD twice daily (starting at just 1.32 mg of CBD twice daily for one week, and then 6 mg of CBD twice daily for another three weeks — each dose consisted of 9 drops (0.3 mL) of "MyCBD" oil labeled as 2% CBD. He took this daily dose again for a week after learning of the tumor reduction but stopped as he did not like the taste and it caused him slight nausea. A scan two months later showed the tumor remained stable in size. Further research is needed on CBD's effect on cancers (Sule-Suso, Sage Open Medical Case Reports, 2019). (For more information about cannabinoids and cancer treatment, see the National Cancer Institute's webpage about this topic.)

Colds, flu, viral infections
CBD has been promoted to fight colds, the flu, and even viral infection with SARS-CoV-2 (which causes COVID-19), but there is currently no direct clinical evidence to support these uses. In fact, when high doses of CBD (hundreds of milligrams per day) were given to children and young adults to determine CBD's anti-seizure effects (see Devinsky study, above), the number of upper respiratory infections reported was slightly higher among those who took CBD compared to placebo (11% vs. 8%, respectively).

On the other hand, laboratory research has found that CBD inhibits the replication of SARS-CoV-2 in animal cells and human lung cells, and interestingly, THC and other cannabinoids diminished CBD's antiviral effects. The same researchers who conducted these laboratory studies looked at COVID infection rates in people taking high-dose CBD. Their analysis of 85 patients tested for SARS-CoV-2 at the University of Chicago Medical Center who were also taking high-dose, prescription CBD (Epidiolex) before getting tested (at any point or up to 2 years before COVID testing) found that only 1.2% tested positive for COVID-19, compared to 12.2% who tested positive among a matched control group who were not taking CBD (Nguyen, bioRxiv 2021 -- preprint). However, only randomized, placebo clinical trials can determine if CBD reduces the risk of infection.

At the same time, animal experiments suggest CBD may to dampen immune system response to infection, by decreasing inflammatory cytokines and the production of immune system cells (Nichols, Cannabis Cannabinoid Res 2020). For example, CBD has been shown to decrease the inflammatory response to infections such as pneumococcal meningitis (Barichello, Eur J Pharmacol 2012).

This dampening of the immune response could potentially have benefit in treating autoimmune diseases, as demonstrated in an experimental model of multiple sclerosis in mice (Kozela, Br J Pharmacol 2011). It could be hypothesized that this could also dampen the devastating "cytokine storm" that occurs in severe cases of COVID-19, but it far too early to know if this would be the case or whether it might make the infection worse.

Topical CBD
Creams, gels and lotions containing CBD are often promoted to treat pain, such as muscle or joint pain. CBD appears to be better absorbed through the skin than THC (Huestis, Chem Biodivers 2007) and there is some evidence that, in animals, creams and gels containing CBD may help reduce inflammation in conditions such as arthritis and multiple sclerosis (Hammell, Eur J Pain 2016; Giacoppo, Daru 2015). However, to date, clinical studies have not provided convincing evidence of a benefit with topical CBD. At best, topical CBD may provide a modest benefit to people suffering from intense forms of pain, with little demonstrated benefit in cases of less intense pain.

In a study of 13 young adults, CBD cream applied to the front thigh area after leg exercises (a series of squats) did not decrease delayed onset muscle soreness (DOMS) in the 48 hours following exercise compared to placebo (petroleum jelly). The cream contained 200 mg of CBD in each 1-oz. container (6.7 mg CBD/mL), which was shared among all of the participants, although the specific amount of cream or CBD was not specified (Garcia, Int J Exc Sci 2019 - Abstract plus correspondence with ConsumerLab). In the other study, a gel containing 10.5 mg or 21 mg of synthetic CBD was applied daily to the knees of people with knee osteoarthritis. Although both groups experienced reductions in "worst knee pain" scores, these reductions were not statistically significant compared to the reduction in pain scores for placebo group that used gel without CBD. Dryness at the site of application and headache were more frequent among those who used the CBD. The study was conducted by a company (Zynerba) seeking to develop the synthetic CBD (ZYN002) as a drug (Hunter, Osteoarthritis Cartilage 2018).

A preliminary study suggests that CBD cream may reduce certain symptoms of peripheral neuropathy, a condition characterized by nerve pain, burning, "pins and needles" sensations and weakness, typically in the hands and feet. In the study, 29 men and women (average age 68) with peripheral neuropathy of the lower extremities (feet and lower legs) due to type II diabetes, chemotherapy treatment, or other causes received one 3 fl. oz container of CBD cream blended with emu oil to enhance absorption (Theramu Relieve CBD compound cream -- 250 mg of CBD per container, 2.8 mg CBD/mL) or placebo cream (similar cream with emu oil but no CBD) and applied the cream to symptomatic areas up to four times daily for one month. Participants who used the CBD cream had modest, but statistically significant reductions in self-reported intense pain, sharp pain, cold and itchy sensations, but no reduction in hot, dull, sensitive, unpleasant, deep and surface pain, compared to placebo. No adverse events were reported. Theramu supplied the cream but did not fund the study (Xu, Curr Pharm Biotechnol 2019).

A clinical trial that suggested some benefit with topical CBD studied 60 young adults with temporomandibular disorder (jaw muscle pain from teeth grinding) in Poland. Participants rubbed a "pea-size" amount of ointment over their jaw muscles twice a day. For half the group, CBD Oil (Charlotte's Web Hemp Extract Oil in Olive Oil -- 67 mg CBD/mL) was added to the ointment (comprising 20% of the total ointment, making it 1.46% CBD, or about 7 mg of CBD per 0.5 gram application). After 14 days, jaw muscle activity at rest had decreased by about 12% in the CBD group versus only about 2% in control group, although this was not a statistically significant difference. Perhaps more importantly, the CBD group reported a 70% reduction in pain intensity versus only a 10% reduction for the control group, although the statistical significance of this difference was not determined (Nitecka-Buchta, J Clin Med 2019).

CBD for Pets:
Preliminary evidence suggests that short-term CBD supplementation may be of modest benefit to dogs with osteoarthritis. There is some concern, however, with the effects of CBD on liver enzymes in dogs and cats, as discussed below.

A study at Cornell University found that giving older dogs with osteoarthritis CBD, compared to placebo, for one month modestly reduced pain and increased activity levels (rising to standing, walking, running, and climbing) as reported by the dogs' owners, and reduced joint pain upon touch when examined by a veterinarian. However, there were no improvements in lameness or weight-bearing (i.e. reluctance to rise, favoring the affected leg when walking, or limping) as assessed by a veterinarian. The dose was 2 mg of an equal mix of CBD and CBDa per kg of bodyweight given twice daily (e.g., for a 20 lb dog: 18 mg of CBD/CBDa in the morning and again at night), and use of other regular supplements (e.g., glucosamine, fish oil, etc.) and NSAIDS was allowed. No side effects were reported with CBD but there was an increase in levels of the liver enzyme alkaline phosphatase, and the researchers recommended monitoring liver enzymes in dogs receiving CBD until long-term safety studies are conducted. The CBD (a hemp extract in olive oil) was provided by ElleVet Sciences, which funded the study (Gamble, Front Vet Sci 2018).

The same ingredient used in the above study was the subject of preliminary, 12-week, safety studies in young, healthy dogs and cats sponsored by the manufacturer. The dogs were given CBD as a softchew (ElleVet Mobility Chews by ElleVet Sciences) at a dose of 2 mg of CBD/CBDa per kg of bodyweight twice daily (e.g., 18 mg of CBD/CBDa in the morning and again at night for a 9 kg, or 20 lb, dog) and this did not significantly increase liver enzymes or cause adverse effects other than a low incidence of loose stool (3.3% of the time) and vomiting (<1% of the time). Food consumption and bodyweight remained consistent, and there were no abnormalities or changes in behavior noted. The cats were given the same ingredient as CBD-infused fish oil in capsules also at 2 mg CBD/CBDa per kg of bodyweight (e.g., for a 4 kg (9 lb) cat, 8 mg CBD/CBDa in the morning and again at night). One of the eight cats studied had a significant increase in a liver enzyme (alanine amino transferase, or ALT). The most common adverse effects were likely due to the capsules (some of which broke when being given to the cats) and included heavy salvation/drooling, excessive licking, gagging, and head shaking. There were no changes in food consumption, bodyweight or behavior. Interestingly, in cats, the bioavailability of CBD/CBDa was only about one-fifth of that in dogs, which would suggest either much lower absorption or faster elimination. The researchers concluded that "...CBD-rich hemp nutraceuticals appear to be safe in healthy adult dogs, while more work in cats is needed to fully understand utility and absorption." (Deabold, Animals (Basel) 2019).

A placebo-controlled study in large dogs with osteoarthritis found that 20 mg of CBD in a liposomal formulation or 50 mg of CBD alone taken daily for 4 weeks significantly decreased pain and increased mobility with no adverse effects on metabolism, hematocrit or other blood chemistry. The beneficial effect remained for at least 15 days after cessation of therapy. A 20-mg dose of CBD not in liposomal form was not effective. Additional laboratory research by the investigators indicated that CBD exhibited anti-inflammatory effects, reducing the production of tumor necrosis factor-alpha (TNF-a) and increasing the production of anti-inflammatory interleukin-10 (IL-10) (Verrico, Pain 2020).

Legality, Quality Concerns, and Tests Performed:

Legality
Although CBD is not psychoactive, it is not permitted to be sold as an ingredient in dietary supplements in the U.S. as it is a FDA-approved drug and, prior to that approval, the FDA considered CBD an investigational new drug. (Note: If an ingredient is marketed as a supplement prior to the FDA authorizing its investigation as a drug, it may continue to be marketed as a supplement, but this was not the case with CBD, according to the FDA).

The FDA reiterated its position in November 2019 that CBD is not a dietary supplement and cannot be added to a food, adding that it " ...has seen only limited data about CBD safety and these data point to real risks" and that "Some CBD products are being marketed with unproven medical claims and are of unknown quality." CBD products are not permitted on flights unless they contain no more than 0.3 percent THC on a dry weight basis or have been approved as drugs by the FDA (e.g., Epidiolex), according to the Transportation Security Administration (TSA). TSA security officers do not search for CBD or marijuana, but, if any illegal drugs is observed during security screening, TSA will refer the matter to a law enforcement officer.

On December 12, 2018, the U.S. Farm Bill passed, permitting farmers to legally grow hemp like any other crop (although this does not extend to marijuana - the strain of hemp higher in THC). While this will probably not change the FDA's stance that CBD is not a legal supplement, and it's not yet clear if the DEA will change its current stance the legality of CBD, with it being easier for farmers to grow, the supply of CBD may increase, hopefully bringing down the high cost of CBD. It may also facilitate research with CBD.

A prescription oral solution of cannabidiol (Epidiolex) was approved by the FDA in June 2018 for the treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. It is the first FDA-approved drug that contains a purified drug substance derived from marijuana, and the first FDA approval of a drug for the treatment of patients with Dravet syndrome (FDA 2018). Epidiolex is approved at a strength of 100 mg of CBD per milliliter and with a starting dosage of 2.5 mg/kg twice daily, increasing to 5 mg/kg twice daily, and if well-tolerated and needed, up to a maximum dosage of 10 mg/kg twice daily (Epidiolex Prescribing Information). For a person weighing 70 kilograms (154 lbs), this would equal 350 mg to 1,400 mg of CBD per day.

Another condition for which CBD has been investigated as a new drug is cancer pain (view a list here of completed, ongoing, and planned studies with cannabidiol).

In Canada, cannabidiol is a controlled substance.

Products on the Market
Despite the fact that CBD cannot be legally sold in the U.S. as a dietary supplement, many CBD products are available. Although it does not appear that individuals have been prosecuted for purchasing these products for their own use, the U.S. FDA has issued many warning letters to companies selling products claiming to contain CBD and/or promoting such products as treatments.

Tests of CBD products purchased at stores in Mississippi showed that most labels did not accurately reflect actual CBD content. Among five tested CBD oils, only Full Spectrum Hemp Oil (Functional Remedies) contained its labeled amount of CBD, while Very Berry Syrup (www.Creating BetterDays.com), CBD OIL (Green Roads), and Industrial Hemp Tincture (East Tennessee Hemp Company) contained only 22%, 39%, and 77%, respectively, and CBD Full Spectrum (Gold) (Hemp Extracts) provided 157% of their labeled amounts. Among 14 CBD vape liquids, two had their labeled amounts or slightly more, nine had just 0.06% to 54% of their labeled amounts, and three that did not list specific amounts of CBD contained synthetic cannabinoids (Gurley, J Diet Supp 2020).

The FDA also published the amounts of CBD, THC and other cannabis compounds it found in products it tested in 2015 and 2016 (click here and select the year to view). Most products contained very small concentrations of CBD — similar to what is normally found in hemp oil (about 0.0025% CBD) while others contained very large concentrations (25% to 35% CBD) yielding doses similar to those used in clinical trials (typically 200 mg or more per day). Many of the tested products did not contain the levels of CBD they claimed. The FDA cautions that "Consumers should beware purchasing and using any such products." 

The reason why hemp oils would not be expected to contain much CBD is that hemp oil is typically made from hemp seeds, which contain little CBD (although some CBD may contaminate the surface of the seeds). In fact, ConsumerLab.com has tested hempseed oils as part of its review of seed oil supplements (sources of omega-3 and omega-6 fatty acids) and found those products to contain well under 1 mg of CBD per serving. CBD is principally found in the flowers and, to a lesser extent, the upper leaves of the hemp plant. A "CBD oil" product is typically an oil, such as from hemp seed or other sources, to which a CBD extract (from hemp flowers) has been added (Mead, Epilepsy & Behavior 2017).

In August 2019, a class action lawsuit was filed against Just Brands USA Inc, the maker of JustCBD brand products. The lawsuit alleges that independent laboratory testing (commissioned by the plaintiff) revealed that some products contained substantially less CBD than claimed on the label. JustCBD Liquid Honey Tincture, for example, was found to contain 48.92 mg of CBD per bottle, rather than the 100 mg listed on the label. JustCBD Apple Rings Gummies, labeled as containing 250 mg per jar, were found to contain no CBD. (Gaddis v. Just Brands USA, Inc. et al).

At least one seller of CBD supplements to the public, PlusCBD LTD, appears to claim that is not illegal to sell these products if they are derived from "industrial" or "agricultural" hemp. Industrial hemp is typically a larger plant with more stalk and less leaves and flowers than that used to produce marijuana or CBD for medical use. It is grown for its fiber (for textiles) and seeds (as food and oil), which would be very low in THC (less than 0.3%) and CBD. It is true that the U.S. Drug Enforcement Agency (DEA) has stated that CBD in trace amounts from cannabis stalk or seeds is not a controlled substance, in contrast to CBD derived from cannabis flower which is a controlled substance -- despite the compound being the same. However, this does not seem to override the FDA's position that CBD cannot be sold as dietary supplement. It would also seem difficult to obtain large quantities of CBD from industrial hemp or cannabis stalk.

Many states now have medical marijuana laws that permit products with high CBD content to be sold by approved dispensaries and used by residents for medical purposes recommended by a healthcare provider. In addition, several states without medical marijuana laws allow products that are high in CBD (e.g., at least 5%, 10%, or 15% CBD) and low in THC (typically less than 0.3% to 0.9%) to be used for specific medical purposes (typically intractable epilepsy) as approved or recommended by a healthcare professional (See list of states on ProCon.org). However, these state laws do not make the general sale of such products legal, and some specifically require that the products be purchased out-of-state.

A synthetic form of CBD may be dangerous. The form, known as 4-CCB (or 4-cyano CUMYL-BUTINACA) is suspected in 52 cases of adverse reactions, including altered mental status, seizures, shaking, confusion, loss of consciousness, and hallucinations, associated with the use of CBD products sold in Utah between 2017 and 2018. Testing confirmed the presence of this synthetic compound in samples of "Yolo CBD oil" as well as other CBD brands (not named) sold in the state. The tests also revealed these products contained no actual CBD. The symptoms typically began within about 30 minutes of exposure (Horth, MMWR Morb Mortal Wkly Rep 2018). Although this compound was not among those analyzed in ConsumerLab's tests in this Review, it would seem unlikely to be in these products since each was found to contain actual CBD.

Tests Performed
Considering the enormous variation that has been shown in the amounts of CBD in marketed products and the fact that many don't accurately disclose their CBD content, as noted above, ConsumerLab.com purchased a sampling of popular products labeled to contain CBD, cannabinoids (other than THC), and/or hemp extracts and tested them to determine the amounts of CBD and other cannabinoids they contained, comparing these amounts to label expectations. Products claiming to contain whole herbs or 250 mg or more of minerals per daily serving or which were tested through CL's Quality Certification Program were also tested for contamination with lead, cadmium and arsenic. See How Products Were Evaluated for more details.

Products were compared on their label accuracy, quality, and cost.

What CL Found:

ConsumerLab found some significant changes in the CBD products purchased in 2020 (see Results table and graphs below) compared to those purchased in 2018/19:

· Products are generally formulated to contain greater amounts of CBD than in the past. Amounts had ranged from 1.3 to 22.3 mg per serving for oral products but now range from 4.7 mg to 51.3 mg, as shown below.

· Most products are now THC-free (i.e., no detectable THC). As also shown in the graph above, only three products had detectable amounts of THC, with only one, from Bluebird Botanicals, containing more than 1 mg per serving. The move to THC-free products may have been driven by well-founded consumer concerns of testing positive for THC on drug screens when using CBD as well as potential effects of THC.

· Prices have generally fallen and lower priced CBD products are available. As shown in the graph below, the lowest cost to get 10 mg of CBD was 24 cents. Although not inexpensive, this is a 70% decline from our Review in 2018, when the lowest cost was 80 cents. In fact, six products in this Review cost less than 80 cents per 10 mg. The drop in price may be due to greater competition, especially from established supplement companies that have entered the CBD market (such as Swanson and Garden of Life), and a greater supply of CBD due to passage of the Farm Act in 2018 which legalized hemp production. Of course, there will always be premium-priced products, such as Lord Jones Hemp-Derived CBD Tincture, which was approximately 10 times as expensive as the lowest cost Approved products, with a 10 mg dropperful of Lord Jones costing $2.40 ($2.67 based on amount found).

Every product contained the amount of CBD listed on its label within an acceptable range and margin of error (see How Products Were Evaluated). Note: Amounts of CBD reported in this Review, include 87.7% of the amount of CBDa found as well as the entire amount of CBD found. CBDa was not detectable in most products, but it could be found in the following: Nature's Love Topical ReLeaf Salve (2.24 mg per gram), NuLeaf Naturals CBD (0.007mg per 2 drops), Bluebird Botanicals Hemp Extract Classic (0.225 mg per 0.5 mL), Plus CBD Oil Hemp Softgel 15 mg (0.07 mg per softgel), and Plus CBD Oil Hemp Softgel 5 mg (4.03 mg per softgel).

Several products did not specify amounts of CBD and, instead, listed amounts of hemp extract, phytocannabinoids, or cannabinoids, all of which are more general terms that include not only CBD but other compounds. Some companies likely avoid the word "CBD" or "cannabidiol" on their product labels out of concern for it triggering regulatory scrutiny. Nevertheless, listed amounts of these broader ingredient names were found to closely resemble the amounts of CBD found in each product -- although there is no guarantee that this will always be the case. For example, nearly all of the "25 mg of phytocannabinoids" in Bluebird Botanicals was CBD (24 mg found) as was nearly all of Nature's Love 8.3 mg of hemp extract (7.7 mg of CBD found). CBDFX gummies and Charlotte's Web liquid actually contained somewhat more CBD than their claimed amounts of cannabinoids.

In our tests in 2018, three products could not be approved: Two contained significantly less CBD than listed and one contained more. This time around, none of the products failed to contain their claimed or expected amounts of CBD. In addition, all products tested for heavy metals were not found to be contaminated. Consequently, all of the products selected for testing were Approved.

Top Picks:

Among products that passed all of the laboratory tests, CL identified its Top Picks, representing a those providing superior value in addition to high quality.

CBD Oral Products for People
All-around: Swanson Extra Strength CBD Full Spectrum 25 mg Oil Drops — Mint. The two Swanson products in this Review provided CBD at lowest cost — about 24 to 25 cents per 10 mg, with Garden of Life products being the next least costly, at 42 to 46 cents per 10 mg. Both Swanson products are made from "full spectrum hemp extract" and clearly label their CBD content. Although this oil is slightly more expensive per mg of CBD than Swanson's 15 mg softgels, being a liquid it provides flexibility of easily adjusting the dose up or down from the suggested 33 drops (1 ml), which is listed as providing 25 mg of CBD (although we found 31.6 mg) — so each drop provides nearly 1 mg of CBD. It also had no detectable THC, which means that a full 33 drop dose would contain less than 0.0054 mg of THC, which is far below the daily amount of 0.39 mg shown to occasionally trigger a positive urine test for THC, as discussed above. 

Low Dose (4-9 mg): We tested two low-dose products, Elixinol (a liquid — 5 mg per ½ dropperful) and Plus CBD Oil's 5 mg softgels. Although Elixinol is a little less expensive (50 cents per 5 mg) than the Plus CBD Oil 5 mg softgels (67 cents each), it is still about 5 times as expensive as Swanson's oil (above), so it would make more sense to purchase Swanson if you want an oil; you can just take a smaller than suggested dose — about 5 or 6 drops would provide 5 mg for about 13 cents. However, if you want the convenience of a softgel at a low dose, Plus CBD Oil's 5 mg softgels are our Top Pick, although they are a more expensive source of CBD than Elixinol.

Moderate Dose (10-24 mg): Swanson CBD 15 mg. These softgels are the lowest-cost source of CBD in this entire Review and each 15 mg softgel is 41 cents. As with Swanson's liquid (above), the CBD in the softgels is from "full spectrum hemp extract" and THC was undetectable. Be aware, however, that neither Swanson product makes a statement about being "THC-free" or below a particular level, so neither is guaranteed to be low in THC even though we could not detect any.

High Dose (25 mg or more): Swanson Extra Strength CBD Full Spectrum 25 mg Oil Drops — Mint. This is also our all-around Top Pick for the reasons noted earlier. If you prefer a softgel, our suggestion is Garden of Life's 30 mg softgels ($1.45 per softgel), although it is about twice as expensive per mg of CBD as the Swanson oil. Be aware that what is a "high dose" for CBD from these products is still a relatively small dose compared to standard dosages of the prescription CBD drug Epidiolex, which can easily be 500 mg to 1,000 mg per day to treat children and teenagers with rare forms of epilepsy.

CBD Topical Balms & Lotions
Top Pick: Nature's Love Organic Topical ReLeaf Salve. This product provided the highest concentration of CBD (7.7 mg per gram) among the three topical products tested, although it is fairly expensive at 67 cents per gram. A gram of Curaleaf Hemp Lotion — Lemongrass is much less expensive, at 13 cents, but provides roughly one-third the amount of CBD (2.5 mg per gram). Swanson's balm provided a bit more CBD (3.5 mg per gram) than Curaleaf's lotion but is more expensive at 28 cents per gram. ConsumerLab was informed by Nuume Organics (on 3/24/2021) that Nature's Love was rebranded as Nuume Organics. Nuume Organics claims that the formulation of this product is unchanged, however, we note that the ingredient list on the Nuume Organics product is slightly different (listing specific essential oils as opposed to listing only "essential oils") and we have not tested product sold under the new brand name.

CBD for Pets
Top Pick: NuLeaf Naturals CBD Maximum Strength 240 mg CBD Per Bottle — This was the only pet product selected for testing in the current Review but it provides what it claims -- 4.8 mg of CBD per 2 drops for 77 cents. This is relatively expensive (about 6 times the cost of CBD from Swanson's oil, for example) but, unlike the oils for people tested in this Review, NuLeaf has no added flavors, such as peppermint (which is in the oils from Swanson and Garden of Life). It is difficult to know how such flavors would be tolerated by a pet. Another possible option to reduce cost would be to open a Swanson 15 mg softgel (41 cents) and use an appropriate amount of oil, since that oil is not flavored. Each Swanson softgel contains 15 mg of CBD, so one third of its contents is comparable to 2 drops of NuLeaf's oil.

Test Results by Product:

The table below lists test results and information for 18 products containing CBD grouped first by those for people, then topicals and then for pets. Products are shown alphabetically within each category. ConsumerLab.com selected ten of these products based on reader suggestions and popularity in the marketplace. Eight other products (each indicated with a CL flask) were tested at the request of their manufacturer/distributor through CL's Quality Certification Program and are included for having passed testing.

Also shown below for each product is the claimed type and amount of hemp ingredient and cannabinoids per serving or unit, the serving size recommended on the label, the amount of CBD, THC, and other cannabinoids found, dietary designations if claimed on the label (i.e. Kosher, Non-GMO) and ingredient and cost comparisons. Check marks in the table indicate that a product passed ConsumerLab.com's quality criteria for that attribute (see Passing Score). The full list of ingredients for each product is found in the last column.

Results of ConsumerLab.com Testing of CBD OIL PRODUCTS

(Click arrows or swipe left or right to see all columns)

Approval Status 

Product Name
(Suggested Serving on Label)

Claimed Amount of Hemp Extract and/or CBD

Cannabinoids Findings

Suggested Serving on Label

Pill Sizeⓘ

Heavy Metalsⓘ

Cost for Suggested Serving

[Cost Per 10 mg CBDⓘ]

Priced

Notable Features

Full List of Ingredients Per Serving

CBD Supplements (Gummies, Liquids & Softgels):

APPROVED

Bluebird Botanicals Hemp Extract Classic

Dist. by Bluebird Botanicals

Serving: 0.5 ml

25 mg full-spectrum cannabinoids

Found:
CBDⓘ: 24 mg

THCⓘ: 1.2 mg
% THCⓘ: 0.12% (claims <0.3% Δ9-THC)
✔
THC/CBD ratio: 2.5%
✔

Other cannabinoidsⓘ: 0.94 mg
Total cannabinoids: 25.9 mg
✔

5% of oil is CBDⓘ

Do not exceed 1 ml (2 servings) per day.

Liquid from bottle

Heavy metals: Pass

$2.25/0.5 ml

[$0.94 based on amount found]

$44.95/0.33 fl oz [10 ml] bottle (approx. 20 servings)

This product contains hemp, which has <0.3% Delta 9-THC.

0.5 ml
Full Spectrum Cannabidiols 25 mg Per Serving.

Other Ingredients: None Listed.

APPROVED

CBDFX® Gummies 300 mg - Mixed Berries

Dist. by CBDFX

Serving: 2 gummies

12 mg hemp extract

10 mg cannabinoids

Found:
CBDⓘ: 11.2 mg

No THC detectedⓘ
(claims <0.2% THC)
✔

Other cannabinoidsⓘ: 0 mg
Total cannabinoids: 11.2
✔

0.3% of gummy is CBDⓘ

No directions on label

Large circular gummy

Heavy metals: NA

$1.67/2 gummies

[$1.48 based on amount found]

$49.99/60 gummies

This product contains less than 0.2% THC. Vegan. Non-GMO. No Corn Syrup.

2 gummies
Calories 30, Carbohydrates 7 g, Sugar (As organic cane sugar) [Includes 1 g added sugars] 1 g, Hemp Extract (Aerial Parts) 12 mg, Cannabinoids 10 mg.

Other Ingredients: Organic Tapioca Syrup, Organic Cane Sugar, Purified Water, Pectin, Tri Sodium Citrate, Citric Acid, Tomato Lycopene (for color), Natural Flavor.

APPROVED

Charlotte's Web™ 17 mg - Mint Chocolate Flavor

Dist. by Charlotte's Web, Inc.

Serving: 2 droppers [1 ml]

28 mg hemp extract

17 mg phyto-
cannabinoids

Found:
CBDⓘ: 18.8 mg

No THC detectedⓘ

Other cannabinoidsⓘ: 1.3 mg
Total cannabinoids: 20.1 mg
✔

2% of oil is CBDⓘ

Adults: Take Two Full Droppers (1 ml) Up To Two Times Daily.

Liquid from bottle

Heavy metals: NA

$2.33/2 droppers

[$1.24 based on amount found]

$69.99/1 fl oz [30 ml] bottle (approx. 30 servings)

Kosher. Gluten Free. Non GMO. 100% Vegan.

Precaution: Contains Coconut.

2 droppers
Calories 10, Total Fat 1 g, Hemp Extract (aerial parts) [Minimum naturally occurring total phyto-
cannabinoids, 17 mg] 28 mg.

Other Ingredients: Fractionated Coconut Oil, Organic Mint Chocolate (Organic Sunflower Oil, Natural Flavors).

APPROVED

Elixinol Organic Balance

Dist. by Elixinol LLC

Serving: 1/2 dropper [0.5 ml]

5 mg CBD

Found:
CBDⓘ: 4.7 mg
✔

No THC detectedⓘ
(claims <0.3% THC)
✔

Other cannabinoidsⓘ: 0.39 mg

1% of oil is CBDⓘ

Take twice daily with food or as needed.

Liquid from bottle

Heavy metals: NA

$0.50/0.5 dropper

[$1.00 based on amount listed]
[$1.06 based on amount found]

$29.99/1 fl oz [30 ml] bottle (approx. 60 servings)

This product contains less than 0.3% THC in accordance to USDA regulations. USDA Organic seal.

1/2 dropper
Cannabidiol (CBD) 5 mg.

Other Ingredients: Organic MCT Coconut Oil, Organic Whole Plant Hemp Extract, Organic Copaiba Oil.

APPROVED

Garden of Life® Dr. Formulated CBD + Sleep

Dist. by Garden of Life LLC

Serving: 1 dropperful [1 ml]

944 mg hemp extract

15 mg CBD

Found:
CBDⓘ: 14.5 mg
✔

No THC detectedⓘ
(claims THC free)
✔

Other cannabinoidsⓘ: 0.16 mg

1.5% of oil is CBDⓘ

Adults take 1 dropperful (1 ml) at bedtime.

Liquid from bottle

Heavy metals: Pass

$1.33/dropper

[$0.89 based on amount listed]
[$0.92 based on amount found]

$39.99/1 fl oz [30 ml] bottle (approx. 30 servings)

1 dropperful

Vitamin D 20 mcg (800 IU), entourage effect blend 4.05 mg.

igen™ Non-GMO Tested seal. Labdoor Certified THC Free seal. Gluten Free.

Precaution: Contains: Tree nuts (coconut).

1 dropperful
Vitamin D (as D3) 20 mcg (800 IU), Broad Spectrum Hemp Extract Blend [Hemp Extract (whole plant) in Organic MCT Oil (from coconut) [15 mg Cannabidiol (CBD)]] 944 mg, Entourage Effect Blend [Essence of Organic Lemon Balm (leaf) Oil, Essence of Organic Orange (peel) Oil, Essence of Organic Lavandin (flower & stem) Oil, Essence of Organic Chamomile (leaf) Oil, more...

APPROVED

Garden of Life® Dr. Formulated CBD 30 mg - Softgel

Dist. by Garden of Life LLC

Serving: 1 softgel

341 mg hemp extract

30 mg CBD

Found:
CBDⓘ: 31.5 mg
✔

No THC detectedⓘ
(claims THC free)

Other cannabinoidsⓘ: 0.12 mg

7.8% of oil is CBDⓘ

Adults take 1 or more softgels daily as desired.

Medium/large softgel

Heavy metals: Pass

$1.45/softgel

[$0.48 based on amount listed]
[$0.46 based on amount found]

$43.39/30 softgels

1 softgel

Entourage effect blend 73 mg

igen™ Non-GMO Tested seal. Labdoor Certified THC Free seal. Vegan. Gluten Free.

Precaution: Contains: Tree nuts (coconut).

1 softgel
Broad Spectrum Hemp Extract Blend [Hemp Extract (whole plant) in Organic MCT Oil (from coconut) [30 mg Cannabidiol (CBD)]] 341 mg, Entourage Effect Blend [Essence of Pure Clove (flower) Oil, Essence of Pure Rosemary (leaf) Oil, Essence of Pure Pepper (fruit) Oil] 73 mg.

Other Ingredients: Non-GMO PlantGel™ Softgel.

APPROVED

Garden of Life® Dr. Formulated CBD 50 mg - Liquid

Dist. by Garden of Life LLC

Serving: 1 dropperful [1 ml]

946 mg hemp extract

50 mg CBD

Found:
CBDⓘ: 51.3 mg
✔

No THC detectedⓘ
(claims THC free)

Other cannabinoidsⓘ: 0.32 mg

5.2% of oil is CBDⓘ

Adults take 1 dropperful (1 ml) 1 or more times daily as desired.

Liquid from bottle

Heavy metals: Pass

$2.17/dropperful

[$0.43 based on amount listed]
[$0.42 based on amount found]

$65.09/1 fl oz [30 ml] bottle (approx. 30 servings)

1 dropperful

Entourage effect blend 1.8 mg

igen™ Non-GMO Tested seal. Labdoor Certified THC Free seal. Vegan. Gluten Free.

Precaution: Contains: Tree nuts (coconut).

1 dropperful
Broad Spectrum Hemp Extract Blend [Hemp Extract (whole pant) in Organic MCT Oil (from coconut) [50 mg Cannabidiol (CBD)]] 946 mg, Entourage Effect Blend [Essence of Organic Peppermint (flower, leaf, stem) Oil, Essence of Organic Orange (peel) Oil, Essence of Organic Lavandin (flower & stem) Oil, Essence of Organic Frankincense (resin) Oil] 1.8 mg, more...

APPROVED

Green Roads® Relax Bears 300 mg - Sweet & Relaxing

Dist. by Green Roads of Florida LLC

Serving: 1 gummy

10 mg CBD

Found:
CBDⓘ: 11.9 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 0 mg

0.4% of gummy is CBDⓘ

No directions on label

Large bear-shaped gummy

Heavy metals: NA

$1.47/gummy

[$1.47 based on amount listed]
[$1.23 based on amount found]

$43.99/30 gummies

None.

1 gummy
Calories 10, Total Fat 0 g, Saturated Fat 0 g, Trans Fat 0 g, Cholesterol 0 mg, Sodium 0 mg, Total Carbohydrate 3 g, Dietary Fiber 0 g, Total Sugars [Includes 0 g Added Sugar] 2 g, Protein 0 g.

Ingredients: Corn Syrup, Sugar (from beets), Water, Gelatin, Citric Acid, Natural and Artificial Flavors, Yellow 5, Yellow 6, Blue 1, 300 mg Hemp-Derived Cannabinoid Extract.

APPROVED

Lord Jones Hemp-Derived CBD Tincture - Naturally Flavored Peppermint

Dist. by Redwood Wellness, LLC

Serving: 1 full dropper [1.2 ml]

10 mg CBD

Found:
CBDⓘ: 9 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 0.072 mg

0.8% of oil is CBDⓘ

Place one full dropper in mouth for 60 seconds and swallow. Repeat as needed.

Liquid from bottle

Heavy metals: NA

$2.40/full dropper

[$2.40 based on amount listed]
[$2.67 based on amount found]

$60.00/1 fl oz [30 ml] bottle (approx. 25 servings)

None.

1 full dropper [1.2 ml]
Calories 10, Calories From Fat 10, Total Fat 1 g, Cannabidiol (CBD) [from broad spectrum hemp extract] 10 mg.

Other Ingredients: Grape Seed Oil, Hemp Seed Oil, Peppermint Oil, Stevia Leaf Extract.

APPROVED

Manitoba Harvest® CBD

Dist. by Manitoba Harvest USA LLC

Serving: 1 softgel

17 mg hemp extract

15 mg CBD

Found:
CBDⓘ: 16 mg
✔

No THC detectedⓘ
(claims <0.01% THC)

Other cannabinoidsⓘ: 0 mg

4.4% of oil is CBDⓘ

Adults, take 1 softgel 1-2 times daily. Increase if needed.

Medium/large softgel

Heavy metals: NA

$0.92/softgel

[$0.61 based on amount listed]
[$0.57 based on amount found]

$54.99/60 softgels

THC Free (Less Than 0.01% THC). Vegan. Non GMO, Gluten Free.

1 softgel
Broad Spectrum Hemp Extract (Cannabis sativa L.) (aerial parts) [Cannabidiol (CBD) 15 mg] 17 mg.

Other Ingredients: Organic Hemp Seed Oil, Modified Cornstarch, Glycerin, Carrageenan, Purified Water.

APPROVED

Plus CBD Oil Hemp Softgel 15 mg

Dist. by CV Sciences, Inc.

Serving: 1 softgel

15 mg CBD
(in 60 mg hemp oil)

Found:
CBDⓘ: 14.7 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 1.1 mg

6.1% of oil is CBDⓘ

As a dietary supplement, take 1 softgel.

Medium/large softgel

Heavy metals: Pass

$1.17/softgel

[$0.78 based on amount listed]
[$0.79 based on amount found]
$69.99/60 softgels

Non GMO. Gluten-Free.

1 softgel
Hemp Oil (Aerial Plant Parts) (Cannabidiol (CBD) 15 mg) 60 mg.

Other Ingredients: Extra Virgin Olive Oil, Vegetable Softgel (Vegetable Cellulose, Water), Silica.

APPROVED

Top Pick

for low dose (4-9 mg)

Plus CBD Oil Hemp Softgel 5 mg

Dist. by CV Sciences, Inc.

Serving: 1 softgel

5 mg CBD+CBDa
(in 60 mg hemp oil)

Found:
CBDⓘ: 5.5 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 0.29 mg

2.3% of oil is CBDⓘ

Take 1 softgel.

Medium/large softgel

Heavy metals: Pass

$0.67/softgel

[$1.20 based on amount found]

$39.99/60 softgels

RAW Formula. Non GMO. Gluten-Free.

1 softgel
Hemp Oil (Aerial Plant Parts) (Cannabidiolic Acid/ Cannabidiol (CBDa/CBD) 5 mg) 60 mg.

Other Ingredients: Extra Virgin Olive Oil, Vegetable Softgel (Vegetable Cellulose, Water), Silica.

APPROVED

Top Pick

for moderate dose (10-24 mg)

Swanson CBD 15 mg

Dist. by Swanson Health Products

Serving: 1 softgel

20.6 mg hemp extract

15 mg CBD

Found:
CBDⓘ: 16.9 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 0.17 mg

13.1% of oil is CBDⓘ

As a dietary supplement, take one softgel per day with water.

Medium softgel

Heavy metals: Pass

$0.41/softgel

[$0.27 based on amount listed]
[$0.24 based on amount found]

$24.69/60 softgels

Non-GMO. Gluten Free. Vegan.

1 softgel
Full Spectrum Hemp Extract (Cannabis sativa L.) (aerial parts) [Cannabidiol (CBD) 15 mg] 20.6 mg.

Ingredients: Vegetarian softgel (modified food starch, glycerin, carrageenan, water, annatto), sunflower oil.

APPROVED

Top Pick

for all-around and high dose (25 mg or more)

Swanson Extra Strength CBD Full Spectrum 25 mg Oil Drops - Mint

Dist. by Swanson Health Products

Serving: 33 drops [1 ml]

41.67 mg hemp extract

25 mg CBD

Found:
CBDⓘ: 31.6 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 2.4 mg

6.5% of oil is CBDⓘ

As a dietary supplement, take 33 drops (1 ml) per day.

Liquid from bottle

Heavy metals: Pass

$0.79/33 drops

[$0.32 based on amount listed]
[$0.25 based on amount found]

$47.50/2 fl oz [60 ml] bottle (approx. 60 servings)

Non-GMO. Vegan. Gluten Free.

Precaution: Contains tree nuts (coconut).

33 drops
Calories 10, Total Fat 1 g, Saturated Fat 0.8 g, Full Spectrum Hemp Extract (Cannabis sativa L.) (Flowers and Leaves) [Cannabidiol (CBD) 25 mg] 41.67 mg.

Other Ingredients: Organic coconut MCT oil, natural flavors (peppermint), mixed tocopherols, luo han guo.

Topicals (Balm, Lotion & Salve):

APPROVED

Curaleaf™ Hemp Lotion - Lemongrass

Dist. by Curaleaf KY, Inc.

Serving: 1 g

2.6 mg CBD

Found:
CBDⓘ: 2.5 mg
✔

No THC detectedⓘ

Other cannabinoidsⓘ: 0 mg

0.2% of lotion is CBDⓘ

Massage into skin until thoroughly absorbed. Use carefully on the face. Avoid eyes, nose, mouth and ears. Repeat as desired. Most effective when applied to clean, dry skin directly after a shower or bath.

Lotion in jar

Heavy metals: NA

$0.13/gram

[$0.50 based on amount listed]
[$0.53 based on amount found]

$14.99/4 oz [113.4 g] jar

Free From: wheat, soy, nuts, eggs, dairy.

Contains 300 mg Total CBD [Per Container].

Ingredients: Aqua, Butyrospemum Parkii (Shea) Butter, Cetearyl Alcohol (and) Cetearyl Glucoside, Tapioca Starch Modified, Organic Aloe Barbadensis (aloe Vera) Leaf Juice, Caprylic Capric Triglyceride, Aroma (Lemongrass), Helianthus Annuus (Sunflower) Seed Oil, Organic Argania Spinosa (Argan) Kernel Oil, more...

APPROVED

Top Pick

for CBD topical balms & lotions

Nature's Love™ Topical ReLeaf Salveⓘ

Mfd. by Nature's Love

Serving: 1 g

8.3 mg hemp extract

Found:
CBDⓘ: 7.7 mg

No THC detectedⓘ

Other cannabinoidsⓘ: 0.43 mg

0.8% of salve is CBDⓘ

For external use only. Massage deeply into skin.

Salve in jar

Heavy metals: NA

$0.67/gram

[$0.86 based on amount found]

$39.99/2 fl oz [60 ml] jar

USDA Organic seal.

Precaution: Allergen Warning: This product contains Coconut and Tree Nut Oils.

Hemp Extract 500 mg [Per Container].

Ingredients: Organic Virgin Coconut Oil, Organic Shea Butter, Organic Beeswax, Organic Proprietary Cultivars Hemp Extract, Organic Essential Oils.

APPROVED

Swanson CBD Full Spectrum 150 mg Balm - Mint

Dist. by Swanson Health Products

Serving: 1 g

2.6 mg CBD

Found:
CBDⓘ: 3.5 mg
✔

THCⓘ: 0.15 mg
% THCⓘ: 0.02%
THC/CBD ratio: 4.4%
✔

Other cannabinoidsⓘ: 0.19 mg

0.3% of balm is CBDⓘ

Apply to skin as needed. For External Use Only.

Balm in jar

Heavy metals: Pass

$0.28/gram

[$0.81 based on amount found]

$15.99/2 oz [57 g] bottle

None.

Ingredients: Helianthus annuus (sunflower) seed oil, Cocos nucifera (coconut oil), beeswax, Olea europaea (olive) oil, Cannabis sativa (hemp), Mentha piperita (peppermint) oil, cetearyl glucoside (and) cetearyl alcohol.

Pet Products:

APPROVED

Top Pick

for CBD for pets

NuLeaf Naturals CBD Maximum Strength - 240 mg CBD per bottle

Dist. by NuLeaf Naturals

Serving: 2 drops (0.1 ml)

4.8 mg CBD

Found:
CBDⓘ: 4.9 mg

THCⓘ: 0.15 mg
% THCⓘ: 1.4%
THC/CBD ratio: 3.1%
✔

Other cannabinoidsⓘ: 0.43 mg
Total cannabinoids: 5.5 mg
✔

5.2% of oil is CBDⓘ

Give 2-4 drops per 25 lbs.

Liquid from bottle

Heavy metals: Pass

$0.77/2 drops

[$1.60 based on amount claimed]
[$1.56 based on amount found]

$38.50/0.17 fl oz [5 ml] bottle (approx. 50 servings)

No GMOs.

2 drops = 4.8 mg Cannabidiol.

Other Ingredients: None Listed.

Unless otherwise noted, information about the products listed above is based on the samples purchased by ConsumerLab.com (CL) for this Product Review. Manufacturers may change ingredients and label information at any time, so be sure to check labels carefully when evaluating the products you use or buy. If a product's ingredients differ from what is listed above, it may not necessarily be of the same quality as what was tested.

The information contained in this report is based on the compilation and review of information from product labeling and analytic testing. CL applies what it believes to be the most appropriate testing methods and standards. The information in this report does not reflect the opinion or recommendation of CL, its officers or employees. CL cannot assure the accuracy of information.

Copyright ConsumerLab.com, LLC, 2021 All rights reserved. Not to be reproduced, excerpted, or cited in any fashion without the express written permission of ConsumerLab.com LLC

ConsumerTips™:

Read Labels Carefully
As noted earlier, hemp oil would not be expected to contain much CBD, while hemp extract or products that specifically list CBD as an ingredient would be expected to contain CBD. Ideally, look for a product that lists the amount of CBD per serving (not just per entire bottle). If a product lists "cannabinoids" it may contain some CBD but you won't know how much.

Dosing:
Most of the research with CBD has involved high doses (several hundred milligrams daily). This is much more than you'll typically get from products being sold on the market. Here's what's been shown to work in preliminary clinical studies, as discussed in more detail in the What It Does section:

· Anxiety (relating to public speaking): 300 mg to 600 mg of CBD daily

· Insomnia: 160 mg of CBD 30 minutes before bedtime to increase sleep time (but will not decrease the amount of time it takes to fall asleep)

· Reduction in seizures: 20 mg of CBD per kilogram of body weight daily (e.g., for a 70 kg adult, this would be 1,400 mg of CBD)

· Schizophrenia: 1,000 mg of CBD daily

· For dogs with osteoarthritis: 2 mg per kilogram of bodyweight, twice daily. (e.g., for a 20 lb. dog: 18 mg of CBD in the morning and again at night).

How to Take:
CBD is fat-soluble (i.e., lipophilic) and taking CBD with, or shortly, after a meal containing fats can dramatically increase its bioavailability which otherwise may be as low as 6% (Devinksy, Epilepsia 2014). A 5-fold increase in blood levels of CBD occurred when an oral solution of CBD (in an alcohol and oil base) was taken with a high-fat/high-calorie meal (i.e., a large meal containing fats) rather than on an empty stomach (FDA - Epidiolex labeling revised 6/2018). Similarly, another small study found a 4-fold increase in blood levels of CBD when a single dose of CBD (200 to 300 mg of CBD in capsules as a 99% purified CBD extract, Vireo Health Violet) was taken with a high-fat meal (500 to 600 Calories from fat) rather than on an empty stomach. In addition, blood levels temporarily reached a maximum level 14 times higher and the half-life of CBD in the blood was extended to 39 hours from 24 hours when CBD was taken with food rather than on an empty stomach (although it's not clear if these effects would be as pronounced with lower doses of CBD) (Birnbaum, Epilepsia 2019).

Special formulations of CBD exist that may enhance absorption of CBD, possibly reducing the need for it to be taken with a meal containing fat. A small, company-funded study in healthy men and women in Germany found that, taken on an empty stomach, absorption of a single 25 mg dose of CBD from hemp extract formulated with an absorption enhancer (VESIsorb) increased blood levels of CBD 2.9 times as much as the same extract in a small amount of oil (medium-chain triglycerides), although, over 24 hours, the increase was just 1.7 times that of the CBD in oil (Knaub, Molecules 2019). Unfortunately, these increases are not as great as that achieved by just taking CBD with a fat-containing meal, as discussed above. (VESIsorb is a "nano-colloid" that includes triglycerides, polyglycerol esters and polysorbate 80 and is also used in some CoQ10 and resveratrol formulations to increase absorption).

A liposomal formulation of CBD produced using sunflower lecithin (phosphatidyl choline) was shown to increase the bioavailability of a 10 mg dose of CBD by 17-fold one hour after consumption compared to an unformulated CBD. In fact, CBD was undetectable in two of the five volunteers taking unformulated CBD. However, the CBD was taken without food and on an empty stomach (Verrico, Pain 2020).

After taking CBD orally, maximal blood levels are reached within about 2.5 to 5 hours. CBD remains in the blood for a fairly long time — studies have shown its half-life (i.e., the time for blood levels to fall by half) to be 18 to 32 hours (Devinksy, Epilepsia 2014) to as long as 56 to 61 hours after 7 days of repeated high-dosing (FDA - Epidiolex labeling revised 6/2018).

Does CBD convert to THC in the body?
Although some preliminary laboratory studies suggested that CBD may convert to THC during digestion (Merrick, Cannabis Cannabinoid Res 2016), a clinical trial in people showed that no THC was detected in the blood up to six hours after consuming a large dose of CBD (300 mg of a 99.5% pure CBD oral solution in corn oil) both with and without food. In addition, none of the participants experienced any psychoactive effects associated with THC (Crippa, Cannabis Cannabinoid Res 2019).

Concerns and Cautions:

CBD can cause side effects and interact with certain medications and conditions, although these effects have typically been reported only with very high daily intake, i.e., hundreds of milligrams daily.

· High daily doses of CBD (20 mg per kg of body weight, i.e., hundreds of milligrams) may cause decreased appetite, diarrhea, vomiting, fatigue, fever, somnolence, and abnormal results on liver-function tests (Devinsky, New Eng J Med 2017; Thiele, Lancet 2018). Elevated liver enzymes have been shown to occur in 8% and 16% of patients given, respectively, 10 and 20 mg of CBD per kg of body weight daily, and it is, therefore, recommended that high-dose CBD should be used with caution in people with pre-existing liver disease and when taking other drugs that can adversely affect the liver, such as antiepileptics, antipsychotics, acetaminophen, certain antibiotics (amoxicillin and nitrofurantoin), antifungals, and verapamil (Brown, J Clin Med 2019).
Side effects at very high dosage are common: A dose of 25 mg per kg resulted in adverse events in 80.8% of children (treated for epilepsy), with decreased appetite, diarrhea, and weight loss being the most common events. Weight loss emerged only after several months on treatment, was clinically significant in 30.7% of patients, and resolved with dose reduction or treatment cessation (Sands, CNS Drugs 2018).

· CBD may lower blood pressure and increase heart rate. A small study among young, healthy men (average age 23) found that, compared to placebo, a single, 600 mg dose of CBD decreased resting average systolic blood pressure (by 6 mm Hg) and increased heart rate by about 10 beats per minute (bpm) approximately one hour after taking; the same dose of CBD also lowered systolic blood pressure (by 5 mm Hg) and increased heart rate (by 10 bpm) during exercise (Jadoon, JCI Insight 2017). Drops in blood pressure (of 10 to 20 mm Hg) upon standing were reported in each of five patients with movement disorders given CBD (100 mg to 500 mg) for several weeks. Two patients also reported lightheadedness. A worsening of symptoms of Parkinson's disease was also noted. In addition, dry mouth occurred in two of the five patients (Consroe, Int J Neurosci 1986). Dry mouth (which also occurs with marijuana use) may be due to inhibition of cells in the salivary glands that contain cannabinoid receptors CB1 and CB2 (Prestifilippo, Exp Biol Med 2006), and CBD can interact with such receptors (Pertwee, Br J Pharmacol 2008).

· Low-dose, full spectrum hemp extracts appear to be generally safe and well-tolerated, based on the amount and type of adverse events reported with PlusCBD products in 2018 through 2019. The most common adverse event reported with oral use was abdominal discomfort, representing 24% of all adverse events reported from 2018 through 2019. This was followed by headache (7%), hypersensitivity (6%), and nausea (6%). Out of 1,334 reports, only two were considered serious but may not have been due to the product. With topical products, hypersensitivity, dermatitis, and rash were most common, although there were only 95 reports in total. During the reporting period, 5 million units were sold, indicating that only 0.03% of sales resulted in an adverse event reported to the company (Schmitz, J Diet Supp 2020).

· Two days after starting to supplement with CBD, a red, pustular bilateral rash occurred on the arms, underarms, buttocks and groin of a 63-year-old man with a history of plaque psoriasis. The rash improved within four days of stopping CBD, and completely cleared several weeks later. This rash was characterized as a pustular drug eruption — which typically appears within 48 hours of exposure to a drug to which an individual is highly sensitive (Pettit, Dermatitis 2018). (ConsumerLab has contacted the author of this report for more details about the CBD product and dose and will post this information if received).

· CBD should be used with caution with sedative and sleep-inducing medications, as it may enhance their effects. CBD could also potentially increase the effects of herbs and supplements that have a sedating effect, such as melatonin, valerian, SAMe, ashwagandha and others, although there do not appear to be any published reports of this occurring.

· Be aware that CBD may interact with other medications that, like itself, are metabolized in the body by the cytochrome p450 enzymes CYP3A4 and CYP2C19. By competing for these enzymes, CBD can reduce the metabolism of such drugs, raising their blood levels and possibly requiring downward adjustment of their doses. For example, several hundred milligrams of CBD daily in epilepsy trials have caused sizable increases in levels of the epilepsy medications clobazam, valproic acid, levetiracetam, felbamate, lamotrigine, and zonisamide (U.S Department of Health; Yamaori, Life Sci 2011; Iffland, Cannabis Cannabinoid Res 2017). Adding 50 mg to 300 mg of CBD per day to treatment with the epilepsy drug brivaracetam was found to increase blood levels of brivaracetam by as much as 95% to 280% (Klotz, Epilepsia 2019).

For the same reason, CBD may increase the blood-thinning effects of warfarin (Coumadin, Jantoven). This was observed in a man with post-stroke epilepsy taking warfarin: His INR (a measure of how long it takes blood to clot) began increasing several weeks after starting CBD (Epidiolex, Greenwich Biosciences, Inc.) for his seizures. His CBD dosing started with several hundred milligrams daily and increased to over 1,000 mg, at which point his warfarin dose had been reduced by approximately 30% (Grayson, Epilepsy Behav Case Rep 2017). Similarly, a dose-dependent increase in INR was reported in a 46-year-old man taking warfarin (80 mg daily) after he began taking Epidiolex (805 mg/day increased to over 3,000 mg/day over several weeks) to help control epileptic seizures. He required a 20% reduction in warfarin dosage in order maintain INR within goal range while continuing Epidiolex (Cortopassi, Am J Health Syst Pharm 2020).

These effects are dose-dependent, and it's possible that lower doses of CBD (single digits or tens of milligrams daily), as in many products in this Review, will have more modest effects.

Nevertheless, use CBD with caution if you take medications metabolized by the enzyme affected by it. Such medications include macrolide antibiotics such as clarithromycin and azithromycin (Zithromax), cyclosporine (Sandimmune), sildenafil (Viagra), antihistamines, Haloperidol (Haldol), certain statin medications such as atorvastatin (Lipitor) and simvastatin (Zocor), testosterone, progesterone, nifedipine (Procardia XL), metoprolol (Lopressor, Toprol XL), the proton pump inhibitor drug omeprazole (Zegerid, Prilosec OTC) and the antipsychotic drug risperidone (Risperdal), ondansetron (Zofran), paroxetine (Paxil), flecainide (Tambocor) and others, such as fluoxetine (Prozac) and fluvoxamine (Luvox), clopidogrel (Plavix), propranolol (Inderal LA), carisoprodol (Soma), cyclophosphamide (Cytoxan), fluconazole (Diflucan), efavirenz (Sustiva, Stocrin), celecoxib (Celebrex), naproxen (Aleve), sulfonylureas (Amaryl, Glynase), losartan (Cozaar), rosuvastatin (Crestor), valsartan (Diovan), enzalutamide (Xtandi) (Brown, J Clin Med 2019). As mentioned above, CBD should also be used with caution when taking medications with the potential to cause liver damage, such as acetaminophen.

· There is also evidence that very high doses of CBD can inhibit the cytochrome p450 enzyme CYP1A2 and, therefore, potentially increase blood levels of caffeine and other drugs that are metabolized by this enzyme. A study showed that when people taking 1,500 mg of CBD were given caffeine, the amount of caffeine in their blood was nearly double the amount that occurred when caffeine was given without CBD (Thai, Clin Pharmacol Drug Dev 2021). Other drugs metabolized by this enzyme include clozapine (Clozaril), Fluvoxamine (Luvox), frovatriptan (Frova) mirtazapine (Remeron) and zolmitriptan (Zomig).

· A small study in healthy men found that a single dose (400 mg) of antifungal drug ketoconazole (Nizoral, Xolegel, Extina) increased blood levels of CBD, while a single dose (600 mg) of the antibiotic rifampicin (Rifadin) decreased blood levels of CBD (Stott, Springerplus 2013).

· A dangerous synthetic cannabinoid (AB-FUBINACA) has been found in some CBD products, including e-cigarette fluid and incense. AB-FUBINACA-related compounds have been linked to several deaths (Shanks, J Anal Toxicol 2016; Lam, Clin Toxicol 2017). It was also detected in a CBD oil purchased from what a consumer believed to be a "reputable online distributor from Colorado." The discovery was made after an 8-year-old boy was given the oil for nine days to help treat a seizure disorder but, instead, experienced a sudden increase in the frequency of seizures as well as agitation, delirium, dilated pupils and rapid heartbeat. The CBD oil (identity not disclosed in report) was found to contain CBD as well as AB-FUBINACA — which is known to cause these symptoms (Rianprakaisang, Clin Toxicol 2019). (ConsumerLab may screen for synthetic cannabinoids in future tests).

· CBD supplements can contain enough THC to cause a positive drug test for marijuana (using a 50 ng/mL of urine limit). This has been demonstrated in several small studies. In one, one of seven adults tested positive at a dose of just 0.39 mg of THC per day (Gustafson, Clin Chem 2003). In the other study, one of 15 people had a positive drug test at a dose of 0.6 mg of THC per day (Leson J Anal Toxicol 2001). In a third study, 7 out of 14 people tested positive after taking a CBD liquid providing approximately 0.8 mg of THC daily for 4 weeks (the liquid was taken sublingually in three divided doses each day, with each dose containing about 10 mg of CBD from a "full spectrum" hemp extract) (Dahlgren, JAMA Psych 2021). There is likely much person-to-person variability in these results due to differences in how people absorb and metabolize THC. Note that higher doses of CBD from hemp extracts will likely provide higher amounts of THC. THC (like CBD) is fat-soluble and, therefore, can be stored in the body and slowly released, potentially affecting drug tests for several days after CBD use. Also be aware that even regular hemp oil and hemp seed can contain small amounts of THC and, at a high enough dose, result in a positive drug test.

· Some branches of the U.S. military, including the Army, Air Force and Coast Guard forbid the use of any hemp-based products, including hemp oil, hemp seeds, and foods that contain hemp, such as yogurt containing hemp seeds. Interestingly, the World Anti-Doping Agency, which helps to oversee drug policies in sports, announced in 2018 that cannabidiol is no longer prohibited by the organization, but cautioned that "cannabidiol extracted from cannabis plants may also contain varying concentrations of THC, which remains a prohibited substance." (Note: Policies on hemp and CBD consumption in professional sports organizations still vary based on the organization).

· The American Academy of Pediatrics has not endorsed Cannabis and cannabinoid use because of concerns about brain development (National Cancer Institute 2017).

· In dogs, giving 2 mg per kilogram of bodyweight, twice daily. (e.g., for a 20 lb dog: 18 mg of CBD in the morning and again at night) for a month was found to cause an increase in levels of the liver enzyme alkaline phosphatase, and the researchers recommended monitoring liver enzymes in dogs receiving CBD until long-term safety studies are conducted (Gamble, Front Vet Sci 2018).

---

Information on this site is provided for informational purposes only. It is not an endorsement of any product nor is it meant to substitute for the advice provided by physicians or other healthcare professionals. The information contained herein should not be used for diagnosing or treating a health problem or disease. Consumers should inform their healthcare providers of the dietary supplements they take.

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Latest Clinical Research Updates for CBD & Hemp Extract Supplements

Help for Arthritic Hands?

9/18/2021

A study tested whether moderate doses of CBD could reduce the pain of hand osteoarthritis or psoriatic arthritis. See what the study found in the Pain section of our CBD Oil and Hemp Extracts Review.

CBD for Burnout?

8/17/2021

Healthcare workers were given daily CBD to see if it reduced symptoms of emotional exhaustion and burnout. Did it work and was it safe? See the findings in the What It Does section of our CBD Oil & Hemp Extracts Review.

CBD Interaction With Caffeine

6/19/2021

Be aware that if you consume caffeine, very high doses of CBD may increase caffeine levels in the body and, potentially, caffeine side effects, according to a new study. Get the details about this and other interactions in the Concerns and Cautions section of our CBD & Hemp Extracts Review. Also see our Top Picks among CBD oils and hemp extracts.

CBD for Pain?

5/04/2021

Can CBD reduce pain severity or help people better tolerate pain? See what a recent study found in the What It Does section of our CBD & Hemp Extract Supplements, Lotions, and Balms Review.

CBD for Low Back Pain?

4/17/2021

Does taking CBD help in treating acute low back pain? See what a recent study found in the What It Does section of our CBD & Hemp Extract Supplements, Lotions, and Balms Review. Also see our Top Picks among CBD products.

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