Hemp. Cannabidiol. CBD. Marijuana. THC. While all of these names link back to cannabis, they refer to different substances with different implications. Still it's no wonder we're so confused about cannabis. How is it that you can buy cannabidiol (CBD) oil legally when you can't buy marijuana legally in all 50 states? Why has it suddenly become so popular? What are the health benefits and risks? Can you get addicted? One thing's for certain: CBD-products have become big business. According to a study by the Hemp Business Journal, by 2020, CBD sales are predicted to reach $1.15 billion. What is CBD? Cannabinoids are chemical compounds produced naturally in our bodies and in some plants. In humans they're called endocannabinoids, and in plants they're called phytocannabinoids. The endocannabinoid system is like our body's operating system—it affects neurotransmitters that bind to receptors and impact pain, mood, appetite, sleep, and how we feel, move and react. Phytocannabinoids derived from plants mimic our body's natural systems as their chemical makeup is similar to endocannabinoids. CBD is a common cannabinoid in cannabis, which is actually a group of flowering plants. A helpful analogy, as explained by Echo Connection, is to think of this: "Hemp and marijuana are to cannabis as lemons and oranges are to citrus. Two related but different plants, from the same 'family.'" It's easy to see where the confusion lies. Marijuana is a term used to generally refer to the dried plant form of cannabis. Some people use the term hemp when referring to cannabis, while others use the term cannabis to refer to varieties of the plant cultivated for non-drug use, such as fiber. The main difference in varieties comes down to tetrahydrocannabinol (THC) content. What is THC? The cannabis plant has hundreds of active chemicals, including more than 120 cannabinoids found in the stalks, seeds and flowers. The two most abundant cannabinoids in cannabis are cannabidiol and tetrahydrocannabinol (THC)—found in both marijuana and hemp. Marijuana, though, has a higher concentration of THC. And while the compounds have similar chemical structures, they have very different psychoactive effects. When heat is applied, THC, an addictive compound, breaks down and creates a mind-altering high by binding with the cannabinoid receptors in the brain; raw cannabis doesn't do this. The process is called decarboxylation. Depending on the amount of THC, it can induce relaxation and enjoyable altered perceptions in some people, and anxiety, increased blood pressure, hallucinations, paranoia and even psychosis in others. On the other hand, CBD is not psychoactive and does not appear to be addictive. It interacts with the human endocannabinoid system by encouraging the release of our own endocannabinoids. How does CBD oil make you feel? Experts agree that the substance affects everyone a little differently, but for the most part, individuals report feeling more relaxed, less anxious and more focused. It does not make you feel "high." Some people claim that CBD oil reduces chronic pain and headaches; others say it helps their insomnia. Some take it for its anti-inflammatory properties. One study comparing the effects of THC and CBD found that THC activates neurotransmitters involved in our "fight or flight" response, while CBD represses autonomic arousal, the nervous system response associated with increased heart rate or respiration, which could be why so many people purchase it for relaxation benefits. A 2015 study found promising results regarding CBD oil's potential in treating anxiety, but also pointed out a need for more rigorous scientific research of chronic and therapeutic effects. Why are people just talking about CBD now? When the 2018 U.S. Farm Bill was passed, federal law removed hemp-derived products from the Drug Enforcement Agency's list of Schedule 1 substances. Although the Farm Bill had no effect on state-level cannabis programs, it led to a "hempslosion" of sorts, giving licensed growers the green light to cultivate and transfer hemp-derived products across state lines for commercial purposes. It's still a highly regulated crop in the United States, though, with serious provisions. And the Farm Bill has no effect on state-legal cannabis programs. Are CBD products legal? This is where discussions can get even more confusing. The hemp plant has naturally occurring (yet trace amounts) of tetrahydrocannabinol. If a product has THC levels above 0.3 percent (by dry weight), the government considers it marijuana. If a hemp-derived CBD product contains THC, it must be under 0.3 percent to be legal. (For perspective, the average marijuana strain today contains about 12 percent THC.) The weather is a huge challenge for hemp growers focused on CBD products. When cannabis plants are stressed by cold weather, they can create more THC. Drought, flooding, heat or cold can all result in unintentional spikes in THC. On the flip side, marijuana-derived CBD is illegal at the federal level and classified as a controlled substance regardless of its percentage of THC. Even in states where marijuana is legal, there are restrictions on where CBD products are sold and how they can be marketed. A statement by the U.S. Food and Drug Administration (FDA) made clear that products that contain CBD—even if derived from legal, commercial hemp—cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use. This is to protect consumers by discouraging the illegal marketing of unsubstantiated health/medical claims. As of this writing, the FDA has approved only one CBD product, Epidiolex, for the treatment of rare, severe forms of epilepsy. If you are buying other CBD products today, their therapeutic benefits are unsubstantiated, and they are largely unregulated in terms of safety. Where do you buy CBD? You can buy CBD oil at dispensaries, "head shops," some health food stores, gas stations, wellness boutiques or online. Both CVS and Walgreens have announced plans to sell CBD oil over-the-counter in select states. How do you take CBD? You can mix oil from capsules into food or drinks or eat it as a gummie or chocolate. Many people take it as a tincture generally made from high CBD strains of hemp mixed with 60 to 70 percent alcohol. Tinctures can be measured by a dropper, sprayed under your tongue or massaged into your skin as an oil, topical, lotion or balm; you can even give it to your pet. You can also vape CBD e-juice, specifically designed for that intent. According to Vaping360, "Most CBD vape juice is made of food-grade ingredients and is safe to consume, but not all CBD oil can be vaped—some products are for oral consumption only." Again, remember that CBD products are largely unregulated in terms of safety. Can you fail a drug test after taking CBD oil? If the amount of THC in the product is more than what the label claims, you can fail a drug test. Most drug screening tests look for a compound created by the body when it metabolizes THC. To increase the likelihood that a product doesn't have more THC than claimed, some people look for a manufacturer that can provide a Certificate of Analysis, or COA, for its product. This shows the results of a company's testing for THC, CBD and various contaminants. What are possible side effects? According to Mayo Clinic, "CBD use also carries some risks. Though it's often well-tolerated, it can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications you're taking, such as blood thinners." Again, the challenge with CBD products is that the FDA has not substantiated the potential benefits or the risks, nor informed any regulatory efforts. According to Hazelden Betty Ford physicians, it's a "buyer beware" environment. What's the difference between hemp seed oil and CBD hemp oil? Hemp seed oil and CBD oil are different compounds that come from different parts of the hemp plant. Hemp seed oil is cold-pressed from just the seeds of the plant (along the lines of sunflower seed oil or jojoba oil); CBD hemp oil is extracted from the entire hemp plant. Hemp seed oil contains no CBD and has been available for decades, especially popular in skin care products and smoothies. CBD hemp oil has only been available since the passage of the 2018 Farm Bill. A good way to determine the difference is to look at the ingredients: Hemp seed oil will be listed as cannabis sativa oil. CBD hemp oil will be listed as cannabidiol, full-spectrum hemp or hemp oil. Is it safe? The World Health Organization declared "CBD is generally well tolerated with a good safety profile." It noted that any adverse effects could be a result of interactions between cannabidiol and a patient's existing medications. The report further stated, "In humans, CBD exhibits no effects indicative of any abuse or dependence potential…To date, there is no evidence of public health-related problems associated with the use of pure CBD." However, one significant safety concern with CBD is that it's mainly marketed and sold as a supplement not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. You can't know for sure that the product you buy has the active ingredients listed on the label. Proper dosages have not been determined and known drug interactions are not part of the labeling requirements. According to a 2017 study published in the Journal of the American Medical Association, of the commercially available CBD products tested, only 30 percent were accurately labeled. What are proven health benefits? For many battling epilepsy, Epidiolex, a purified form of CBD oil, is a lifesaver. The prescription was approved by the FDA in June 2018. In approving the first cannabis-derived medicine, the FDA determined that the antiseizure benefits of Epidiolex outweigh any potential risks. Other FDA-approved cannabis-related products include Marinol and Syndros (for use in anorexia and weight loss due to AIDS or to chemotherapy-induced nausea and vomiting) and Cesamet (approved for refractory chemotherapy-induced nausea and vomiting). Although clinical trials are still in the early stages, there's emerging evidence that suggest some strains and dosages of CBD can be effective in the treatment of post-traumatic stress disorder, schizophrenia, psychosis, neuropathic pain, Type 1 diabetes, cancer and cognitive symptoms associated with HIV and Alzheimer's disease. Another area needing more research is cannabinol, or CBN, a cannabinoid believed to be sedating in effect. We asked clinicians at the Hazelden Betty Ford Foundation to discuss cannabidiol and its relationship to substance use disorders. Is CBD addictive? It does not appear to be addictive. The challenge, though, is not knowing that you're purchasing from reputable retailers and suppliers. If CBD includes high levels of THC, that's another story. What are concerns? It's not regulated by the government, so you might be getting a little CBD or none at all. According to the Child Mind Institute, "Products are unreliable in delivering a consistent amount. They could have less, or more, than advertised, and most do not offer independent verification of active contents." Because almost all CBD products on the market are unregulated, you can't depend on the purity or the dosage listed. Very little research has been done regarding how the chemical compound acts on the brain, impacts brain development or affects users long term. Lab testing isn't mandatory for CBD products in every state. If used as a sleep aid, there's a concern you may become tolerant to it. There's little known about drug-to-drug interactions between CBD and other medications, and how they're metabolized by the liver. People want to use it instead of evidence-based treatment, presenting problems in certain situations. Can it be an effective/beneficial method for treating some substance use disorders? Proponents of CBD claim that it's helpful in treating substance use disorders, despite there being no scientific evidence to support that. There are also people who make this claim about marijuana, even though there's also no science to support the use of marijuana for treating addiction. There are actually studies showing it can be associated with a higher risk of developing substance use disorders. Why is taking CBD a potential risk for some people in recovery? The Hazelden Betty Ford Foundation does not recommend the use of CBD for those in recovery unless it is FDA-approved and in a prescribed form. The biggest risk of using store-bought CBD supplements is that it may include THC—despite what it says on the label—and we know THC can be addictive. Generally speaking, the potential benefits of CBD products can be obtained through other, more reliably safe and effective means. Consumers should also use caution when buying over-the-counter CBD products because they may contain contaminants and doses higher than what's indicated on the label, an especially dangerous situation for children. Before trying CBD, talk with a licensed physician about safe dosages, possible adverse interactions with other medications you may be taking and alternatives that may be more effective and safe.