Christopher Froehlich, Catherine J Randall Research Scholar, The University of Alabama
Alan Blum, MD, The University of Alabama Center for the Study of Tobacco and Society


Cannabidiol (CBD) is one of the two main chemical components of marijuana, a plant that contains more than 100 identified compounds. Unlike its psychoactive counterpart, delta-9-tetrahydrocannabinol (THC), CBD does not cause a “high”. Popular demand for CBD-containing products has been driven by personal testimonies on social media attesting to the chemical’s usefulness in treating pain, anxiety, depression, cancer-related symptoms, high blood pressure, and neurological conditions, starting around 2018.1 The increasing variety of CBD products includes lotions and bath bombs for skin care, oils and creams for pain, tinctures for anxiety, and gummies for relaxation. In this same time period, cases of electronic vaporizer related lung illnesses appeared. Many of the illnesses involved products containing THC or CBD (e-cannabis). This poster is a companion to Myths and Realities of Medical Marijuana (link).

CBD Production

  • Hemp: Hemp comes from the plant Cannabis sativa, the same species as marijuana. It is grown for its fibrous stalks, not its leaves, and can be used to make textiles and biodegradable plastics. Hemp has low concentrations of THC which are regulated by federal law.2,3
  • Extraction: CBD oil is made by removing CBD from the cannabis plant and diluting it in an edible oil.4
  • Purity: The Drug Enforcement Agency reports that it is not aware of any industrial methods that can entirely separate CBD without contamination from other cannabinoids.5 This is one factor affecting legality and medical approval. Some scientists argue that the combination of multiple cannabinoids is necessary for medicinal benefit.6

Comparing THC and CBD

Cognitive deficits remain days after use 7 Not psychoactive7
Extracts not FDA approved. Synthetic forms are 8 FDA approved to treat some types of epilepsy 8
Neuropathic/palliative pain, CINV, spasticity in MS/SCI 7 Neuropathic/palliative pain, spasticity in MS/SCI 7

CINV= Chemotherapy induced nausea and vomiting. MS= Multiple Sclerosis. SCI= Spinal Cord Injury

Legal Concerns

  • Legality: CBD is regulated under the Food, Drug, and Cosmetic Act. This act prohibits the addition of CBD to foods and the marketing of CBD for health products without approval from the Food and Drug Administration (FDA). CBD may be used in cosmetics if it is listed as an ingredient and does not cause harm.5,9,10
  • Health Claims: The FDA prohibits retailers from making specific health claims about CBD. Retailers inform patients to talk to their doctors about potential uses and risks.9,11
This full-page ad with 40% off coupon code for CBD oil appeared in USA Today

This full-page ad with 40% off  coupon code for CBD oil appeared in USA Today

FDA Warns 15 Companies for illegally selling various products contaning cannabidol as agency details safety concerns

An article from the United States Food and Drug Administration on its efforts to curtail illegal sales of CBD products, fda.gov, November 25, 2019


Industry Value: Consumer sales of CBD products in the US are projected to reach $1.8 billion by 2022, up from $500 million in 2018. By 2025, the industry is projected to be worth $23 billion. 12

This business advertises CBD manicures and pedicures, with a student discount, on Tuscaloosa Transit Authority busses.


  • Drug Interactions: CBD is absorbed by a drug receptor that metabolizes about a quarter of all drugs. 13 This may inconsistently alter the effects of drugs like Warfarin. 13,15
  • Drug Approval: Epidiolex (CBD) is the first drug made of cannabis extracts approved by FDA and is approved to treat two rare and severe forms of childhood epilepsy. 8
  • Possible Benefits: Outside of the approved uses, more research is needed. Studies demonstrate potential use in the treatment of insomnia and anxiety. 16 Animal trials show benefits in the treatment of inflammatory pain, such as pain from arthritis. 17

E-Cigarette, Or Vaping, Product Use-Associated Lung Injury (EVALI)

Lung Illnesses: THC was found in 75% of products used by patients with EVALI and 94% of patients. Vitamin E acetate, which may cause toxicity in high concentrations, was found in 94% of patients. CBD was not consistently found. Until more is known about these illnesses, the CDC recommends avoiding THC-containing e-cigarettes and unlicensed tobacco-containing e-cigarettes. 18


CVS’s website sells CBD products in their personal care department’s

CVS’s website sells CBD products in its personal care department’s alternative care section. At the top of the webpage, the company lists states that products can be shipped to and provides a link to information about third party testing of CBD products.

CBD stores in Johnston, RI, placed an ad for free CBD samples at this bus stop

One of the two CBD stores in Johnston, RI, placed an ad for free CBD samples at this bus stop, outside a dollar store and discount grocery store.

This stand at Baltimore Washington International Airport sells CBD lotions, muscle and joint creams, lip balms, face masks, and more.


Although there appear to be risks associated with the vaping of CBD, the topical use of CBD and the ingestion of CBD-containing products appear to be safe. The biggest risk facing consumers may be spending money on products that do not provide the health benefits touted by manufacturers.


  1. Williams A. Why is CBD everywhere? New York Times. 2018 Oct 28:Sect. ST:1
  2. Congressional Research Service. Defining hemp: A fact sheet [Internet]. 2019 Mar 22. Available from: https://fas.org/sgp/crs/misc/R44742.pdf
  3. Rubin R. Cannabidiol products are everywhere, but should people be using them? 2019 Nov 20;322(22):2156–58. DOI:10.1001/jama.2019.17361
  4. Hazekamp A. The trouble with CBD oil. Karger. 2018 Jun 12;1:65-72. DOI: 10.1159/000489287
  5. Drug Enforcement Administration. Establishment of a new drug code for marihuana extract [Internet]. 2016 Dec 7. Available from: https://www.federalregister.gov/documents/2016/12/14/2016-29941/establishment-of-a-new-drug-code-for-marihuana-extract
  6. Centrifugal partition chromatography’s new use: medical marijuana [Internet]. Nature news. Nature Publishing Group; 2018 [cited 2020Mar20]. Available from: https://www.nature.com/articles/d42473-018-00066-4
  7. Kilmer, J. Cannabis/Marijuana in the college setting: Emerging science and implications for prevention. 2020 Mar 25.
  8. Gaston TE, Szaflarski M, Hansen B, et al. Quality of life in adults enrolled in an open-label study of cannabidiol (CBD) for treatment-resistant epilepsy. Epilepsy Behav. 2019 Jun;95:10-7. Available from: https://doi.org/10.1016/j.yebeh.2019.03.035.
  9. Food and Drug Administration. FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns [Internet]. 2019 Nov 25. Available from: https://www.fda.gov/news-events/press-announcements/fda-warns-15-companies-illegally-selling-various-products-containing-cannabidiol-agency-details
  10. Food and Drug Administration. FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD) [Internet]. 2020 Mar 11. Available from: https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
  11. CBD Center of RI [Internet]. About CBD. [cited 2020 Apr 2] Available from: https://cbdcenterofri.com/about-cbd/
  12. Mikulic M. Total U.S. cannabidiol (CBD) consumer sales from 2014 to 2022. Statista [Internet]. 2019 Aug 9 [cited 2020 Apr 2]. Available from: https://www.statista.com/statistics/760498/total-us-cbd-sales/
  13. Government of the District of Columbia Department of Health. Medical cannabis adverse effects & drug interactions. Washington, DC: The Department; Available from: https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Cannabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf
  14. Yamaori S, Koeda K, Kushihara M, et al. Comparison in the in vitro inhibitory effects of major phytocannabinoids and polycyclic aromatic hydrocarbons contained in marijuana smoke on cytochrome P450 2C9 activity. Drug Metab Pharmacokinet. 2012;27(3):294‐300. DOI:10.2133/dmpk.dmpk-11-rg-107
  15. Grayson L, Vines B, Nichol K, et al. An interaction between warfarin and cannabidiol, a case report. Epilepsy Behav Case Rep. 2017 Oct 12. 2017;9:10‐1.  DOI:10.1016/j.ebcr.2017.10.001
  16. Shannon S, Lewis N, Lee H, et al. Cannabidiol in anxiety and sleep: A large case series. Perm J. 2019 Jan 7. 2019;23:18‐041. DOI:10.7812/TPP/18-041
  17. Hammell DC, Zhang LP, Ma F, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain. 2016 Jul;20(6):936‐48. DOI:10.1002/ejp.818
  18. Hollingsworth, H [Internet]. Waltham, MA: UpToDate; c.2020. E-cigarette or vaping product use associated lung injury (EVALI). 2020 May 26 [cited 2020 Jun 4]. Available from: https://www.uptodate.com/contents/e-cigarette-or-vaping-product-use-associated-lung-injury-evali?search=cbd&source=search_result&selectedTitle=8~41&usage_type=default&display_rank=8