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Within the past decade, cannabidiol (CBD) has become a fixture in the health supplement industry. CBD products are now easily found in retail settings and are associated with health claims ranging from analgesia to cancer prevention, often without scientific evidence to support the claims. Although legislative changes have removed legal restrictions on hemp and CBD, the legal framework within the United States remains complicated. However, despite legal ambiguity and uncertainty, cannabis sales are expected to reach $80 billion by 2030.1

A total of 33 states and the District of Columbia (DC) have legalized the medical use of cannabis; of these, 11 states and Washington, DC, have also legalized the recreational use of marijuana.2 The rapid expansion of over-the-counter CBD products has placed the primary care clinician in a difficult position. Patients routinely ask: “Are CBD products safe? Should I use CBD for my (fill in the blank) condition(s)?” In seeking the answers to these questions, clinicians are often provided with conflicting and confusing guidance.

Cannabis vs Marijuana vs Hemp

Cannabis is a generic term used to describe plants and products made from Cannabis sativa and Cannabis indica. Cannabis has been an agricultural fixture for more than 6000 years.3 Atakan reported in 2012 that at that time cannabis contained more than 400 chemical compounds of which approximately 60 were cannabinoids,3 and these numbers are growing. The 2 most-studied cannabinoids are CBD and Δ-9 tetrahydrocannabinol (THC). Cannabis is the preferred term when discussing medical products. Many medical cannabis products contain greater percentages of CBD than THC, while marijuana — which contains higher percentages of THC — usually refers to cannabis flowers or leaves that are used recreationally. Hemp is a variety of cannabis that has been cultivated for nonpharmacologic use and contains virtually no THC. Legally, hemp cannot contain more than 0.3% THC. Hemp fiber is often used in clothing and other industrial settings.

CBD vs THC

While CBD and THC possess similar chemical structures, their effects are quite different and divergent (Table 1).3-5 Humans have 2 endogenous cannabinoid receptors: cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2). THC activates CB1, which is responsible for its psychoactive properties.6 CBD does not directly act on CB1 and carries a different pharmacologic profile.7 CBD appears to have a neuroprotective effect and mitigates the incidence of THC-induced anxiety, psychosis, and cognitive impairment.8,9