Overview
Cannabidiol (CBD) is one of over 100 cannabinoids found in Cannabis sativa plants, distinct from THC (tetrahydrocannabinol, the psychoactive component). CBD is non-psychoactive (doesn't produce "high") and has gained massive popularity for anxiety, pain, and sleep despite evidence quality varying dramatically by application.
Primary applications focus on anxiety reduction (moderate evidence), chronic pain management (mixed evidence, often better with THC), sleep support (limited direct evidence), epilepsy treatment (strong evidence for specific rare forms - prescription Epidiolex for Dravet syndrome and Lennox-Gastaut syndrome).
Evidence quality is strong for specific epilepsy forms (prescription Epidiolex), moderate for anxiety and pain, preliminary for most other claimed benefits.
Safety is generally good at typical doses (25-100 mg daily) with minimal side effects, though drug interactions exist (particularly medications metabolized by CYP450 enzymes), and unregulated products might contain contaminants or inaccurate CBD levels.
What it means
Non-psychoactive cannabis compound - won't get you high. Best evidence: epilepsy (FDA-approved Epidiolex for rare seizure disorders). Moderate evidence: anxiety (25-75mg helps some people). Weak evidence: sleep, pain (works better with THC). MAJOR problems: products rarely contain labeled CBD amount, some have illegal THC levels, can fail drug tests. If buying, demand third-party COA (certificate of analysis). Typical dose: 25-100mg daily.
Mechanisms and Evidence
CBD mechanisms are complex and not fully elucidated. Unlike THC which binds CB1 receptors (producing psychoactive effects), CBD has low affinity for CB1/CB2 receptors but modulates endocannabinoid system indirectly.
Additional mechanisms: serotonin 5-HT1A receptor agonism (might explain anxiolytic effects), TRPV1 receptor activation (pain, inflammation), GPR55 antagonism, and modulation of calcium signaling.
Anxiety
For anxiety, human trials show 25-75 mg reduces anxiety before public speaking and in social anxiety disorder. A Brazilian study found 300 mg acutely reduced anxiety during simulated public speaking. Chronic doses (25-75 mg daily) are used by consumers though rigorous trial data at these doses is limited. Effects appear dose-dependent with inverted U-curve (very low and very high doses less effective).
What it means
Anxiety sweet spot seems to be 25-75mg daily. Too little or too much (300mg+) less effective. Public speaking study: 300mg one-time dose reduced anxiety significantly. Your mileage will vary - individual response is highly variable.
Pain and Sleep
For chronic pain, evidence is mixed. Some trials show modest pain reduction in chronic conditions (arthritis, neuropathic pain) while others show minimal benefits. Often combined with THC for pain (which has better evidence than CBD alone).
For sleep, limited direct evidence - anecdotal improved sleep might be secondary to anxiety reduction vs direct sleep-promoting effects.
Product Quality Crisis
CRITICAL QUALITY ISSUE: Studies show 70%+ of online CBD products contain less CBD than labeled, contain THC above legal limits, or have contaminants (pesticides, heavy metals, solvents). Choose third-party tested products with certificates of analysis (COAs) from reputable labs.
What it means
The CBD wild west: most products are mislabeled junk. 70%+ don't contain what the label says. Some have illegal THC levels (hello, failed drug test). ONLY buy products with recent third-party COA showing actual CBD content and purity. No COA = don't buy.
Drug testing concerns: Some CBD products contain trace THC which might accumulate with chronic use, potentially causing positive drug tests for marijuana. If subject to drug testing, use pure CBD isolate (0% THC) rather than full-spectrum products.
Dosing and Safety
Dosing varies widely: 25-75 mg daily for anxiety or general wellness (consumer typical). 100-300 mg for acute anxiety or pain. Much higher (hundreds of mg) for epilepsy under medical supervision. Start low, increase gradually.
Drug interactions: CBD inhibits CYP450 enzymes (particularly CYP3A4 and CYP2C19), potentially increasing blood levels of medications metabolized by these (anticoagulants, antidepressants, benzodiazepines, immunosuppressants, many others) - consult doctor if on medications.
Side effects generally mild: fatigue/drowsiness, diarrhea/GI upset, dry mouth, and appetite changes. Medication interactions most concerning.
Pregnancy/breastfeeding: safety unknown, avoid.
CBD regulatory status is complex - legal federally in US if from hemp (<0.3% THC) but state laws vary. FDA approval only for Epidiolex (epilepsy).
CBD shows promise for anxiety and pain with good safety profile, but evidence quality varies significantly by application, product quality is inconsistent, and realistic expectations are needed given marketing hype.
References
Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836.
Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017;318(17):1708-1709.