The ABC’s of CBD: The Basics of CBD Oil

"Nothing gives them that rise and shine, get up and go feeling more than cocaine!"

Believe it or not, in the 1880s it was not uncommon to see advertisements marketing the use of cocaine in children to soothe their colic or give them energy and alertness. Today, cocaine is a banned substance with overwhelming amounts of scientific evidence written about the short- and long-term risks of its use. But at one point in time, it was a popular item sold on the streets in the form of tonics, elixirs, and cough drops.

As history has shown us before, there may be risks associated with the use of these so-called miracle “cure-all” drugs. More likely than not, you’ve probably seen multiple online advertisements, read social media posts, or have heard from online commenters about using cannabidiol oil, aka CBD oil. People have talked about using it for a wide variety of ailments, such as chronic pain and seizures, but also for clear skin or weight loss. While everyone may have different opinions or views on CBD oil and its use, this article will cover the basics about CBD oil including what it is and whether it’s legal to be purchased or used in Iowa.

So what are cannabinoids? Is that marijuana?

The umbrella term “cannabinoids” is used to denote the chemicals that are related to delta-9-tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana. The marijuana plant itself contains more than 100 types of cannabinoids. To clarify, the FDA has not recognized or approved the marijuana plant itself as medicine. They have only approved the scientific study of two main cannabinoids from marijuana, THC and cannabidiol (CBD). As of right now, there are two drugs approved by the FDA which DO contain THC: dronabinol and nabilone, used for treating chemotherapy-induced nausea and improving appetite in patients with severe weight loss from AIDS. The FDA has also approved a CBD-based liquid called Epidiolex to treat two rare, severe types of childhood epilepsy: Dravet syndrome and Lennox-Gastaut sydnrome.

If the FDA approved Epidiolex, doesn’t that mean that CBD oil is approved?

Unfortunately, no. Following the approval of Epidiolex, the FDA was quick to issue a disclaimer on the approval of the CBD-based liquid. “This is an important medical advance. But it’s also important to note that this is not an approval of marijuana or all of its components. This is the approval of one specific CBD medication for a specific use. And it was based on well-controlled clinical trials evaluating the use of this compound in the treatment of a specific condition.”

I’ve heard people say that marijuana is an herbal medication, so why can’t I buy it?

Some sites and sellers have promoted CBD oil as an herbal medication, however it is important to note that the FDA does not recognize substances with THC or CBD as dietary supplements and they cannot be sold as such. Most ingredients or products that are sold or marketed as dietary supplements do not have to be proven safe under the FDA’s satisfaction, but they must be labeled as dietary supplements and they cannot be marketed as treatments, cures, or symptom relievers for any specific illness or disease.

Why aren’t products with THC or CBD approved?

Before a drug or medication can reach the market, they must be granted FDA approval. These substances are subject to an intense battery of tests and clinical studies by the FDA to ensure their safety and efficacy. Simply put, a medication must be able to do what the manufacturers say it can do, be just as effective if not more effective than any currently available treatments on the market, and while all drugs have side effects, the risks of the medication must be evaluated and mediated if possible. The FDA has cited difficulties with the approval of products containing THC or CBD due to the variability in the amount of THC or CBD in each individual product, as well as a lack of evidence and scientific scrutiny due to the nature of the product as an illegal substance and drug of abuse.

What are the biggest concerns and risks associated with marijuana use?

THC is a psychoactive agent, and multiple scientific studies have looked at the association between marijuana use and development of psychosis. Research has shown that increased marijuana use has been associated with increased rates of violence, development of psychiatric disorders such as schizophrenia, and people with cannabis-induced psychosis makes up a noticeable portion of emergency room patients in states such as Colorado where recreational marijuana is legal. Marijuana has also been found to affect brain development, especially in younger people where long-term marijuana use may result in impaired thinking, cognitive functioning, and memory. Short-term effects of marijuana may be harmful as well, including its effects on breathing, motor movement, and increased heart rate or blood pressure.

What is hemp? Is it the same thing as marijuana?

Hemp and marijuana are two distinct plant species, although they belong to the same family of Cannabis sativa plants. Compared to marijuana, hemp has relatively lower levels of THC and greater levels of CBD, meaning that it produces less psychoactive effects than marijuana. Hemp has been used in the production of a wide variety of goods, including fibers, textiles, paper, cosmetic products, and food.

Is hemp legal?

Under the federal government and the FDA it is legal if it does not contain more than 0.3% THC. Anything above that and it falls under the marijuana ban.

Is hemp or hemp oil legal in Iowa?

The Iowa Senate has passed the Iowa Industrial Hemp Act, but it still needs to be passed by the House. If passed, it would allow Iowa farmers to register their fields and plant hemp but would most likely require regular testing to make sure that their hemp does not exceed the 0.3% THC allowable limit. CBD from hemp would then be legal to be used in products but cannot be used to produce medicinal marijuana. Hemp oil is illegal in Iowa. However, federal law has recognized hemp seed oil as “Generally Regarded As Safe” meaning that it can be marketed in products without requiring approval, but these products must still comply with all the requirements regarding dietary supplements and cannot make disease treatment claims.

Is medical marijuana allowed in some states?

Yes. Some states have fully legalized marijuana so it can be used both medicinally and recreationally, whereas some states have only allowed medicinal use. There are also states that have not allowed for any use of marijuana at all, recreationally or medicinally. Each state has their own rules and regulations about what is and isn’t allowed, so doing your research is always a good idea.

Will the federal government arrest me for using medical marijuana, even though it’s legal in my state?

No, and there’s a law that prohibits them from doing so. The Rohrabacher-Farr amendment signed in 2014 prohibits federal prosecution of individuals who comply with their state’s medicinal cannabis law. If you are using medicinal marijuana in a state that allows it and properly following the law in the state, the federal government cannot punish you.

Is medical marijuana legal in Iowa?

In Iowa, medical marijuana is legal but there are several requirements that patients must meet. First, the patient must be over the age of 18 (or have a primary caregiver if they are under 18), they must prove permanent Iowa residency, and must have a qualifying medical condition such as cancer or intractable epilepsy. For a full list of qualifying conditions, you can visit the Iowa Department of Public Health’s webpage here. Patients must visit their physician who completes a certification form that states that the patient does have at least one of the qualifying conditions. Patients or their primary caregiver must then apply for a registration card and pay an associated fee. Once the card is issued, they can purchase medical marijuana products from a certified dispensary in Iowa. Currently, they are in 5 locations: Sioux City, Council Bluffs, Windsor Heights, Waterloo, and Davenport.

What medicinal marijuana products are available in Iowa?

Per Iowa Law, products cannot contain more than 3% of THC. The law allows for oral, topical, nebulizable, and suppository forms of medical marijuana. Right now, MedPharm Iowa is the only licensed company that can grow marijuana and produce medications from them. Their website has a list of their products that are available for sale, which you can find here.

I live in Iowa, and I’ve seen some stores that sell CBD oil. Is that legal?

Under Iowa law, if the products are being sold by a store that has not been granted a cannabis-dispensing license by the state, those products are illegal. Additionally, only people with an approved registration card can purchase CBD products. Otherwise, the buying, selling, or using of these products is still illegal.

What’s your recommendation on CBD oil? Should I use it?

There is research that is still being done on CBD and THC and their potential benefits or harms for use in patients, so that’s a hard question to answer in regard to the general population. If you are a patient or the primary caregiver of a patient who is suffering from a qualifying condition in which the use of medical marijuana could be used for, your doctor or care provider would be a good resource for determining the risks or benefits of using medical marijuana. Every patient may have differences in their individual conditions or characteristics, so it’s never a bad idea to gather more information to make the best decision for your health or the health of your loved ones.

Co-Authors: Jinny Guo, PharmD Candidate 2019, Matti Mason, PharmD Candidate 2020