CBD seems to have seeped into everything.
With advocates hailing it as a cure-all for ailments from A to Z, it comes in bottled water, chocolate, tea, candy, coffee, dog treats, bath bombs, even mascara products.
And you can find it pretty much anywhere. A simple web search will bring up plenty of local smoke shops, pharmacies, wellness centers and other stores that carry CBD products. The MacArthur Center in Norfolk will become host to a seller _ the CBD Shoppe.
But while CBD is easy to find, clear information about what it is, what it does and even whether it's legal is much more elusive. It's caught in a hazy tangle of regulations, some of them contradictory, and claims about its effectiveness. Amid the confusion, at least one local law firm has created a new hemp and medical marijuana practice.
Lawmakers, regulators, physicians, business people and consumers all are trying to figure out how to regulate, sell and use this natural substance that comes from hemp and marijuana plants.
WHAT IS IT?
CBD is short for cannabidiol, a chemical compound found in cannabis plants _ both hemp and marijuana. Unlike the chemical compound THC, which also is found in those plants, CBD does not induce a "high." The main difference between marijuana and hemp is the amount of CBD and THC in the plants — if it has more than .3% of THC, it's a marijuana plant.
CBD often is sold as an oil, but it is a chemical compound, not an oil that's extracted from the plants, like olive oil.
The CBD products on store shelves that anyone has access to are supposed to have CBD extracted from hemp plants. If they contain CBD from marijuana plants, they're illegal. Some of the confusion comes from the fact that other states allow medical marijuana products with CBD on stores shelves.
WHAT IS IT USED FOR?
CBD is hailed by many as a wonder drug that can treat depression, anxiety, seizures and other conditions. Some have even said it can cure cancer. None of these claims are backed by scientific evidence.
You don't need a prescription to buy CBD products. They are easy to obtain, but what do you do with them?
Rita Woods wants to point interested users in the right direction.
She and her daughter, Sophia Woods, opened Hemp House Wellness in Virginia Beach last year. The CBD boutique sells a wide range of products, such as oils, rubs, tea and dog treats.
"We've been doing this for a while, and our intention is to set a very high bar in terms of education as much as anything," Rita Woods said. "People were not seeking it out when we first started. It was something we were ahead of the curve in recognizing the potential benefits which could come with incorporating CBD."
Woods and her husband, Ron, have owned the Olde Towne Drug Center Pharmacy in Portsmouth since the 1980s. He's a pharmacist and she used to work in supply-chain operations for the textile industry. Sophia was recently offered a fellowship related to the hemp industry, Rita said.
"I really knew what to look for because of that prior experience," she said of understanding the quality of seeds, how they're processed and issues to look for in manufacturing.
The federal Food and Drug Administration does not have guidelines, yet, for putting its stamp of approval on CBD products. Regulation and oversight is mostly left to manufacturers and sellers, so consumers can't be sure that they're getting what a product label says.
The FDA has tested certain CBD products and found that some do not contain the level of CBD they claim. It began issuing warning letters to companies in 2015. So far this year, letters have been sent to four companies: Massachusetts-based Curaleaf Inc., New Jersey-based Advanced Spine and Pain LLC, Washington-based Nutra Pure LLC and Florida-based PotNetwork Holdings Inc. Only one company was issued a warning letter in 2018.
Rita said she has a thorough vetting process for products she considers selling, including requiring detailed information on extraction methods and lab tests that show what is contained in the product, as well as any potential pesticides or solvents. Even the source of where the hemp is grown, down to the state, is an important factor.
"Oregon, Colorado and California are highly regulated states because they have been in the industry for so long. Kentucky also has a large hemp industry" she said. "I'm not looking for European seed because it's not going to be tied to what the FDA is doing for the U.S."
The Woods are also careful with how they market the products in their shop. On the shop's website, the language is worded to avoid making any claims about what CBD can do and states that "none of our manufacturers make claim to curing, treating or preventing any diseases."
Instead of making claims, Rita explains differences they have seen in customers with autism, seizures, anxiety and other conditions. One customer's son, who has Tourette Syndrome, began to see a decrease in seizures and tremors within just a few days of using a CBD product, Rita said.
"You find it (CBD) everywhere, and not all CBD is the same. That's the part where the awareness has to come through," she said. "CBD will get a bad rap if people are not using a quality product that really is what it says it is."
Shop staff never tell patients to come off their medications and only say that a specific product may make a shift in how they're feeling instead of making any medical claims, she said.
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"That's not the role we're playing here. If anything, we're encouraging our clients to be very open with their clinicians because that's how they're going to be really current with what's happening in terms of the difference it might make and make adjustments accordingly."
Their motto of sorts is "start low and slow" when trying a product. But that leaves figuring out dosage to the customers.
"That's for them to figure out, not for us to tell them. These are not researched products with specific doses that are tied to research," she said. "The clients are the researchers and the research-ees."
CBD products put doctors in a tough spot. More and more patients are eager to use them, but there are no definitive benefits and many questions about dosage, drug interactions, potential liver damage, unregulated manufacturing standards, and little to no information on long-term and short-term effects.
Children and pregnant women who use CBD products are especially at risk of adverse effects, said Dr. Christopher Holstege, chief of the Division of Medical Toxicology at UVA Health and director of the Blue Ridge Poison Center.
CBD affects neurochemicals in the brain, and its impact on growth and development in children and fetuses isn't known.
Virginia's allowance for registered patients to use medical marijuana extracts from state-approved dispensaries makes it even more of a sticky situation.
"How does that play with the federal government if I'm prescribing this? That's not clear either," Holstege said. "It gets challenging for clinicians as well. It gets confusing for the clinicians on where they fall in this. You don't want to lose your license."
Natural cure-alls have waxed and waned in the public imagination many times before.
"From a medication standpoint," Holstege said, if there is a potential for complications for it, I'm not sure why I would want to put it into my body. Being natural does not mean it equates with being safe."
He expects CBD research to increase now that regulations have eased up on hemp, but it could take years before enough date is collected to support regulations.
Bottom line: Holstege wouldn't recommend using CBD yet.
"The federal government is there to make sure that we're getting products safely. This is one we're all watching with a lot of interest because this is the new fad right now," he said. "I wish there were substances out there that can cure anything."
WHAT ARE THE LEGAL ISSUES?
Anyone can get their hands on CBD, but how do you know whether it's legal?
An important distinction is whether the CBD comes from marijuana or hemp. Marijuana is still considered illegal by the federal and Virginia state governments, but the state allows patients to use CBD derived from the plant as long as they have certification from a physician and are registered with the state for prescriptions _ referred to as affirmative defense.
But none of the five pharmaceutical processors which were chosen to grow, cultivate and process medical marijuana in Virginia have opened yet. New York-based Columbia Care, which will operate a dispensary in Portsmouth, expects to open by November.
Hemp-derived CBD is technically not illegal since the passage of the federal 2018 Farm Bill was passed. But it's illegal for sellers to market the products as dietary supplements or promote them as being able to treat, cure, diagnose, mitigate or prevent any disease or condition. In a July letter sent to Virginia industrial hemp processors, the Virginia Department of Agriculture and Consumer Services stated that Virginia Governor Ralph Northam's administration directed the department to treat hemp-derived extracts as approved food additives and require food safety inspections of processors.
Even so, CBD-infused food and beverages for interstate commerce are illegal under federal law. But Virginia's state law allows them. So are shops that sell food and beverages containing CBD following state law but breaking federal law?
"That's a simple question with a complicated answer," said Jonathan Gallo, an attorney with Norfolk-based law firm Vandeventer Black.
The intended use of the product and how it is labeled and marketed are the main concerns of legality.
The FDA declined several interview requests from The Virginian-Pilot.
"As is the case in a lot of things, the law is slow to react, so there appears to be some differences there (between the state and federal laws)," Gallo said. "So it'll be interesting to see what happens ... The issue is that it takes a while to create regulation. It has to be written and reviewed."
Gallo and attorney Anne Bibeau head a new hemp and medical marijuana practice that was created by the Norfolk law firm this year. Gallo was previously employed at the New Hampshire Department of Health and Human Services and was on a team which implemented the state's first therapeutic cannabis program after three years of developing program regulations, application processes, selection and licensing of medical cannabis dispensaries.
"We had to write the regulations because there were no regulations. It was a clean sheet of paper," he said. "The cannabis industry is growing exponentially and the businesses are going to need legal counsel just like other businesses."
There have been a few inquiries for the practice in the last few months and Gallo said he expects them to increase. But the lack of regulations makes his job more difficult.
"If the law is not set, it certainly makes it more challenging to provide guidance to clients and it's going to continue to change," he said. "So that is why we have to keep abreast of everything that's going on, which we do, to make sure we give our clients the best service possible."