CBD has been in the news in the last few years as the new elixir. It is marketed as pills, food, CBD-infused cosmetic products, and dietary supplements, and promoted as the miracle cure for several diseases. CBD manufacturers describe the compound as having antidepressant, anti-anxiety, analgesic, and anti-inflammatory properties; and many swear by these effects. But the question is: Is this real or just hype?
CBD, short for Cannabidiol, is the second most abundant active ingredient in the cannabis plant. CBD is a component of the hemp plant and marijuana; however, unlike marijuana, which contains 5-20 percent tetrahydrocannabinol (THC), the hemp plant contains no more than 0.3 percent of THC. Unlike THC - the main psychoactive compound in cannabis - CBD does not cause a “high”; hence, it has no potential for abuse or addiction.
CBD manufacturers leverage this quality of CBD and the fact that it is natural to market and romanticize several unapproved products with so many medical claims - most of which are largely based on anecdotes and animal studies.
Currently, there is only one FDA-approved CBD drug – Epidiolex. This medication has strong scientific evidence for its effectiveness in treating two severe childhood seizure disorders: Dravet syndrome and Lennox-Gastaut syndrome. In three randomized, double-blind, controlled clinical trials, this medicine was found to lower the frequency and severity of seizures in children with either disease.
While we may not hurry to dismiss the claimed benefits of CBD in treating other conditions, clinical evidence supporting these is lacking and more human studies are required to substantiate these claims.
Again, as a result of the insufficiency of research data, determining what dose of CBD is right or toxic for treating a condition may be far-fetched.
The paucity of evidence is not the only downside to the CBD buzz, the fact that their production is unregulated is another cause for worry. Although the FDA has prohibited the production and sale of CBD, its regulatory activity for CBD has been limited over the years. This begs the question of the safety of these products.
A 2017 study published in the Journal of the American Medical Association (JAMA) found that only about 30 percent (26 of 84) of samples of CBD oils, liquids, and tinctures purchased online contained the exact concentration of CBD printed on their labels; several of them contained more and about 25 percent of them contained less.
Furthermore, while pure CBD does not have any psychoactive effects, some of these CBD products were found to contain THC - contrary to claims on their labels - which could lead to impairment, intoxication, and positive drug tests. There are also reports of CBD products potentially containing other contaminants, such as heavy metals, at unsafe levels.
These pose great concerns for employers in permitting CBD use in the workplace. Other than Epidiolex, an employee has no guarantee about the safety, efficacy, and content of CBD products on the market. Consequently, employers need to educate employees about these problems and the legal implications of positive test results for THC - which may occur with the ingestion of CBD products containing significant amounts of THC.
In light of this, should employers allow CBD use in the workplace?
The 2018 Farm Bill creates some ambiguity in this regard. The bill removes hemp-derived products from its Schedule 1 group of drugs, describing “hemp” as the Cannabis sativa plant and any component of the plant, including seeds and all derivatives, extracts, cannabinoids, etc., with a THC concentration of not more than 0.3 percent on a dry weight basis.
This THC concentration distinguishes hemp from marijuana, which is still unlawful. Conversely, the use of hemp-derived CBD is now legal in every state of the country; this creates some confusion for employers in creating policies for CBD use in the workplace.
Since current drug testing methods cannot tell if a positive result was triggered by a hemp-derived CBD product (which is federally legal) or marijuana-derived CBD product (which is federally illegal), it may be implausible to tell if an employee’s claim to using pure CBD is truthful.
Employers, therefore, have to walk a fine line: employers should examine the laws in their states before taking any step. A reasonable step to take, however, is to update workplace drug-use policies to address CBD use; this includes whether or not to use it, how to use it, when to use it and for what medical conditions to use it.
Furthermore, employers should revise their drug-testing policies to address the following concerns regarding CBD:
- Expectations of employees
- An evidence-based rationale for drug testing
- Consequences of a positive drug test including termination, suspension, or refusal to hire.
- Response to claims of false-positive results.
For federal employees, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention’s Division of Workplace Programs notes that “there is no legitimate medical explanation for a marijuana-positive test result other than a verified prescription.”
This implies that all federal agencies must inform applicants and employees of the risk of CBD products in yielding a positive marijuana test. As a result, several federal departments including NASA, the Department of Defense, and the Navy have prohibited their members from using CBD products.
By and large, the onus lies on employers to educate employees about the use of CBD. Currently, evidence supporting these purported health claims of CBD products is lacking, so employees should know what they are consuming. For employees who choose to use CBD, it is best to consult with a physician before they purchase one.