It seems like everyone is high on CBD oil products these days. The ‘miracle' oil is found in cosmetics, skincare, tinctures, teas, salves, and more, and it promises to alleviate everything from acne and anxiety to arthritis and autoimmune disease. The global CBD oil market is expected to grow at a compounded annual growth rate of 31.08 percent from 2018 to 2022 (Research and Markets). But just how safe and effective are these products, and can they get patients high?

“While the term ‘cannabis' often draws association to marijuana, cannabinoids represent a diverse class of hydrophobic compounds, deriving from plants (phytocannabinoids), animals (endocannabinoids), and even chemical synthetics,” explains Adam Friedman, MD, FAAD, an associate professor of dermatology in the department of dermatology at George Washington School of Medicine and Health Sciences in Washington, DC and the Residency Program Director and the Director of Translational Research.

“Because it was strictly non-medicinal and illegal, marijuana and its derivatives were not always ideal research subjects, but in the 1990s, through the study of this ‘illegal' material, scientists discovered our own endocannabinoid system—a set of receptors, enzymes, and ligands that exogenous cannabinoids, such as marijuana derivatives, utilize to impart their physiologic effects,” Dr. Friedman says.

This discovery helped fuel a huge push to better understand the endocannabinoid system's role in health and disease. “Cannabidiol, or CBD, is one of the major non-psychogenic compounds in the Cannabis sativa plant and as such has garnered much attention as a potential therapeutic agent,” he says. “I think it is important to set the record straight about CBD not being psychoactive, which is why Hemp-derived CBD is legal in all 50 states.”

Patients may not fully grasp this concept straight away, so more explanation may be needed. “In our bodies, there are simply two cannabinoid receptors: cannabinoid receptor 1 (CB1R) in brain and neural cell lines (which is what THC binds to) and cannabinoid receptor 2 (CB2R) in the immune system (which when activated, inhibits inflammation and other activities),” Dr. Friedman explains.

CBD is a CB1r antagonist, a CB2r agonist, and importantly also  a weak TRPV1 agonist (a receptor involved in itch/pain, explaining CBD's ability to also regulate some neural activities), he says. “CBD's action at these receptors regulates skin physiology by being anti-inflammatory, lipostatic, and antiproliferative,” Dr. Friedman says.

CBD Oil: The promise

“CBD has shown tremendous promise in the world of collagen vascular diseases such as scleroderma and lupus,” he says. “In fact there is an oral synthetic cannabinoid derived from THC but made to act like CBD and bind to the CBR2 very strongly called ajulemic acid that has received orphan and fast track status from the FDA for some of these diseases due to significant results in Phase 2 studies,” Dr. Friedman says.

There is also promising evidence supporting the use of CBD in eczematous disorders and acne. “There is impressive in vitro data showing that CBD can inhibit sebum production from stimulated sebocytes and inhibit the prototypical inflammatory cascade from P. acnes stimulated immune cells,” Dr. Friedman says. A single-blinded, split-face study using 3% cannabis seed extract cream (which contained CBD) demonstrated decreased skin sebum and erythema content.

CBD Oil: Choosing the right product/s

There is not a lot of human data—especially on specific brands—which makes recommendations for CBD oil cosmetics or skincare tricky. “It is also important to realize that really CBD works best when combined with its cannabinoid cousins (many of which we don't know how they work), which should also be included during manufacturing,” Dr. Friedman notes.

There is extraordinary variability in quality, for example, based on how the CBD is processed or extracted. “It's not enough to say you're getting CBD or hemp extract, as it could be processed so intensely that the phytonutrients are stripped away,” he says. “I tell my patient to look for whole plant extract on the packaging—the full spectrum of cannabinoids work in concert more efficiently and effectively than one on its own.”

Patients can call the companies and ask what they do to assure accuracy and consistency in products and request any test results. “If a company uses an FDA-registered facility that utilizes good manufacturing practices (GMP), that's a good start,” he says. “Some companies offer a certificate of analysis of any product it sells upon request.” Until these issues are addressed, it is buyer beware. “As there is nothing in the product that will irritate the skin or is a likely allergen, I am all for CBD oil in skincare,” he adds.