BY ALICE O’LEARY RANDALL AND ELOISE THEISEN (NP)
photo: elsa olofsson
Perhaps you have made the decision to try CBD (which stands for Cannabidiol). Or perhaps you are already using CBD but need some guidance in finding the right CBD oil and products. That is the purpose of this excerpt from Pain-Free with CBD. We want to help you find a CBD product that is safe, high quality, and easy to acquire on a continuing basis.
But we especially want you to be safe. It is likely that you or someone you love is in pain and suffering from one of the 21 ailments covered in chapter 3 of Pain-Free with CBD, and you are interested in using CBD for painful conditions like arthritis, inflammatory bowel disease, or multiple sclerosis. These are complex ailments and require the attention of a doctor, nurse, or other healthcare professional. We encourage you to discuss CBD with the members of your healthcare team because many of these illnesses have a wide variety and large number of prescribed medications, and you want to be certain there are no harmful interactions. It can be hard to discuss CBD products with your doctor because of the stigma attached to anything having to do with cannabis or even natural remedies. Fortunately, the attitudes of physicians are changing as they, too, become educated about the endogenous cannabinoid system.
HOW TO BUY CBD OIL
If you live in a state with a medical cannabis law (or full legalization), you can visit a dispensary to look for and acquire CBD products, although depending upon the state, you may need a doctor’s recommendation to enter the dispensary.
Perhaps the most amazing thing about shopping for CBD is that you can do so from the comfort of your home. Most CBD product manufacturers provide online shopping at their websites. Here you can find a few recommended CBD brands from reputable companies.
You may be thinking, “What about Amazon?” Well, search for ‘CBD oil’ at Amazon, and you might be overwhelmed by the choices. However, these products are actually hemp oil, not CBD extract. In fact, Amazon prohibits sale of any products with cannabidiol (CBD) but does not prohibit searches using the term ‘CBD.’ This should give you a good idea of how the market has blurred the lines between hemp oil and CBD.
Hemp-Derived CBD vs. Hemp Oil
Amazon’s array of CBD products brings us to a very important discussion: the difference between hemp-derived CBD and hemp oil.
The 2018 Farm Bill created a huge “green rush” that is continuing to develop and expand. Hemp is now legal to grow in any state, and products manufactured from hemp can be sold throughout the United States.
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Hemp oil, as opposed to CBD oil, is derived from the stalks and seeds of the hemp plant. It has been available for years in health food stores, where people would purchase it as a food supplement. It is very high in antioxidants, omega-3, and omega-6 but contains a miniscule amount of CBD. Hemp oil is made by pressing the hemp seeds and stalks to obtain the oil.
To achieve any therapeutic benefit, you must obtain CBD oil that is extracted from the leaves of the hemp plant using a solvent and distillation process. There are several processes for CBD extraction, and those who are interested can find plenty of websites that explain the various options for extracting CBD.
In years past, it would require an enormous amount of hemp leaves to extract CBD, and it was not a particularly efficient or economical process. With the recent CBD “green rush,” efforts have been underway to get more bang for the buck. This has entailed modifying the hemp plant to manufacture more CBD while still retaining the THC at less than 0.3 percent. These efforts will continue as long as cannabis remains illegal under federal law.
For those who live in a medical cannabis or fully legalized state, there is another option for where to buy CBD oil and products: cannabis-derived CBD. This means that the CBD is extracted from a cannabis plant rather than hemp. It also means the CBD oil will have THC, although the THC may be at very minimal levels. These CBD oils are normally provided as tinctures with ratios of both compounds. So, for example, you might be able to obtain a 3:1 tincture, which means there are three parts of CBD to one part of THC. There are many different ratios available, some as high as 18:1. In oils with this high level of CBD, the intoxicating effects of THC will be neutralized by the CBD, but THC will still contribute to the overall therapeutic effect. As you may choose to learn, there are some diseases that benefit from the addition of a small amount of THC.
Cannabis-derived CBD is far more efficient and economical. Without the restraint of keeping THC at less than 0.3 percent, which hobbles the hemp farmer, a cannabis farmer can manipulate his or her plants to produce higher amounts of CBD than would normally be produced.
HOW TO CHOOSE CBD OIL: THE RIGHT PRODUCT FOR YOU
As you begin your search for the right CBD product, there are several considerations that will affect your decision. You will discover there are numerous delivery methods, including tinctures, topical preparations, vape pens, transdermal patches, capsules, and edibles. Regardless of delivery method, however, there are considerations that factor into every decision. Some of these factors are simple and straightforward, such as cost. Others will call on you to make a personal decision about the different types of CBD oil available, and it may take a couple of different tries before finding the CBD therapy that is right for you.
Factors for consideration when you buy CBD oil include:
1. Full-Spectrum or Isolate
As you read the labels or packaging information for the CBD products, these terms will likely appear. Basically, they refer to the final product of the extraction process. An isolate CBD product undergoes a process that extracts just the CBD molecules in isolation and then puts those molecules of CBD into a carrier medium of some sort: oil, salve, etc. In full-spectrum CBD, the extraction process captures the CBD as well as other cannabinoids, terpenes, and compounds from the plant. These additional compounds contribute to the entourage effect, which is a theory that cannabinoid compounds work more effectively together rather than in isolation. There is no universally right or wrong choice, and patients will need to experiment to determine which product works best for them.
CBD can come in many forms. A concentrate is a high-potency CBD oil. Concentrates may be referred to as wax, shatter, rosin, and FECO (full extract cannabis oil). These products allow patients to consume large dosages of CBD. The potency of a concentrate ranges from 20 percent to over 70 percent. The potency of the concentration varies depending on what part of the plant was used to process the oil. As you buy CBD oil, keep in mind the following: stalks and stems will produce only small amounts of CBD, leaves have more, and the flowers, or cola, will contain the most CBD. Unfortunately, concentrates are difficult to measure. Since most people tend to eyeball the amount they are consuming, accuracy of the dose is nearly impossible.
3. Speed and Duration
The manner in which the CBD product is used will determine the speed and duration of the effect. Inhalation remains the most rapid way to introduce cannabinoids into the human body. CBD vape pens can provide rapid onset of relief, but that relief may be short-lived compared to CBD capsules, which take time to digest and enter the system but have a longer period of effect. For those who may be concerned about the effects of CBD, transdermal patches offer an interesting benefit because they can be removed, and the effects will dissipate in about 20 minutes. When treating pain, you may discover that a combination of delivery methods and types of CBD oils is preferable—for example, capsules for systemic relief, with a vape pen used to treat breakthrough pain.
4. Ease and Familiarity
If you are new to CBD and still learning how to choose the best CBD oil for yourself, you may have initial feelings of anxiety as you navigate your way through this unfamiliar territory. This is natural. It is important to remember that CBD is safe and nonintoxicating. Delivery methods have vastly improved, and you no longer must smoke CBD in order to obtain relief. If you prefer taking pills, you will find CBD capsules available in varying doses. Tinctures are another option. As you learn more about CBD, this will all become easier.
This is an area that few people initially think of, but it can have a huge impact on how you feel about a product. Not too long ago, before the CBD boom gathered steam, CBD oil was a bit like classic ice cream, with one flavor: vanilla. CBD oil tasted a lot like hemp, which is to say it tasted like mown grass. Some people did not mind, but others were repulsed. As the market began to grow, entrepreneurs realized that flavor was an issue and became more inventive. Currently, many CBD products have flavors such as mint, citrus, and berry. It is important to recognize that most flavored CBD tinctures are made with CBD isolate, not full-spectrum CBD. Manufacturers of full-spectrum CBD have modified their formularies in recent years, and high-quality CBD tinctures now have a more neutral flavor.
For most of us, cost is a consideration. Insurance will not cover the costs of CBD medication, so if you decide on CBD therapy, the costs will be out-of-pocket. This is where understanding the difference between hemp oil and hemp-derived CBD oil is of vital importance. Hemp oil will be significantly cheaper but has no therapeutic benefit because it has no CBD. Exploring your options is important, but do not get fooled into buying hemp oil disguised as CBD oil.
HOW TO TAKE CBD OIL: DELIVERY METHODS FOR CBD
When determining where to buy CBD, it’s important to understand the different forms available and to consider how to take CBD oil. There are essentially four ways to use CBD for medical purposes: oral, inhalation, topical/transdermal, and suppository. Each has its advantages.
1. ORAL INGESTION
CBD can be orally ingested via four methods: capsules, tinctures, edibles, or pastes and concentrates.
Capsules: Capsules are familiar, and many people choose capsule form for their CBD oil. The advantage of capsules is the familiarity of the method and the fact that they will act systemically, delivering a measured dose of CBD to the entire body. Capsules come in many different strengths, and new users should find the lowest strength available. Costs are equally broad.
Concentration: 5 mg and up
Speed: 1 to 2 hours
Duration: 6 hours
Ease of Use: Good
Cost: $30+ depending on quantity and dose
Tinctures: The ongoing renaissance of cannabis as medicine has reignited interest in tinctures, which were once a staple for physicians even as late as the mid-20th century. Today’s entrepreneurs researched original preparations of cannabis in old pharmacopeias and developed modern CBD tinctures based on those preparations. Tinctures can be alcohol or oil based, with oil-based tinctures taking longer for onset. Tinctures have many advantages. Taken properly (hold the drops under the tongue and let them absorb), they can be very fast acting. They are discreet and easy to transport. They can be very effective for breakthrough pain. Use caution, and be sure you are getting hemp-derived CBD, not hemp oil. CBD oil tinctures run a broad gamut in price. You might need your math cap to determine which are the best buys because each website seems to provide different measurements, from ounces to grams, and at different prices. Costs can range from $60 for a half ounce at one website to $139 for 30 ml at another. However, when converting the measurements, these are approximately the same price. Suggestion: Siri or Alexa can be a big help in converting ounces to milliliters or milligrams to grams.
Concentration: 2.5 to 5 mg
Speed: 15 minutes to an hour; oil-based tinctures may take 1 to 2 hours
Duration: 6 to 8 hours
Ease of Use: Moderate
Flavor: Affected by the oil in which the CBD is suspended
Cost: $25+ depending on size of bottle and manufacturing
Edibles: People are intrigued with cannabinoid edibles, and there are, of course, CBD edibles. For those who hate to take pills or tinctures, CBD edibles may be a fun way to take medicine. After all, there are adult gummy daily vitamins and supplements. So, if you are taking CBD oil strictly as a supplement, the edible format may not be bad. In fact, it may ensure that you take the CBD every day. The problem with edibles as a medicinal delivery form is the production, which may not be up to the same standards as those employed by tincture and capsule manufacturers. And gummies are likely to have sugar, which may be a serious problem for some. Additionally, anything you ingest takes longer to reach your bloodstream, and the times can be erratic depending on what else you may have ingested.
Concentration: Normally around 10 mg per edible
Speed: 1 to 2 hours
Duration: 6 to 8 hours
Ease of Use: Good
Flavor: A vast variety
CBD Drinks: CBD is literally everywhere! There are dozens of brands of CBD water, infused sodas, teas (kombucha is a big hit in this category), and beer. Until a few years ago, such concoctions would have been unthinkable because the theory was that cannabinoids could be dissolved only in oil, which is why CBD is so commonly referred to as CBD oil. But new extraction methods have allowed manufacturers to dissolve CBD in water, which has led to these new delivery forms. From a therapeutic delivery perspective, these drinks really are not an option. There are stability issues, and the CBD can leave the liquid and cling to the container’s interior. While this is not the best scenario for someone seeking pain relief, CBD drinks can be a refreshing source of hydration and provide another way to feed your Endocannabinoid system (ECS) and contribute to an overall sense of well-being.
Pastes and Concentrates: Depending on how much CBD you require on an ongoing basis, concentrates or pastes may be an appropriate option for you. These delivery forms can be obtained with CBD content varying from 45 percent to almost 90 percent. This allows for a more economical administration of CBD oil but requires more active involvement of the patient in terms of preparation and administration.
The iconic image of someone smoking a joint to get medical relief from cannabis is still prevalent, but similar to just about everything else, modern technology has provided new answers to old methods.
Vaporizer Pen or E-Cigarette: The terms vaporizer pen (more commonly referred to as a “vape pen”) and e-cigarette are often used interchangeably, but e-cigs are more associated with tobacco smokers. Vape pens allow the user to purchase “pods” of CBD oil that fit on the rechargeable pen. Vaping is much easier on the throat and lungs than smoking a joint. With vaping there is minimal smoke, and it is cooler in temperature and has little to no odor. Many CBD manufacturers will arrange partnerships with vape pen manufacturers so as to simplify pod production. Only buy vape products from reputable manufacturers.
Concentration: Variable; 2 mg and up
Speed: Very rapid onset—a few minutes
Duration: 2 to 3 hours
Ease of Use: Moderate
Cost: $20+ Disposables are an inexpensive way to become acquainted.
CBD salves are a wonderful delivery method for localized pain such as arthritis or neuropathic pain. There are creams that have a smooth texture and salves that are more formidable. Deciding which to use is a personal choice. Some have menthol added, making them similar to Bengay. Simply apply the salve to your aching muscles or joints.
Concentration: Large variety of concentrations ranging from 100 mg to 500 mg of CBD per container
Speed: 10 to 20 minutes
Duration: Several hours—very dependent on site and patient’s overall physical condition
Ease of Use: Good
Transdermal patches are applied to the skin, and the CBD is absorbed into your body. The effects can last for 8 to 12 hours.
Concentration: 10 mg per patch
Speed: 20 minutes
Duration: 8 to 12 hours
Ease of Use: Good
Cost: $12 to $20 depending on potency
A fairly new entry on the CBD market is the CBD suppository, which is a sublingual method. There is very little clinical research about this delivery form, and rectal bioavailability has its skeptics. Nevertheless, this option is available and could be useful in some situations, such as end-of-life care or when certain diseases such as ALS, MS, and cancer become advanced to the point of rendering a patient incapable of ingesting or inhaling CBD.
Concentration: 25 to 50 mg per unit
Speed: 15 to 30 minutes
Duration: 1 to 3 hours
Ease of Use: Moderate to Difficult
Cost: Availability is sketchy and price variable—$50 for 10 on one website
HOW TO IDENTIFY HIGH-QUALITY CBD
It cannot be said often enough: All CBD is not alike. The market is unregulated, so it is advised to proceed with caution. Always know what to look for when buying CBD oil.
The first thing to look for is a listing of ingredients on the label. If there is no list of ingredients, then it would be best to avoid purchasing that or any product from the labeled company. The number one thing to look for when buying CBD oil is the phrase “hemp-derived CBD” on the label. Hemp oil is not the same as CBD oil. The label should specify “hemp-derived CBD,” or it may even say “cannabis sativa (<0.3%).” Beware of any product label that makes a specific claim of being able to “cure” or “heal” when searching for where to buy CBD oil.
2. Brand Transparency
Whether you buy CBD online or in one of the many CBD shops that have been popping up, you want to look for brand transparency. A transparent CBD company will not hesitate to share information about the product, and that information should be immediately available. Do not trust a salesperson’s response of “Oh, I can get that for you. What’s your email?”
The cost of the product does not indicate the quality. Indeed, it is quite the opposite in some cases. Keep in mind that the market is unregulated, and there are charlatans who will gladly charge you 10 times what a product is worth.
WHAT TO LOOK FOR AS YOU BUY CBD OIL
Because the CBD market is largely unregulated, there are no nationwide rules for what should be on a product label, but here are a few things to look for:
1. Amount of CBD in the Item and Serving Size
Normally this will be found in an obvious position on the label. It will typically read something like “600 mg,” which indicates the total concentration of CBD in the container. If you are buying a tincture, capsules, suppositories, or patches, there should be information on the dose per unit. It will say something like “60 capsules with 10 mg CBD each.”
2. Batch Number
Batch or lot number provides the means to access the lab test, and, ideally, one can go to the product website and download the lab test. This is something you are more likely to find in states with medical cannabis laws or on products that come from states with medical cannabis laws. Sometimes it will be found stamped on the bottom of the container.
3. Product Testing
The batch or lot number will lead you to the lab report (or COA—certificate of analysis), which has an enormous amount of data. The information listed will typically include percentage of CBD and other cannabinoids, terpenes (compounds that contribute to the aroma of cannabis), heavy metal screening, pesticide screening, and solvent screening. It is not necessary for you to understand all of these, but it is important that a company provide the analysis.
USING CBD FOR THE FIRST TIME: HOW TO TAKE CBD OIL
So, you have made a product selection and are now ready to use CBD for the first time. If you have used cannabis in the past, you are probably comfortable with using CBD without any reservations. But if you have never used cannabis, aka marijuana, then you may be a bit nervous. This is understandable because of the previously discussed stigma and misinformation. However, you need not be nervous. CBD will not intoxicate you, and there is no high. Just remember, start low and go slow. In other words, start with a low dose and increase slowly.
Deciding on a Dose
Most CBD products such as tinctures and capsules will have recommended doses on the label or packaging. If you have never taken cannabinoids before, you may want to start with half the recommended dose. When taking capsules, always start with one a day for three to five days just to see what effect they may have. Sometimes the other ingredients in capsules can cause complications such as diarrhea.
A CBD BUYER’S GUIDE FOR BUDGET SAVERS
As you have learned, learning how to buy CBD oil and CBD products can be daunting. Move slowly and deliberately to find the product that is best for you. Here are some tips to do so:
1. Determine which form of CBD is best for you—oral, inhaled, or topical—and focus on that method. Do not let yourself be distracted by online ads or ‘helpful’ CBD store merchants who try to steer you toward another method of administration.
2. Use the Internet to comparison shop. Even if you plan to buy your CBD near you locally, it does not hurt to shop around, and the Internet is an easy way to do so.
3. If it seems too good to be true, it probably is. This is an old maxim but a very helpful one when you shop for CBD. Beware of products or websites that use the words cure and heal.
4. Look for companies that offer sample-size product so you can try a product before investing a significant amount of money.
5. Compare apples to apples. In other words, try to standardize the offerings. One company may list 30 ml of tincture. Another may say 1 ounce. They are the same thing. Alexa or Siri can be a big help with conversion math, or you can make use of asknumbers.com.
6. If you are buying CBD oil online, identify a product and company you like and then research the company. Spend some time doing different searches about the XYZ CBD Co., and see what is being said about it on the web.
7. It is okay to say, “No thanks.” If you are undecided or uncomfortable, just say no. There are numerous franchise CBD stores that often offer just one product line of CBD. Do not purchase simply because you are there and the clerk seems nice. Do your homework!
Excerpted with permission from Pain-Free with CBD: Everything You Need to Know to Safely and Effectively Use Cannabidiol, by Alice O’Leary-Randall and Eloise Theisen, published by Rockridge Press. Copyright ©️ 2019 by Callisto Media. All rights reserved.
About The Authors
Alice O’Leary Randall is a senior spokesperson for the medical cannabis movement, cofounded in 1976 with her late husband, Robert C. Randall, the first person in the United States to legally receive medical cannabis. For more than two decades, Robert and Alice worked tirelessly to reform the prohibitions against cannabis. After Robert’s death in 2001, Alice became a hospice nurse and later a grief counselor. She retired in 2012 and reentered the medical cannabis field. She frequently writes and speaks on the issue. Working with Mary’s Medicinals of Denver, she developed the Cannabis Primer series in 2015 and Mary’s Prime time in 2017. She has served on the board of directors for the American Cannabis Nurses Association and the advisory board for United in Compassion, an Australian medical cannabis organization. Her book Medical Marijuana in America: Memoir of a Pioneer was first released in April 2014. Her most recent publication is Mary’s Cannabis Primers Collection: Vol I. Both titles are available on Amazon. Learn more at aliceolearyrandall.com
Eloise Theisen, AGPCNP-BC is a board-certified Adult Geriatric Nurse Practitioner with over 20 years of experience in nursing. Prior to cannabis, Eloise worked for about 14 years in oncology at John Muir. She started her own cannabis practice about in 2014, and she has treated over 6,000 patients using cannabis. In 2018 she cofounded Radicle Health in Walnut Creek, California. Eloise was possibly the first health care partner (HCP) to bring a clinical dosing regimen to the cannabis space and has assembled the knowledge and data to use CBD and cannabis to help with a broad range of conditions and disease, especially those that commonly afflict seniors—pain, insomnia, anxiety, and depression. There are very few HCPs nationally with the same level of expertise and experience. Eloise is the current President of the American Cannabis Nurses Association and will serve as President through 2022. Learn more at radiclehealthcare.com