What Consumers Should Know About the Risks and Uncertainties of Over-the-Counter CBD
Over-the-counter cannabidiol, or CBD, products may look familiar and widely available, but their safety and contents are not guaranteed. In its 2023 advisory on CBD’s potential harms, side effects, and unknowns, the Substance Abuse and Mental Health Services Administration (SAMHSA) urged the public to be cautious—particularly when considering CBD products for children.
CBD is sold in oils, foods, beverages, cosmetics, fabrics and other products. A survey cited by SAMHSA found that as many as one in three U.S. adults reported using CBD products in 2020. The advisory emphasizes that products sold outside the prescription-drug system can differ substantially from the formulations studied in clinical research.
Labels may not accurately reflect the amount of CBD in a product, and some products may contain tetrahydrocannabinol (THC), pesticides, microorganisms, heavy metals or other contaminants. THC can cause intoxication, while inconsistent concentrations can make dosing difficult—especially for children who accidentally consume CBD products packaged as gummies, candies or other foods.
Potential health concerns associated with CBD include interactions with prescription medications, liver toxicity, and possible reproductive or developmental effects. These risks do not mean that every CBD product will cause harm, but they do highlight the difference between a commercially marketed product and a medicine that has undergone controlled testing and regulatory review.
The U.S. Food and Drug Administration has approved one prescription drug containing CBD: Epidiolex, which is used for certain rare seizure disorders. As the FDA explains, that approval applies to a specific purified formulation, dose and medical use—not to the many CBD oils, supplements, foods and beverages sold in stores or online. Research supporting Epidiolex also identified risks such as liver injury and drug interactions, which can be monitored in clinical care.
State-licensed cannabis dispensaries may impose testing, labeling and manufacturing requirements that are absent from some general retail channels. Those requirements may make products more consistent within a particular state, but they do not make dispensary products FDA-approved or universally safe. Rules vary by state, and a product’s CBD content, THC content and contaminant controls can still differ. Consumers should not assume that a dispensary product has been evaluated for medical effectiveness.
Related products containing delta-8 THC present additional concerns. The FDA says delta-8 THC products have not been approved for safe use and may contain variable concentrations or chemical byproducts from manufacturing. The agency reported adverse-event submissions involving hallucinations, vomiting, anxiety, confusion and loss of consciousness, as well as thousands of poison-control-center exposure cases, many involving children. Its consumer guidance on delta-8 THC recommends keeping these products away from children and pets.
The practical takeaway is straightforward: treat nonprescription CBD as an incompletely regulated consumer product, not as a proven treatment. People who take prescription medicines, have liver disease, are pregnant or breastfeeding, or are considering CBD for a child should consult a health professional before using it. Parents and caregivers should keep CBD and THC products secured and seek medical help or contact poison control after a suspected accidental ingestion.
