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CBD for Your Anxiety: Ethical Concerns

By Ashwini Nagappan

In the past year, cannabidiol (CBD) products have flooded the consumer marketplace, with products such as oils, CBD-infused food, and animal products. The Agriculture Improvement Act of 2018, also known as the Farm Bill, descheduled hemp, facilitating CBD’s introduction to mainstream popularity. So, what is CBD?

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The Cannabis sativa plant contains over 500 components, including over 100 different cannabinoids that can bind to cannabinoid receptors and result in neurotransmitter release in the brain. Tetrahydrocannabinol (THC) is the most well-known cannabinoid, with cannabidiol (CBD) trailing behind of late. Although both derive from the same plant, a characterizing difference between the two is that THC is psychoactive, whereas CBD is not. Rather, CBD has other touted effects such as relieving anxiety and improving quality of sleep. Although both hemp and marijuana derive from the same Cannabis sativa family, hemp contains a low concentration of THC and high concentration of CBD, and thus it is not psychoactive. Marijuana, on the other hand, contains a high concentration of THC and a low concentration of CBD.

Perhaps CBD is popular because it carries some of the hyped effects of marijuana without the high sensation and the socially stigmatized history of marijuana. Perhaps it is popular because it is the next big thing in “fad seeking culture.” Or maybe it is because it can become a new staple of “wellness culture.” Whatever the factors may be for its popularity, most importantly to note, By the end of 2018, the CBD market was valued at about $591 million, with projections to grow to approximately $20 billion by 2024.

While the popularity of CBD amongst consumers increases, there are no clear regulations or standards for those who sell CBD products because the FDA is waiting to release a “sound, science-based” policy. Until then, consumers are purchasing products with little to no regulatory oversight. Why are consumers purchasing CBD? Where are they purchasing CBD from? Are there any safety concerns associated with CBD products? This post aims to answer these questions and highlight the need for immediate regulations.

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Currently, common anxiety treatments include psychotherapies and prescription medications. That said, there is growing public interest in complementary and alternative medicine (CAM) treatments for anxiety, such as meditation, yoga, and CBD. According to a 2018 study, anxiety ranked number three of the top three clinical conditions for which CBD users reported using it for (with chronic pain and arthritis/joint pain ranking second and third).

However, science has yet to confirm CBD’s benefits for anxiety. While there is preliminary evidence that CBD might help with treating anxiety disorders, the only CBD-containing prescription drug available is Epidiolex, which was approved by the FDA in 2018 for the intended use of targeting the epileptic symptoms of two pediatric syndromes: Lennox-Gastaut’s and Dravet’s. However, although off-label use is legal, in general, the majority of consumers are not obtaining their CBD through a prescription. CBD products can be purchased online, at herb shops, vitamin/supplement stores, pharmacy stores, cosmetic stores, cafes, restaurants, and bars, to name a few. Consumers seeking CBD products to relieve their anxiety have a whole host of unregulated options, and many of these consumers might be purchasing products with questionable safety.

Unlike CBD purchased from a marijuana dispensary, where the standards are high and strict, the quality protection standards for the CBD bought online or at a local store might be nonexistent. Unregulated CBD products may contain toxins and other chemical compounds, which can be harmful to health. In a 2018 study, researchers analyzed the components of nine commercially available cannabidiol e-liquids marketed as “100% natural CBD extracts.” They found that, while all of the e-liquids contained CBD, two contained tetrahydrocannabinol (THC), four contained 5-fluoro MDMB-PINACA (5F-ADB), and one contained dextromethorphan (DXM). The researchers highlight that when the products were purchased, 5F-ADB, colloquially known as Spice or K2, was listed as a Schedule I drug because it has been identified in cases of cardio toxicity, overdose, and death due to its abuse. On the other hand, DXM is an over-the-counter cough suppressant and is not controlled by the CSA. However, if abused in high doses, it can be psychoactive, lending to its street names, Skittles and Robo.

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One study found that repeated use of DXM at high doses can induce anxiety-like behavior in rats. Additionally, articles have suggested that DXM withdrawal symptoms include anxiety. In a 2017 study, researchers analyzed eighty-four CBD extracts sold online, either an oil, tincture, or vaporization liquid, and detected THC in 18 of the 84 samples. If THC is in a product that is not marketed to contain it, people might unintentionally ingest THC. While THC may be anxiolytic, it also might have the opposite effect and induce anxiety.

The purpose of this post is not to discuss the pros and cons of using CBD for anxiety. Rather, it is to call to attention how consumers are purchasing CBD products as an alternative method for their anxiety-related concerns despite there being little supporting evidence that it might help with anxiety. Clinical researchers need to perform high-quality controlled trials to determine the efficacy of CBD for anxiety, the side effects, the dosage, etc.

Additionally, consumers are purchasing these products in an unregulated yet booming market, where some products might contain undesired components that could exacerbate anxiety. The FDA should not wait to release a policy while unregulated products are being sold. If we want to seriously protect the public from unsafe products, we need a range of broader, macro-level regulations as well as narrow, purveyor-level responsibilities.


Ashwini Nagappan is a Research Assistant in the Wexler Lab in the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Ashwini earned her BA in Public Health/Sociology at NYU and is an MBE-candidate at the University of Pennsylvania. Her research interests lie in direct-to-consumer medicine and related emerging technologies. She hopes to continue her education through a PhD in Health Policy with a focus in bioethics.

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Nagappan, A. (2020). CBD for Your Anxiety: Ethical Concerns. The Neuroethics Blog. Retrieved on , from


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