A bottle of CBD oil and flower on a white trayShare on Pinterest
Jeremy Pawlowski/Stocksy
  • Topical CBD products are often mislabeled, with some products containing levels of CBD that differ from what’s listed on the label.
  • Other CBD products may contain THC, the main psychoactive ingredient found in cannabis, despite being labeled ‘THC-free.’
  • According to experts, mislabeled ingestible and transdermal CBD products may pose health risks, especially for individuals taking certain medications.
  • Knowing how to identify a trustworthy CBD manufacturer can help consumers inform their decisions when purchasing CBD products.

CBD (cannabidiol) is often marketed as a cure-all, but most products are unregulated.

In fact, the Food and Drug Administration has approved only one CBD product, Epidiolex, for the treatment of seizures associated with two rare and severe forms of epilepsy: Lennox-Gastaut syndrome, and Dravet syndrome.

According to a new study, many topical CBD products available online or at retail stores don’t contain the amount of cannabidiol that’s listed on the label. The research, recently published in Jama Network Open, shows that some CBD products may even contain THC — the main active ingredient found in cannabis that causes a “high” — despite claims of being THC-free.

“Misleading labels can result in people using poorly regulated and expensive CBD products instead of FDA-approved products that are established as safe and effective for a given health condition,” Tory Spindle, PhD, co-author of the new study and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, said in a press release.

CBD and THC (delta-9-tetrahydrocannabinol) are the most commonly known compounds in cannabis. While THC can produce a high, CBD doesn’t.

Under the Agriculture Improvement Act of 2018, (the Farm Bill), CBD products that contain less than 0.3% of THC are not considered illegal under federal law. This has led to the proliferation of questionable CBD products that have not been thoroughly tested to ensure they contain what the label claims they do.

Still, some THC-containing CBD products disclose on labels that they contain 0.3% or less THC. This may vary depending on whether the CBD product is full-spectrum, broad-spectrum, or CBD isolate.

In the new study, researchers from Johns Hopkins University in Baltimore tested 105 topical CBD products — including lotions, creams, and patches — purchased online and at retail stores in 2020.

Only 85% of the products listed the amount of CBD in milligrams on the label, researchers found. Of products that listed the CBD amount, only about 25% were accurately labeled.

By contrast, over half contained more CBD than listed on the label, while almost 20% contained less CBD than listed on the label.

Researchers also detected THC in 35% of 105 products, although all were within the legal limit of 0.3%. However, four THC-containing products were still labeled THC-free and 19 didn’t mention THC on the label at all.

Earlier research has found similar inaccurate and misleading labeling of CBD products.

In a 2017 study, researchers from the University of Pennsylvania tested 84 CBD liquid extracts purchased online. Around 30% contained the amount of CBD listed on the label. However, more than 40% contained more CBD than listed on the label, and around 25% contained less CBD than listed on the label.

In addition, researchers detected THC in more than 20% of the products.

Jamie Corroon, ND, MPH, the founder and medical director of the Center for Medical Cannabis Education in Del Mar, California, said mislabeled CBD products are certainly a problem, but the health risks may depend on the product and how it’s mislabeled.

Inaccurate amounts of CBD and THC

If you use a CBD product that contains more CBD than listed on the label, especially for ingestible products, higher amounts of CBD could enter your bloodstream. Still, it’s unlikely that topical CBD products like lotions or creams, including those containing 0.3% or less of THC, would produce a “high.”

According to Corroon, mislabeled topical CBD products that could present a higher risk are transdermal products — similar to nicotine patches — that are designed to move the compounds into the bloodstream through the skin.

Of course, the presence of THC in a transdermal or ingestible CBD product presents different risks.

For example, a person who ingested a mislabeled CBD product “might be driving a vehicle when the effects [of the THC] hits, and that could cause problems for them,” Corroon said. “It’s also possible that they might fail a drug test.”

Indeed, a 2019 study by Johns Hopkins researchers found that the use of CBD products containing less than 0.3% THC may result in a positive result on a urine drug screening test.

Possible drug interactions

Experts have expressed concern that the amount of CBD in a product could interact with prescription medications that a person is taking, such as antibiotics, blood pressure medications, cholesterol medications, and pain medications.

Corroon said for accurately-labeled CBD products, the risk of a drug interaction is “pretty small” unless the person consumes an entire bottle of CBD extract or uses a high-potency CBD product. “Nonetheless, the risk exists,” he said.

Drug interactions with CBD may occur during the metabolization process. CBD is metabolized in the body by a family of enzymes known as cytochrome P450 (CYP450). Within the CYP450 family is an enzyme called CYP3A4, which also metabolizes about 60% of prescription medications.

However, CBD can interfere with CYP3A4 and inhibit how a medication is broken down in your system. If your body metabolizes a medication too slowly, it could mean that you end up with more medication in your system than you need, which may lead to unwanted or harmful side effects.

The FDA doesn’t regulate CBD products the way that it does prescription drugs, although the agency will send warning letters to companies if they run afoul of the law.

This lack of upfront regulation, though, can make it difficult for people to find quality CBD products. One way to choose a high quality CBD product is to ask a healthcare professional you trust for their recommendations.

While there’s no standard laboratory testing of CBD products, Corroon said that some companies do go the extra mile to ensure their products meet certain quality standards. Those that do, don’t hide that information, he added.

“There are manufacturers out there that are making it easy for you to look at a certificate of analysis, such as linking to it from a QR code on the label,” Corroon said. “This hopefully would be more accurate than the label, especially if the analysis was done by an independent third party.”

Another sign that a CBD manufacturer cares about quality is they don’t make health claims about their products — these kinds of claims are not allowed by the FDA for CBD products.

According to Corroon, companies that want to stay in the marketplace for the long haul tend to be very mindful of the FDA and other government regulations for CBD products.

“If a company is out there making a lot of claims, to me that’s a red flag,” he said. “So any company that’s saying ‘we can treat this’ or ‘we can cure that,’ I would avoid them.”

Research shows that many CBD products are mislabeled, with some containing THC despite being labeled THC-free. But many CBD products containing 0.3% or less THC are transparent about the THC content on labels.

Though the health risks of mislabeled CBD products remain low, some people, such as those taking medications for certain health conditions may face an elevated risk of a negative interaction.

Familiarizing yourself with CBD labels and looking for a certificate of analysis can help ensure you’re purchasing a quality CBD product that’s gone through some degree of vetting. You’ll also want to steer clear of any CBD products making health claims.

Additionally, experts like Corroon advise being cautious of where you buy your CBD. “Convenience stores and gas stations are probably not the best places to find your CBD products,” he said. “At least to find ones that have an accurate representation of the content on the label.”