CBD oil and food products in the UK: the rules and the evidence

CBD is one of many cannabinoids found in hemp and cannabis plants and can also be made synthetically. The FSA notes that CBD extracts can be derived from most parts of the plants and selectively extracted, which concentrates them, and that some processes alter other chemical components. In the UK the same substance can be regulated as a food, as a medicine, or as something else depending on how it is presented and what it contains, so the label and claims matter as much as the ingredient.

CBD sold as food, often as a food supplement, includes oils, drops, tinctures and sprays, gel capsules, sweets, bakery products and drinks. The FSA says such products are widely available in shops, cafes and online.

The FSA's position is that CBD food products, as novel foods, must be authorised before they are put on the market so that their safety is assured. It acknowledges that a lot is still unknown about CBD as a food while applications go through risk assessment. To help consumers the FSA published a list of CBD products linked to applications moving through the process. The agency stresses that the list is not an authorisation, that products on it have not yet been fully assessed for safety, that inclusion is no guarantee of eventual authorisation and that products not on the list should not be on the market in England and Wales.

In practice this means that the presence of a CBD oil on a shop shelf does not show it has passed a safety assessment. A consumer can check the product against the FSA list, and treat unlisted products with caution.

Based on the information it has, the FSA advises consumers to think carefully before taking any CBD product, and as a precaution does not recommend CBD for vulnerable groups unless under medical direction. The groups it names are children under 18, people taking any medication, those trying to conceive, and those who are pregnant or breastfeeding. People with health concerns are advised to contact a healthcare professional before consuming CBD.

For healthy adults, advice issued in October 2023 recommends limiting consumption of CBD from food to 10mg per day, which the FSA equates to about four to five drops of 5% CBD oil. The advice rests on average lifetime exposure to CBD-containing foods and on updated advice from its independent scientific committee. The FSA warns that some products contain more than 10mg per serving, and encourages people to check labels. It explains that the more CBD consumed over a lifetime, the more likely long-term effects such as liver damage or thyroid problems become, with risk related to the amount taken.

• Check the CBD content per serving on the label and add up all CBD products taken in a day.

• Do not assume a higher-strength product is better; the FSA advice is a ceiling, not a target.

• Discuss any CBD use with a pharmacist if you take prescribed medicines, since NIH says CBD has been associated with drug interactions.

The MHRA states that products containing CBD used for medical purposes are medicines. A company that markets a CBD-containing product making a medicinal claim, for example to treat anxiety, pain or epilepsy, will be considered to fall within the definition of a medicinal product in the Human Medicines Regulations 2012 and would need the appropriate authorisation. The MHRA's general borderline guidance explains it considers explicit and implicit claims, ingredients, how a product is presented, and marketing such as websites, social media and customer reviews.

A shop or website that describes a CBD oil as a treatment for a named disease is therefore operating in medicines territory, regardless of the "wellness" label. That is a reason to be sceptical of such claims, not a reason to believe the product has been tested as a medicine.

NIH reports that a purified, prescription CBD product has been approved in the United States for seizures linked to two rare, severe forms of childhood epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. For other uses the evidence is limited. A small study found less anxiety during a simulated public-speaking test in people with social anxiety disorder after CBD than after placebo, and some research suggests modest benefits for anxiety, chronic pain and sleep, but quality is limited.

NIH also records that over-the-counter CBD products may contain more or less CBD than their labels state and may contain contaminants such as THC. CBD itself may cause reduced alertness, mood change, reduced appetite and gastrointestinal symptoms such as diarrhoea, and has been associated with liver injury, male reproductive harm and interactions with other drugs. Sleepiness, diarrhoea, abnormal liver function tests and interactions appeared to be due to CBD itself rather than contaminants.

Tell your GP if you use CBD, particularly if you take anti-epileptic drugs, blood thinners, antidepressants or other regular medicines, and before surgery. Report suspected reactions to the Yellow Card scheme. If you are subject to workplace or sports drug testing, ask the testing body about CBD products, since contamination with THC has been reported. Anyone with epilepsy should never replace prescribed medicine with a food-grade CBD product.