The Centers for Disease Control and Prevention (CDC) warns doctors, public health departments and others about insufficiently labeled cannabidiol (CBD) products that may contain a certain compound of THC or tetrahydrocannabinol, the chemical that creates the psychotropic high for marijuana users. Background Marijuana, which can also be called weed, marijuana, or drug, refers to all parts of the plant Cannabis sativa L. Any part of the cannabis plant that contains 0.3% or less THC by dry weight is defined as hemp, 1 The cannabis plant contains more than 100 cannabinoids, including THC, which is psychoactive (i.e. The.
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There is significant interest in developing therapies and other consumer products derived from cannabis and its components, including cannabidiol (CBD). The FDA recognizes the potential opportunities that cannabis or cannabis-derived compounds can offer and recognizes the strong interest in these possibilities. However, the FDA is aware that some companies are marketing products that contain cannabis and cannabis-derived compounds in forms that violate the Federal Food, Drug and Cosmetic Act (FD&C Act) and that may jeopardize the health and safety of consumers. The agency is committed to protecting public health and, at the same time, taking steps to improve the efficiency of regulatory pathways for the legal marketing of cannabis and appropriate cannabis-derived products.
The FDA has a number of resources available that address cannabis and cannabis-derived products, such as CBD, and the agency wants to ensure that consumers and other stakeholders have access to these resources in one centralized place. Below you will find a series of frequently asked questions and answers on this topic. To date, the agency has not approved a marketing application for cannabis for the treatment of any disease or condition. However, the FDA has approved a drug derived from cannabis and three cannabis-related products.
These approved products are only available with a prescription from an authorized healthcare provider. The FDA has approved Epidiolex, which contains a purified form of the drug substance CBD for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients 1 year of age or older. Epidiolex has also been approved for the treatment of seizures associated with the tuberous sclerosis complex in patients 1 year of age or older. That means the FDA has concluded that this particular drug is safe and effective for its intended use.
The agency has also approved Marinol and Syndros for therapeutic uses in the United States, including the treatment of anorexia associated with weight loss in patients with AIDS. Marinol and Syndros include the active ingredient dronabinol, a synthetic delta-9-tetrahydrocannabinol (THC) that is considered the psychoactive component of cannabis. Another FDA-approved drug, Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC and is synthetically derived. The FDA remains concerned about the proliferation of products claiming to contain CBD that are marketed for therapeutic or medical uses, even if they have not been approved by the FDA.
Often, these products are sold online and are therefore available throughout. Selling unapproved products with unsubstantiated therapeutic claims is not only a violation of the law, but it can also put patients at risk, as these products have not been proven to be safe or effective. This deceptive marketing of unproven treatments also poses significant public health problems, as patients and other users can be influenced not to use approved therapies to treat serious and even fatal diseases. Unlike FDA-approved drugs, products that have not undergone FDA review as part of the drug approval process have not been evaluated to determine if they work, what the appropriate dose may be if they do, how they might interact with other drugs, or if they have side effects.
dangerous or other type of security. worries. The FDA is aware that unapproved cannabis or cannabis-derived products are used for the treatment of a number of medical conditions including, for example, AIDS wasting, epilepsy, neuropathic pain, spasticity associated with multiple sclerosis, and nausea induced by cancer and chemotherapy. FDA relies on applicants and scientific researchers to conduct research.
The agency's role, as set forth in Act FD&C, is to review data submitted to the FDA in a request for approval to ensure that the drug meets legal approval standards. The FDA will continue to facilitate the work of companies interested in properly marketing safe, effective and quality products, including scientific research on the medicinal uses of cannabis. Additional information on research on the medical use of cannabis is available from the National Institutes of Health, in particular the National Cancer Institute (NCI) and the National Institute on Drug Abuse (NIDA). The FDA is aware that several states have passed laws that remove state restrictions on the medical use of cannabis and its derivatives or are considering doing so.
It is important to conduct medical research on the safety and efficacy of cannabis products through appropriate and well-controlled clinical trials. We welcome the opportunity to speak with states considering supporting medical research into cannabis and its derivatives, so that we can provide information on federal and scientific standards. Information from reports of adverse events related to cannabis use is extremely limited; FDA mainly receives adverse event reports for approved products. General information on possible adverse effects of cannabis use and its components may come from published clinical trials, as well as spontaneously reported adverse effects submitted to the FDA.
Additional information is needed on the safety and efficacy of cannabis and its components. Cannabis clinical trials conducted under an IND request could collect this important information as part of the drug development process. An exception to section 201 (ff) ((B) exists if the substance was marketed as a dietary supplement or as a conventional food before the drug was approved or before new drug investigations were authorized, as appropriate. However, based on available evidence, the FDA has concluded that this is not the case for THC or CBD.
The FDA is not aware of any evidence that would challenge its current findings that THC and CBD products are excluded from the definition of a dietary supplement under section 201 (ff) ((B) of the FD&C Act. Interested parties may submit to the agency any evidence they believe relates to this topic. Our ongoing review of the information that has been presented so far has not led us to change our conclusions. When a substance is excluded from the definition of a dietary supplement under section 201 (ff) ((B) of Act FD&C, the exclusion applies unless the FDA, in the agency's discretion, has issued a regulation, prior notice and comment, determining that the item would be legal under Act FD&C.
To date, no such regulation has been issued for any substance. Many other legal requirements apply to dietary supplement products, including requirements related to current Good Manufacturing Practices (CGMP) and labeling. Information on these requirements and on FDA requirements can be found in all product areas on the FDA website. THC (dronabinol) is the active ingredient in approved drugs, Marinol capsules (and generics) and Syndros oral solution.
CBD is the active ingredient in the approved drug, Epidiolex. Hemp seeds are the seeds of the Cannabis sativa plant. The seeds of the plant do not naturally contain THC or CBD. The hemp seed-derived ingredients that are the subject of these GRAS notices contain only traces of THC and CBD, which the seeds can collect during harvesting and processing when in contact with other parts of the plant.
Consuming these ingredients derived from hemp seed cannot cause consumers to get high. GRAS findings may apply to human food ingredients marketed by other companies, if they are manufactured in a manner consistent with the notices and meet the specifications listed. Some of the intended uses of these ingredients include adding them as a source of protein, carbohydrates, oil and other nutrients to beverages (juices, smoothies, protein drinks, vegetable alternatives to dairy products), soups, sauces, dressings, vegetable alternatives to meat products, desserts, baked goods, cereals, snacks and nutritional bars. Products that contain any of these ingredients derived from hemp seeds must declare them by name in the ingredient list.
These GRAS findings do not affect the FDA's position on adding CBD and THC to foods. A cosmetic is defined in 201 (i) as (articles intended to be rubbed, poured, sprayed or sprayed, introduced or otherwise applied to the human body or any part thereof to cleanse, beautify, promote attractiveness, or alter appearance), and (articles intended to be used as a component of any such articles; except that this term shall not include soap. FDA can take action if it has information that an ingredient or cosmetic product is not safe for consumers. Consumers can report adverse events associated with cosmetic products through the FDA MedWatch reporting system, either online or by phone at 1-800-FDA-1088, or by contacting the consumer complaint coordinator at the nearest FDA district office.
For more information, see the FDA website on how to report a complaint related to cosmetics. The FDA has sent warning letters in the past to companies that illegally sold CBD products that claimed to prevent, diagnose, treat or cure serious diseases, such as cancer. Some of these products further violated the FD&C Act because they were marketed as dietary supplements or because they involved the addition of CBD to food. When a product violates FD&C, the FDA considers many factors when deciding whether or not to initiate compliance action.
These factors include, among other things, the agency's resources and the threat to public health. The FDA can also consult with its federal and state partners to make decisions about whether to initiate federal compliance action. To conduct clinical research that could lead to the approval of a new drug, including research with plant materials such as cannabis, researchers must work with the FDA and submit an IND request to the Center for Drug Evaluation and Research (CDER). The IND application process provides investigators with a path to follow that includes regular interactions with the FDA to support efficient drug development while protecting patients enrolled in trials.
For research for use as a drug for animals, researchers would establish a new investigational animal drug (INAD) file with the Center for Veterinary Medicine to conduct their research, rather than an IND with the CDER. Expanded access is one possible avenue for a patient with a serious or life-threatening disease or condition to try an investigational medical product (drug, biological product, or medical device) for treatment outside of clinical trials when comparable or satisfactory therapies are not available. Manufacturers can make investigational drugs available to individual patients in certain circumstances through expanded access, as described in the FD&C Act and implementing regulations. We understand that parents are trying to find treatments for their children's medical conditions.
However, the use of unproven medications can lead to unpredictable and unforeseen consequences. Caregivers and patients can rest assured that FDA-approved drugs have been carefully evaluated for safety, efficacy and quality, and that they are monitored by the FDA once they are on the market. The FDA continues to support robust, scientifically based research into the medicinal uses of drugs containing cannabis or cannabis-derived compounds, and will continue to work with companies interested in marketing safe, effective and quality products. With the exception of Epidiolex, Marinol and Syndros, no product containing cannabis or cannabis-derived compounds (whether plant or synthetic) has been approved as safe and effective for use in any patient population, whether pediatric or adult.
The FDA has approved Epidiolex, which contains a purified form of the drug substance CBD, for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients 1 year of age or older. Controlled clinical trials that prove the safety and efficacy of a drug, along with careful review through the FDA drug approval process, are the most appropriate way to bring cannabis-derived treatments to patients. Due to the proper and well-controlled clinical studies that supported this approval, and the assurance of manufacturing quality standards, prescribers can rely on consistent drug strength and consistent administration that support the appropriate dose needed to treat patients with these complex and severe epileptic syndromes. FDA is aware that some cannabis products are marketed as animal health products.
We want to emphasize that the FDA has not approved the use of cannabis in animals and that the agency cannot guarantee the safety or effectiveness of these products. For these reasons, the FDA cautions pet owners against using such products and recommends that you talk to your veterinarian about appropriate treatment options for your pet. Signs that your pet may be experiencing adverse effects from ingesting cannabis may include lethargy, depression, severe drooling, vomiting, agitation, tremors, and seizures. If you are concerned that your pet will suffer adverse effects from ingesting cannabis or any substance containing cannabis, immediately consult your veterinarian, local animal emergency hospital, or an animal poison control center.
While the agency is aware of reports of pets using various forms of cannabis, to date, the FDA has not directly received any reports of adverse events associated with animals receiving cannabis products. However, adverse events from accidental ingestion are well documented in the scientific literature. If you think your animal has suffered from ingesting cannabis, we recommend that you report the adverse effect to the FDA. Visit Report Animal Drug and Device Information for more information on how to report an adverse event related to an animal drug or how to report an adverse event or problem with a pet food.
With respect to products labeled to contain hemp that may also contain THC or CBD, as mentioned above, it is prohibited under section 301 (II) of the FD&C Act to introduce or deliver for introduction into interstate commerce any animal feed to which THC or CBD has been added. In addition, according to 21 CFR 530.20, additional labeled use of a drug approved for humans in a food-producing animal is not permitted if an animal drug approved for use in food-producing animals can be used in an additional label for use. In addition, under 21 CFR 530.20 (b) (, if scientific information is not available on the human food safety aspect of the use of the approved drug for humans in food-producing animals, the veterinarian should take appropriate measures to ensure that the animal and its food products do not enter the supply of food for humans. For more information on the use with additional labels of FDA-approved drugs in animals, see Additional Labeled Use of FDA-Approved Drugs in Animals.
Mayo Clinic does not endorse companies or products. Advertising Revenue Supports Our Nonprofit Mission. This week's CDC report found that more than half of the 52 possible cases tested positive for a synthetic compound called 4-CCB or reported using a product called CBD oil Yolo, whose samples contained synthetic rather than authentic CBD. .
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