The Agricultural Improvement Act of 2018 includes a provision that removes hemp-defined as cannabis with less than 0.3 percent tetrahydrocannabinol (THC), the psychoactive substance in marijuana-from the Controlled Substances Act. At the federal level, the provision makes it wholly legal to cultivate, possess, sell and distribute these strains of hemp, from which cannabidiol (CBD) oil is extracted. The legality of CBD at state levels varies. To access CBD oil legally in Missouri, patients must be approved to participate in the Missouri Hemp Extract Registration Program, available only to patients diagnosed with intractable epilepsy. Despite this, CBD is widely available in the state at stores specializing in CBD products, drugstores, supermarkets and even gas stations. In Illinois, CBD is legal as long as it meets federal guidelines for THC concentration. According to Washington University physician Jennifer Griffith, MD, PhD, a pediatric neurologist at St. Louis Children’s Hospital, this easy access to CBD in its various forms-oil, topical ointments, tinctures, vaping and edibles-is creating a new area of concern for pediatric subspecialists and community pediatricians.

"There is only one FDA-approved drug derived from a pure form of CBD oil, Epidiolex, which has proven effective in reducing seizures in some severe types of epilepsy," she says. "Other than that, there have been no well-designed, randomized controlled trials to tell us if CBD is safe and effective for other conditions like mood disorders, inflammatory conditions or pain. In addition, there is little regulation over the CBD products manufactured. Dr. Griffith cites a study in which multiple CBD products available online were tested for their actual concentrations of cannabinoids. The results ranged widely, from products with negligible amounts of CBD to those with concentrations higher than that contained in the FDA-approved Epidiolex. "The study also found unlabeled THC in some of the products, which has big implications for an over-the-counter remedy some parents may want to give their children," says Dr. Griffith. Dr. Griffith believes most parents who give their children CBD products are simply desperate to find something that helps.

"My approach with parents is to first find out why they decided to start their child on CBD, and then explain to them my concerns about CBD’s unknowns, Bliss Harmony including its efficacy and safety long term," she says. "I make it clear to them that even when I can’t recommend a CBD product, they need to keep me informed about what supplements they are giving their child. My goal is to maintain a therapeutic relationship with my patients and their parents so that anything I prescribe is safe for them in light of their CBD use." Parents also need to be aware of CBD’s side effects, including sedation and generalized fatigue