Should I Become an Herb Lady?

Wading through /AskWomen, the subreddit where women ask candid questions to strangers online, can feel like a last resort. On any given day, its top links may include disclosures of useless beauty products, experiences with pregnancies after 40, confessions about walking around alone at night and anecdotes of nice-turned-creepy coworkers. While Reddit is too popular as a whole to feel like a community, a sense of intimacy permeates /AskWomen as if its pages weren’t completely accessible to anyone on the internet. With 2.2 million subscribers, it’s clearly filling a basic need: women are looking for answers.

I’m a frequent lurker of /AskWomen as both an avid Reddit user and a woman. The topic of cannabidiol, colloquially known as CBD, has cropped up frequently in the forum over the past year. Members have sworn by using it for insomnia and recommended it as a method to soothe period cramps. Questions on CBD as a method to treat anxiety have been posed to the group twice recently, both times met with a spectrum of opinion. 

Some folks were bluntly cynical (“they’re a scam”) while others chalked CBD’s helpful effects up to a cocktail of solutions (“I can't totally rule out the fact that it might be placebo, Buddhist practice, or my antidepressants finally affecting the anxiety”). There’s no expert analysis here—just a congregation of anonymous accounts who have decided to crowdsource their experiences in order to legitimize a potential antidote for their anxiety. This behavior is the digital version of a whisper network that most women can relate to; where modern medicine, doctors and health coverage fail, other women often feel like the most trustworthy source of information. 

The CBD gold rush over the past few years mostly stemmed from Congress passing the federal Farm Bill in 2018, which made some cannabis plants legal and loosened restrictions on the use of CBD hemp products that contain less than .3% THC. Since then, these low-THC products have flourished, largely unchecked by federal regulators (more on that later).

A quick CBD primer: Cannabis is a plant and is used as the umbrella term for marijuana or hemp. THC is a compound found in cannabis that gets you high, and marijuana is a high-THC variety of cannabis. CBD is also a compound found in cannabis that by itself does not cause a “high,” and hemp is a high-CBD variety of cannabis. CBD’s health benefits have been touted as wide-ranging, but to date, there’s not a ton of evidence on the medical benefits of CBD, in part because laws around cannabis make it challenging to study. 

Most of the CBD products born out of the recent explosion have been used to address anxiety, insomnia, and chronic pain, though the general scientific consensus is that we need more research through high-quality evidence in human studies to pinpoint CBD’s effectiveness in managing these conditions. The Food and Drug Administration (FDA) is also currently looking into the substantial lack of research on the sex-dependent effects of CBD—that is, whether CBD affects men and women differently. 

“Many of these products are illegally marketed and purport to target a myriad of health concerns, including conditions more commonly experienced by women than men, such as chronic pain, sleep disturbances, anxiety and depression,” wrote Dr. Kaveeta Vasisht, the director of the FDA’s Office of Women’s Health, in a letter introducing the FDA’s conference on CBD and gender last November. 

So how did CBD, an unregulated cannabis compound with minimal scientifically proven benefits for general consumption, grow into such a massive industry so quickly? This essay isn't about whether CBD works, but how its marketing works for it. Especially with women. 

Let’s take a moment and talk about the FDA. FDA approval just means a product is deemed safe to use, and if a product hasn’t been approved by the FDA, the brand that makes the product can’t legally claim that it will cure any ailment. Epidiolex, a prescription drug used to treat two rare and severe forms of epilepsy, is the first and only FDA-approved medicine with CBD in it. 

The manufacturing process of unapproved CBD products is not currently reviewed by the FDA. There’s also been no FDA evaluation of whether unapproved CBD products are effective for their intended use, what the proper dosage is, how they could interact with other drugs, whether they have dangerous side effects and, of course, if they have sex-dependent effects. 

The FDA has cracked down on CBD products that are a “threat to public health.” This included, for example, products that claimed CBD could treat teething in infants or protect against neurological diseases such as Parkinson’s and Alzheimer’s. But mostly, little guidance has been issued by the FDA about what claims can be made about the use of CBD, who can see it or how products should be labeled. Again, those pesky laws that restrict academic research on cannabis have made things super slow. A lack of regulation breeds Wild Wests. 

To put numbers behind it: the global CBD market size was estimated at $2.8 billion in 2020 and is expected to reach $3.8 billion by the end of this year. (This is just CBD we’re talking about — the global legal cannabis market is of course much, much bigger.) 

As a long-time sufferer of anxiety and chronic pain, I’ve been tempted for years by the siren song of CBD products that promise to improve my health. I used to longingly peruse the aisles of a “natural” pharmacy in my Brooklyn neighborhood; a CBD tincture for stress would certainly be easier than another doctor’s visit. At the beginning of the pandemic, when anxiety felt inescapable and sleep was elusive, I ordered CBD bath salts in a moment of fragility. It made the bathwater smell like citrus and made my body feel relaxed and briefly dizzy. But was it really the CBD...or simply a hot bath? 

As ever, I’m just a data point. In 2019, more than 64 million Americans reported trying CBD, the majority of whom are female. 

There is an ongoing study at Yale looking into how CBD affects the brain to determine if it affects women and men differently and if CBD has the potential to treat anxiety disorders (a condition that’s twice as prevalent among women than men). According to Dr. Sarah Lichenstein, the leader of the study, the majority of existing research on the neurological effects of CBD comes from a single small study conducted on a group of 15 men. The use of CBD during pregnancy and breastfeeding is also a public health concern per the FDA, with preclinical studies showing that high doses of CBD in pregnancy have caused problems with the development of the male reproductive system.

Given the state of the science, the creeping popularity of CBD products that are specifically “for women” seems amiss. Over the past year, I’ve seen these products touted as a cure-all for a wide range of women’s health concerns: a CBD tampon, a patch for hot flashes, CBD-infused lubricants for arousal. 

When I google to see if “CBD for men” is a thing, my search engine auto-fills to “CBD for menstrual cramps.” 

“CBD for women” of course produces a flurry of results. I find drops and gummies for “the woman who does it all.” Another site promises customizable creams and oils based on “episodic needs” such as PMS or hot flashes. I found one company that’s inevitably trademarked the name “SHEbd.” Each site boldly credits science (“Not a miracle. Just science.”), burying a subsequent legal disclaimer per the FDA to indicate that, no, actually, the science isn’t yet proven.

Justin Lechner and Sarabeth Perry, the founders of Bace Health, told me that when you’re starting a company in the CBD space, there’s a pressure to create something new—to differentiate. “Both investors and peers in the industry ask what you’re going to do differently,” Lechner said. “Will it be CBD in a drink? In a mask? The push for novelty in a very crowded market is leading to use cases that are unproven.” 

For example, the CBD beverage market is red hot, predicted to grow substantially in the coming years. But a recent report found that liners inside aluminum cans can drain a cannabis drink’s potency before a customer even cracks it open. (As I was researching this story, I told my friend Shannon, a regular user of the CBD drinks that claim to “can a feeling,” about this finding. She responded: “At least now I know I can drive after I drink those!”)

A combined lack of regulation and emerging research has put the onus on consumers to have a discerning eye when it comes to CBD products, and that especially applies to women. A 2017 study showed that nearly 70 percent of CBD products sold online are mislabeled. A 2018 study states that women may be at a greater risk of adverse outcomes given the “telescoping effect” (gender-related progression to dependence) of cannabis use in women. Current evidence suggests that women are more sensitive to the effects of cannabinoids. 

But as I interviewed cannabis founders for this story, it was hard to get a straight answer as to what consumers should look out for when evaluating the efficacy of a CBD product. 

“The tricky part about designing for cannabis as a whole is all of the regulation and compliance information that has to be taken into account,” wrote Courtney Zalewski, co-founder of the cannabis branding firm Studio Good, in a DM to me. “We have to use certain size fonts, have certain disclaimers, warning labels have to be a certain size, etc. I really try to treat each constraint as an opportunity to make it feel like it's intentional and part of the design versus a requirement by the government. It’s hard.” 

A quick browse through a few CBD sites online will quickly make you privy to the design choices that Courtney is talking about. The “this statement has not been evaluated by the FDA” disclaimer is everywhere—it’s required by law, but it clearly hasn’t slowed down the demand or reception of CBD health products among women. Ultimately, affluent women indulging in the occasional CBD serum—or gummies, or face mask, or hand sanitizer, or tampons, or lube, or patch for their hormones—is not a huge public health concern (especially in the FDA’s eyes). 

People have been peddling things to women to take advantage of their failed relationship with healthcare since the beginning of time, and CBD is simply a recent iteration of this. After all, women are the dummies who keep buying the inefficacious products, right?!

But while CBD is not regulated and has little proven health benefits, it’s also understandable that women might not really care about “regulated” or “proven.” CBD has become part of a general expression of wellness, an industry that has stepped up with snake oil, pseudoscience, and a lack of transparency to fill in the medical research gap. Because the medical establishment is so likely to dismiss their pain, why would they care if something is FDA approved or not? It’s the same explanation for why women are more susceptible to faux-legitimate terms like “natural” and “backed by science” when it comes to products that address, say, reproductive health. CBD companies are simply opportunistic—along with the rest of the wellness industry—and get to upsell products with this language by huge margins. 

But I’d argue that within those margins lurks something much larger and more pernicious. It’s a signal of a rapidly growing, fill-in healthcare system. 

In this system, it’s easier to blindly trust a well of magical thinking around health to cope with our deeply unhealthy modern environment than to try and navigate it alone. In this system, it’s easier (and often cheaper) to put off getting important medical care, such as a proper diagnosis, to buy tinctures instead. In this system, it’s easier to fire off a personal health question on Reddit than be completely alone in your confusion and pain. And in this system, it’s easy to think that the model of women’s health is wealth—once you have money, your chronic stress and chronic pain can be handled with an $88 “comfort cream.” This system picks up, with speed, where the other one dropped the ball. 

As I’ve been researching this story, I keep coming back to a 2006 paper in the Journal of Medical Ethics called “Feminism and public health ethics.” The paper finds that gender is a risk factor for increased inequity in public health, and outlines that the effects of gender, discrimination, and poverty can all be linked to the ill health of women. The paper also states that “gender inequality and discrimination harm girls’ and women’s health directly and indirectly, throughout the life cycle.” Directly and indirectly, throughout the life cycle. 

This seems somewhat obvious now—2006 was a lifetime ago—but the harm with labeling health products (in this case, CBD products) as “for women” is that it implies they must be bought. The glaring example of how the gender research gap in medicine plays out in real life: women are do-it-yourselfers. A 2021 survey in the Journal of Women's Health of almost 1000 women showed that 90% (most between the ages of 35 and 44) had used cannabis and would consider using it to treat gynecologic pain. Roughly 80% said they would consider using it for procedure-related pain or other conditions. Trying CBD can’t hurt, right? Right? 

I’m not one to balk at natural medicine, especially when the existing systems fail you. I bought the CBD bath salts. I run a website where I test health and wellness products myself, in large part because I’ve been burned too many times trying to solve the mysteries around my own physical health while simultaneously having my real pain dismissed by the medical establishment.

The best piece of medical advice I’ve ever received came from a Fleabag episode, where Kristin Scott Thomas’s woman-in-business character profoundly discloses over a martini that “women are born with pain built-in.” She leans back, nodding after delivering her truth bomb: “It’s our physical destiny. Period pains, sore boobs, childbirth, you know. We carry it within ourselves throughout our lives. Men don’t.” 

Justin and Sarabeth from Bace Health pointed out to me that the majority of the current research on CBD is looking to find harm, and there’s a “real bias that leaves out the potential health benefits.” I believe this, and I believe that most CBD founders have probably benefited from CBD use first-hand. Most of the “About” pages I read on CBD websites while researching this story feature personal stories from founders who recall the impact that CBD had on them during particularly stressful and painful moments in their lives. 

These websites then implore me to experience the “magic” of cannabinoids myself. They tell me to “find calm in the everyday chaos” and “return to your natural self” through “quality drugs.” One website declares that stress is no longer allowed to “wreak havoc on our minds” and that self-care is, actually, “a form of activism.” They’re not wild, indefensible claims. They’re more subtle—a wink to the inevitable pain that accompanies the human condition. 

Citations

1. “Cannabidiol (CBD) — what we know and what we don’t,” Peter Grinspoon, MD, Harvard Health Publishing, April 2020
2. “Cannabis Use: Neurobiological, Behavioral, and Sex/Gender Considerations,” Bassir Nia A., Mann C., Kaur H., Ranganathan M., PubMed, December 2018
3. “Females are still routinely left out of biomedical research — and ignored in analyses of data,” Elizabeth Cooney, Stat News, July 2020
4. “The Relevance of Sex in the Association of Synthetic Cannabinoid Use With Psychosis and Agitation in an Inpatient Population,” Nia A.B., Mann C.L., Spriggs S., DeFrancisco D.R., Carbonaro S., Parvez L., Galynker I.I., Perkel C.A., Hurd Y.L., PubMed, July 2019
5. “Penn Study Shows Nearly 70 Percent of Cannabidiol Extracts Sold Online Are Mislabeled,” Penn Medicine News, November 2017
6. “Value of the CBD beverages market in the United States from 2018 to 2022,”Jan Conway, Statista, November 2020
7. “Women More Prone to Anxiety Than Men, Review Finds,” Steven Reinberg, WebMD, June 2016
8. “Cannabidiol Market Size, Share & Trends Analysis Report By Source Type (Hemp, Marijuana), By Distribution Channel (B2B, B2C), By End-use (Medical, Personal Use), By Region, And Segment Forecasts, 2021 - 2028,” Grand View Research, February 2021
9. “Legal Marijuana Market Growth is Expanding over 17.8% by 2027, Precedence Research”, December 2020
10. “Cans suck the THC out of pot drinks. Where does that leave Canopy Growth?,” Jeff Lagerquist, Yahoo! Finance, February 2020
11. “Feminism and public health ethics,” Wendy Rogers, Journal of Medical Ethics, June 2006 
12. “Willingness to Use Cannabis for Gynecological Conditions: A National Survey,” Leo Han, Katie Alton, Alyssa Covelli Colwill, Jeffrey T. Jensen, Sara McCrimmon, and Blair G. Darney, Journal of Women’s Health, March 2021
13. “Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology,” “Bhattacharyya S, Morrison PD, Fusar-Poli P, Martin-Santos R, Borgwardt S, Winton-Brown T, Nosarti C, O' Carroll CM, Seal M, Allen P, Mehta MA, Stone JM, Tunstall N, Giampietro V, Kapur S, Murray RM, Zuardi AW, Crippa JA, Atakan Z, McGuire PK., Neuropsychopharmacology, February 2010
14. “Modulation of effective connectivity during emotional processing by Delta 9-tetrahydrocannabinol and cannabidiol,” Fusar-Poli P, Allen P, Bhattacharyya S, Crippa JA, Mechelli A, Borgwardt S, Martin-Santos R, Seal ML, O'Carrol C, Atakan Z, Zuardi AW, McGuire P. , International Journal of Neuropsychopharmacol, May 2010
15. “Cannabinoid Modulation of Functional Connectivity within Regions Processing Attentional Salience,” Bhattacharyya, S., Falkenberg, I., Martin-Santos, R., Atakan, Z., Crippa, J. A., Giampietro, V., Brammer, M., & McGuire, P., Neuropsychopharmacology, May 2015
16. “Distinct effects of {delta}9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing,” Fusar-Poli P, Crippa JA, Bhattacharyya S, Borgwardt SJ, Allen P, Martin-Santos R, Seal M, Surguladze SA, O'Carrol C, Atakan Z, Zuardi AW, McGuire PK., PubMed, January 2009 
17. “Neural basis of Delta-9-tetrahydrocannabinol and cannabidiol: effects during response inhibition,” Borgwardt SJ, Allen P, Bhattacharyya S, Fusar-Poli P, Crippa JA, Seal ML, Fraccaro V, Atakan Z, Martin-Santos R, O'Carroll C, Rubia K, McGuire PK., Biol Psychiatry, December 2008
18. “Modulation of auditory and visual processing by delta-9-tetrahydrocannabinol and cannabidiol: an FMRI study,”Winton-Brown TT, Allen P, Bhattacharyya S, Borgwardt SJ, Fusar-Poli P, Crippa JA, Seal ML, Martin-Santos R, Ffytche D, Zuardi AW, Atakan Z, McGuire PK, Neuropsychopharmacology, June 2011
19. “Induction of Psychosis byΔ9-Tetrahydrocannabinol Reflects Modulation of Prefrontal and Striatal Function During Attentional Salience Processing,” Bhattacharyya S, Crippa JA, Allen P, et al., Arch Gen Psychiatry., January 2012