The People's Perspective on Medicine

Will CBD for Pain Make You Fail the Marijuana Test?

People who take CBD oil to alleviate pain should be warned that there is a possibility–though not a probability–that their urine will test positive.
Hand with pen drawing the chemical formula of CBD

One lesson learned from the terrible opioid crisis of the past few years: a lot of Americans are in a lot of pain. With doctors increasingly reluctant to prescribe narcotics for pain relief, people are looking around for substitutes. One compound that has garnered a good bit of interest lately is cannabidiol, aka CBD. Cancer patients utilize cannabinoids from the same plant that produces marijuana to alleviate cancer pain (Journal of Pain Research, April 23, 2018). People who suffer severe recurrent migraines are also turning to cannabis compounds (Journal of Headache Pain, May 24, 2018). One tricky question: will use of such agents result in a person being identified as a drug abuser? Many people utilizing CBD by swallowing it, smearing it on their skin or vaping it would like to know the answer.

Cannabinoids for Back Pain:

Q. The discs and vertebrae in my spine are degenerating and causing me severe pain. I started taking CBD oil for pain a few months ago.

Once it had time to build up in my system, the pain relief was miraculous. Sadly, I recently did a home drug test and it was positive for THC. I need to talk to my doctor because I have no idea how to address this. It’s legal to buy CBD oil OTC in my state, but there’s no way to prove it is the source of any THC in my test.

A. Cannabidiol (CBD) oil is legal in many states because it does not make people euphoric. It is not supposed to have any tetrahydrocannabinol (THC) in it. THC is the compound that produces a marijuana high. State by state regulation means that anyone who wishes to use this compound for pain relief will need to become familiar with the relevant laws of that state.

The FDA has approved one purified form of cannabidiol as a prescription anticonvulsant medication, Epidiolex. In addition, research on CBD oil suggests some benefit against pain and inflammation (Molecules, online, Sept. 27, 2018). However, scientists have not yet determined the circumstances in which it might be most valuable. 

Side Effects of Cannabidiol:

People using cannabidiol have reported fatigue, nausea, diarrhea and irritability. People on the anticoagulant warfarin (Coumadin) should avoid cannabidiol, as it may raise blood levels of warfarin. Like grapefruit, CBD can inhibit the intestinal enzyme CYP3A4, which the body uses to process a wide range of medications (Current Drug Metabolism, 2016).

But Will It Lead to a Positive Urine Test for Marijuana?

Unfortunately, certain CBD manufacturers are not able to remove all traces of THC. One study found that some people tested positive for THC after taking CBD oil (Journal of Pain Research, Feb. 12, 2016). ConsumerLab.com has written that people taking CBD oil aren’t likely to fail a marijuana drug test, but it is not impossible.

According to recent research, people who consume CBD by vaping run a risk of positive urine drug tests for marijuana (Journal of Analytical Toxicology, Nov. 4, 2019).

The scientists concluded:

“Accurate labeling and regulation of ∆9-THC content in CBD/hemp products are needed to prevent unexpected positive drug tests and unintended drug effects.”

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Darkovska-Serafimovska M et al, "Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases." Journal of Pain Research, April 23, 2018. doi: 10.2147/JPR.S160556
  • Baron EP et al, "Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort." Journal of Headache Pain, May 24, 2018. doi: 10.1186/s10194-018-0862-2
  • Bruni N et al, "Cannabinoid delivery systems for pain and inflammation treatment." Molecules, online, Sept. 27, 2018. doi: 10.3390/molecules23102478
  • Zendulka O et al, "Cannabinoids and Cytochrome P450 interactions." Current Drug Metabolism, 2016. DOI: 10.2174/1389200217666151210142051
  • Wertlake PT & Henson MD, "A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana." Journal of Pain Research, Feb. 12, 2016. doi: 10.2147/JPR.S96856
  • Spindle TR et al, "Urinary pharmacokinetic profile of cannabinoids following administration of vaporized and oral cannabidiol and vaporized CBD-dominant cannabis." Journal of Analytical Toxicology, Nov. 4, 2019. https://doi.org/10.1093/jat/bkz080
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I work in Federal Gov. We are drug-tested. After having 3 doctors recommend CBD or CBG I looked into the possibility of taking it. Even the oil with the lowest percent THC (.03). I was told the THC might not show up on the drug test but the cannabinoids would. I was told there are over 120 cannabinoids, and they also test for those.

I believe it depends on the source of the CBD as to whether you will test + for THC. My understanding is this:
CBD from a marijuana source, for example Charlotte’s Web products, must have less than .03% THC per (federal?) guidelines. If ingested (drops, capsules, gummies), this will show + on a drug test. It did for me.
CBD from hemp will not test positive. I haven’t tested this, yet.
There are many products, with more arriving daily. Always check for quality-control certification.

Happened to me. I live in a state where marijuana use is illegal. I had started using CBD products for shingles/nerve pain. I’m not sure that it worked as I had to pretty much live with the pain until a neurologist figured out a good treatment program. My internist is not happy with prescribing Norco any longer, but at this point in my recovery, some type of pain relief is still needed. To be honest, I’m not sure that the Norco worked all that well for the nerve pain I was in either.

i started taking CBD oil for allieviation of back pain, neck and knee pain and hoped it would help neuropathy. To my surprise, it helped and really stopped IBS. I am not sure I take enough to fix the pain, but it does help. I hate being high and have never had a problem. I suspect if the THC creeps in or cannot be totally removed. it isn’t enough to worry about. Eventually, I believe the recreational use with come. I believe Michigan is already working on it. If it does, there will have to be rules as there are with alcohol use. I also think we haven’t scratched the surface of the medicinal uses for this plant.

CBD oil has been an effective alternative to taking NSAIDs for my rheumatoid arthritis. In the four months I’ve been using it, I’ve had to supplement it on only four occasions with acetaminophen. That’s a heck of a lot better than tearing up my gut with other drugs.

Also, our daughter who has mild CP has used it for a few weeks, and it dramatically reduces her intentional hand tremors… Go figure…

The urine test at my local VA Hospital tests positive for Pot when using the CBD oils. The VA will not prescribe pain med’s if you have a positive test.

An aside, but on the subject of CBD oil, I have a German Shepherd with Degenerative Myelopathy, which is the canine version of ALS/ Lou Gehrig’s. There is NO cure for this disease. After trying every supplement recommended, chiropractic adjustments, home-cooked food, B-12 injections, etc., I started spraying CBD oil in his mouth and rubbing CBD oil into his spine three days ago. That afternoon, when we walked, was the first time he did not drag his hind feet with every step he took. Since then, his hind feet do not splay out to the sides as much, and he has more energy, even bouncing through the snow. I don’t know if this will delay the progression of this incurable disease, but this is the first thing that has made any difference at all.

You made my day! I’m so happy for you and your Pup.

How long does it take CBD oil to leave your system, so it wouldn’t show up on tests?

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