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.

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