Be Prepared for Patients to Ask About CBD

Cannabidiol (CBD) products are moving into some pharmacies and mainstream retailers...not just smoke shops, dispensaries, etc.

CBD and THC are cannabinoids found in two varieties of the cannabis plant...marijuana and hemp. CBD doesn't cause a "high" like THC.

Hemp with 0.3% THC or less is no longer a federally controlled substance and is a legal source of CBD...after last year's Farm Bill.

But cannabis STATE laws vary. For example, cannabis is fully legal in California...but all forms are illegal in Idaho.

FDA regulations add to the confusion. They say CBD can't be sold as a supplement...since it was first approved as an Rx drug (Epidiolex). But CBD is allowed in hemp-derived "cosmetics"...creams, lotions, etc.

This leaves a lot of murkiness with CBD...especially with orals, tinctures, foods, etc...and enforcement is spotty.

So far, the most conclusive evidence is with Epidiolex...a purified CBD solution approved for two rare and severe seizure disorders.

Emphasize that there's not good evidence yet to support popular CBD claims...such as relieving chronic pain, anxiety, or insomnia.

And the variety of CBD products leaves many unknowns about their safety, quality, dosing, etc.

In general, recommend avoiding CBD in pregnant or breastfeeding women...and lean away from it in patients taking multiple meds.

Educate that CBD may cause drowsiness, diarrhea, etc...and using it with CNS depressants (benzos, opioids, etc) may worsen sedation.

Be aware of many potential interactions. For example, CBD inhibits CYP2C8, 2C9, and 2C19...and might raise levels of meds such as amitriptyline, valproic acid, and warfarin. Or CBD levels might be increased by CYP3A4 inhibitors, such as clarithromycin.

Plus high CBD doses are linked to elevated liver function tests. Explain most urine drug tests check for THC...not CBD. But high CBD doses with trace amounts of THC...or impure products...could lead to a positive THC test.

If patients plan to try CBD, suggest checking the product for a "certificate of analysis" from an independent lab. This doesn't confirm safety or efficacy...but shows levels of CBD, THC, and contaminants.

Dive deeper with our chart, Comparison of Cannabinoids...and access our Natural Medicines for more on efficacy, safety, and interactions.

Key References:

-www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#othercbdapproved (05-16-19)

-Health Effects of Cannabis and Cannabinoids: National Academies Press (US); 2017

-Can Fam Physician 2018;64(2):111-20

Pharmacist's Letter. June 2019, No. 350604

Be Prepared for Patients to Ask About CBD
Cannabidiol (CBD) products are moving into some pharmacies and mainstream retailers...not just smoke shops, dispensaries, etc.
CBD and THC are cannabinoids found in two varieties of the cannabis plant...marijuana and hemp. CBD doesn't cause a "high" like THC.
Hemp with 0.3% THC or less is no longer a federally controlled substance and is a legal source of CBD...after last year's Farm Bill.
But cannabis STATE laws vary. For example, cannabis is fully legal in California...but all forms are illegal in Idaho.
FDA regulations add to the confusion. They say CBD can't be sold as a supplement...since it was first approved as an Rx drug (Epidiolex). But CBD is allowed in hemp-derived "cosmetics"...creams, lotions, etc.
This leaves a lot of murkiness with CBD...especially with orals, tinctures, foods, etc...and enforcement is spotty.
So far, the most conclusive evidence is with Epidiolex...a purified CBD solution approved for two rare and severe seizure disorders.
Emphasize that there's not good evidence yet to support popular CBD claims...such as relieving chronic pain, anxiety, or insomnia.
And the variety of CBD products leaves many unknowns about their safety, quality, dosing, etc.
In general, recommend avoiding CBD in pregnant or breastfeeding women...and lean away from it in patients taking multiple meds.
Educate that CBD may cause drowsiness, diarrhea, etc...and using it with CNS depressants (benzos, opioids, etc) may worsen sedation.
Be aware of many potential interactions. For example, CBD inhibits CYP2C8, 2C9, and 2C19...and might raise levels of meds such as amitriptyline, valproic acid, and warfarin. Or CBD levels might be increased by CYP3A4 inhibitors, such as clarithromycin.
Plus high CBD doses are linked to elevated liver function tests. Explain most urine drug tests check for THC...not CBD. But high CBD doses with trace amounts of THC...or impure products...could lead to a positive THC test.
If patients plan to try CBD, suggest checking the product for a "certificate of analysis" from an independent lab. This doesn't confirm safety or efficacy...but shows levels of CBD, THC, and contaminants.
Dive deeper with our chart, Comparison of Cannabinoids...and access our Natural Medicines for more on efficacy, safety, and interactions.
Key References:
-www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#othercbdapproved (05-16-19)
-Health Effects of Cannabis and Cannabinoids: National Academies Press (US); 2017
-Can Fam Physician 2018;64(2):111-20
Pharmacist's Letter. June 2019, No. 350604

In March of 2009, Todd S. Eury, launched the Pharmacy Podcast Show. Over the years, the Pharmacy Podcast has accumulated over 75,000+ listeners and subscribers and is the most popular and downloaded podcast about the Pharmacy Industry.

The Pharmacy Podcast Show transformed into the Pharmacy Podcast Network (PPN) in 2014 and will continue to collect the thought leading interviews with some of the most brilliant minds in Pharmacy with over 30 co-hosts. The PPN is a Digital Health Publication and Content Developing partner to the Pharmaceutical industry focusing on Specialty medications, pharmacy business supportive technologies, and industry trends.

The PPN is the world's largest network of podcasts dedicated to the pharmacy professional and industry insiders leading with our hosts interviewing dynamic people in the pharmacy industry making a difference for our profession, customers, and patients.

The definition of “Innovation” is: A new method, idea, product, or process. Processing, implementing, operating, or designing beyond the status-quo. Pharmacists are the HUB of Healthcare & the PPN is the Pharmacist's biggest fan. 

In March of 2009, Todd S. Eury, launched the Pharmacy Podcast Show. Over the years, the Pharmacy Podcast has accumulated over 75,000+ listeners and subscribers and is the most popular and downloaded podcast about the Pharmacy Industry.
The Pharmacy Podcast Show transformed into the Pharmacy Podcast Network (PPN) in 2014 and will continue to collect the thought leading interviews with some of the most brilliant minds in Pharmacy with over 30 co-hosts. The PPN is a Digital Health Publication and Content Developing partner to the Pharmaceutical industry focusing on Specialty medications, pharmacy business supportive technologies, and industry trends.
The PPN is the world's largest network of podcasts dedicated to the pharmacy professional and industry insiders leading with our hosts interviewing dynamic people in the pharmacy industry making a difference for our profession, customers, and patients.
The definition of &ldquo;Innovation&rdquo; is: A new method, idea, product, or process. Processing, implementing, operating, or designing beyond the status-quo. Pharmacists are the HUB of Healthcare &amp; the PPN is the Pharmacist's biggest fan.&nbsp;

Pharmacy Podcast Network

The Pharmacy Podcast Network is ranked as the number one podcast in healthcare dedicated to the Business of Pharmacy and TOP 25 Podcasts in U.S. Business News. The most influential voices in the pharmacy industry are published on the Pharmacy Podcast Network (PPN). The PPN is the leading audio authority of the pharmaceutical & pharmacy industry with more than 30 hosts, 1,200+ episodes, supporting more than 25+ pharmacy industry associations, with more than 80,000 listeners world wide. 

The PPN is an Audio Branding & Public Relations Communications company dedicated to the Pharmaceutical industry focusing on Community, Long-term care, Health System, Specialty, pharmacy business supportive technologies, and industry trends. 

Pharmacy Podcast™ is a registered trademark

The Pharmacy Podcast Network is ranked as the number one podcast in healthcare dedicated to the Business of Pharmacy and TOP 25 Podcasts in U.S. Business News. The most influential voices in the pharmacy industry are published on the Pharmacy Podcast Network (PPN). The PPN is the leading audio authority of the pharmaceutical &amp; pharmacy industry with more than 30 hosts, 1,200+ episodes, supporting more than 25+ pharmacy industry associations, with more than 80,000 listeners world wide.&nbsp;
The PPN is an Audio Branding &amp; Public Relations Communications company dedicated to the Pharmaceutical industry focusing on Community, Long-term care, Health System, Specialty, pharmacy business supportive technologies, and industry trends.&nbsp;
Pharmacy Podcast&trade; is a registered trademark

Advertisement