Tuesday, February 18, 2020

CBD Series -- Part 1

Cannabidiol (CBD):  What is the real story?

John Hollis is an innovator.  He is always monitoring trends and new directions in pharmacy.  I am a perpetual clinical skeptic, always ready to question the latest brand new “thing.”  With CBD, we followed our patterns.  John began discussions with hemp farmers in Kentucky, one of the first states to legalize hemp production, back in 2015, long before CBD was introduced into the marketplace.  John drove out to hemp farms to watch the production and even critiqued the process by which CBD oil was produced, suggesting carrier oils that would provide the greatest bioavailability of the active ingredient.  John insisted on examining the source even before working with the product.  As CBD oil became available for use, John was ready to move forward.  I was, unsurprisingly, skeptical.  One afternoon, John was rushing out of the pharmacy, late for a meeting, and the lab was a mess of CBD soaked glassware.  I assured him that I would clean up and that he was free to charge forward.  During clean-up, I realized that CBD oil had spilled on my bare skin.  As a result, I could smell the CBD oil on my hands as I left the pharmacy, shaking my head, slightly irritated with myself (and John) as I knew it would be a long, aromatic drive home through Nashville rush hour traffic.  Much to my surprise, it was the easiest commute I had ever driven!  I was polite, even charming to other drivers.  The traffic was the same.  I, with the addition of CBD, was not.  This began my research into CBD.

While there is a huge amount of media attention devoted to CBD, the accuracy of information has been questionable.  New research has provided a clearer picture of how and why CBD works in the body.  We are beginning a new educational series on CBD, starting with understanding how CBD differs from marijuana, then moving to how CBD works on the Endocannabinoid system in the body, and finishing with information on using CBD in disease states.

To begin, CBD stands for Cannabidiol.  Like marijuana, the plant family is cannabis sativa; however, there are huge differences in CBD and marijuana.  CBD is derived from the hemp plant which is a cousin of the marijuana plant, and hemp contains lower levels of THC (tetrahydrocannabinol) which is the psycho-active ingredient in marijuana.  Hemp also contains higher levels of CBD than the marijuana plant, so the active levels of medication in the two plants are reversed:  hemp is high in CBD and low in THC, and marijuana is just the opposite.  By law, CBD oil has to have 0.3% or less THC.  CBD oil that contains THC is referred to as “Full Spectrum CBD.”  For reference, marijuana has from 5 to 28% THC, and the more THC, the more potent marijuana becomes.  Very importantly, CBD is legal in all 50 states. 

CBD oil is usually packaged in a 30 milliliter (or 1 ounce) bottle.  The amount of CBD listed on the label is the entire amount in the bottle.  It is not the amount per dropperful.  For example, if a 30 ml bottle of CBD has 2400 mg on the label, it means that there is 2400 mg per 30 ml or 80 mg per dropperful.  We will explore this at length along with dosing in a future post.

And now, does CBD work?  At this point, CBD has been promoted for an extensive variety of health conditions, and more research definitely needs to be completed.  CBD is being used to address anxiety and insomnia,* and may offer options for chronic pain and inflammation.**  We will address these disease states in upcoming posts.  The strongest evidence that CBD is effective comes from the FDA which recently approved the prescription drug Epidiolex (Cannabidiol) for the treatment of seizures in children.  

Side effects of CBD are mild and can include nausea, fatigue, and irritability.  The most important concern is that CBD does not currently fall under any regulatory agency, so evaluating the quality of CBD falls on the consumer.  Any reputable provider of CBD will have a Certificate of Analysis to prove that what you are buying contains actual CBD.  Each lot of CBD produced will have a certificate of analysis for that particular lot number.  The certificate of analysis is the official record that documents that a chemical contains what it is supposed to contain.  We always have our certificate of analysis per lot available and others should also.  Feel free to ask for this information when you purchase CBD oil.

The bottom line is that CBD is not marijuana.  CBD can potentially provide a safe and effective option for managing anxiety, insomnia and chronic pain.  It is important to read the labels carefully and to have information about the origin of the product, and to discuss CBD with your physician or pharmacist to make sure that it does not interfere with your current medication. 

Next time, we will discuss how CBD works in the body, so stay tuned!

*Cannabidiol as a Potential Treatment for Anxiety Disorders. Blessing EM, Steenkamp MM, Marmar CR. Neurotherapeutics 2015;12(4) 825-836.
**Cannabinoids and Pain:  Sites and Mechanisms of Action. Starowicz K, Finn DP, Adv Pharmacol. 2017; 80: 437-475.