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What Pharmacists Should Know About CBD

There’s been increasing demand for products such as CBD gummies in recent years. It’s something that is requested regularly, and because of that, many pharmacies are beginning to carry OTC CBD products. Pharmacies can boost their profits by offering a strong selection of products that don’t require a prescription. However, it’s important to remember that CBD is different from typical OTC products in a number of ways.

About CBD

There are different varieties of cannabis sativa, which is a herbaceous plant. Two of the best known varieties are marijuana and hemp. Cannabinoids, like CBD, can be found in both of these plant. Marijuana contains a cannabinoid known as tetrahydrocannabinol (THC). It has psychoactive properties and is the reason marijuana products are known for giving users a high.

While low concentrations of THC can be found in hemp, the CBD extracted from this plant does not have psychoactive properties and will not cause a high.

The Farm Bill passed in 2014, which defined hemp as a product separate from marijuana. According to the bill, hemp is a cannabis plant with less than 0.3% THC. This bill also allowed to hemp to be researched in states where it was legal to cultivate hemp. In the Farm Bill passed in 2018, hemp was removed from the controlled substances list. Since then, many hemp derivatives, such as CBD, have been researched. This also made it legal to cultivate, sell, distribute, and possess products derived from hemp.

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The Growing Popularity of CBD

Since 2018, CBD products have exploded in popularity, and it is now considered to be fairly mainstream. There is a wide assortment of CBD products on the market, and companies link all kinds of benefits to CBD. There are products that claim to cure insomnia, anxiety, pain, and so much more. Some brands have gone too far when describing the benefits of CBD. For example, Curaleaf Inc., a company based in Massachusetts, was warned by the FDA for making unsubstantiated claims about the products that they sell. In 2019, there were more than 20 companies that received FDA warnings for making claims about the effectiveness of CBD products. This is unusual to see, particularly for supplements.

It’s clear that the FDA is paying close attention to CBD products, but the same can’t be said for other regulators. Although companies have received warning letters, there have currently been very few consequences for companies that make over-the-top claims about the products that they sell.

Beyond that, because the market for CBD products has expanded so rapidly, there have been issues with adulteration and mislabeling. One report, which was conducted by Penn Medicine in 2017, discovered that approximately 70% of CBD products being sold online had issues with mislabeling. Some products are over-labeled, which means they contain a lower concentration of CBD than stated on the label. Others are under-labeled, which means the CBD concentration is higher than what’s on the label. The report discovered that just 30% of the tested products had CBD content within 10% of the amount that was listed on the label.

The Safety of Patients Should Be Your Top Priority

Before a pharmacy opts to stock CBD products, it’s important to research these products. The safety of patients should be paramount.

Managers need to choose the products they sell with care. There are many factors that should be considered, including recent research, independent testing, and the bioavailability of the products.

What You Should Know About Benefits, Side Effects, and Dosing

Reports from Harvard Health have found that CBD products could help users to fall asleep and sleep restfully. In a report conducted by the European Journal of Pain, it was found that applying CBD to the skin could reduce inflammation and pain linked to arthritis. There are also studies that have found that CBD can reduce neuropathic and inflammatory pain. The data that is currently available suggests that CBD can be used to manage a number of health symptoms. However, there is no evidence that suggests that CBD can cure diseases.

It’s common for people that have used CBD products to feel as though they’ve been sedated. These effects may be stronger if a patient is taking benzodiazepines. Additional negative side effects that have been linked to CBD include fatigue, nausea, and feelings of irritation. When the FDA evaluated Epidiolex, they found some safety risks, like the possibility of liver injury. Pharmacists should look at products closely so that they can inform patients about any potential for harmful side effects.

There are currently not any dosage guidelines for CBD. There is some dosage data in the clinical trials for Epidiolex, but it’s difficult to say if this data applies to OTC use for other products. Since CBD is typically sold as a supplement rather than a medication, it can be hard to determine how safe and pure these products are. FDA regulation for dietary supplements is different from the regulation process for medications.

The FDA has stated that there is the potential for adverse drug interactions when using CBD. This makes it especially crucial for pharmacists to provide advice and guidance to patients. CBD could make a medication more effective or cause potentially harmful side effects. Safe dosage for CBD may vary based on the medications that a patient is taking.

It’s important to remember that we still have limited information about cannabidiol and the effects that it has on the body. In spite of that, CBD products are still incredibly popular with patients. This can be challenging for pharmacists, which is why you may want to seek out training on this topic. If you look at the most current research on CBD, it will be easier for you to provide accurate advice and guidance to patients. This will make it easier for patients to use CBD safely.

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How CBD Is Extracted: The Best Ways To Extract CBD

Cannabis is one of the most adaptable plants and possibly one of Mother Nature’s best gifts to humankind. This is because cannabis is a potent source of compounds that have proven to be effective in combating and treating various types of illnesses. It is particularly rich in CBD, popularly known as cannabinoids. Although you might know this already, cannabis naturally contains CBD (cannabinoids) and THC (tetrahydrocannabinol).  CBD interacts with the body’s endocannabinoid system boosting its ability to regulate various functions of the body and trigger homeostasis. On the other hand, THC is the psychoactive compound known to produce a ‘high’ feeling when consumed.

CBD, the non-psychoactive compound, packs numerous properties that have proven to be useful in a wide range of applications. CBD oil, for example, has gained a lot of popularity in the health and wellness sector, and for a good reason.  It is one of the most effective natural treatments and home remedies for chronic pain, inflammation, migraines, anxiety, stress, skincare, and hormone balance, among other benefits.  The compound (CBD) is thus extracted from the cannabis plant, making it available to a multitude of users worldwide. This article outlines the various methods used to extract CBD from cannabis/hemp and how each extraction process is different from the other. You will also learn how various extraction methods affect the purity and quality of the end product.

Sources Of CBD

CBD, short for cannabidiol, is a chemical compound mainly commonly found in the cannabis plant. The compound itself is believed to pack numerous health benefits, and medicinal properties hence used to treat many ailments ranging from anxiety and pain, weight loss, and protect and boost brain health. These properties alone have seen the popularity of CBD skyrocket over the recent past. One of the reasons why CBD is effective in treating numerous chronic conditions is because it interacts with the body’s endocannabinoid system within the central nervous system. This is the part responsible for maintaining balance with the body.

Although CBD can still be obtained from wild marijuana, industrial hemp provides more and much better-quality CBD with very little (less than 0.3%) THC. This thus means the end product obtained from industrial hemp will be free of THC, thus safe for all to use.

How Is CBD Extracted

CBD extraction is the process by which the CBD compound is obtained from the plant material and then separated from other cannabinoids, leaving you with the pure CBD compound. This can/is achieved through a number of ways, with some extraction methods producing better quality CBD oil than others.  The process a manufacturer chooses to use to extract CBD affects the purity and quality of the final product. Familiarizing yourself with the various extraction methods and their benefits will help you have an idea of the best CBD suppliers and products to use.

The most common methods of CBD extraction are:

1. Carrier oil extraction method

2. The Rick Simpson Method

3. Alcohol extraction

4. CO2 extraction

1. The Rick Simpson CBD Extraction Method

Named after the founder, the Rick Simpson extraction method is the most straightforward and cheapest method of extracting CBD from the cannabis/hemp plant. It is also considered the worst method, especially when it comes to isolating CBD from other cannabinoids.  The method involves using a hydrocarbon (hexane, propane, butane, pentane, acetone, etc.) to absorb the cannabinoids. The hemp plant material is thus soaked in the hydrocarbon solvent, which extracts CBD from the plant, leaving it in a liquid form.  The solvent produced is then boiled to evaporate the hydrocarbons, leaving you with CBD oil. The low boiling point of these hydrocarbons makes the process quite easy and straightforward.

Hydrocarbons are, however, highly flammable, which makes the process quite dangerous from the get-go.  This extraction method destroys some of the essential plant waxes while leaving harmful residues behind. CBD oil obtained through this extraction method is thus prone to toxic compounds and contaminants, hence not safe for use.

2. Carrier Oil CBD Extraction

As the name suggests, carrier oil is used to extract CBD from the hemp plant. The most commonly preferred carrier oils for this method include jojoba, coconut, olive, and hemp seed oil.  The plant material has to be decarboxylated (heated at a certain temperature for a set amount of time) to activate compounds inside it. The decarboxylated plant material is then dipped into the carrier oil, after which it is heated again (at a set temperature) for several hours to help draw all cannabinoids from the plant material into the carrier oil. The method is thus straightforward and produces good quality and safe CBD oil.  CBD oil obtained through this method is perishable, putting a need for preservatives to be added to boost its shelf life. The potency of CBD oil from this extraction method is considerably much lower than most other extraction methods.

3. Alcohol CBD Extraction

The FDA considers ethanol to be a safe product to use. This is why most products from personal care to paint items have ethanol in them. That said, ethanol provides an excellent solvent for CBD.  Like you guessed, alcohol is used in the extraction process to produce better quality CBD oil as compared to the other extraction methods discussed above.   This is because ethanol doesn’t leave impurities in the extracted compound, and secondly, is safe for human consumption. Since ethanol is a polar solvent, it helps extract more than just CBD – you’ll get more water-soluble compounds (including chlorophyll) in the solvent as well. For this reason, the plant material has to be decarboxylated first (in a container) before introducing ethanol for the extraction.

With the plant material decarboxylated, ethanol is dripped through the container, dissolving and stripping the cannabinoids from the plant material. The solution obtained is then boiled off to leave CBD and other cannabinoids.  Some manufacturers may also choose to soak the entire plant in the ethanol liquid for some time until all the CBD has been dissolved, after which ethanol is separated from the compound. This extraction method’s only downsides are the high boiling point of ethanol and the lengthy purification process required to purify CBD. Ethanol also has a tendency of pulling out plant waxed alongside CBD hence leaving impurities behind.

4. CO2 Method Of Extraction

This is considerably the best and most widely-used method of CBD extraction.  Many industries today use carbon dioxide to extract CBD from the cannabis or hemp plant. The method is highly effective and produces the purest CBD oil possible. However, the carbon dioxide extraction method is divided into three subcategories: mid-critical, subcritical, and supercritical. The supercritical method is the most commonly adopted and preferred method for CBD extraction today.

This extraction method (supercritical) involves using specialized equipment and CO2 to extract CBD from the hemp plant material. The specialized equipment converts CO2 into liquid form, which is then passed through the plant matter. CO2 in liquid form pulls any CBD and terpenes from the plant matter, after which carbon dioxide is separated from the solution leaving only CBD and terpenes. The best part about this extraction process is that the end product is pure and that CO2 can be recycled for the same purpose repeatedly. With the environment controlled, CO2 can be reused severally, making the extraction process quite manageable and economically sound too.  Many companies use this extraction method for large scale CBD extraction.

Mid critical and subcritical CO2 extraction processes are, however, gentler hence doesn’t pull terpenes and other larger molecules from the hemp plant material. These methods are thus preferred when looking to create full-spectrum CBD oil for various uses. The supercritical extraction method is mainly used and recommended if looking to produce high quality and pure CBD products.  CO2 extraction is undoubtedly the best method for producing CBD products.  This is why you need to dig a little deeper into the production and extraction method used before making an order for CBD oil or related products from any supplier.

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CBD For Medical Practitioners

If you are reading this, chances are you are one of the many medical practitioners who’ve been approached by patients seeking advice regarding CBD oil. This product has become extremely popular in the past several years as alternative medicine. You can pick up a bottle of CBD oil almost everywhere now, from the local community pharmacy to almost every online store. But what do we really know about this substance? Is the advice we’ve been offering different from the one we should be providing? This read is meant to address these questions and hopefully create a set of ideas that health professionals can utilize when talking about CBD oil.

CBD Background

In the previous article, we touched on the background surrounding cannabinoid therapy: what it is and why you need to know about it. But let us have a quick refresh. The cannabis plant contains active compounds, often referred to as cannabinoids. Among them, cannabidiol (CBD) and THC (tetrahydrocannabinol), are the largest constituents. THC is the compound responsible for the psychoactive properties that come with consuming cannabis and the product for which legal restrictions are applied. On the other hand, CBD does not have psychoactive properties, but it’s hypothesized to be one of the primary components responsible for the alleged therapeutical cannabis benefits. The body contains two endocannabinoid receptors named CB1 and CB2. According to several studies, CBD has been seen to bind to these receptors and thus having the effects observed.

What Can CBD Oil Be Used For?

Cannabis has been used for non-psychoactive properties since 3000BC when Chinese texts show its use to treat cramps and pain. But what conditions do people use it for today?

Do a simple Google search, and you will come across numerous results claiming it is beneficial for an array of conditions, including anxiety, depression, stress, acne, MSK symptoms, multiple sclerosis, insomnia, and many others. The anecdotal claims are too many to mention. However, in medical practice today, anecdotes rarely have their way into medical policy. However, there’s major evidence supporting some of these claims, an example being the report published by BMJ in 2015 called Medical Cannabis: the Evidence, summarizing what we currently know. Human trials don’t have adequate evidence, but the existing clinical trial results suggest that CBD has antioxidant, neuroprotective, and anti-inflammatory properties. A study on rats in 2016 by D.C Hammell found that topical cannabidiol application had the potential to treat arthritic pain and inflammation. As such, it would be ignorant to dismiss all the claims made by users about the benefits derived from the consumption of CBD. At the same time, there is inadequate evidence for medical professionals to recommend it as a treatment option.

What Advice Should Medical Practitioners be Giving?

As of this writing, we have not untangled the complicated pharmacology for every cannabinoid to be differentiated by medical potential, and so, we do not really know what isolated cannabidiol is ideal for. However, the reality is that there are people self-treating with the compound. The million-dollar question is what medical practitioners should advise patients who wish to try CBD oil or are already using it to treat conditions such as arthritic pain.

Taking into consideration the potential benefits as well as current evidence base but stressing the lack of human trials to support its use is one of the best ways to go about it. This is referred to as the open approach. Ideally, encouraging self-care is vital but works best when created with expert advice and with the right measures in place. At this point, it would be beneficial to get a full history of reason for consumption, dosage, length of use as well as the form of administration. This information, combined with precise drug and patient history, will help medical professionals create a holistic approach tailored to the patient.

Cannabidiol oil is metabolized through the CYP 450 hepatic enzymes. These enzymes are tasked with metabolizing about 70% of all drugs. As such, cannabidiol is a potent inhibitor of CYP2D6 and CYP3A4. This is important information to reveal when having a discussion with patients regarding the use of CBD oil. Even though we do not know actual interactions in most cases and the knowledge on the enzymatic effects is still limited, it is important to convey the theoretical understanding of medications that could be affected. Specifically, it has been found that consuming CBD increases clobazam and warfarin levels.

Moreover, CBD is currently categorized as a food supplement and has no MHRA medicinal or herbal authorization. That’s why no medicinal claims cannot be legally attached to its use. However, it has more implications. Achieving MHRA authorization requires the substance to maintain highly reproducible percentage limits of the mentioned drug content. This is usually between 90 to 110 percent. What this implies is that an Atorvastatin 10mg tablet, for example, needs to contain between 9 to 11mg of Atorvastatin. Clearly, this is vital in order to maintain therapeutic continuity. The lack of MHRA authorization means this isn’t a requirement, and so, the quality control process is not as stringent.

A good example here is unlicensed Vitamin D supplements. According to a study published in 2013 by Garg S, 15 different preparations were analyzed, and only 8 were found to contain within the 10 percent of the stated dose, and the actual doses ranged from 8 to 201 percent of the stated content. Another study found variation even within pills from the same packaging ranged from 52 to 126 percent of the stated dose. The possibility of such a variation in CBD creates a higher level of uncertainty around its use for therapeutic purposes, something important to convey to patients.

Summary

Once you have portrayed the above points, it is the patient’s choice whether to indulge or not. As with most discussions surrounding medication or treatment, explaining the benefits vs risks is the most important thing. Some things are red flags for extra caution, high-risk drug interactions being a good example. However, if there are major benefits and there are no adverse effects to be deduced, then a managed approach to safe consumption is certainly the best strategy.

Every patient is different and so, don’t be afraid to ask for more time in order to formulate an answer you are confident with. Keep in mind that there’s no definitive answer and the decision is up to the patient. As medical professionals, our duty is to advise based on our professional judgment and create a safe space for patients to explore the available treatment options.