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.
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.
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.