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What You Should Know About CBD for Your Patients

CBD, CBD for doctors
What You Should Know About CBD for Your Patients

One of our core principles at TelMD is encouraging a patient-centered approach to health care. What that means is listening to patients and leverage their thoughts, feelings, and worldviews and combine them with professional expertise to help them identify their best healing options.

This is a bit of a differentiator from many conventional health care practices, where often patients feel like they can’t be honest with their doctor for fear of their doctor judging them, or only strictly advocating for one modality of healing. 

From the practitioner perspective, doctors took the oath to “do no harm,” which can leave them in a tricky situation when it comes to complying with patient choices that they may be less practiced in––like herbalism, acupuncture, and supplements, for instance.

This dilemma has presented itself for many doctors in recent years as treatments like medical marijuana and CBD have entered the public sphere. Many patients are coming into their doctor’s office asking: “Should I try CBD for my pain/inflammation/insomnia/stress/anxiety?”

While CBD is considered relatively safe by the WHO because of its non-psychoactive, non-addictive qualities; the truth is, commercial CBD products that are sold in gas stations, for instance, may be far less safe due to the presence of additives, impurities, and harsh chemical solvents. 

This article outlines the key facts that every practitioner should know about CBD so you can make more informed decisions about whether or not to recommend or condone its use with your patients.

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What is CBD?

is short for cannabidiol, which is one of the many compounds found in the cannabis family of plants. Two varieties of cannabis are hemp and marijuana plants. The compound that most people are familiar with in the marijuana plant is THC––which is what gives people the “high” feeling.

But not all cannabis plants contain THC and some only trace amounts. The plants with very low THC are called hemp plants, and it is from these plants that CBD is usually derived.

In the absence of the psychoactive effects of THC, many of the other beneficial compounds of the hemp plant become more available for human use––such as CBD.

CBD became popularized in the US in the early 2000s after a mother from Colorado was desperately seeking support for her daughter who suffered from a rare form of epilepsy called Dravet’s Syndrome. After trying everything for years with no luck, she stumbled upon research about the possible health benefits of cannabis for epilepsy.  The mother connected with marijuana growers in Colorado (where it was legal) who offered a strain of hemp with extremely low THC. After finding the right dosage, her daughter’s seizures drastically decreased in severity and frequency. From that point forward, word got out about the possible health benefits of CBD, and it has now become a (largely unregulated) multi-billion dollar industry. 

How Does CBD Work? 

While scientific studies catch up with the surging demand for CBD, the truth is, the evidence that we currently have (double-blind placebo studies on humans) on its potential health benefits is quite limited. 

As mentioned above, there has been strong enough evidence to suggest that CBD can help with certain forms of seizures, and for that reason, there exists an FDA-approved drug, Epidiolex, which specifically treats people suffering from rare forms of epilepsy like Dravet’s Syndrome and Lennox-Gastaut Syndrome. The scientific theory behind its efficacy is that CBD oil “helps suppress seizures by slowing down messages being sent to the brain, changing calcium levels in brain cells and decreasing inflammation in the brain.”

When it comes to other health conditions, like anxiety, depression, insomnia, pain, and inflammation, what does the evidence say about how well CBD might work?

Before the appropriately intense focus on Covid-19 research, CBD was and still is the subject of much scrutiny and debate in the medical and pharmaceutical communities.

There are animal studies that show promising results in pain and inflammation reduction. Many CBD researchers are currently studying the ways in which CBD interacts with our endocannabinoid system. It is suspected that CBD has a relationship with our endocannabinoid system that can help to decrease inflammation and promote an overall feeling of wellness. 

But actual scientific evidence is still forthcoming.

Regardless, according to many polls, including this one from Gallup in 2019, most Americans surveyed are not only familiar with CBD, but 14% are using it regularly for a variety of reasons. Out of those regularly using CBD, 40% are using it for unspecified pain, 20% for anxiety, 11% for sleep/insomnia, and 8% for headaches/migraines.

High-quality CBD can cost upwards of $80-$120 a bottle. While clever marketing and placebo undoubtedly play significant roles in the public demand for CBD, at the end of the day, what most CBD users will say is that they use it because it “works” for them.

You might hear stories of people who “tried everything,” and turned to CBD as a last resort. Or others who are tired of taking pills that may or may not help their chronic conditions, and others are just curious about finding more “natural” solutions.

Regardless of your opinion on whether or not CBD “works,” it’s clear that a significant percentage of our population is using it, and touting its benefits. 

Is CBD Legal?

As of April 2020, CBD is currently legal in almost every state except for Iowa and Idaho, with varying degrees of regulation within each state. Because it is such a new industry, regulations around CBD are changing all the time, and vary from state to state. The CBD market currently exists in a gray area, though it is expected that within the next few years more widespread permission and regulation will be in place. 

Will THC Get My Patients “High?”

Most high-quality CBD brands will not run the risk of making your patients feel “high.” Pure CBD is only allowed to contain up to .03% THC, which is essentially just a trace amount so no psychoactive effects should be felt.

However, because of the lack of regulation, the exact ratios of compounds from one CBD brand to the next can differ. This is why it’s extremely important that any CBD brand that your patients use is third-party tested with lab results available for each bottle. 

For patients concerned with THC content; for instance, those who get drug tested at work (although it is highly unlikely for CBD products to show up in drug test), or those with a history of mental illness (who may be avoiding even trace amounts of THC), certain CBD brands will sell products called “CBD Isolate” or “Broad Spectrum CBD,” which explicitly remove THC from the product.

However, for patients without a history of mental illness or those do not run the risk of getting drug tested, they may prefer something called “full-spectrum CBD.” Essentially, “full-spectrum” is like whole wheat bread, whereas “isolate” is like white bread: it’s more processed, and only contains CBD, whereas full- spectrum contains a multitude of other beneficial compounds. The theory is that all of the other compounds found in the cannabis plant, like  CBGA, THCA, and CBDA, and terpenes ––all work together to give an overall beneficial effect to the body. This is called the “entourage effect.”

What Should I KnowAbout CBD?

Many open-minded medical professionals feel somewhat ambivalent about CBD. There is currently not enough data to support medical usage, but at the same time, many people are taking it safely and experiencing positive results, based on anecdotal evidence.

Considering the grand scheme of risky activities that humans engage in daily, CBD use is generally considered to be one of the least harmful. As the World Health Organization published in their 2018 report:

CBD is generally well tolerated with a good safety profile. Reported adverse effects may be as a result of drug-drug interactions between CBD and patients’ existing medications…

To date, there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”

Two important takeaways from the WHO report:

1. Reported adverse effects are possible for patients who are currently on various medications.

2. The report specifies “pure” CBD. The quality of each CBD product plays a significant role in its safety and efficacy. 

Ultimately, it’s your decision to support or condone CBD use for each of your patients. If they are already taking CBD and experiencing positive health benefits, the risks are relatively low. If they are just starting out, their experience and safety can be greatly improved by having more information through a precautionary approach. Special precautions should be taken for those who are currently on medications and considering CBD usage. 

A Checklist For Safer CBD Use

As we pointed out above, CBD is a largely unregulated market. Like many markets not subjected to rigorous testing, quality can vary greatly from one product to another. For this reason, it is supremely important that if patients are using CBD, they make sure it is high-quality and well-sourced. 

What qualifies CBD as “high quality” or “well-sourced?” Generally speaking, the qualifications below have the greatest potential to harness the possible healing benefits of CBD without the risk of external additives or solvents which may lead to adverse effects.

  • Organically-grown CBD can reduce the risk of pesticide exposure.
  • CBD grown in the US theoretically has higher regulatory requirements.
  • CBD extraction processes are important, and can determine how “pure” the CBD product becomes. Look for CBD with clean extraction processes such as CO2, as many traditional extraction methods can leave harsh chemical solvents in the product. 
  • Using standard CBD oil that only contains the hemp plant matter and oil (like fractionated coconut oil) vs.using flavored CBD products or vaping, may reduce the risk of consuming additives. 
  • Users should consult with a CBD professional to find their correct dosage, as the amount can vary greatly from person to person, and taking too much can result in undesirable effects like lethargy or foggy-headedness.
  • CBD oil should be stored in a glass bottle (plastic can potentially leach into fats, like the oil that carries CBD).
  • CBD should always be tested by a third party, and lab results should be available to the public.
  • Full-spectrum CBD with trace amounts of THC (always under .03%) might not be the best option for those who are subject to drug tests and/or those with a history of mental illness. Use THC-free CBD instead.
  • Patients who are taking medications should take CBD with caution, and pay close attention to the drug-drug interactions. CBD may increase or decrease the effect of many medications. 

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