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CBD Products: Are They Worth the Risks?

Kelley-Ross Pharmacy GroupAsk The PharmacistCBD Products: Are They Worth the Risks?
4
Mar
2020
4.03.2020

CBD Products are becoming more widely available in retail stores throughout Washington State. There are many theoretical uses for CBD products, but it is difficult to know if they work for these different purposes. Additionally, as CBD comes from Cannabis plants, there is significant concern over the legality of the product and regulations surrounding its use. Here is an overview of the medicinal and legal factors to consider when using CBD products so that you may be a more informed consumer.

Kelley-Ross stocks a variety of human and pet CBD products. Give us a call at 206-324-6990 to learn more!

What is CBD?

Cannabidiol, or CBD, is a component of cannabis that is nonpsychoactive, or does not produce mind-altering effects. In contrast, THC, another component of cannabis, produces the “high” that is associated with marijuana use.

The body produces its own cannabis-like molecules and has a network of proteins called CB receptors that cannabis components can bind to. These receptors serve many purposes including pain control, body temperature control, movement, immune function, and brain function. Researchers have found that THC tends to associate with the body’s own receptors, but CBD likely has other actions in the body1. CBD has been shown to work for conditions such as seizures, arthritis, and anxiety.

How to Use CBD

  • By mouth: Meals that have high fat content may increase the how much CBD gets into the body. It is important to be consistent with how you are taking this medication relative to meals. For CBD capsules, make sure you swallow the capsule whole. For tinctures, the manufacturers suggest placing the liquid under the tongue and holding for at least 30 seconds prior to swallowing to allow for the CBD to get into the system more easily.
  • On the skin: Applying CBD to the skin is most ideal for purposes that are localized to one area of the body such as skin conditions, arthritis, and nerve pain. The amount of CBD that can get into the blood depends on the site of application. Make sure you DO NOT apply topical products to open wounds. Talk to your doctor or pharmacist about whether a topical product would be recommended for your needs.
  • Inhaled: Be cautious with this method of using CBD. There is limited evidence to suggest that this is a safe way to take in CBD and increasing evidence that indicates this may cause severe lung illness.

Legal Considerations

Since the passage of the 2018 Farm Bill, CBD products are no longer considered a “Schedule 1” controlled substance in the U.S., which means they are not subject to the same regulations as marijuana with regards to who can legally grow, sell, or use this product. As a result, CBD is more easily accessible in many states, some of which are allowing the sale of CBD over the counter. However, CBD products are required to contain no more than 0.3% THC content in order to fit these criteria.

Despite this, many states have their own rules and regulations regarding who may sell or possess these products. It is important to be mindful of your state’s laws regarding the sale of these products, and, if you are traveling, whether you can transport CBD across state lines.

For example, Idaho State law indicates that products with any content of THC are illegal in the state. In Washington State, businesses need to register with the Washington State Liquor and Cannabis Board to be able to sell CBD products. In Washington State, marijuana use was decriminalized as part of Initiative 502, which means that individuals over 21 years old can consume cannabis-products (including CBD).

Drug Testing

The U.S. Drug Test Centers organization estimates that using about 2000 mg of CBD per day could cause a positive drug screening based on the 0.3% THC threshold. Since drug tests are testing for THC, high usage of CBD products could cause a positive drug test.

Additionally, the U.S. Drug Test Centers states that it is possible for a “false” positive to show up on a drug screening after using CBD products. During an experiment at the University of Utah, a different component of cannabis, CBN, has triggered some false positives in drug screenings. While a follow-up test may show the difference between THC and CBN, if the source of the product contains more than the 0.3% THC content, it would be possible to test positive. It is important to note that THC from marijuana and THC from CBD products are the same compound, so testing positive from a legal CBD product may have consequences.

If you decide to consume CBD, know your source. Ask to verify that the product has less than 0.3% THC content. If you know your source of CBD, and it has less than 0.3% THC, there very minimal risk of testing positive for THC, but it is not a 0% chance. The best option would be to avoid using CBD products if you are expecting a drug test.

Safety Considerations

Food products (ie. gummies): Although the FDA is restricting the sale of CBD in food products, some CBD products are sold as gummies or desserts. It is important to keep these products away from children and pets to prevent accidental consumption.

Drug Interactions: CBD has the potential to affect the way certain prescription medications are processed in the body, including antidepressants, seizure medications, and blood-thinners. Discuss with your pharmacist whether CBD products interact with your medications.

Side effects:

  • Tiredness/dizziness: Be careful when using these products. It is possible that these symptoms will resolve with continued use
  • Liver toxicity: Have labs performed as recommended by your provider. Call your doctor if you notice any dark urine or yellowing of the skin or eyes.
  • Suicidal thoughts: If you notice any thoughts of suicide call your doctor or contact 1-800-273-8255.

Dosing: Many of these products have not been tested in humans in studies for every disease/purpose that the manufacturers claim, so it is important to discuss how to take these products with your doctor or pharmacist. In general, the best approach is to start with the lowest dose possible, and gradually increasing after a week based on desired effect and side effects.

Take-Home Points
  1. Know the product you are buying. Make sure you are purchasing your product from a reliable source. If available, ask for the data which shows the THC content to make sure it is less than 0.3%.
  2. Tell your doctor and pharmacist if you are using these products. These have the potential to interact with other medications and cause side effects. Your providers may want to do additional testing to make sure these products are safe.
  3. Know your state laws. Though your state may allow the sale and possession of CBD products, it is important to be aware of the states that have more stringent rules if you travel with or mail these items.

 

Prepared by Ali Icenogle PharmD Candidate 2020

See also a previous Kelley-Ross CBD Blog 

References:

  1. Devinsky, O., Cilio, M. R., Cross, H., Fernandez‐Ruiz, J., French, J., Hill, C., … & Martinez‐Orgado, J. (2014). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791-802.
  2. Freund, T. F., Katona, I., & Piomelli, D. (2003). Role of endogenous cannabinoids in synaptic signaling. Physiological reviews, 83(3), 1017-1066.
  3. FDA. (2018). Epidiolex Package Insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
  4. Malfait, A. M., Gallily, R., Sumariwalla, P. F., Malik, A. S., Andreakos, E., Mechoulam, R., & Feldmann, M. (2000). The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences, 97(17), 9561-9566.
  5. Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2016). Transdermal cannabidiol reduces inflammation and pain‐related behaviours in a rat model of arthritis. European journal of pain, 20(6), 936-948.
  6. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in anxiety and sleep: a large case series. The Permanente Journal, 23.
  7. Linares, I. M., Zuardi, A. W., Pereira, L. C., Queiroz, R. H., Mechoulam, R., Guimaraes, F. S., & Crippa, J. A. (2019). Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Brazilian Journal of Psychiatry, 41(1), 9-14.
  8. Hemp Synergy. https://www.hempsynergy.com/hemp-oil-tinctures/1500mg-60ml-tincture?flavor=&gclid=EAIaIQobChMI3-av4-rR5wIVh_hkCh3dowfwEAQYASABEgKafvD_BwE
  9. Christiani, D. C. (2019). Vaping-induced lung injury. N Engl J Med, 6(10.1164).
  10. Bruni, N., Della Pepa, C., Oliaro-Bosso, S., Pessione, E., Gastaldi, D., & Dosio, F. (2018). Cannabinoid delivery systems for pain and inflammation treatment. Molecules, 23(10), 2478.
  11. Congressional Research Service. (2019). The 2019 Farm Bill (P.L. 115-334): Summary and Side-By Side Comparison. https://crsreports.congress.gov/product/pdf/R/R45525
  12. Idaho Office of Drug Policy. (2019). Cannabidiol (CBD). https://odp.idaho.gov/cannibidiol/
  13. Washington State Liquor and Cannabis Board. (2019). Hemp/CBD FAQ’s. https://lcb.wa.gov/hemp/hemp-cbd-faqs
  14. Washington State Liquor and Cannabis Board. (2019). Know the Law. https://lcb.wa.gov/mj-education/know-the-law
  15. U.S. Drug Test Centers. (2019). Can You Fail a Drug Test Due to CBD? https://www.usdrugtestcenters.com/drug-test-blog/181/can-you-fail-a-drug-test-due-to-cbd.html
  16. Kroner, G.M., Doyle, K., Johnson-Davis, K.L., McMillin, G.A. (2019). Comparative Cannabinoid Cross-Reactivity in THC Immunoassays. AACC Annual Scientific Meeting. https://www.abstractsonline.com/pp8/#!/6831/presentation/653
  17. Bonn-Miller, M. O., Loflin, M. J., Thomas, B. F., Marcu, J. P., Hyke, T., & Vandrey, R. (2017). Labeling accuracy of cannabidiol extracts sold online. Jama, 318(17), 1708-1709.
  18. FDA (2020). FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd#food
  19. Millar, S. A., Stone, N. L., Bellman, Z. D., Yates, A. S., England, T. J., & O’Sullivan, S. E. (2019). A systematic review of cannabidiol dosing in clinical populations. British journal of clinical pharmacology, 85(9), 1888-1900.

 

Kelley-Ross is an independently owned corporation operating 4 pharmacies in Seattle. Kelley-Ross provides a wide range of pharmacy services, including prescription dispensing, compounding, medi-set packaging, compliance packaging, long-term care facility services, consultant pharmacist services, immunizations and a variety of health screenings.

We provide Clinical Community Care. This means that our staff combines expert medication therapy management and clinical skills, with caring, patient centered pharmacy services. By using the triad approach – patient, provider and pharmacist – we can help patients maximize their healthcare resources while achieving optimal health outcomes.

Our high service level and commitment to problem solving has made Kelley-Ross the pharmacy of choice for patients and providers across the Northwest.