Cannabidiol, popularly known as CBD, has been a controversial subject in the clinical setting. The dark era of cannabis prohibition did a lot to hamper research. Consequently clinician training has been void of the mechanisms of cannabinoid-based therapy.
Fortunately, things have taken a different turn and now there is emerging scientific evidence in this area. With the pace set, it’s time to get the relevant stakeholders (clinicians) on board. And that is exactly what one organization is doing.
The Medical Cannabis Clinicians Society in the UK provides a platform for clinicians to share practical knowledge and spark conversations on medicinal cannabis. The society is made up of an independent network of clinicians offering consultation and treatments as well as spearheading research in this area.
In their recently released guidelines, the society extensively explored CBD and provided recommendations for physicians. Below is a breakdown of the highlights.
In the UK, two cannabinoid-based drugs have been approved and licensed for use by the public: Sativex®, for the treatment of spasticity in multiple sclerosis, and Epidyolex®, a treatment for seizures. While the former has a 1:1 tetrahydrocannabinol (THC) to CBD formulation, the latter is 98% CBD.
On the safety of CBD, the guideline cited a 2018 WHO report which found that CBD was “generally well tolerated with a good safety profile.” There is no evidence on CBD causing severe side effects or dependence.
As outlined in the guidelines, therapeutic benefits include the following properties:
The strongest evidence for the therapeutic significance of CBD lies in the treatment of intractable childhood seizures.
CBD can be consumed through various methods and this affects how it is broken down and used in the body:
The response to CBD is individualized and is affected by age, tolerance, genetic, body fat percentage, and other factors. A low dose to start with is considered 10mg daily; this can be increased gradually over four weeks to 60mg.
Since CBD is excreted through the kidneys, those with impaired kidney function should be monitored and liver function should also be checked if they are taking a very high dose. Therefore, patients with liver or kidney impairment may need to start at a lower dose.
CBD also interacts with some drugs that are metabolized through the cytochrome P450 pathway, such as some anticonvulsants, antibiotics, antifungals, anticoagulants, antacids, heart medications, and St John’s Wort.
Common side effects found in clinical trials of high-dose CBD include sleepiness, decreased appetite, and diarrhea.
The guidelines also provide a nice checklist of questions for patients to consider when buying CBD products.
We recommend both patients and physicians review this guidance to aid in conversations about CBD and to learn more about this growing and popular therapeutic option.
Image Credit: Elena Borisova
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