Cannabidiol (CBD) products will make a debut in some pharmacies and mainstream retailers...not just smoke shops, dispensaries, etc.
CBD and THC are cannabinoids found in two varieties of the cannabis plant...marijuana and hemp. But CBD doesn't cause a "high" like THC.
Hemp with 0.3% THC or less is no longer a federally controlled substance and is a legal source of CBD...after last year's Farm Bill.
But cannabis STATE laws vary. For example, cannabis is fully legal in California...but all forms are illegal in Idaho.
FDA regulations add to the confusion. They say CBD can't be sold as a supplement...since it was first approved as an Rx drug (Epidiolex). But CBD is allowed in hemp-derived "cosmetics"...creams, lotions, etc.
This leaves a lot of murkiness with CBD...especially with orals, tinctures, foods, etc...and enforcement is spotty.
Steer patients asking about CBD to your pharmacist to get the facts.
So far, the most conclusive evidence is with Epidiolex...a purified CBD solution approved for two rare and severe seizure disorders.
But it's "buyer beware" with most other CBD products.
There's not good evidence yet to support popular CBD claims...such as relieving chronic pain, anxiety, or insomnia.
And there are lots of unknowns about safety, quality, and dosing.
Plus CBD can have side effects...such as drowsiness or diarrhea.
Also keep in mind, high CBD doses could lead to a positive THC urine drug test...if the product has trace amounts of THC or is impure.
If patients use CBD, add it to their profile...so the pharmacist can check for potential interactions.
For instance, using CBD with benzodiazepines (alprazolam, etc) or opioids (hydrocodone, etc) may worsen sedation. And CBD might raise levels of meds, such as amitriptyline, valproic acid, and warfarin.
Help check CBD products for a QR code that can be scanned to see a "certificate of analysis" from an independent lab. This doesn't confirm safety or efficacy...but shows levels of CBD, THC, and contaminants.
Dive deeper with our chart, Comparison of Cannabinoids.
- www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#othercbdapproved (05-16-19)
- Health Effects of Cannabis and Cannabinoids: National Academies Press (US); 2017
- Can Fam Physician 2018;64(2):111-20