A Pharmacist’s Perspective on CBD Oil
CBD oil has popped up all over the place. You can find it at corner stores, online stores, health food stores, and at your local pharmacy.
Should you be taking CBD oil? Where should you buy it?
I have written the following in the hopes that you can make a more informed decision.
The endocannabinoid system (ECS) is part of our bodies that involves endocannabinoid (the first part of this word “endo” is used because they are endogenous, meaning within the body) neurotransmitters that act on cannabinoid receptors. The cannabinoid receptors are found throughout the central nervous system (CNS) and the peripheral nervous system (PNS). The ECS is responsible for eliciting a number of physiological and cognitive effects. This is part of the reason that humans have historically modified the ECS with exogenous (the first part of this word “exo” is used because they are outside of the body) substances, specifically by ingesting Cannabis.
Cannabis, commonly referred to as Marijuana in the United States and Ganja in Nepal, is a popular psychoactive plant that is used worldwide in a number of different ways. The plant has over 100 unique cannabinoids. The majority of these cannabinoids have not been fully characterized scientifically. The three most studied cannabinoids are tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN). THC is probably the most famous cannabinoid because it is responsible for the psychoactive properties of the plant, causing the “high”.
Let’s focus on CBD:
Cannabidiol (this is the where the “CBD oil” gets the “CBD” from) is different than THC because it has not been found to have psychoactive effects. Therefore, CBD is thought to be not habit forming or have the potential for abuse. This is also part of the reason CBD is sold in a variety of retail settings in states in the U.S. that have not yet legalized medical or recreational Cannabis. CBD still has an effect on the ECS and therefore was studied to see if there were any health benefits.
Epilepsy is the health benefit of CBD that has the most formal research to support its medicinal use. This is part of the reason why the Food and Drug Administration (FDA) approved a pharmaceutical grade CBD oral solution this past June 2018. The CBD oral solution is available by prescription under the brand name Epidiolex and is made by Greenwhich Biosciences. Epidiolex has FDA approval to treat seizures associated with Lennox-Gastaut syndrome (LGS) or Dravet syndrome (DS) in patients greater then 2 years of age. This is the first drug approved by the FDA that is derived from Cannabis.
It will be interesting to watch this medication to see if it gets any other FDA approved uses or if it starts being prescribed for other conditions and gains “off-label” uses. For example, there is some preliminary research showing the potential for CBD to help treat some anxiety disorders and for CBD to have anti-inflammatory properties. There needs to be more research in this area before the FDA will approve other uses of CBD. I am looking forward to see what future research reveals.
What CBD product should I take? Where should I buy CBD products?
In the U.S., the FDA does not ensure that the active ingredients of over-the-counter (OTC) herbal and vitamin supplements contain what the label states. I know, crazy right! When I learned about this in pharmacy school, I was shocked. I had always taken vitamins and didn’t think that I had to worry about what was in them. Because of that, as a pharmacist, I recommend people to take OTC herbals and vitamin supplements that are verified by a third-party lab to ensure the product actually contains what is listed on the label. Here is a Consumer Reports article that gives some examples of third-party labs that test OTC products:
OTC CBD (excluding Epidiolex, since this is the only FDA approved CBD) is considered to be an OTC herbal product and is therefore not tightly regulated by the FDA. Theoretically, an unverified OTC CBD product may not contain the strength and purity of CBD that the label claims. I will not mention specific brands by name, but I would encourage a person to make sure that they are purchasing CBD from a reputable source. There are some compounding pharmacies that make their own CBD products and will ensure the integrity of their products. I would encourage you to reach out to your local pharmacy to see what products they carry and/or compound. For example, in our area there is Colonial Village Pharmacy in Webster Groves, MO. The pharmacist Steve Zielinski, PharmD is knowledgeable about OTC CBD products and offers them for sale.
I hope this helped! If you would like to talk about anything mentioned above in more detail, please feel free to contact Dr. Strong or myself.
All the best,
About the author:
Hi everyone! I am married to Pratistha and I have been a licensed pharmacist in Texas since 2007. I have worked in a variety of pharmacy settings over my career and I have about 4 years of teaching experience. I taught for one year UT Austin/UTPA Coop Pharmacy Program and for 3 years at the UTRGV Physician Assistant Program. I enjoy teaching patients and students so I volunteered to help with my wife’s practice. I am also the clinic manager; officially know as “Mr. Manager.”
Epidiolex (cannabidiol) [prescribing information]. Carlsbad, CA: Greenwich Biosciences, Inc; June 2018.