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CBD Oils: Are There Dangers/Precautions (Pharmacist Perspective)

This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2019.  

For the original video go to: https://www.youtube.com/watch?app=desktop&v=3P2jRYNS1CI


Bob: Today we are going to talk about CBD oils. Are there dangers or precautions? We are going to give you a pharmacist’s perspective. This is Chris, the pharmacist who we are very happy that he is here. I’ve been wanting to do this topic for months. It’s taken a while to get him on board.


Brad: Well, he’s a busy person.


Bob: Yes, busy guy. Again, Chris the pharmacist, we’ve had him here before and hopefully we’ll have him many more times in the future. He’s going to give us the real scoop on it, right?


Brad: Right.


Bob: All I’ve been hearing about CBD oil, Brad, is that it’s good. It’s a miracle drug.


Brad: Right, you’re going to lose weight with it, you can cure your cancer, all kinds of things.


Bob: Anxiety, depression.


Brad: I’m thinking, well it’s a CBD oil. It’s in little bottles. Maybe it’s one of those things that can work, but we have to find out what’s behind this. So, we’ve got Chris here to help us.


Bob: Do we want to say what it is first?


Chris: Well, there’s the marijuana plant, and basically it’s got about 140 some odd chemicals that come out of it, but there are two that most people are interested in, there is THC, which is the one that gets you high. It’s the one that everybody seems to be all about. But CBD is the one that’s kind of catching on. It’s an interesting chemical compound, because you don’t get high from it. The new guidelines from each state, and you should probably check with your state’s laws and ordinances, but most of it’s pretty much decriminalized because the CBD oils that you see everywhere now, in gas stations, supermarkets, pharmacies, vape shops, they all basically come from, essentially, hemp. So, hemp, by design, for basically the laws, can only contain 0.3% THC. So, there’s no chance that you can get high from it.


Bob: Or less THC, right?


Chris: To a degree, and we say that with the degree because the products that are out there, not everything’s what it seems.


Bob: Right, it not all monitored the way it should be.


Chris: I mean, it’s the wild wild west right now and I think we really have to pump the brakes a little bit. Some of the claims with CBD are a little crazy and people want to gravitate to something that’s going to help them. If you have a problem like anxiety-depression, you want relief from the pain from cancer, or arthritis or what have you, and actually, more importantly, seize your control. I think it really does have applications for patients. We’re easily about 20 years behind the 8 ball in so far as trying to get up to date with the research that needs to be done.


Bob: Yes, because it’s been around a long time.


Chris: It’s been around for thousands of years. It’s not like its brand spanking new. I think with the decriminalization of marijuana and the states now legalizing it, I think you’re finding that people are gravitating towards alternate routes of healthcare. Again, there’s still lots of research that needs to be done, so it’s not just a simple cut and dry answer. It’s something that may work for you, but there’s risks associated with it too. We have to watch it. It can make you feel nausea or queasy. It can affect your liver. We do have to be careful.


Bob: You mentioned the percentage of that, can you do that again? This was with seizures?


Chris: Well, yeah, and there’s actually the only prescription CBD drug out there is a seizure drug call Epidiolex. It’s used for two very specific seizure disorders, typically in children. It’s right in their safety guidelines. It is a black box warning that says you do need to make sure that you’re taking liver tests on these patients. From 5-20% of patients have had either liver failure or at least liver injury.


Bob: That’s a significant amount.


Chris: That’s specifically for Epidolex, which is a very very potent prescription version of CBD so it’s not like the products that you’re getting anywhere else. So, there’s a clear distinction that needs to be made.


Brad: So, isn’t that a topical use or is it oral?


Chris: Well, CBD can be ingested in many different ways. For that one it’s an oral medication. So, you take it by mouth. From that standpoint, and again, it’s a very specific subset of people.


Bob: Chris, talk about how people do take the oil.


Chris: CBD can be ingested. Let’s say you’re somebody that has performance anxiety, if you’re going to do something like this, a video with Bob and Brad for example, I did not use CBD oil before we came on.


Brad: We better test you maybe.


Chris: Ha-ha. It shows up on tests. You have to be careful with that and we can touch on that later too. Let’s say somebody’s a little bit uncomfortable about speaking, or just an anxious situation or just has an anxious day, CBD does have a tendency to work for people to help them feel a little more relaxed in some cases. You should always check with your doctor to make sure it’s appropriate for you.


Brad: What about doses? Is there any idea what does to take?


Chris: Remember when I said, wild wild west? We’re really behind in the science that we need to do applicable doses. One interesting study that I read that was probably poor science, but at least showed some results, was a Brazilian study and it just took people that wanted to do it. They kind of did a public speaking simulation. They kind of came up with a target dose. They had about 53 people come through the study and basically set them in a scenario where they had to speak in front of people, so it created anxiety. They just didn’t quite feel right or comfortable. They tried varying doses of CBD and what it comes out to be is 300 mg which seemed to be the sweet spot. It’s an oral dose. It seemed to work really well. The interesting thing on the study was that a dose as low as 150 mg was useless and a dose as high as 600 mg was useless. But 300 was kind of right in the middle. That’s just one example. It wasn’t double blinded, so we didn’t see a placebo done with that. In my world, a lot of times doctors will prescribe Propranolol for people with speaking engagements. It works really well but you know, it’d be nice to see it get one-on-one, just to see what’s going on. I’m sure that there’s research facilities out there and the university setting, it’s a hot topic. But it’s hard to come by. It’s interesting that consumers can get it all you want, but the universities have trouble getting it to study it. It’s kind of an interesting conundrum.


Bob: So, at your pharmacy, how is it offered?


Chris: Where I work, it’s basically going to be something that’s going to be topical. It would be something that you would rub on. It’s gong to be for pain and it can actually be used for anxiety, can be used for rest.


Brad: So, you just rub it on your skin?


Chris: Yes. Non-prescription, right off the shelf. There’s drops that you can place underneath your tongue. We were talking about ways to ingest it. You could vape it.


Bob: So, when you get it in your pharmacy, does it tell dosages to take it at?


Chris: They have suggested doses.


Bob: Or can they just take as much of it as they want.


Chris: It’s interesting because I kind of looked at some of the products that we carry and so they have anxiety relief, pain relief, to help you rest, calms. They have all sorts of different names and packaging that suggests their uses, and they give guidelines. There’s not a controlled dose though. So, it’s very very difficult to figure out just how much is enough. So that’s a problem. We just don’t have enough controlled studies that show what we should be dosing it as.


Bob: Are these large companies that are offering this that you feel that you can trust at this point as far as the quality of the product?


Chris: I mean, as a businessperson, I think they are all trying to get it right. I would imagine that they’re all trying to make the best and greatness. So, there’s different ways to process it, to extract it and they’re working to try and make it emulsified so that it absorbs better, more effectively, so that you’re getting more bang for your buck. I think there’s a lot of good science that’s going into it. But what we need is the science, the research to show proper dose and proper frequency, minimization of side-effects, things that we have to be careful with as far as liver damage, which is actually a big thing with that. If you’re on a blood thinner, it’s certainly something we want to be mindful of because there is a risk for bleeding out, which is very very significant.


Bob: A lot of people are on blood thinners, so this is really important for you to know.


Brad: So, if you’re on blood thinners and you’re considering CBD, you better consult with your physician.


Chris: I would just say no at this point. You just don’t know. We don’t know the doses. It varies from batch to batch. There was a study that showed that they took all these samples of products and only 20% actually had the right amount of CBD in there.


Bob: That’s what I was wondering.


Chris: There was stuff that had much to much and there was stuff that had much too little and there was stuff that had a lot of THC in there, which is the active component in marijuana. So, putting yourself at risk, you can test positive like I said earlier. With the decriminalization of it I think there’s a lot of employers that may or may not have problems with it, but again you should check with your employer, you should check with your doctor. These are things that you really want to be clear on.


Bob: Right, if you’re in a position that there’s no tolerance for it. I mean, maybe a pilot or something like that. You don’t want to take a chance.


Chris: It could cause problems, so we want to be really careful with that. With your own health too, you want to make sure that it’s something that’s safe with your medication.


Bob: How long have you been a pharmacist?


Chris: 24 years.


Bob: So, 24 years, have you seen drugs like this before that, I know I’m putting you on the spot, but that seems like it’s having so much promise and then all of a sudden, they kind of unveil, take the wrapping off, and they find out that, no, this is not as good as they thought.


Chris: Yeah, I’ve seen it on the prescription side of things. There’s many many things that the FDA has allowed to go through and then all of a sudden as we get into larger scale, more mass people taking it. All of a sudden there’s acute liver failure. Vioxx was a very popular one.


Bob: I was going to bring up Vioxx.


Chris: I figured you guys are physical therapists so I’m sure you guys remember that anti-inflammatory.


Bob: Yeah, my mom was on it.


Chris: It was a great drug.


Bob: Yeah it was THE drug!


Chris: But it caused cardiovascular problems. So, they pulled it off the market.


Bob: So, we’ve seen this before. It comes out with great promise and then you realize, you know, take the veil off.


Chris: There’s times when you have to pump the brakes. I think we just need to learn more so we can help people to maybe even help themselves. I think it works well when you have a physician that’s on board and is knowledgeable with the products as well, or your pharmacist or your nurse practitioner, or your PA or whomever you get your care through. I think it’s important to make sure that everybody has kind of a teamize approach to ensure that we do what’s safest for the patient. To ensure that they’re getting the safest thing that they can do for themselves. But we just don’t even know real doses. Touching on that earlier example I said.


Bob: You go low, you go high and it’d be ineffective, and you have to really find that sweet spot. So how do you do that?


Chris: And what are the dangers if you’re taking other prescriptions.


Bob: Right.


Chris: You want a grain of salt with this one. You want to be super careful with it. There’s lots of studies that are now showing that yes, it can help you with anxiety and depression. Is it something that we want to embrace? I think it’s certain something that we can reach out for and see if we can help some people. Again, you want to do it in a very professional setting in so far as allowing your doctor to be in on the care plan. I think that’s very important. Some people self-medicate and it’s certainly a choice that can be made by themselves but it’s just something to be aware of the risks. You want to make sure that if you’re going to be a user of it, that you probably see your doctor to make sure that they’re looking at your liver functioning. That’s one of the few organs we don’t replace well. That’s not a joke. It’s something that we have to be careful with that because we just don’t know these doses. If you’re going to choose something, be consistent. Probably go to the same source, go to the same product. Go to the same retailer. You can always guarantee that you’re getting at least the same quality product that your body’s adjusted to.


Bob: You’ve mentioned anxiety and depression, is there any other areas you think that this is really showing promise in right now?


Chris: If you want to look at specifically medical marijuana, it’s a little off topic, but medical marijuana has THC and CBD. You get the benefits of both. If you’re somebody that’s suffering severely from cancer pain, or glaucoma or actually seizure disorders, those three in particular probably show that medical marijuana probably has a real application in all three for very different reasons.


Bob: What about CBD oil?


Chris: Well, CBD oil will work in all those cases as well, but medical marijuana will be a step above that. If you are a cancer patient and you’re taking something like a very strong prescription narcotic. Just throw out Fentanyl for example, or Oxycodone for example. Which are buzz topics in the medical world as well. Some people have just found that the medical marijuana provides them better pain relief. They don’t feel as weird from the side effects as the opioids do. I think from the standpoint of quality of life, I think there’s an application but again we have to be super careful. We have to make sure that it’s legal in your state. We have to make sure that your doctor is on board with it.


Brad: We were talking before, Chris, you and I and didn’t you mention there is a CBD oil-based prescription that is used for seizures? You’ve seen it very effective.


Chris: Well, it’s a newer product that came out last year. It’s called Epidiolex.


Brad: But isn’t that the one that you said is topical?

Chris: Nope, there’s actually some for CBD oil and seizure control. There’s some incredible videos out there of patients that have had severe seizures and then they take a CBD oil product. I’ve actually seen it applied on a child’s feet and it actually abated the seizure. It’s almost miraculous what it can do. There are applications where they’re studying for Parkinsonism as kind of helping with the motor movement to try and help with the issues with that. There’s some interesting topically, they talked about its improvement for acne. It’s certainly something that can help out. I think the mainstays are going to be anxiety, depression, pain relief and seizure control. They are the main ones. But it’s got a lot of other claims. I think we have to be careful because there’s some wild claims out there that say it may cure cancer. I think the carrot is way out in front of the horse on that one. I think with proper medical research, large scale studies, I think maybe we can see some very positive effects that may occur from it. But we still don’t know the dangers of it. I think what we’re going to see when more and more people start to use these products, we’re going to start to see a litany of side-effects that do occur.


Brad: Years down the road?


Chris: Years, days, weeks, months. It just kind of depends. If you report it to your doctor, then they can put it into a database and then they can actually learn from it so we can do more for people.


Bob: They’ll learn from experience, especially if someone’s been down the road for a long time here. These things start to crop up, so you really want to have shown caution.


Chris: Oh yeah, very much so, very much so.