How can community pharmacists in the UK get involved with medicinal cannabis and what advice should they give patients? Clifton Flack explains…

 

There’s no getting away from or ignoring the buzz around CBD (cannabidiol) over the last year. Since Holland & Barrett began selling CBD early in 2018, the controversial cannabis-derived supplement is gaining legitimacy and normalisation.

Consumers are beginning to turn to their doctors and pharmacists for advice on what type, strength and dosing they should consider.

Since there is a lack of clinical data to provide solid medical opinion, the alternative is to turn to both the science and subsequently anecdotal evidence to understand how CBD works and benefits those who use it.

When we talk about CBD, we are referring to a single molecule that is found in both cannabis and hemp plants. Cannabis is renowned for its high levels of THC-inducing psychoactive effects, while hemp is known for its fibers, used to produce fabric, paper and plastics.

There are three categories of cannabinoid therapeutics and while the molecules are the same, the source, application and regulatory framework are significantly different.

1. Pharmaceutical Cannabis. Possibly soon to be available in the UK, limited to only 5 FDA approved drugs including 2 from British based GW Pharma. Full phased clinical trials and data has been carried out on these drugs.

2. Medical Cannabis Not available yet in the UK, medical cannabis has been rolled out across many Western countries to varying success in the US, Canada, Germany, Australia and Israel. These products are mostly dry herb-based and include high levels of THC and often tend towards making pseudo medical claims.

3. Hemp derived CBD is legally available as a food supplement in the UK with over 500,000 customers. CBD is low-to-zero THC with compliant companies prohibited from making medical claims.

There is a growing body of anecdotal evidence freely available on line of CBD improving the situation of people with a broad range of health conditions including; insomnia, anxiety, pain, Crohns, Parkinsons, fibro, asthma and many more besides.

While the data is lacking, the testimonies become harder to ignore. Websites and social networks are awash with video diaries, blood test results and scans showing the clear impact CBD is having on individuals.

From a scientific perspective, CBD has been proven in laboratories all over the world for decades that CBD exhibits a natural anti-inflammatory effect. The connect between inflammation and many human diseases has also been well documented.

At the Hebrew University of Jerusalem In Israel, Dr Yossi Tam has been investigating the potential of CBD to treat fatty liver disease. The study is not only proving the potential of CBD but also actively seeking out the mechanisms of how the molecule acts to prevent fat accumulation at cell level.

The ramifications stretch far beyond that of the initial investigation and obesity could soon be treated with CBD in combination with other cannabinoids. The prevention of cirrhosis and diabetes would make use of the same formulation and delivery mechanisms.

Evidence is also mounting of the effects CBD can have on dermatological conditions. Many around the world apply CBD topically to alleviate the suffering from eczema and psoriasis, whilst athletes use CBD as a massage rub both pre and post-activity.

Armed with the knowledge and experience to recommend the best application and dose management is where pharmacists will gain advantage over the health food industry where this type of knowledge is lacking.

Customers should be free to choose a product based on the range of delivery mechanisms they offer, the range of strengths and importantly, the background of the company producing. Some pharmacists, for example, may prefer not to stock a clear lifestyle brand, in favour of a one produced under strict GMP certifications.

CBD brands differ aesthetically and the formulations vary significantly. While we refer to CBD, the reality is regulations insist producers use a ‘full spectrum’ hemp extract resulting in a product with potentially up to 200 additional minor cannabinoids.

We know very little about many of these compounds, as such where one product will work for one person and not another can often times be attributed to these fractional differences in cannabinoid profile. Consumers should understand there can be a journey of experimentation to find the right product and dose they need.

In the absence of CBD being integrated into the healthcare system, UK pharmacists must become the source of trust people have when seeking advice on the use of CBD.

 

Clifton Flack is the founder of cannabis biotech company CIITECH.

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