By Sultan Dajani
Cannabidiol (CBD) products, including oils, capsules, oral sprays, skin creams, gummy bears, vaping liquids and drinks have rapidly become available in high street outlets and online.
However, sold mainly as a food supplement, CBD cannot make any medicinal claims and should not be confused with medical cannabis, which is available only on prescription. Cannabis contains tetrahydrocannabinol (THC), the compound that produces a ‘high’ and which is illegal in over the counter products.
Research suggests that approximately six million UK adults have used CBD and it is important that consumers are confident of the quality and safety of the CBD products they are buying. With so much uncertainty around CBD, this represents a significant opportunity for pharmacy businesses to provide consumers with professional advice and stock trusted reputable brands.
Quality is a significant issue for CBD products. A report published in June this year by a leading industry membership body for manufacturers and investors in the CBD and cannabis-based medicinal products found that CBD products can vary significantly in terms of quality ingredients with the potential to mislead consumers.
With the proliferation of CBD products in the marketplace, it is vital that pharmacy is a trusted source of quality products. For example, Dragonfly oil is a product that has passed a Centre for Medicinal Cannabis product and ingredient quality test in which 30 other brands were audited by an independent testing laboratory and confirmed that it complied with all test criteria which included containing the stated amount of CBD oil as advertised, THC-free confirmed, seed to shelf quality control with pure CBD content, no solvents and no contaminants, packaging compliant with Food Supplement status and batch number and use-by-date on every pack.
These test findings confirm responsible producers’ commitment to investing in a ‘from seed to shelf’ approach which enables product integrity to be guaranteed and provides consumers assurance regarding product quality and safety.
At the end of 2017, the World Health Organisation (WHO) recognised that CBD may have the potential to help health issues such as pain, anxiety and insomnia. Evidence of benefit in these conditions is related to CBD having a calming effect in the central nervous system, mediated by CBD’s interaction with the CBD 1 and 2 receptors, 5-HT1-A receptor, alpha-3 glycine receptors, opioid receptors and others.
In terms of pain, CBD has been shown to have anti-inflammatory effects, and a review in the Journal of Experimental Medicine concluded that CBD oil is an effective treatment for chronic pain.
Research also demonstrates benefit of CBD oil in anxiety, fear, stress and sleep. A double-blind placebo-controlled study in 24 people with social anxiety disorder found that treatment with CBD before simulated public speaking significantly reduced anxiety, cognitive impairment and discomfort in their speech performance.
In a clinical trial involving 72 adult patients, CBD oil reduced anxiety scores and sleep scores within the first month. Acute administration of CBD has been shown to reduce resting blood pressure and the blood pressure increase to stress in humans, associated with increased heart rate. A double-blind placebo-controlled trial in 70 healthy people found that CBD reduced the time to fall asleep and improved sleep efficiency though the changes were not statistically significant.
A WHO report concluded naturally occurring CBD is safe, well-tolerated in humans and is not associated with any negative public health effects. Side effects of high doses of CBD (typically 1 gram per dose) have been reported in clinical studies; these include dry mouth, light-headedness and drowsiness.
Lowered blood pressure can also be an issue for patients with low blood pressure (either naturally or as a result of medication). There have been no reports to date of physical dependence effects (tolerance or withdrawal).
In the absence of data demonstrating safety in pregnancy and breastfeeding, CBD should not be taken by pregnant women.
CBD oil inhibits some cytochrome P450 enzymes in the liver, so it may interfere with the medicines metabolised by these enzymes (e.g., anti-arrhythmic, antibiotics, antidepressants, antidiabetic agents (oral), antiepileptics, antihistamines, benzodiazepines, calcium-channel blockers, HIV antivirals, NSAIDs, proton pump inhibitors, statins steroids) but it is not yet clear whether these interactions occur with recommended doses of CBD oil.
Care should also be taken if taking any medication that causes drowsiness including opioids, such as co-codamol or anti-histamines.
In conclusion, pharmacy can, and should, be the go-to source for professional advice on quality CBD products containing the stated amount of CBD and an absence of THC and other contaminants.
Sultan Dajani is resident pharmacist and prescriber at Wainwrights Chemist in Bishopstoke.
This article also appears in the September issue of Pharmacy Business.