Do you know about CBD products?

Medical marijuana has always been a popular and, not to mention, controversial issue. But now, his grandson, cannabidiol (CBD), enjoys his own 15 minutes of fame. These days, it is virtually impossible to turn on the TV, surf the Internet or even surf the street without seeing or hearing something about the CBD.

Although CBD comes from the same plant as marijuana, CBD has little, if any, tetrahydrocannabinol (THC), the chemical that gives marijuana its euphoric or hallucinogenic effects. Therefore, as long as the amount of THC falls below a certain amount, CBD products are legal to sell (although that does not guarantee that the products are completely safe).

CBD is used to treat many health conditions, such as seizures and other neurological disorders, pain and inflammation. CBD comes in a wide variety of products and doses: you can find CBD that is sold in tinctures, gummies, capsules, pills, oils, pens, aerosols, creams and suppositories, and more. But not all CBD products are safe, or are the same. And the jury is still aware of the quality of these products and how well they work.

To better handle the challenges, I spent time talking with my colleague, Michael Schuh, PharmD, MBA, FAPhA, clinical pharmacist and assistant professor of family medicine, palliative medicine and pharmacy at the Mayo Clinic in Florida. He is also an expert in integrative medicine and CBD.

What is the biggest mistake about CBD?

CBD is like a potent herbal supplement, but what many people don’t realize is that CBD has side effects and drug interactions like any medication. Basically, if it is a dose strong enough to cause therapeutic effects, it is sufficient to cause side effects and drug interactions. Another problem is that few of the products are standardized or examined to ensure that you get a pure and high quality product. This makes it difficult to know what you are really using. In fact, there is no real way to examine CBD products at this time. Anything that swallows, inhales, injects or absorbs through the skin that has direct contact with the bloodstream has the risk of side effects or unforeseen interactions.

Many companies say that CBD products are completely safe, but you mentioned that CBD products have drug interactions that are not widely known. Can you give us an example?

The liver plays an important role in the functioning of medications because it contains special catalysts or enzymes that activate them so that they can have an effect on the body. These enzymes can also help eliminate these medications from the body after they have done their job. CBD slows the ability of liver enzymes to activate medications to work and their ability to break down medications that are eliminated from the body. An example is clopidogrel, an antiplatelet medication used to prevent strokes or heart attacks. If you have already had a heart attack and are trying to prevent another, taking CBD can prevent the liver from converting clopidogrel into its active form, resulting in another heart attack. There is evidence that CBD also inhibits other enzymes that break down at least 50-60% of all prescription medications. These enzymes break down opioids and other drugs that depress the nervous system or CNS depressants. If you inhibit any of these pathways, you can risk a drug overdose because your body cannot eliminate CNS depressants as quickly as it should. This is because CBD decreases the speed with which your body processes CNS depressants, so your body does not process them as fast as you normally would. As a result, CNS depressants can rise to dangerously high levels.

Given the problems to ensure the quality of the CBD products you have highlighted, what are the key indicators that you can offer readers to help them make better informed decisions about CBD products?

CBD is only a depressant. It has no euphoria, but it is still a nervous system depressant, even without THC.

Patients should contact their doctor or pharmacist about CBD. Unfortunately, even most of these health professionals do not know the real evidence in the CBD literature. I recommend that patients only trust the information they find on websites operated by the US federal government. Research universities and academic sites, such as the Mayo Clinic.

Understand that money is driving the CBD industry, not clinical efficacy. Only in rare pediatric epileptic disorders has any clinical value currently recognized.

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