Intro to CBD 101

Before we begin, please note that we at Clover Internal Medicine Associates are neither advocating nor intending that CBD use can be utilized to cure or treat diseases or illnesses.  As a disclaimer, we at Clover Internal Medicine Associates will continue to stress and advocate that the use of CBD outside of FDA-approved indications remains to be off-label, with limited scientific studies and is not intended to treat a disease or otherwise have a therapeutic or medical use.  At this time, FDA only approved one CBD product, Epidiolex, as the only prescription product to treat rare and severe forms of epilepsy.  We also would like to encourage our viewers to follow their state regulatory bodies in regard to CBD uses, purchases and distributions. 

In the last 5 years, we have seen a precedented increase in demand of CBD use thanks to the approval by U.S. Congress for the 2018 Farm Bill which allowed for industrial hemp (hemp containing less than 0.3% THC) to be federally grown, produced and process in all 50 states. 

So, what do we currently know?  CBD affects and interacts with Endocannabinoid System (ECS) in our body that work alongside our Central Nervous System (CNS) to maintain homeostasis or balance to our sleep, stress responses and mood.  CBD contains negligible amounts of THC, the psychoactive component of cannabis, and that it is non-psychoactive and does not cause the recreational “high” in users.  Furthermore, CBD does not have the potential for abuse or addiction.  The World Health Organization (WHO) Expert Committee on Drug Dependence recommended not scheduling CBD within the International Drug Control Conventions.  WHO cited the fact that there are no case reports of CBD abuse or dependence; no public health problems have been associated with CBD use; CBD has been found to be generally well tolerated with a good safety profile; and that there is no evidence that CBD is liable to be abused.¹ Furthermore, the U.S. Health and Human Services Department (HHS) conducted a scientific review on CBD and concluded that CBD does not present a significant risk to public health.  HHS found that there is no evidence for classic drug withdrawal, no evidence that CBD causes physical or psychic dependence and no potential for abuse under the Controlled Substances Act (CSA).²

According to Food and Drug Administration (FDA), CBD use are not without risks.  During its review of the marketing application for Epidiolex — a purified form of CBD that the FDA approved in 2018 for use in the treatment of two rare and severe seizure disorders — the FDA identified certain safety risks, including the potential for liver injury. This serious risk can be managed when an FDA-approved CBD drug product is taken under medical supervision, but it is less clear how it might be managed when CBD is used far more widely, without medical supervision, and not in accordance with FDA-approved labeling.  Another is drug interactions.  Information from studies of the FDA-approved CBD drug Epidiolex show that there is a risk of CBD impacting other medicines you take – or that other medicines you take could impact the dose of CBD that can safely be used. Taking CBD with other medications may increase or decrease the effects of the other medications.³

If you have additional questions regarding CBD, give our office a call and set up an appointment with one of our physicians for further discussions.

References:

1. WHO Expert Committee on Drug Dependence, fortieth report. Geneva: World Health Organization; 2018 (WHO Technical Report Series, No. 1013). License: CC BY-NC-SA 3.0 IGO.

2. Giroir, Brett P (Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC). Letter to: Robert W. Patterson (Drug Enforcement Administration, U.S. Department of Justice, Springfield, VA). 2018 May 16.  Accompanied by: U.S. Food & Drug Administration’s “Basis for the Recommendation to Place Cannabidiol in Schedule V of the Controlled Substances Act.”

3. What to Know About Products Containing Cannabis and CBD.  https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

Author

Dr. Leon Tio Leon Tio, DO, MA, FACOI, is a board-certified and fellow in Internal Medicine and Hospitalist at Clover Internal Medicine Associate in Fort Worth, Texas. Dr. Tio takes a “whole person”, holistic approach to care and focuses on underlying causes of an illness, rather than symptoms. After completing his bachelor’s degree with honors in Biology at the University of Texas at Arlington, Dr. Tio went on to earn his Masters Degree in Bioethics and Doctorate in Osteopathic Medicine at Kansas City University of Medicine and Biosciences in Kansas City, Missouri. He then completed his residency in Internal Medicine with University of North Texas at Medical City of Fort Worth. In addition, Dr. Tio also received Fellowship in Internal Medicine from the American College of Osteopathic Internist for his work and dedication to Internal Medicine.