CBD – Is it ready for prime time?

Unless you have been living under a rock, you have probably noticed the avalanche of information out there about CBD or Cannabidiol. There is so much hype and chatter out there it can be difficult to make sense of it all. What exactly is CBD? Is it legal or not?

Is CBD marijuana or does it just come from marijuana? Does CBD contain THC? I heard there’s a new CBD drug approved by the FDA, that means it’s safe and effective right?

Let’s spend a few minutes unpacking this subject and getting some clarity before we click ‘submit your order’ and wait by the mailbox for the CBD—especially if you are a healthcare professional in monitoring for Substance Use Disorder.

Is CBD Legal?

Without diving into the political debate too much, let’s just recognize the fact that there is a sweeping change in the public opinion (and state laws) regarding the use of marijuana and its constituent chemicals. Whether you agree or disagree with legalization, many experts recognize that this wave has started and is likely to be unstoppable at this point. It’s probably going to happen, for better or worse. But even though some of our neighboring states have legalized and/or decriminalized marijuana for a variety of uses, legalization is not in the immediate future for us in Indiana.

In 2018, Indiana Governor Eric Holcomb signed a law that specifically allows the sale and use of CBD oil as long as it contains less than 0.3% THC and is made from hemp rather than marijuana. So this means that you can walk into a business and purchase CBD legally as long as it meets the state’s requirements for purity and origin. So far so good. It’s legal on the state level.

What about on the Federal level? This is where it gets tricky, because the DEA has not changed its position that CBD is still synonymous with marijuana—they are still one in the same. The DEA has officially recognized and scheduled the new FDA approved drug Epidiolex, which is “pure” CBD and contains less than 0.1% THC. It is FDA approved for a couple of very specific types of seizure disorders, and not for many of the indications CBD is purported to be effective for such as joint inflammation, anxiety, etc. All other formulations of CBD (i.e. those not FDA approved) are still considered by the DEA to be marijuana and covered by the federal ban.

Does CBD Work?

What about effectiveness? It’s FDA approved, so it must be safe and effective right? The answer is ‘Sort of.’ The FDA approved CBD to treat two rare seizure disorders called Lennox-Gastaut Syndrome and Dravet Syndrome. Thus far it is not approved for generalized seizure disorders or any of the many other conditions that people claim it works for. Does it work for insomnia, anxiety, joint pain and mood? Maybe. We just don’t know. The marijuana plant contains hundreds of compounds with a wide range of possible effects that we are only beginning to understand. Of these many compounds, CBD is definitely the front-runner when it comes to popularity, but we still don’t really know if many of these are truly effective.

The possibilities are very exciting, however. Think of how wonderful it would be to identify a substance that effectively controls pain but has no mood or mind-altering effects and was non-addictive! My response is “Yes, please.” But the fact of the matter is we are just not there yet. Public opinion suggests that CBD will be found to be effective and the current popularity is because it really works. However, it’s just as likely that scientific data will emerge to determine that it’s nothing more than placebo. I am excited to see where the research takes us.

CBD and Drug Screening

Lastly, and perhaps most importantly, what about drug testing? If you are in monitoring for Substance Use Disorder and subject to drug screening, you are best advised to avoid CBD products entirely. The fact of the matter is, CBD products sold on the internet often contain high enough levels of THC to trigger a positive drug screen and there is no way for a drug testing company or Medical Review Officer to tell the difference. A drug screen positive for THC is positive for THC, plain and simple. When testing highly accountable professionals such as those in health care, where patient safety is at risk, we just can’t take a chance with the potential for an impaired provider.

Source Dr. David Cummins M.D., FASAM, Medical Director
Tuesday, 28 July 2020 11:15