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pharmaceutical cbd oil

A prescription for medical cannabis would only be given when it was believed to be in your best interests, and when other treatments had not worked or were not suitable.

Generally, the more THC the product contains, the greater these risks are.

The risks of using cannabis products containing THC (the chemical that gets you high) are not currently clear. That’s why clinical trials are needed before they can be used.

The specialist will discuss with you all the other treatment options first, before considering a cannabis-based product.

How do I get a prescription?

You cannot get cannabis-based medicine from a GP – it can only be prescribed by a specialist hospital doctor.

Nabiximols (Sativex) is a cannabis-based medicine that is sprayed into the mouth.

Nabilone can be prescribed by a specialist to help relieve these symptoms, but only when other treatments have not helped or are not suitable.

What about products available to buy?

It is licensed in the UK for people with MS-related muscle spasticity that has not got better with other treatments.

CBD can also affect how your liver works, so doctors would need to monitor you regularly.

More serious effects may occur with concomitant use of central nervous system depressants, such as barbiturates, benzodiazepines, fentanyl, morphine, and propofol. These effects are the result of the synergistic effects of sedation and hypnotic effects at high doses. Increased sedative effects may also be seen with herbal supplements, including kava, melatonin, S-adenosylmethionine, and St. John’s wort. 13,14

ABSTRACT: Cannabidiol (CBD) is becoming more prevalent, and pharmacists must be knowledgeable about these products in order to counsel patients effectively. CBD laws and regulations are determined at the state level in the United States. Non–FDA-approved CBD products are not regulated and may contain harmful chemicals. Pharmacists must counsel patients on where and how to obtain products and to check the amount of CBD and delta-9-tetrahydrocannabinol in the product. CBD has numerous drug interactions that should be evaluated by a pharmacist. CBD is most promising for treatment-resistant seizures, and more research is necessary to evaluate its use for other indications. Sativex is currently being investigated in the U.S. for treatment of spasticity associated with multiple sclerosis and schizophrenia. In general, more studies of CBD are needed.

Cannabidiol (CBD) is gaining popularity across the United States. Pharmacists must be able to answer patients’ questions about CBD and make recommendations. This article will provide specific information about CBD, including laws, how to select a non–FDA-approved CBD product, indications for use, side effects and warnings, drug interactions, dosing and directions, pharmacokinetics, and the future of CBD oil. After reading this article, pharmacists should feel confident about counseling patients about CBD and recommending CBD products.

Dosing and Directions

In December 2018, the Agriculture Improvement Act, which removed hemp from Drug Enforcement Administration (DEA) regulation as a controlled substance, was passed and signed into U.S. law. Hemp is defined as a cannabis plant that contains no more than 0.3% THC. (In contrast, marijuana has a higher THC.) Hemp is now regulated by the U.S. Department of Agriculture and is legal in all 50 states. Laws and restrictions regarding the selling of hemp products vary by state, making it questionable to travel with CBD products. 2

CBD is metabolized in the liver, mainly by CYP2C19, CYP3A4, and UGT. This can lead to interactions with prescription drugs, OTC medications, and herbal supplements. 1,14

More evidence is needed to support the use of CBD for anxiety. Studies have found that CBD 300 mg may be effective for anxiety related to public speaking, and doses of 400 mg to 600 mg may help patients with social anxiety disorder and public speaking–related anxiety. Studies are inconclusive concerning the utility of CBD for anxiety. 13

Laws Concerning CBD

CBD was first isolated from the Cannabis sativa plant in the 1930s. CBD is a nonpsychoactive part of the plant, whereas delta-9-tetrahydrocannabinol (THC) is the major psychoactive part of the plant. In the 1970s, researchers evaluated CBD as a pharmacologic agent. 1 Epidiolex, a 100 mg/mL oral solution with less than 0.01% THC, became the first FDA-approved CBD-containing drug in June 2018. 2 The drug is Schedule V and indicated only as an anticonvulsant for Lennox-Gastaut syndrome or Dravet syndrome in patients aged 2 years and older. 3

Starting at a low dosage is recommended for elderly patients and patients with moderate or severe hepatic impairment. The dosage should be 1.25 mg/kg to 5 mg/kg twice daily or 0.5 mg/kg to 2 mg/kg twice daily, respectively. 3

Vinuli Withanarachchie works on a project funded by the NZ Health Research Council

Partners

The stigma and reputational risk of discussing cannabis use with medical professionals also deter patients from requesting a prescription. Studies of medicinal cannabis users found patients conceal their cannabis use to avoid moral judgments in the provider–patient relationship.

A restrictive regime

Yet these new approvals are hardly consolation for the majority of people who continue to self-medicate with illegally sourced cannabis, including via “green fairies”, personal networks, drug dealers or by growing their own.