The hype and consumer hope surrounding cannabidiol (CBD) and medical marijuana remains palpable. Just drive through a state that has recently legalized medicinal use of the plant and you will be inundated with billboards touting the value of “getting your medical card” for everything from anxiety to pain. But surrounding the publicity is also much misinformation and misunderstanding by consumers seeking medical benefits.
Healthcare providers are challenged with understanding the interchangeable use of terms surrounding “cannabis” and monitoring the safety of these products for patients living with serious health conditions. As a prescriber, provider or pharmacist, you know the importance of understanding drug interactions and sharing that information when discussing new therapies with your patients. Unlike prescription medicines, which must be studied for interactions with other drugs in order to gain approval through the Food and Drug Administration’s (FDA) rigorous review and approval process, medical marijuana and other cannabis products are not studied this way or held to established growing and production standards. Furthermore, medical marijuana products are by no means a “generic” substitute for FDA-approved cannabinoid products that have gone through the rigor of review. In fact, a recent study of non-FDA approved products conducted by the University of Pennsylvania Perelman School of Medicine found that nearly 70% of CBD products were mislabeled containing higher or lower CBD concentrations than noted and another 20% contained undisclosed THC. This lack of regulation and consistency can have detrimental impact on patients with already compromised health, especially children. In the FDA’s November 2019 consumer update, the agency reinforced its concerns around the lack of appropriate processing controls and practices in the production of CBD products and the risk it can cause consumers due to not only unlabeled THC levels but also the presence of pesticides, heavy metals and other contaminants that could have detrimental impact on consumer health.14
Numerous medical associations and societies have shared their position on the medicinal use of Cannabis Sativa L. and consistently cite the need for more evidence-based data on the risks and benefits. As recently as September of 2019, the American Academy of Family Physicians (AAFP) issued a position paper entitled, “Marijuana and Cannabinoids: Health, Research and Regulatory Considerations.” The AAFP describes marijuana and related substance misuse as "complex issues impacting family medicine, patient health and public health.” The AAFP paper continues noting that the association and its members, “recognize that there is support for the medical use of marijuana and cannabinoids but advocates that usage be based on high-quality, evidence-based public health policy and patient-centered research, including investigation of its impact on vulnerable populations.”15 Other medical associations including the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) have issued similar statements, as state laws continue to evolve surrounding the use of medical marijuana.
The AAP has taken one of the strongest stances given the impact marijuana use can have on child brain development. In a position released as early as 2015, the AAP opposed cannabis use outside of the established process by the Food and Drug Administration to approve pharmaceutical products. The Academy is clear that it supports further study of cannabinoids, which limited research to date suggests may help adults with specific conditions. However, they also note that further research to determine the efficacy and correct dosing for cannabinoids is required, as is done for any other medication.16
When safety is paramount, as it should be with any medication used to treat chronic diseases or acute ailments, the value of consistent labeling, data-based dosing and a controlled, contaminant-free manufacturing environment should not be discounted. To ensure patient safety amidst the hype and hope surrounding the cannabis plant, healthcare providers can play a critical role in ensuring greater education, awareness and appropriate evidence-based use of cannabinoid therapies.
What’s Coming in Future Issues?
- Interpreting the Outcomes & Impact of the FDA’s Position on CBD Products
- DEA Scheduling: Demystified for Payers, Policymakers & Healthcare Providers
- Leading the Pack: State Medical Marijuana Laws and Regulation Best Practices
14“What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD,” FDA Consumer Updates, November 25,2019. Available at https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis. Accessed 9 December 2019.
15American Academy of Family Physicians, AAFP News, “AAFP Releases Marijuana, Cannabinoids Position Paper,” Available at https://www.aafp.org/news/health-of-the-public/20190920cannabispaper.html
16American Academy of Pediatrics, News Room, “American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use,” https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Reaffirms-Opposition-to-Legalizing-Marijuana-for-Recreational-or-Medical-Use.aspx