by Emily Ross, PharmD Candidate,
Class of 2020

You can add it to your morning coffee or smoothie. It is available in drops, creams, gummy bears, face masks and so much more. Some say it can help with anxiety, depression, insomnia, arthritis pain and a variety of other issues. You have likely seen it in your local market, pharmacy or shop on the corner. That’s right, we are talking about the latest health trend – CBD.

With all these new products to hit the market it has people wondering: Is CBD safe? Does CBD work? Should I use CBD? We are going to discuss these concerns and more to see if CBD is worth all the hype.

What is CBD?

Let’s start off with basics – CBD stands for cannabidiol. This is a chemical component of the plant Cannabis sativa which has two primary species – hemp and marijuana. The hemp variety contains a higher percentage of CBD. The other major component in the cannabis plant is THC – which is the psychoactive agent responsible for producing the effects most people associate with marijuana. For the purposes of this article, we will be focusing on CBD.

What is CBD Used For?

From relieving pain to helping with insomnia, people are using CBD for a variety of reasons. Many of the problems CBD has the potential to relieve is based on its action in what is called the endocannabinoid  system (ECS.)

This is a special system in the human body that is involved in many life functions including sleep, appetite, pain and immune system. By acting on receptors in the ECS, it may help treat issues listed with the above systems. In addition, it may also have anti-inflammatory effects that would help with chronic conditions such as arthritis.

Another indication for using CBD for many people is to relieve anxiety and depression symptoms. There are studies that show CBD to have an antidepressant effect due to its interaction with serotonin. Serotonin is a molecule in the body that regulates mood and behavior.

In addition, there are unsupported claims that CBD can help to reduce cancer-related symptoms, decrease acne, benefit heart health and may even prevent diabetes. I have just listed a few of the many different reasons people are using this new product.

Does CBD Work?

CBD makes a lot of great promises; however, this only goes so far if there are not proven benefits and results. There have been many studies done in animals and humans with CBD on the possible benefits. CBD has show efficacy in small clinical trials in reducing stress and anxiety, but more research is needed.

The research as to whether it is effective for pain relief is very early and the results are uncertain. As of now, there may be benefits due to the anti-inflammatory properties. CBD works in a different way than traditional prescription pain relievers, such as opioids, so there may be use for combination therapy when recommended by your doctor.

Is CBD Safe?

As of now, there has not been serious or major adverse effects reported in these studies. Though, CBD has been reported to have some side effects and can interact with other medications. Common side effects include:

  • Fatigue
  • Irritability
  • GI upset (nausea, diarrhea)
  • Dry mouth
  • Changes in appetite

Another big consideration is that CBD products are like herbals and other dietary supplements: there is no standardization on products. Different companies have different additives, and those may contain trace amounts of THC.

As of now, there are no regulations (FDA) in place that guarantee the safety of all the ingredients in the product. The FDA has issued a warning statement that there are many unanswered questions about the science, safety and quality of products that contain CBD.

Should You Try CBD? The Bottom Line

CBD comes in many forms and is being used to treat a variety of issues. While there are many convincing reasons to try it, more studies need to be done in order to make a conclusion and treatment decision regarding CBD. Everyone is different and what works for one person may or may not work for another.

The most important thing to remember is to talk to your doctor or pharmacist before starting any new supplement or product to make sure that it is safe for you.

References:

Bemben, Nina M. “CBD Oil and Medical Marijuana: Pharmacists Need to Know the High Points.” Wolters Kluwer, 21 May 2019, www.wolterskluwercdi.com/blog/cbd-oil-and-medical-marijuana-pharmacists-need-know-high-points/.

FDA Office of the Commissioner. “What to Know About Products Containing Cannabis and CBD.” U.S. Food and Drug Administration, FDA, 17 July 2019, www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.

Grinspoon, Peter. “Cannabidiol (CBD) – What We Know and What We Don’t.” Harvard Health Blog, 5 June 2019, www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

Kubala, Jillian. “7 Benefits and Uses of CBD Oil (Plus Side Effects).” Healthline, Healthline Media, 26 Feb. 2018, www.healthline.com/nutrition/cbd-oil-benefits#section7.

Volkow, Nora D. “The Biology and Potential Therapeutic Effects of Cannabidiol.” NIDA, 24 June 2015, www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/biology-potential-therapeutic-effects-cannabidiol.

Williams, Reagan A. “CBD Oil: Leading Patients to Safe Use.” Pharmacy Today, Nov. 2018, www.pharmacytoday.org/article/S1042-0991(18)31505-6/fulltext.



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marijuana interactions with prescription drugs - scriptsave wellrx

With the growing legalization of marijuana, which has been approved for recreational use in 10 states and for medical use in 33 states1, there’s naturally a lot of buzz around the medical benefits. Emerging research suggests it may be a safer substitute for opioids to treat pain. But what about potential drug interactions?

Limited Research

But as research continues into possible benefits of using marijuana for treatment, questions remain about how cannabis might interact with prescribed or over-the-counter (OTC) medications a person may also be taking.

Some states have legalized the use of marijuana for medical purposes, as well as for recreation to varying degrees, however, the federal government has not. The tight federal restrictions create a challenge in researching how marijuana interacts with other products, either OTC or prescribed.

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Interactions With Medications or Lifestyles

Some examples of medication types and common interactions include:

Drug Type Lifestyle Interaction
Tricyclic antidepressants May result in adverse cardiovascular effects, such as tachycardia and cardiac arrhythmias.
Nonsteroidal antiinflammatory drugs (NSAIDs) Administering nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with marijuana may limit some of marijuana’s pharmacologic activities.
Benzodiazepines Using marijuana with benzodiazepines may result in an exaggerated sedative effect.
Amphetamines Using marijuana and amphetamines together may cause adverse cardiovascular effects, such as tachycardia and cardiac arrhythmias.
Beta-blockers Concurrent use may result in decreased beta-blocker efficacy, significantly increased heart rate and cardiac output lasting for 2-3 hours, myocardial infarction and cardiac arrhythmias.

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Synthetic Marijuana (Marinol)

In addition to tetrahydrocannabinol (THC), cannabidiol (CBD) is found in high concentrations in marijuana. CBD does not produce any of the psychoactive responses and appears to block some of the effects of THC by acting as an antagonist at the cannabinoid receptors. Cannabinol is weakly psychoactive and appears to be primarily formed from the metabolism of THC. Another metabolite of THC is thought to contribute to the tachycardia and appetite-stimulating effects of cannabis.2,3

An FDA-approved synthetic form of marijuana uses a chemical compound similar to those found in cannabis. Marinol (drobinol) is approved to help with nausea induced by chemotherapy as well as anorexia caused by AIDS.

The Takeaway

For most patients, cannabis:

  • Is relatively safe
  • Well-tolerated, and;
  • Carries fewer risks of adverse drug interactions than many commonly prescribed drugs.

Given its therapeutic versatility, one of the best arguments for cannabis is that it can actually reduce the need to combine multiple medications, therefore lowering the potential risk of adverse interactions.4

References:

  1. https://www.businessinsider.com/legal-marijuana-states-2018-1
  2. https://health.usnews.com/health-care/patient-advice/articles/2018-03-08/how-does-marijuana-interact-with-medications
  3. https://www.pharmacytimes.com/publications/issue/2014/december2014/drug-interactions-with-marijuana
  4. https://www.leafly.com/news/health/cannabis-cannabinoids-drug-interactions

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medical marijuana mmj - scriptsave wellrx - rx discounts -blog image

by Mitchell Welton, PharmD Candidate 2019
University of Arizona

The use of marijuana draws a wide range of strong opinions out of people. Its advocates will tout all of its potential benefits of medical marijuana, while its opponents try to draw from the negative stigma that surrounds it. As in all hotly contested topics, the truth usually falls somewhere in between the opposing viewpoints. While the use of marijuana still remains illegal at the federal level, there are many states that have approved its medical use for qualifying individuals to treat certain conditions, and even fewer states have approved its recreational use.

California was the first state to legalize marijuana for medical use in 1996 and since then many states have followed suit. About a dozen states have legalized marijuana for medical use. The difference between medical and recreational use warrants its own discussion and the disagreement can be seen at a legislative level with more leniency being extended to medical over recreational. This author would generalize medical marijuana in this article as containing a higher concentration of CBD over THC, for all intents and purposes, in order to discuss medical marijuana compared to FDA approved cannabinoids.

Medical Marijuana (MMJ) Uses

The two chemicals of interest found in marijuana are tetrahydrocannabinol (THC) and cannabidiol (CBD) although the plant itself may contain up to 400 different chemicals. A recreational smoker would be looking for a higher concentration of THC which is the psychoactive component delivering the “high” that users seek. 1 CBD is the cannabinoid that doesn’t produce the “high” and has recently been approved by the FDA as an oral solution, called Epidiolex, to treat seizures. There are currently only three FDA approved, cannabinoid medications on the market. 2

The first of these medications was approved in 1985 by the FDA known as Marinol or dronabinol. A synthetic form of THC first approved for the treatment of chemotherapy induced nausea and vomiting. Its indication was expanded to include the treatment of weight loss and anorexia in people with AIDS. Other studies have found efficacy in achieving pain relief in patients with multiple sclerosis (MS) and treating other neuropathic pain. 3 Cesamet, or nabilone, is another synthetic cannabinoid that mimics THC also approved in 1985 for the treatment of chemotherapy induced nausea and vomiting with off label use to treat fibromyalgia shown in a 2011 systematic review of cannabinoids for chronic pain. 4 The third, Epidiolex, has already been mentioned which is the first FDA approved drug derived from marijuana. The previous two drugs where synthetic. Epidiolex is used in the treatment of two rare, but severe forms of epilepsy. 2

MMJ Safety Factors

There are multiple factors to consider when thinking of safety between the two types of marijuana. First that comes to mind is the administration. Let’s take dronabinol for example as it has been around the longest from an FDA approval standpoint and such has been examined in multiple studies. This is a liquid filled capsule taken by mouth. Like many oral medications it may take some time for it to be absorbed which means a delay in its effect. This is something to keep in mind as a quick onset of action would be preferred when treating nausea and vomiting. Once the capsule is taken by mouth and absorbed the next consideration is its excretion from the body.

Dronabinol has an elimination half life of 19 to 36 hours meaning there will be a therapeutic level of the medication in the blood for a significant period of time. Other considerations I would bring to attention of the reader is the environment in which the medication is produced. Part of the FDA requirement is the manufacturing standard the medication is subjected to. Conditions must be controlled in its production which would allow us to assume there would be little tainting or contamination. Lastly, this synthetic medication is a pure isomer of THC meaning the end user is not consuming the potential 400 other chemicals found in the marijuana plant which could account for less of a “high” from any other psychoactive cannabinoids. 5

Marijuana in contrast when smoked has a much more rapid onset of action however may be inappropriate for use in patients with asthma or COPD. Ingesting marijuana will have a slower onset and more unpredictable absorption. Once in the system the body would eliminate marijuana faster than dronabinol. Though its production is not regulated like the FDA approved medications, each state has its own laws limiting the cultivating of your own marijuana and licensing of larger cannabis farms. 5

No matter where you might stand on the issue, there is a place in healthcare for the use of marijuana. The question lies in the best way to regulate and manage it. It is important to always evaluate safety and efficacy with any treatment used. Patients should always be treated with evidence-based methods and in accordance to state and federal laws. For better or for worse marijuana, and its use, continues to garner support and opposition in larger numbers. This is a landscape that will continue to change as we look for developments in the application of its use.

 

References:

  1. What Is the Difference Between Medical and Recreational Marijuana? (2018, September 10). Retrieved from https://docmj.com/2017/06/05/difference-medical-recreational-marijuana/
  2. Office of the Commissioner. (n.d.). Press Announcements – FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. Retrieved from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm
  3. Dronabinol: Marinol. (n.d.). Retrieved November 19, 2018, from Micromedex.
  4. Nabilone: Cesamet. (n.d.). Retrieved November 19, 2018, from Micromedex.
  5. Morrow, A. (n.d.). Marinol or Marijuana: Which Is Better? Retrieved from https://www.verywellhealth.com/is-marinol-better-than-smoked-marijuana-1132483

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Epidiolex: A new CBD epilepsy drug

by Roxanna Orsini,
PharmD Candidate Class of 2019, University of Arizona

Treatments are available that can successfully control seizures for most people with epilepsy. However, there’s a soon-to-be-released medication, recently approved by the FDA, called Epidiolex.

What is Epidiolex?

Epidiolex (cannabidiol) is a new FDA-approved epilepsy medication that is derived from Cannabis Sativa plant (marijuana). Cannabidiol (CBD) does not create feelings of euphoria or intoxication, the “high” that is often experienced with Cannabis, which comes mainly from the compound tetrahydrocannabinol (THC), which is also found in marijuana.

Which forms of epilepsy does Epidiolex treat?

The FDA approved Epidiolex for treatment of seizures associated with two rare and severe forms of epilepsy, in patients two (2) years and older.5

  • Lennox-Gastaut Syndrome
    • Begins in childhood and continues to adulthood with some changes in presentation with age.3
    • Often characterized by multiple types of seizures (particularly tonic and atonic) and an intellectual disability.
    • An EEG (electroencephalogram) can display a classic pattern of background slowing and spike-wave bursts with frequencies less than 2.5 per second. 2
    • Found in 2-5% of childhood epilepsies.2
  • Dravet Syndrome
    • Begins during the first year of life and is a lifelong disease.3
    • This is a rare genetic epileptic brain disease.
    • Infants will have normal development up until an increase in seizure frequency occurs after the first seizure which is often associated with a fever. 1
    • Most children develop some level of developmental disability.
    • Seizures can be triggered by various factors such as body temperature, emotional stress or excitement, and photosensitivity.1

Coming Soon!

While Epidiolex has been approved for release, the expected time to market is September 2018. A few things to know about the medication before it is released:

Effectiveness

The study for Epidiolex involved 3 randomized, double-blind, placebo controlled clinical trials which included 516 patients who had either Lennox-Gastaut Syndrome or Dravet Syndrome.3 Results showed that patients taking Epidiolex along with other anti-epileptic drugs (AEDs) showed a decrease in seizure frequency when compared to the placebo.3

Precautions

Side effects (3,5) are often something to be aware of before starting a new medication. A few reported side effects to Epidiolex include:

  • Elevated liver enzymes
  • Sedation
  • Lethargy
  • Sleep Disorders
  • Diarrhea
  • Rash
  • Increase in suicidal thoughts
  • Decrease in appetite
  • Abdominal discomfort
  • Abdominal pain

Cost

The company has not release any official information about cost for Epidiolex, however NY Times analysis estimates a cost of $2,500 to $5,000 a month.4 It is possible that this medication may be approved by insurances so make sure to discuss options with your provider.

Future Opportunities

Even though this medication is only currently approved for these two forms of seizures, it does open the door to future possibilities.  Always keep communication open with your healthcare provider so they can help guide you on therapy options as more clinical studies arise with new information.

 

References:

  1. Epilepsy Foundation. (2018). Dravet Syndrome. [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome [Accessed 11 Jul. 2018].
  2. Epilepsy Foundation. (2018). Lennox-Gastaut Syndrome (LGS). [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs [Accessed 11 Jul. 2018].
  3. FDA.gov. (2018). FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [online] Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm [Accessed 10 Jul. 2018].
  4. Kaplan, S. (2018). D.A. Panel Recommends Approval of Cannabis-Based Drug for Epilepsy. [online] Nytimes.com. Available at: https://www.nytimes.com/2018/04/19/health/epidiolex-fda-cannabis-marajuana.html [Accessed 5 Jul. 2018].
  5. Micromedexsolutions.com. (2018). Micromedex Products: Please Login. [online] Available at:
    http://www.micromedexsolutions.com/micromedex2/librarian/CS/B42F8E/ND_PR/evidencexpert/ [Accessed 5 Jul. 2018].

 


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and get registered to take advantage of our free medication adherence tools.

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visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

 

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