The rise and rise (and fall?) of CBD oil…

Over the thirty-five years of my career it has been a cherished wish that the public generally, and pharmacy colleagues specifically, would eventually become enlightened to, if not dependent on, the validity and superiority of science in decision making particularly in the choice of medicinal treatments we use.  Sadly, that cherished wish remains unfulfilled and was painfully dashed when I attended the UK Pharmacy Show at the NEC Birmingham at the end of last year.

Twenty-three stands featured CBD oil products and it seems pharmacists are being; educated, coarsed, bullied or brainwashed (not sure which) into the ideological belief that CBD is, must be, has to be, the panacea mankind has been seeking since we climbed down from the trees onto the Savannahs of Africa.  The commitment to this ideology from venture capitalists is, to say the least, impressive.   Not since the infancy of e-cigarettes has venture capital splashed out so much on glitzy stands at the UK Pharmacy Show.  This year there was only one vaping stand.

I picked a CDB stand at random and when I asked, what I thought to be fairly innocuous question, I was assigned to Joe as he, I was told, was the most knowledgeable and would be better qualified to deal with me.  He was currently writing a book for the company on CBD and was an enthusiastic thirty something with a first-class degree in English.  Firstly, he assured me his company was an ethical company – unlike some competitors he intimated – an assurance I found naïve.  He referred me to studies listed online on a website “NCBI project cannabis” and this was set up, he informed me, to advise government as he felt government really had failed to keep up, or even catch up, with all the exciting scientific findings about CBD.  The National Institute for Healthcare and Clinical Excellence (NICE) assessment NG144 adopted by DoH in January 2020 would suggest government is well informed about these “exciting scientific findings”.

My questions, I told him, were on three issues; the quality, safety and efficacy of CDB products and he wanted first to talk about safety as it seemed he knew something about CDB safety and quoted a paper published by the UK government that he claimed confirmed CDB products are completely safe, absolutely.   I knew this very study, I told him, and he was perhaps exaggerating the study claims.  It was designed to confirm that by manipulating CDB oil either in vivo or in vitro consumers could not easily convert some CBD (the safe molecule) into some THC (delta 9 tetra-hydrocannabinoid) (the psychoactive molecule) no matter how they tried.   He didn’t seem to understand that from this point CDB oil is safe.   We agreed that on the whole it was probably not a dangerous product.

Efficacy was a difficult issue to discuss, he told me, as his company cannot make medical claims for their CBD products, yet.  He could quote scores of papers that show efficacy across a range of conditions.    The products he sold were licensed as foods which restricted what he could say but CBD works.  Such as?  Well, Dravet syndrome (rare form of epilepsy) he offered and confirmed that a medical product will soon get a marketing licence (Epidyolex).  I told him I didn’t see many of these patients in my pharmacy and if I did, I might be reluctant to treat.  Had he nothing more common?   Eczema is a good example where CDB oil is very effective as it has both antibacterial and anti-inflammatory effects.   CBD oil is infused into a cream and I could recommend this to my customers so long as I don’t claim it works.  I asked about the cream formulation and if the cream might be the active agent but he dismissed this out of hand.

We then talked about quality.   How did I know that the CBD oil he was selling contained the stated percentage of CBD (1%, 5% or 10%) and he told me all product quality was verified by an independent laboratory for his company so no worries here.   I noted that on the CBD oil he sold which was 15 ml contained 10,000 mg and according to the bottle label there was a direction to use two drops up to three times daily but the label also stated a warning not to use more than 200 mg per day.   If a drop –a drop is 0.6 ml – one drop contains a massive 400mg.    He didn’t want to comment on that and would come back to me.   I enquired what oil the CBD was contains in and he told me it was coconut oil    He seemed unaware that coconut oil would be solid at room temperature and when I pointed this out, again he told me he would come back.   It turns out, and both of us should have known, that CBD oil is hemp oil as that’s where it comes from- the hemp plant.

Joe’s boss was now hanging over us too much and it was clear he was uncomfortable given the type of questions I was asking.   He mentioned to Joe that he had an “appointment” and his appointment had arrived.  Joe thanked me for the challenging conversation and he promised he would come back.   Unsurprisingly he never did.  I was unlikely to be the kind of pharmacist who would stock CBD oils, creams, facial washes and, oh yes, suppositories.

Editor Update. Since Terry wrote this post there is a report that Cannabis oil products ‘could be off the shelves in a year’. From the BBC article:

Oils, snacks and drinks containing the cannabis extract cannabidiol (CBD) will be “taken off the shelves” next year if they do not gain regulatory approval.

The Food Standards Agency (FSA) said products had to be registered by March 2021 or they would be pulled.

Despite rising sales of CBD goods, not one product has been approved in the UK yet, raising safety concerns.

The FSA has also issued new advice on CBD use, saying it should not be used alongside other medication.

Cannabidiol is derived from cannabis but does not have any psychoactive properties. It is sold in some pharmacies and health food shops as a supplement and used to treat conditions such as pain or insomnia.

Trials have found CBD products on sale that contain unlisted and potentially hazardous ingredients, or illegal levels of tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis.

Many may contain little or none of the extract itself, contrary to their marketing claims and despite their high prices.

 

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