The use of cannabidiol, commonly known as CBD, in the medical world has been greeted with debate in the past few years.
Throughout history, cannabis has been used for medicinal purposes, even by some historical figures like Queen Victoria, who reportedly used it for menstrual cramps. However, with the rise of modern medicine and a lack of hard-grounded scientific evidence, CBD has been at the center of some controversy recently.
At the intersection of medicine and law, CBD prescriptions are not commonplace in hospitals due to many reasons, one of which is the cloudy legality that goes with it.
In the state of Arizona, CBD oil derived from imported hemp does not require a prescription, as it can be bought over the counter at stores and dispensaries. In 2014, a court ruling determined that CBD can be used for treating certain ailments. However, CBD derived from marijuana is prohibited, as purchasing cannabis is still illegal in the state of Arizona.
“The [Food and Drug Administration] recognizes the medical benefits of CBD,” said Dr. Mohab Ibrahim, a pain management physician and an anesthesiologist at Banner — University Medical Center Tucson. “However, the [Drug Enforcement Administration] is the one that can give legal status. The DEA doesn’t consider CBD by itself to be legal, but drugs that contain CBD, up to a certain percentage, are legal.”
Both CBD and tetrahydrocannabinol, or THC, the chemical in marijuana responsible for its psychological effects, act on the body’s cannabinoid receptors, which are responsible for bodily processes such as appetite, pain and memory.
The difference between CBD and THC boils down to less psychoactive properties in CBD compared to THC, according to Ibrahim.
“It takes higher doses of CBD to get what we call the psychoactive side effects,” Ibrahim said.
As with most other drugs, the dosage is the most crucial aspect in determining its safety and efficacy. Currently, CBD has a wide variety of uses in the medical world. It can be used to treat pain, seizures, depression, anxiety and insomnia.
There is conflicting data as to whether or not CBD is an effective means to relieve pain and what line of therapy it should be classified under. Physicians are free to inform their patients of what CBD is and what it can be used for, but ultimately the decision to use it comes down to the patient.
“[CBD] works for some people and doesn’t work for others," Ibrahim said. "There might be some chronic pain conditions that might be responsive to CBD and some others that are not. We just need to do more research to find out which conditions will be responsive.”
However, like many medical treatments, CBD could pose some risks. Recently, the FDA announced that the use of CBD could come with some unwanted side effects, including liver damage, male reproductive toxicity and interactions with other prescription drugs.
A wide variety of drugs, including anti-depressants and anti-seizure medications, are used to alleviate pain conditions in some patients. However, more interventional techniques may be used to treat pain, too. Injections and surgery are two possibilities to help patients with chronic pain be treated.
“Most physicians will be comfortable trying something else first. It comes down to the patient’s preferences, their level of comfort and the location [of the pain],” Ibrahim said. “Until there is a consistent policy, CBD will not be the first line of treatment. Physicians will still educate their patients about it, but it may not be the number one choice [for treatment].”
The murky waters of legality and the conflicting data are two reasons as to why CBD is not the first line of treatment when it comes to pain management amongst the majority of physicians.
“In the future, when the political situation improves and the legal situation becomes less murky, then there could potentially be a bigger push towards CBD,” Ibrahim said. “CBD use is also not very highly regulated. Depending on the conditions of growing the plant, you might get different constitution of what is in it.”
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