Unapproved CBD products may not be as safe as they seem

Kenneth Finn, MD / Meds / May 26, 2019

In recent years, a flood of cannabis and cannabis-derived products like CBD have entered the market – often claiming to cure or treat an array of health issues and ailments.

These products are everywhere, but there is little scientific evidence to support the hype that surrounds them.

As a doctor, I’m deeply concerned at where this industry is heading – and the potential risks to patients and consumers.

I urge my peers to take this issue seriously and stand with me in addressing these growing concerns.

As doctors, we strive to alleviate suffering

Most people are unfamiliar with my chosen specialty, known as physical medicine and rehabilitation medicine. My peers and I are called physiatrists.

Together, we seek to restore the functional abilities and enhance the quality of life of people that face a wide range of physical, psychological or emotional disabilities.

Doctors refer their patients to me after other treatments have proven unsuccessful. By the time patients arrive at my office, they’re often at their wit’s end, suffering from the physical and psychological toll of chronic pain.

In recent years, many have asked me whether cannabis and cannabis-derived products like CBD would help them.

These patients rightfully turn to me and ask, “Doctor, what should I do?”

Silence is no way to help patients

The reality is that patients are being misled. As of yet, there is no clear and convincing evidence about the safety and efficacy of most cannabis products – and it’s up to doctors to let our patients know.

Last year Epidiolex, a drug used to treat a narrow spectrum of seizures, became the only pharmaceutical formulation of purified, highly concentrated CBD to be approved for use by the U.S. Food and Drug Administration (FDA).

As with all prescription drugs, there are serious potential side effects, including liver toxicity, significant drug interactions, behavioral side effects such as suicidal behavior and ideation, as well as somnolence and sedation.

These risks can be managed if the person is under a doctor’s supervision.

But the risks cannot be properly monitored if no doctor is involved – which is typically the case when a person purchases an over-the-counter CBD product.

A local budtender might recommend these CBD products enthusiastically, but does the budtender realize that the product might be contaminated with heavy metals, pesticides, fungicides, rodenticides, insecticides, molds, E. coli, or fungus, just to name a few?

Labels can be misleading

In 2015 the Journal of the American Medical Association (JAMA) published a research paper demonstrating that in 23 percent of samples tested, THC levels were higher than indicated on the product label, which could put people at risk of experiencing other adverse events.

Sixty percent contained THC below the level claimed on the product label, which could leave the patient unable to achieve the desired medical benefit.

41 percent had no detectable levels of CBD.

Upon evaluating more than ten thousand cannabis products, the State of California discovered that 18 percent failed tests for potency and purity.

And Oregon released a report earlier this year that noted the state has failed to keep up with mandatory inspections, reaching only three percent of its dispensaries, and admitting that its poor testing potentially exposes consumers to multiple contaminants from cannabis products.

Bogus medical claims

Many producers of products containing CBD are making unfounded medical claims regarding their products’ ability to cure or alleviate many diseases and conditions.

The FDA has very strict regulations on such activity and has issued warnings to some organizations that are selling CBD products. Unfortunately, enforcement is rare. And products with very high CBD concentrations are widely available.

Some of these businesses continue to operate illegally and perpetuate their false claims in plain sight – so consumers have little to no protection.

To my physician peers: It’s time we speak up!

Words shared by a friend have long stuck with me: “What made the most noise was when the doctors said nothing.”

If the medical community is not speaking up about the significant risks associated with unregulated and untested CBD products, it’s not surprising that consumers feel that these products must be safe.

Fellow physicians and allied health care professionals, we can’t wait any longer. We must speak up, loudly and often, and warn the public about the potential risks they face.

I propose we place a “hold” on the sale and marketing of over-the-counter and internet-based CBD products.

Let’s be willing to stand up to our patients’ pressure for us to “endorse” CBD products until after robust clinical trials are completed.

Let’s put public health and safety ahead of commercial interests.

Let’s put our patients first.

Kenneth Finn is a physiatrist.

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