CBD Oil Uses in Palliative Care
If you are on social media or watch the news, chances are you have heard about the health trend of using CBD oil (cannabadiol) to treat a variety of health concerns.
From ADHD to anxiety and chronic pain, it seems many people are turning to this nonpsychoactive oil to improve their health.
However, it is important to note that long-term studies have not been completed on the oil so there is really no way to know what it actually works for or in what doses it should be taken.
Physicians in the medical community are split on whether the oil is making a difference for patients or if it is just a placebo effect.
For my palliative care and end-of-life patients, many of them have already tried CBD oil and other marijuana and hemp products prior to coming to see me.
What is CBD and does it get me high?
Prior to recent years, marijuana and thus hemp and CBD were illegal substances. With the trend of legalizing these products for medical use, CBD is no longer considered an illegal substance in many states.
CBD is one of hundreds of cannabinoids that are found in the marijuana and hemp (cannabis) plants. CBD does not cause the euphoria or high that is associated with its cousin – THC. THC is the chemical compound in marijuana that is known for those smoke-laden hippie-reminiscent scenes at concerts and coming out of the VW vans of the past.
CBD – specifically THC-free CBD – does not create any sort of euphoria. It works with the body’s endocannabinoid system. Researchers are only just starting to understand this system of the body.
Hemp-derived CBD can be purchased without special permission or prescription. Marijuana-derived CBD must be purchased through a licensed dispensary with a medical marijuana card (obtained after evaluation by a physician to verify a qualifying condition).
Should I try CBD?
Many of my patients experience high levels of pain whether from injuries or ongoing illness. So, with their medical provider and, in some cases, on their own, they will search for ways to reduce or eliminate their pain.
Medical marijuana is one method that they often try out. For some patients, however, they do not like the feeling they get with medical marijuana, so they will often try hemp-derived CBD oil instead to see if they can find relief.
It is up to you and your medical care team on what methods you are comfortable with and are willing to try.
There is no “prescription” for medical marijuana or marijuana-derived CBD oil. Physicians authorize (by completing patient applications) that they feel their patients may benefit from this additional therapy and that they meet one of the Delaware qualifying conditions. I approach each case individually and will authorize use of these treatments, particularly if a patient has already had positive effects from hemp-based CBD oil.
According to Rosemary Mazanet, MD, PhD, an oncologist and chief scientist at Columbia Care – which provides medical cannabis products in 13 states: “Even if it’s placebo, if people think it’s working for them, that’s good because people take so many benzodiazepenes, which can be addictive over periods of time.”
The best recommendation is to talk to your medical care provider and to your family. If you decide to try CBD oil, be sure to get a quality product (not something from the gas station) and start with a lower dose to see what effect it might have on your body. You can slowly build up to see if you find improvement in your condition.
There are side effects from CBD, which may include dry mouth, low blood pressure, light headedness, drowsiness, diarrhea, nausea, and irritability.
Specialist hospital doctors can prescribe or recommend cannabis-based products for treatment. The products can be used when the specialist identifies a clinical need for a person and other treatments are not suitable or have not helped.
About medicinal cannabis products
‘Medicinal cannabis’ is a broad term for any sort of cannabis-based product used to relieve symptoms.
Many of these products are available to buy online without a prescription, but their quality and content cannot be guaranteed. These products could be illegal and potentially dangerous.
Some products that might claim to be medicinal cannabis, such as ‘CBD’ oil or hemp oil, are available to buy as food supplements from health stores and other outlets, but there is no guarantee these are effective or of good quality.
Some cannabis-based products are available on prescription as medicinal cannabis. These are only likely to benefit a very small number of patients.
Prescriptions for a medicinal cannabis product
Medicinal cannabis products are only available on a prescription written by, or recommended by, a specialist hospital doctor.
This is because there is currently limited scientific evidence medicinal cannabis is safe and effective. It is also because there are relatively few licensed products available that have undergone the normal strict testing for medicines. This testing means that medicines are safe, of good quality, and are effective.
A hospital specialist might consider prescribing a medicinal cannabis product for you or your child if:
- your child has one of the rare forms of epilepsy that might be helped by medical cannabis
- you have spasticity from Multiple Sclerosis (MS) and treatments for this are not helping
- you have vomiting or feel sick from chemotherapy and anti-sickness treatments aren’t helping
Medicinal cannabis will generally only be considered when other treatments were not suitable or had not helped. The specialist will discuss with you the most suitable treatment option.
If the above does not apply it is unlikely your GP will refer you or your child for medicinal cannabis.
How medicinal cannabis products might help
Epidyolex for children and adults with epilepsy
Epidyolex is a highly purified liquid containing CBD (cannabidiol).
CBD is a chemical substance found in cannabis that has medical benefits.
It will not get you high, because it does not contain THC (tetrahydrocannabinol), the chemical in cannabis that makes you high.
Epidyolex can be prescribed for patients with Lennox-Gastaut syndrome and Dravet syndrome (both rare forms of epilepsy).
Nabilone for chemotherapy patients
Many people having chemotherapy will have periods where they feel sick or vomit.
Nabilone can be prescribed by a specialist to help relieve these symptoms, but only when other treatments have not helped or are not suitable.
Nabilone is a medicine, taken as a capsule, which has been developed to act in a similar way to THC (the chemical in cannabis that makes you high). You may have heard it described as a “manmade form of cannabis”.
Nabiximols (Sativex) for multiple sclerosis (MS)
Nabiximols (Sativex) is a cannabis-based medicine that is sprayed into the mouth.
It is licensed in the UK for people with MS-related muscle spasticity that has not got better with other treatments.
There is some evidence medical cannabis can help certain types of pain, though this evidence is not yet strong enough to recommend it for pain relief.
Researchers are currently investigating other possible uses of medicinal cannabis.
Products available to buy
Some cannabis-based products are available to buy over the internet without a prescription.
It’s likely most of these products – even those called “CBD oils” – will be illegal to possess or supply. There’s a good chance they will contain THC, and may not be safe to use.
Health stores sell certain types of “pure CBD”. However, there’s no guarantee these products will be of good quality.
They tend to only contain very small amounts of CBD, so it’s not clear what effect they would have.
Is medicinal cannabis safe
The risks of using cannabis products containing THC (the chemical that gets you high) are not currently known. That is why clinical trials are needed before they can be licensed for use.
“Pure” products that only contain CBD, such as Epidyolex, do not carry these unknown risks linked with THC.
But in reality, most products will contain a certain amount of THC.
The main risks of THC cannabis products are:
- psychosis – there is evidence that regular cannabis use increases your risk of developing a psychotic illness such as schizophrenia
- dependency on the medicine – although scientists believe this risk is probably small when its use is controlled and monitored by a specialist doctor
Generally, the more THC the product contains, the greater these risks are.
Cannabis bought illegally off the street, where the quality, ingredients and strength are not known, is the most dangerous form to use.
Side effects of medicinal cannabis
After taking medicinal cannabis, it is possible side effects can develop. These include:
- decreased appetite
- greater weakness
- a behavioural or mood change
- feeling very tired
- feeling high
- suicidal thoughts or hallucinations
If you experience any side effects from medicinal cannabis, report these to your medical team. You can also report them through the Yellow Card Scheme.
CBD can affect how other drugs work. If you are taking a CBD drug along with other medication, always discuss possible interactions with your specialist.
CBD can also affect how your liver works, so doctors would need to monitor you regularly.
It is now legal for adults 21 and older to possess up to three ounces of cannabis and up to 24 grams of concentrated cannabis for personal use in New York. Adults may smoke or vape cannabis wherever smoking tobacco is allowed under the smoke-free air laws, with a few exceptions.
Cannabis use is not allowed in motor vehicles (even if they are parked) or in outdoor dining areas at restaurants. Smoking or vaping cannabis in prohibited areas may result in a civil summons and fine.
It is still against the law for people younger than 21 years old to possess, sell or use any amount of cannabis. Also, no one may legally possess more than three ounces of cannabis and 24 grams of concentrated cannabis, sell any amount without a license, or drive while under the influence or impaired by cannabis.
After legal sales begin and home cultivation begin:
- Adults will be allowed to purchase cannabis products at licensed retailers.
- Adults will be allowed to grow three cannabis plants at home. Homes with more than one adult will be allowed to grow six plants (three mature and three immature plants).
- Adults will be allowed to store up to five pounds of cannabis in their home.
- Cities and towns may have on-site consumption areas where people can use cannabis.
Medical cannabis has been legally available to New Yorkers through the State’s medical marijuana program since 2014.
People may be eligible to use medical cannabis to treat their health condition if a state-registered health care provider certifies that medical cannabis is clinically appropriate. Patients must also register with the state to be able to purchase medical cannabis.
The new law expands the eligibility of medical cannabis, increases the number of caregivers allowed per patient, allows prescriptions for as many as 60 days (up from 30) and allows smokable cannabis to be purchased in medical cannabis dispensaries.
Once regulations are finalized, certified medical cannabis program patients will also be able to grow up to six plants at a time at home.
For more information about whether medical cannabis could help you, talk to your health care provider.
Under federal law, cannabis possession and use in all forms remains illegal. There are a few FDA-approved prescription medications that contain cannabis-derived products, such as CBD, or are made with synthetic products related to cannabis.
For more information on the federal law, visit the FDA webpage on cannabis and cannabis-derived products.
Cannabis (also known as marijuana) is the second-most commonly used recreational drug in NYC, after alcohol. It can be smoked, vaped or ingested as a food or beverage (edibles), producing reactions such as a relaxed, euphoric feeling, anxiety and an increased heart rate.
The cannabis plant contains hundreds of compounds, including THC (delta-9-tetrahydrocannabinol). THC is a psychoactive compound that makes people feel high. Different forms of cannabis contain different amounts of THC and produce different effects. The more THC that a cannabis product contains, the stronger the effect.
Concentrates, such as dabs, wax and oil, may have much higher amounts of THC — 40% to 90% — than other forms of cannabis, which are usually about 20% THC. Concentrates can cause a faster, more intense effect than other forms of cannabis and may lead to an increased health risk. Cannabis added into food and beverages has a delayed and longer-lasting effect than smoked or vaped cannabis.
A person’s reaction to cannabis also may be affected by their age, height, weight, health status, medications taken, tolerance and what other food, liquids and drugs they have consumed that day.
The legal status of cannabis has made the study of health effects difficult. As more states legalize cannabis for adult use and medicinal use, there has been some increase in research on the benefits and risks of cannabis. However, the study of cannabis remains restricted by its classification as a Schedule I controlled substance by the federal government.
The below information is based on studies that have provided strong evidence of how cannabis can impact health. However, at this time, more information is needed to better understand the health risks and benefits of consuming cannabis.
Cannabis has been shown to be helpful for some conditions:
- Chronic pain in adults
- Chemotherapy-induced nausea
- Multiple sclerosis spasticity symptoms
Some people may experience immediate, unwanted reactions after taking cannabis. These effects can be due to taking a type or amount of cannabis they are not used to, or to taking multiple doses in a short time.
These reactions, which typically go away after the cannabis wears off, can include:
- Temporary anxiety
- Faster heart rate
- Impaired reactions or distorted perceptions
- Temporary panic, paranoia or hallucinations
- Severe vomiting
- Respiratory problems from smoking cannabis
Research has shown links between cannabis and some health risks:
- Lower birthweight in newborns after a person smoked cannabis while pregnant
- Higher risk of motor vehicle crashes when driving while impaired
- Earlier onset of psychotic disorders for those already at risk, particularly people who start using cannabis at a younger age or use it more frequently
- More frequent respiratory symptoms, especially when the person has chronic bronchitis
- Lung injuries due to vaping cannabis
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Here are some tips to help you use cannabis more safely:
- Avoid driving after use. It is unsafe and illegal to drive while under the influence of or impaired by any substance, including cannabis. No one drives better while high. If you drive while impaired, you are at a higher risk of dying in a crash or harming yourself and others.
- Avoid using too much cannabis too quickly. Different forms and strains of cannabis can produce different effects and some are stronger than others. Some forms and strains of cannabis can have a delayed effect. For example, edibles can take up to four hours to feel their full effects. Start with a small amount and wait until you feel its effects before deciding whether to take more. Start low and go slow.
- Avoid taking different drugs at the same time. Taking cannabis with other drugs, including alcohol, can cause unpredictable effects. If you take prescription drugs, ask your health care provider about the possible effects of taking them with cannabis.
- Avoid smoking cannabis rolled or mixed with tobacco. There is no safe amount of tobacco use or of secondhand tobacco smoke exposure for those around you.
- Talk to your health care provider about how cannabis use may affect other health issues. Cannabis may affect you differently if you have a chronic or acute health condition.
- Be wary of synthetic cannabinoids, also known as K2. They are not cannabis. The effects of synthetic cannabinoids are unpredictable and may be different than cannabis.
- Keep cannabis out of reach of minors. Children have mistakenly eaten cannabis that resembles food. If you have edibles in your home, keep them separate from other food and beverages. Keep all cannabis products in a secure place that cannot be seen or accessed by people younger than 21.
- If a child mistakenly eats anything containing cannabis, call the NYC Poison Control Center at 212-POISONS (212-764-7667). (PDF)
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CBD is one of the compounds of the cannabis plant and a chemical byproduct of industrial hemp. Unlike THC, CBD does not induce a high or cause impairment. People use CBD for different reasons, but there is not strong evidence of its health effects.
CBD products that have less than .03% THC are legal in the U.S. However, CBD has not been approved for use in foods and beverages by the FDA, so it is unlawful in NYC to sell food or drinks containing CBD. The Health Department may issue violations to food service establishments and retailers that offer food or drink containing CBD.
If you are a food service operator, learn more about the laws on CBD sales.
- If a child mistakenly eats anything containing cannabis, call the NYC Poison Control Center at 212-POISONS (212-764-7667). (PDF)