In
the
NEWS
The Cannabis Conundrum
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Photo by Adam Fondren, Rapid City Journal.
Understanding a popular but still investigational medicinal plant.
O
ne in seven Americans
say they use cannabidiol
(also known as CBD)
products, according to a recent
Gallup poll. Some people use
CBD for pain, while other use
it for anxiety or for sleep. Available as an oil, CBD is a nonpsychoactive chemical compound
derived from the cannabis or
hemp plant that is believed to
have therapeutic effects. Since
being legalized federally last
year, cannabidiol has gained
popularity as an additive to lotions, various foods and drinks,
and even the fibers of workout
clothes, among other products.
For nurses encountering patients
using CBD, it’s important to understand the benefits, safety,
and regulation of the cannabis
plant—and its derivatives.
In 1970, cannabis was classified as a controlled substance and
deemed to be a Schedule I drug.
However, 33 states and Washington, DC, have since legalized
its sale for medicinal purposes,
and 11 states and Washington,
DC, allow recreational use. The
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AJN ▼ December 2019
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Vol. 119, No. 12
2018 Farm Bill
legalized—under
strict conditions—
the sale of hempderived CBD,
which contains
less than 0.3%
tetrahydrocannabinol (THC),
the principal
psychoactive
component of
cannabis. (Cannabis containing
over 0.3% THC
is considered to
be “marijuana”
and is still classified as a drug.) But many CBD
products are mislabeled: an analysis published in JAMA found
that of 84 products purchased
online, 26% contained less CBD
than disclosed on the label, and
about 22% contained THC, some
in amounts twice the legal limit
for nonpsychoactive products.
The only CBD product approved by the Food and Drug Administration is Epidiolex, which is
used to treat seizures associated
with the rare epilepsy syndromes,
Lennox–Gastaut and Dravet. CBD
has also shown promising but
limited results in alleviating the
withdrawal effects of cocaine and
methamphetamine use, and in
reducing alcohol consumption in
people with alcohol use disorder,
thereby potentially diminishing
liver and brain damage.
A recent literature review found
that CBD may help reduce episodic anxiety associated with
stressful events, such as public
speaking, and may be effective
in the treatment of patients with
schizophrenia. However, its potential as a treatment for chronic
anxiety hasn’t been studied, and
data on its effects on pain, spasticity, and Parkinson’s disease
remain sparse.
Despite the limited science,
some manufacturers of CBD
products continue to falsely tout
them as cures for a range of conditions, including depression,
anxiety, cancer, and AIDS. In response, the Federal Trade Commission (FTC) in September sent
letters to three unnamed companies, warning them, the FTC said
in a statement, “that it is illegal to
advertise that a product can prevent, treat, or cure human disease
without competent and reliable
scientific evidence to support such
claims.” Such warnings, however,
may not be sufficient to stem public enthusiasm for CBD products.
By 2022, CBD-related consumer
spending is expected to reach about
$1.8 billion—up from roughly
$500 million in 2018.
To help nurses care for patients
using medical cannabis, the National Council of State Boards of
Nursing has released The NCSBN
National Nursing Guidelines for
Medical Marijuana. Among the
recommendations are that nurses
stay informed on the benefits and
risks of cannabis, become familiar
with state laws, assess patients for
adverse effects, and communicate
clinical findings to other members
of the health care team (see https://
ncsbn.org/the_ncsbn_national_
nursing_guidelines_for_medical_
marijuana_jnr_july_2018.pdf).
Another resource is the American
Cannabis Nurses Association, which
offers an online course (see www.
cannabisnurses.org).—Dalia Sofer
Bonn-Miller M, et al. JAMA 2017;318(17):
1708-9; White CM. J Clin Pharmacol 2009;
59(7):923-34.
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