By: Amanda Winslow, PharmD, BCPS
Cannabidiol, more commonly known as CBD has been one of the hottest trends of 2019. In December 2018, the United States passed the Farm Bill that, among other things, legalized hemp. Now, cannabis products with less than 0.3% THC are no longer considered Schedule I controlled substances. This prompted a huge surge in CBD products coming to market accompanied by countless health claims. A quick internet search will give you a wide variety of results from oils of varying strengths to gummy bears to skin serums. Although these products are no longer a controlled substance, the FDA has reported that these products are not supposed to be marketed as food or dietary supplements because a prescription medication with CBD as the active ingredient, Epidiolex, was approved in 2018. However, it seems like the FDA is more concerned with improper advertisement of these products claiming health benefits, rather than prosecuting for manufacturing or selling. All of these issues aside, it is possible to obtain and sell CBD products and patients are certainly looking for them.
Here are some highs and lows to consider regarding the sale of CBD products in your pharmacy.
Full Medication Profile
One of the major responsibilities of a pharmacist is to make patients aware of the risks of taking medications either alone or in combination with other medications. Selling CBD in your pharmacy would ensure you know which of your patients are taking CBD. Then a drug interaction report would be run against their medications. Since CBD has now been studied as a pharmaceutical product, there is information available on drug interactions. Primarily metabolized by the liver, it is a substrate of CYP2C19 and CYP3A4 and is a moderate inhibitor of CYP2C19. This may increase the effect of CNS depressants, citalopram, or cilostazol. The effects of CBD may be increased by valproate products, diltiazem, itraconazole, ritonavir and clarithromycin, just to name a few. Some of the more widely advertised “health benefits” of CBD are reducing seizures and increasing appetite in patients with chronic diseases. These types of patients are likely to have some medications that interact with CBD. Be sure to do your due diligence and provide the patient with the risks and/or benefits of the product before selling.
Supply and Demand
Profitability is a clear benefit in this situation. CBD is a popular topic and many patients are in the market to purchase. This could potentially be quite a large revenue source for your pharmacy. Just be sure to balance the need of profit and the oath you took as a pharmacist to care for your patients.
Providing a quality product
Because this product is not regulated by the FDA, it may be difficult to filter out unreliable products. Look for a reputable company with good manufacturing practices (GMP). This is no easy task, but is essential.
The FDA has begun testing available products and many were found to be misbranded, with either the wrong percentage of CBD in the product or with the wrong THC ratio. THC is an especially important part of the equation because it is still illegal in many states. Ensuring you have a well-manufactured product will give you ease of mind in your recommendations.
As for making recommendations, pharmacists should always be wary. There is little to no high-quality data relating to CBD because it was previously a Schedule I controlled substance in the United States. Pointing someone to a product they are looking for is different than recommending a product with expert opinion. The lack of evidence places more liability on the pharmacist’s judgment because there is no direct literature proving benefit.
Many patients are avoiding traditional medication because a friend told them “CBD would work and is safer.” Be sure to educate patients on traditional medications available and refer to a physician if their symptoms seem to indicate it. While CBD may be a good adjunct therapy, we have other, more proven medications for many disease states.
Lastly, the FDA holds regulatory power and CBD products technically violate the FD&C Act. While the FDA has not yet made a move to prosecute companies making these products, they could do so at any time. Before deciding to sell any CBD products, be sure to consult with an attorney about your state and local laws.