I recently admitted a patient who regularly uses cannabidiol (CBD) for pain and anxiety relief. Is CBD helpful in treating health disorders?- GK, NJ
Justin Kim, RN, Jenna Reitsma, RN, and Bridget Parsh, EdD, RN, CNS, reply-As the popularity of the cannabis-derived, cannabidiol (CBD) grows, understanding its uses, effects, formulations, and considerations is becoming more important.1,2 With the changes in public sentiment, impeded scientific research, and ongoing legislative battles, the lack of knowledge of CBD has public health implications.3 CBD has been promoted as a sleep aid, anti-inflammatory agent, pain reliever, and cancer symptom therapy.4,5 Many patients may use CBD regularly for a wide variety of reasons.
The term "cannabis" refers to all products derived from the plant Cannabis satvia which contains more than five hundred chemical substances. "Marijuana" is part of the Cannabis satvia plant that contains substantial amounts of tetrahydrocannabinol (THC), the component which produces the "high".1,6 Processed into a variety of product formulations such as foodstuff, tinctures, and concentrates, CBD may be inhaled from vaporizers, ingested orally, or applied topically.7
Unlike THC, CBD does not give a high or intoxicating effect, making it unpopular for recreational use but of interest for medicinal use.8,9 As of this writing, a purified form of CBD derived from cannabis is only approved by the US FDA for the treatment of rare and severe seizure disorders. Dronabinol (synthetic THC), and Cesamet, which contains nabilone (a synthetic substance similar to THC), are approved by the FDA to treat nausea and vomiting caused by cancer chemotherapy. Dronabinol is also used to treat loss of appetite and weight loss in patients with HIV/AIDS and anorexia associated with weight loss in patients with AIDS.6,7,10 Research on the health effects of cannabis and cannabinoids has been limited in the US, leaving patients, healthcare professionals, and policymakers without the evidence they need to make sound decisions regarding their use of cannabis.3 Though few clinical studies are available, there are numerous clinical trials currently taking place.11 These trials for CBD include anti-psychotic, anti-inflammatory, and pain relief uses.12 Other investigations on CBD usage include treatment of obesity, anxiety, neuropathies, spasticity, mental illness, post-traumatic stress disorder, autism spectrum disorders, and pain related to cancer and osteoarthritis.2,9,12-14,
Adverse reactions from CBD may include gastrointestinal effects such as diarrhea and decreased appetite; liver injury; negative effects on mood such as agitation, irritation, and drowsiness; drug-to-drug interactions; decreased urination; and hepatotoxicity.3,5,6,15 Withdrawal symptoms such as nervousness, irritability, restlessness, insomnia, anorexia, headache, diaphoresis, and abdominal pain can occur after frequent or heavy use.2,16 Monitored rehabilitation and detoxification may be an option for patients experiencing withdrawal symptoms, especially with cannabis.16
Laws regulating cannabis have been evolving, making it possible for nurses to come in contact with patients using CBD.2,7,8 Healthcare professionals must remember to use non-judgmental therapeutic communication such as using opened-ended questions, asking if the patient has any concerns, speaking in a welcoming tone to determine the usage of any over-the-counter or possibly illegal substances. Monitor patients closely for signs of withdrawal, liver involvement, and adverse reactions. Consult with the pharmacist about possible drug interactions with CBD. Additionally, inform patients that the labeling of CBD products has been identified as inconsistent and may not reflect the content accurately.6 Finally, provide patients with supporting resources, if necessary (see Resources for patients).
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