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A pharmacist’s guide to CBD

It’s important to keep these three considerations in mind in case a patient asks about this alternative to medication
Gerardo Sison medical writer headshot
By | Sep. 8, 2022
CBD tincture - Cbd oil in pharmacies

Key takeaways

  • Hemp-derived CBD is legal across all 50 states, but with varying laws, and is available in multiple forms, including oils and capsules.

  • CBD interacts with the body’s endocannabinoid system but does not produce psychoactive effects, unlike THC.

  • The FDA has approved only one CBD product, Epidiolex, for treating certain seizures, with all other CBD products not FDA-regulated or officially dosed.

  • Pharmacists should advise patients on CBD based on local laws, potential side effects, and possible drug interactions, considering the lack of regulation and testing for CBD products.

With the increasing popularity and production of cannabidiol (CBD) products, pharmacists are bound to encounter patients who have concerns about the administration, side effects, and other aspects of CBD use. Hemp-derived CBD has been legalized in all 50 states with varying laws and is accessible as an oil, among other dosage forms. Over one-third of Americans have used CBD at least once. 

Pharmacists, in particular, should be equipped with up-to-date knowledge on CBD products, as CBD products may be found on pharmacy shelves. Understanding the laws and research behind CBD products is key for counseling patients and ensuring maximum safety and effectiveness. 

Continue reading to learn more about CBD products, their uses, and how pharmacists and other healthcare workers can address CBD use in their patients. 

CBD mechanism of action

CBD is extracted from the cannabis sativa plant and does not have psychoactive effects that can cause a “high.” The compound responsible for that psychoactive feeling is THC, or delta-9-tetrahydrocannabinol. CBD and THC can be found in both hemp and marijuana. However, hemp is defined as a cannabis plant that contains less than 0.3% THC, whereas marijuana is defined as a cannabis plant that contains more than 0.3% THC.

The endocannabinoid system is believed to influence many functions in the body, such as sleep, learning, pain control, and appetite. Cannabinoids, such as CBD, interact with cannabinoid (CB) receptors throughout the body to elicit a response. CBD is a lipophilic substance that can act as a CB1 and CB2 receptor antagonist or inverse agonist.

CBD dosage forms

CBD can be found in many dosage forms, such as:

  • Oils
  • Sublingual tablets
  • Capsules
  • Nasal sprays
  • Topical creams

The dosage form chosen depends on the specific product and indicated use. 

There is only one FDA-approved prescription CBD product called Epidiolex, which is approved for adults and children aged 1 year and older. It comes as a 100 mg/mL CBD oil used to treat seizures in people with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. The usual starting dosage is 2.5 mg/kg twice daily. 

All other CBD products are not approved or regulated by the FDA, and CBD dosages are not defined by specific guidelines. Some manufacturers may falsely advertise their CBD products for various unproven claims and benefits. 

The usual recommended dosage of CBD products is a dosage low enough to be effective and safe. When used for other reasons besides epilepsy, CBD dosages can vary. The range of oral CBD doses usually lies between 100 mg and 800 mg.

CBD uses

CBD has been studied and used for various purposes. Its therapeutic effects may be useful for treating various medical ailments and conditions. In addition to its approved use for epileptic seizures, CBD may help with the following:

3 considerations when talking to patients about CBD

As a pharmacist, you may be in a position to talk to patients about CBD oil or related products. For example, a patient might come to the counter to ask about a CBD product sold in the pharmacy, or they might mention that they take a CBD supplement when picking up their prescription. Here are some things to keep in mind when counseling patients on CBD. 

1. Understanding laws and regulations

It’s important to know that CBD products are not currently regulated by the FDA, and CBD laws and regulations vary by state. Pharmacists should advise their patients about CBD based on local laws and regulations. 

Around 30 different states have legalized CBD for medical use. Hemp, which CBD is typically derived from, is legal in all 50 states and is regulated by the U.S. Department of Agriculture. In certain states, such as New York and Minnesota, CBD products must be dispensed from authorized dispensaries. Hemp-derived CBD products are not controlled substances, whereas marijuana-derived CBD products may be classified as Schedule I substances. 

2. Choosing CBD products

There are no specific regulations or guidelines for testing the safety, effectiveness, or quality of CBD products. As a result, CBD products may contain harmful substances or inaccurately labeled amounts of active ingredients. 

Pharmacists may want to counsel patients to purchase CBD products from states where CBD is legalized and more likely to be tested. Patients may also want to check the product label to see how much CBD it contains in a single dose. In addition, manufacturers may provide a Certificate of Analysis or Hemp Authority seal that shows the potency and quality of their CBD products. 

3. CBD side effects and drug interactions

CBD may cause side effects, such as drowsiness, decreased appetite, and diarrhea. It may also cause mood changes, such as irritability and agitation. Serious side effects of CBD may include liver injury and reproductive toxicity in men and women.

Patients who take CBD should also know what drugs should not be taken with CBD. Benzodiazepines, opioids, barbiturates, and other CNS depressants may interact with CBD, causing an increased risk of severe drowsiness. Some herbal supplements, such as kava, melatonin, and St. John’s wort, may also interact with CBD and cause increased drowsiness. 

CBD is metabolized in the liver by CYP enzymes and may interact with inhibitors or inducers of CYP2C19 and CYP3A4 enzymes. Pharmacists should assess the potential for drug interactions by going over the patient’s list of medications. 

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The pharmacist’s role in the use of CBD

Pharmacists can be strong advocates for ensuring the safety of patients taking CBD. Because of the laws and regulations (or lack thereof) surrounding CBD, pharmacists may be reluctant to address its sale and use for patients. 

While one prescription CBD product has been FDA-approved and studies have shown promising results for CBD benefits, it’s best for pharmacists to err on the side of caution. Pharmacists can counsel patients about the dosages, potential side effects, and possible drug interactions of CBD products.