Nfld. & Labrador

Don't expect your doctor to prescribe CBD, says physicians' college

People are looking for cannabis products with CBD, citing anecdotal evidence. But until the research is there to support it, your doctor is probably not going to help you get it.

Lack of medical evidence supporting CBD means doctors aren't going to suggest it, says Dr. Linda Inkpen

High-CBD cannabis is available in both its traditional form and in tinctures or oils. (BC Cannabis Stores)

Demand is high for CBD products but there isn't yet much medical evidence backing their use, which means doctors in Newfoundland and Labrador aren't likely to prescribe or recommend them as a medical treatment.

As with any other medication, physicians must have the expertise and experience to authorize the use of CBD for their patients, says Dr. Linda Inkpen, registrar at the College of Physicians and Surgeons of Newfoundland and Labrador.

Even if they feel qualified to suggest CBD, doctors must ensure conventional therapies have been tried and assess for addiction risk before authorizing a treatment that lacks clinical backing. 

"That's what we hold our physicians accountable to in the interim until we find out exactly what we're dealing with, and it's what our patients should expect," Inkpen told CBC Radio's On The Go.

Across the province, customers going to licensed cannabis retailers in search of CBD products are leaving disappointed — supply hasn't been able to keep up with demand.

CBD or cannabidiol is, like THC, a cannabinoid, which is a naturally occurring compound in the cannabis plant. Unlike THC, CBD doesn't make you high, but many people have reported anecdotally that using high-CBD cannabis or CBD extracts has helped them with everything from anxiety to pain relief.

CBD is a naturally occurring compound found in cannabis plants. (Kim Brunhuber/CBC)

As a result, the demand for CBD products has exploded across the country, but demand is outstripping supply. A spokesperson for the province's liquor corporation, which also oversees recreational cannabis sales, previously told CBC News it has been hard to keep CBD products in stock, and two retailers confirmed demand for the products is high.

CBD is sold via the recreational cannabis market, but those retailers are prohibited by law from making health claims or providing medical advice about cannabis products. Some patients have looked to their physicians and the medical cannabis market, but they are unlikely to have CBD prescribed via that route, Inkpen said.

"The college's stance is the same as the other colleges right cross the country," she said.  

"We are cautioning patients and physicians who choose to either authorize use of these products, or patients who choose to use them, to be very, very cautious and careful until the evidence is in of what the short-term and long-term benefits might be for these products, and what the short-term and long-term disadvantages might be."

Lack of research so far

Right now, there just isn't enough information on those potential harms and benefits, Inkpen said. Research has been limited on cannabidiol because of the legal issues around the cannabis plant, especially in the U.S.

Even in countries like Canada, where some research on cannabis has been done, results could still be years away.

"Medical research takes time," Inkpen said. Studies go though multiple phases, from laboratory to animals and then humans, and each one can take months or years. Information about longer-term harms and benefits takes even more time.

CBD capsules and oils are produced by several licensed suppliers, but retailers in N.L. have said they have trouble keeping them in stock. (Cannabis NL)

Inkpen said she recently looked into ongoing research on CBD and found there were more than 60 short-term and long-term research studies currently underway worldwide, looking at 23 different diseases or conditions. About a third of those studies were based in Canada, she said. 

What patients should know

In the absence of prescribing physicians and completed medical research, some people might be taking matters into their own hands.

In the months leading up to cannabis legalization, the college heard more often from patients wondering where they could be prescribed cannabis product, Inkpen said. Since Oct. 17, those calls have decreased.

Medical research takes time.- Dr. Linda Inkpen

She can't say if that means people are instead visiting recreational cannabis retailers to buy CBD for non-recreational use, but Inkpen acknowledged that could be the case.

But while cannabidiol doesn't have the psychoactive effects of THC, there are four categories of people who are particularly advised to exercise caution with the use of cannabis, she said: those with ongoing chest conditions like asthma, if using an inhaled cannabis product; people who are pregnant; people with ongoing mental health conditions, or the propensity for them; and those with addictions, or the propensity for them.

"There's a lot of anecdotal information out there right now that might be of some concern when using these products with them," Inkpen said.

Additionally, people who are using over-the-counter products, including cannabis, should make their physician or nurse practitioner aware in case of any potential reactions with prescribed treatments, she said.

High-CBD dried flower cannabis products are also available, but not necessarily in stock. (Cannabis NL)

And Inkpen suggested referring to the Health Canada website for information and updates as people wait for further guidance from the results of ongoing research into CBD and its potential harms and benefits for a variety of conditions.

"I would have to refer members of the public, and our prescribers as well, to please be guided by what Health Canada has been doing and continues to do, and what information and research is happening worldwide on this particular substance."

Read more from CBC Newfoundland and Labrador

With files from On The Go

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