For 35 years, it has been my cherished wish that the public generally, and pharmacy colleagues specifically, would become enlightened to the validity and superiority of science in decision making, particularly in the choice of the treatments we endorse and use. Sadly, that wish remains unfulfilled and was painfully dashed again at the Pharmacy Show last October.
No fewer than 23 stands featured CBD (cannabidiol) oil products. It seems pharmacists are being educated, coerced, bullied or brainwashed (not sure which) into the belief that CBD is the panacea mankind has always been seeking for ever. The commitment to this ideology from venture capitalists is, to say the least, impressive. Not since the infancy of e-cigarettes has so much been splashed out on glitzy stands at the Pharmacy Show. Last year, there was only one vaping stand.
I knew this very study, I told him, and he was perhaps exaggerating its claims
I picked a CBD stand at random. I was assigned to ‘Joe’ as he was “the most knowledgeable” and “would be better qualified to deal with me”. Firstly, Joe assured me his company was an ethical company – unlike some competitors at the show, he intimated – an assurance I found naïve. He referred me to studies listed on an “NCBI project cannabis”website set up, he told me, to advise government who, he felt, had failed to keep up with the exciting scientific findings about CBD.
My questions, I told him, were on three issues: the quality, safety and efficacy of CBD products. He wanted first to talk about safety. He quoted a paper published by the UK government that he claimed confirmed CBD products are completely safe. I knew this very study, I told him, and he was perhaps exaggerating its claims.
It was designed to confirm that by manipulating CBD oil in vivo or in vitro, consumers could not easily convert CBD (the safe molecule) into THC (the dope molecule), no matter how they tried. In this context, CBD was safe. We agreed that, on the whole, CBD was probably not a dangerous product.
Efficacy was difficult to discuss, he told me, as his company could not make medical claims yet. Joe could quote scores of papers that showed efficacy across a range of conditions. The products he sold were licensed as foods, which restricted what he could say, but “CBD works”. As an example, he offered Dravitts’ syndrome (a rare form of epilepsy) and confirmed that a medical product would soon be licensed (Epiduox). I told him I didn’t see many such patients in my pharmacy and if I did, I might be reluctant to treat. Had he nothing more, well, common? He volunteered eczema as an example where CBD oil is very effective, as it has both antibacterial and anti-inflammatory effects. CBD oil is infused into a cream and I could recommend this to my customers, so long as I don’t claim it works. I asked whether the cream formulation might be the active agent, but he dismissed this out of hand.
We then talked about quality. How did I know his CBD oil contained the stated percentage? He told me product quality was verified by an independent laboratory, so no worries there. I noted that the label of the CBD oil he sold stated 15 ml containing 10,000 mg and a direction to use two drops up to three times daily, along with a warning not to use more than 200 mg per day. If a drop is 0.6 ml, then one drop contains a massive 400mg. He didn’t want to comment on this and said he would come back to me.
I enquired what oil the CBD was contained in and he told me it was coconut oil. When I pointed out that coconut oil would be solid at room temperature, he again told me he would come back. It turns out, and both of us should have known, that CBD oil is hemp oil. It comes from the hemp plant.
His boss was now hanging over us and it was clear he was uncomfortable. He told ‘Joe’ his ‘appointment’ had arrived. ‘Joe’ thanked me for the insightful conversation and promised he would come back. Unsurprisingly, he never did. I think his boss knew I was unlikely to be the kind of pharmacist who would stock CBD oils, creams, facial washes and, oh yes, suppositories.
Perhaps five years from now I will read this column again and think how stupid and wrong I was.