n summer 2018, I was a fourth-year pharmacy student sifting through medication lists of my surgical patients at Owensboro Health Regional Hospital when I noticed a common theme on medication lists: CBD oil. I started to research CBD vs. THC and the progression of legalizing marijuana for recreational and medicinal purposes. The findings were unsettling to me. However, I quickly moved on to the next rotation and put it in the back of my mind.
Fast forward to the end of 2019. The topic of marijuana legalization came up in my Intro to Public Policy course in my M.P.H. program, and I felt compelled to, once again, research medical marijuana. I wrote a policy memo about my researched concerns, turned in the assignment, and proceeded to the next quarter of the program, tabling my concerns as before.
Fast forward to one month ago, a product in my pharmacy reminded of that unsettling feeling I had years ago, and I went online to look for progress with medical marijuana. I discovered that some researchers and medical providers have noticed that people still purchase what they believe to be THC-free products for their ailments, however, many of those products have significant amountsof THC in them. I was disheartened to learn that much of my concerns had not changed over the years, and that my colleagueswere seeing and vocalizing similar concerns.
America is fragmented on the various topics surrounding marijuanapolitically, medically, religiously, and individually, with conflicting information as the foundation. It is important to note that marijuana is a complex plant with over 500 known components, and its two main and most studied components are THC and CBD. Potency of marijuana is based on its THC concentration, the primary component that causes most side effects.
While CBD is put in everything from OTC medications to shampoo, there are three categories of medical marijuana laws: loose medical, restricted access, and non-THC. Under loose medical, a patient’s prescriber must believe the use of medical marijuana is necessary and the patient’s access should be readily available. With restricted access, a patient would either be restricted to particular types of available medical marijuana products, be required to meet specific qualifying criteria such as a certain medical condition, or, in some cases, qualify for both. Under non-THC laws, which are the most restrictive, available products must have little-to-no THC with high CBD concentrations for a specific list of qualifying illnesses.
My concern is that the THC:CBD ratios in some formulations have changed from a ratio of 14:1 in the mid-1990s to nearly 6-fold greater at an 80:1 ratio today. Studies state that a 1:1 THC:CBD ratio is best for improved medical benefits and reduced chances of side effects. This is not always the case with medical marijuana that is “recommended” or “referred” (not “prescribed”) to patients. This leaves patients at risk to not achieve their desired health outcomes or potentially suffering side effects. Although caregivers (people who grow or dispense medical marijuana) may have limitations at the local or state level to how much a patient can receive, there are still many locations lacking regulation of dispensaries.
As a pharmacist, I have seen CBD oil and medical marijuana benefit many, and I always want people’s medications to work for them. Admittedly, dispensaries are providing a much-needed service. So, if there was federal collaboration to make sure products are always safe and effective for the patient, that would be much more settling to me. I believe that Americans should push for a minimum federal dispensary regulation policy to securely monitors consistently puremedical marijuana dispensed in each state. Additionally, a federal Drug Enforcement Administration (DEA) policy could betterregulate medical marijuana providers and consumers. Lastly, providers, pharmacists, and researchers should come together to create recommendation or referral guidelines for approved medical indications.
Fast forward to today. Now, that is a settling vision for the future that I can keep in the forefront of my mind.
Written by Candace Olusola, Pharm.D., M.P.H.
Community pharmacy health outcomes pharmacist