There is no question that products made with hemp-based cannabidiol have achieved an extraordinary level of popularity. Independent surveys tell us that as many as 64 million people over the past two years have tried non-Food and Drug Administration-approved foods, dietary supplements, cosmetics and products billed as health aids that contain CBD.
And, as a pediatrician, I’m hearing an increasing number of inquiries from parents and other physicians about CBD use in pediatric patients. I’ve had parents coming into my office who have heard, whether it be from the internet or friends in the line at Starbucks, that their children with illnesses could benefit from having CBD integrated into their treatment regimen. They want me, as their child’s primary physician, to tell them what to buy, where to buy it and how to administer it.
But I’m not ready to do that just yet.
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It’s easy enough to buy CBD products online and even in some retail establishments, but this commerce is not treated with the gravity it warrants. CBD products are marketed with the promise of a plethora of health benefits, but seldom is it pointed out that this is a pharmacologically active substance that alters body chemistry. There may well be significant benefits to help people live longer and better, but the scientific evidence is lagging behind the sales pitches.
The FDA is deliberating on the proper regulatory pathway for CBD. From a physician standpoint, I think there are three obstacles that need to be overcome before the substance should be green-lighted for widespread medical use.
First, we need a structure in which CBD products are administered with professional, clinical oversight. Today, most CBD purchases are occurring outside of the doctor-patient (or, in cases like mine, doctor-parent) relationship. We’re prescribing medicines without knowing what else our patients may be using for therapies, and CBD has the potential to react harmfully with other drugs.
Second, we need more research. Whatever the label of a non-FDA-regulated product says about safe and proper doses is not based on rigorous scientific evidence.
We don’t know the right doses of cannabidiol to administer to patients of different ages and varying health conditions. We don’t know nearly enough about side effects and adverse reactions. To say that physicians and patients cannot engage in informed decision-making about these products is, to say the least, an understatement.
And, finally, we need some meaningful, common-sense regulation around these products. Right now, the CBD products you can buy online or in a neighborhood shop may contain any number of chemicals and contaminants that are not on the label. There are no assurances of manufacturing purity and definitely no rigorous scientific testing.
Most of these products have been alleged to contain amounts of THC, a psychoactive drug in cannabis that creates a “high.” So, how can I, as a pediatrician, tell a parent how to obtain a product that may be harmful for their young child? Without adequate regulation and enforcement, it’s a “let the buyer beware” environment.
My own daughter has a rare neuro-genetic disorder, and she’s been helped less by conventional prescription medicines than by a modified ketogenic diet. I’ve kept an unopened bottle of CBD oil in my medicine chest for the last 18 months, wondering if I might ever use it to try to improve my daughter’s condition.
And I wait for clinical researchers, scientists and the FDA to tell me that this bottle is a viable option.
Dr. Elizabeth Jalazo is a pediatrician in Chapel Hill, North Carolina.
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