Transcription:

Bill Klaproth (Host):  So, the perception of CBD oil as a wonder drug for pain management and other things seems to be growing every day. But what do we really know about this? And is it right for you? Should you even consider this? So, we’re going to talk with Dr. Igor Koturbash, Co-Director at the Center for Dietary Supplements Research at the University of Arkansas Medical Sciences and we’re going to learn more about CBD oil.

This is UAMS Heath Talk from the University of Arkansas for Medical Sciences. I’m Bill Klaproth. Dr. Koturbash thank you so much for your time. This is a really interesting topic. So, first off, what is CBD oil?

Igor Koturbash, MD, PhD (Guest):  Well, that’s a very interesting question. Probably the first thing is just to start what CBD is and then what is CBD oil. So, CBD itself is the non-psychoactive component of the cannabis sativa plant. So, there is THC or tetrahydrocannabinol which is the psychoactive right and CBD or cannabidiol is the non-psychoactive component for it. Usually it has been delivered in the form of oil and usually it is being delivered together with a sachet oil which is being used as a vehicle. So, cannabidiol itself is not really oil, it is just being delivered in a form of oil.

Host:  So, do you rub it over the affected area?

Dr. Koturbash:  Usually actually this is drops so that they are orally ingested.

Host:  Okay so it’s drops and what do you do, you drop them in some water or something?

Dr. Koturbash:  No, usually they go sublingual, so you usually put several drops in your mouth. But there are also some creams now being also developed with CBD and they have a little bit different vehicle.

Host:  Right, so this oil, I mean the big question is, does it get you high?

Dr. Koturbash:  Cannabidiol itself is believed not to make you high. It is considered as a non-psychoactive component. That said, when you extract cannabidiol from cannabis sativa plant, you are always facing some levels of tetrahydrocannabinol, THC which makes you high. Currently, when there is no current good manufacturer practices for cannabidiols. The majority of the products that are on the market, contain THC from small amounts to some substantial amounts. And when our colleagues at National Center of Natural Products Research at Ole Miss Oxford, they did some analyses of the products. Some of them contain up to 45% THC which is enough to make you really very high. So, in other words, when you buy a CBD product, you always have to remember there is a substantial chance you may fail the drug test.

Host:  So, a lot depends on the manufacturer it sounds like. So, is this legal in Arkansas?

Dr. Koturbash:  Yes and no. It is kind of a gray area I would say. It certainly depends on how you sell it. CBD has been approved by FDA in the form of a drug called Epidiolex. So, if you sell it as a drug, you need to first seek FDA approval. FDA clearly stated that CBD cannot be sold as a dietary supplement. So, when you buy CBD which is labelled as a dietary supplement, it is being illegally sold. If you are selling CBD, you are not allowed to make any claims like to cure cancer, arthritis and any other disorder it is being now touted as being helpful for.

Host:  So, should you check with your doctor first before starting to take CBD oil on your own?

Dr. Koturbash:  It is clearly a great idea to talk to your doctor before you take any medication or anything you take. And if you decide to take CBD oil, first of all, you need to talk to your doctor about it and hear what the doctor says about it. Second, doctors need to know about it because CBD has a very high potential to interact with other drugs. That means that it can either negate the positive effects of your drugs so your drug is not going to work, or it can actually make the drug work even stronger or increase its toxicity or negative side effects of the drug. And certainly, doctors need to be aware if you have some prescription drugs and you want to take CBD; it’s very important to let doctor know about it.

Host:  So, we hear about CBD oil being used for pain management. What are some of the other conditions someone may use CBD oil for?

Dr. Koturbash:  To my knowledge, the effectiveness of cannabidiol has been shown in treatment of some  forms of epilepsy so the pediatric syndrome and the Dravet syndrome. These are severe forms of epilepsy that are resistant to conventional therapy but Epidiolex, the drug which is based on cannabidiol has shown very promising results. To my knowledge, this is the only one purpose where effective of cannabidiol has been proven including clinical trials. There is no other purposes or positive health effects that have been convincingly demonstrated for cannabidiol.

Host:  Okay, that’s really good to know. But for sure, we know that there has been tests and it does prove valuable for the treatment of epilepsy. So, now you are a researcher Dr. Koturbash. Can you talk about some of the interesting things your research has found with CBD oil treatment?

Dr. Koturbash:  Yes, so we did a number of studies and we continue those studies using the animal models, right because technically, before you try to give something to people, you need to make sure that these drugs or supplements or whatever we are going to call CBD as; are not only effective but also safe. And so we conducted a set of studies. First, we were looking at toxicity of CBD oil, in other words whether it can cause negative health effects because although its claims are that CBD is nontoxic and even at high doses it has been safe. What we have found is that no CBD I not safe especially it may hamper your liver health. And if you look at the label of the drug Epidiolex that was developed to treat epilepsy, it has in very large letters on the label it says warning, potential for severe liver injury. So, you need to monitor your liver health.

And according to clinical trials five to twenty percent of study participants developed elevation of liver enzymes suggesting that the liver has been negatively affected. We saw the same in animal models, in mice. We investigated them kind of like margins at which doses you start seeing toxicity. And certainly the very big question is the chronic low dose exposure. When you give one time, your liver can be very forgiving. When you start using lower doses but for long time; no one knows, and this is one of the major interests in our lab actually looking at the effects of the prolonged low dose exposure to cannabidiol.

We are also looking into the drug interaction potential. We saw that cannabidiol can interact with many drugs and we have recently published a study showing that coadministration of cannabidiol and acetaminophen which is major liver toxicant known, that coadministration of cannabidiol and acetaminophen can result in liver injury. So, such things are really very important to know because cannabidiol is being used for pain management for example and acetaminophen is present in like the Tylenol and actual drugs that are being used for pain management. So you have to be very careful when coadministering cannabidiol with other drugs.

Host:  Well that is really important information. We just don’t know about the drug interactions yet and the effect it will have on potentially someone’s liver. And as you say, we don’t even know yet if this is really right for pain management, although a lot of people are flocking to it to help them with pain management. The only thing we know for sure is that it has shown to help epilepsy. So, really good information doctor. Thank you so much for your time today. we really appreciate it.

Dr. Koturbash:  Sure, thank you so much. My pleasure.

Host:  And for more information just visit www.uamshealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is UAMS Health Talk. Thanks for listening.