Talking to Your Doctor About CBD
It is always very important to be open and honest with your physician when talking about adding CBD to your wellness plan. Your physician and any other healthcare professional needs to know exactly what YOU are doing for your own health and well-being so that they can adjust their plan for you accordingly. While CBD is considered very safe to use, there are some potential interactions that both you and your healthcare provider should know about—and the only way to do that is with open and honest communication.
Preparing
Legal Questions
The first thing to do is to ensure that CBD is legal in your state, city, region, or country. If CBD is not legal in your area, your doctor is most likely not going to be willing to talk about it beyond saying just that. In addition, remember that while CBD (with 0.3% THC or less) is legal in most states in the US, Cannabis is still a Schedule 1 drug and while incorrect, many physicians still equate THC with CBD and—for whatever reason—have not kept up to date on the most recent evidence. They may have some concerns over their license to practice, they may have a bias or they may simply not have had the time to become more educated about CBD.
Along a similar vein, you may just want to check with the provider beforehand with a general question about CBD—you may get a feel for how the next conversation would proceed. If, for example, they are dismissive, it may be wiser to talk to another healthcare professional who may be more open-minded.
Do Your Research
Here at LeafReport, we are trying to make that research easier.
First, what health issue are you trying to address? Try to narrow it down as much as possible. For example, if your first thought was “overall wellness”, there isn’t much research done on that. Why? Because from a scientific perspective, that is way too broad and difficult to assess: everyone’s sense of wellness is subjective to some extent. So, try to narrow it down to something like:
- Fatigue
- Depression
- Anxiety
- Sleep issues/insomnia
- If you have a chronic disease, these are associated with inflammation, so you may want to research the most recent findings on CBD as an anti-inflammatory agent.
Once you have narrowed down your question, read through as much credible information as you can. Again, here at LeafReport we do our best to report accurate information using the most recent evidence-based research.
Second, determine how you want to ask your physician the questions you want answered. Unfortunately, most physicians do not have a lot of time to spend, so make sure you list your most important questions first. Ask your doctor if you can record their answers so that you can review the answers later and understand them better.
One very important area to research is for any interactions between CBD and any medications or supplements you are currently taking. Your pharmacist is your best resource on these interactions—but make certain that when you approach them, the pharmacy is not busy—you want to make sure they have the time to answer your questions.
There are also some very good online resources to check for potential interactions between CBD and your medications. WebMD and Medscape both are excellent up-to-date resources. Just keep in mind that these lists are expanding, so keep checking them from time to time.
Knowing about Potential Drug Interactions
People tend to think “if it is natural, it must be safe” or something along those lines. While CBD has an excellent safety profile and IS a natural, plant derived substance, it CAN interact with various medications—and in some people the possibility remains that it won’t work for them or won’t work as well for them as it may for others.
It is important for everyone to understand that CBD—and every other substance you take into your body—is treated cautiously by the body. There are many reasons for this, but essentially, evolution has taught our bodies that we benefit if substances are first “checked out” and at least partially detoxified or in some way altered before passing through into the blood and flowing through the whole body. This is called “First Pass Metabolism” and is performed by the liver.
First Pass Metabolism
Food is absorbed through the digestive tissues into the blood and passes into the hepatic (liver) portal vein system. The liver is one of the central organs of detoxification and general metabolism—the hepatic portal system detoxifies drugs and other substances, limiting the damage these substances may produce. [1] First pass metabolism (FPM) can be affected by age, genetics, general health history and the health of the digestive tract and the liver as well as a variety of other factors.[2],[3],[4]
There are essentially two phases of FPM—in Phase 1, one group of enzymes detoxifies substances by chemically altering them. In Phase 2, another set of enzymes makes substances more water soluble to make them easier to excrete in the urine.
In Phase 1, a group of enzymes in the liver known as the Cytochrome P450 (CytP450, CYP450) system—this includes over 200 different enzymes divided into families (eg. CYP1, CYP2, CYP3…) that take part in Phase 1 of detoxification. If two or more substances are present, there are several possibilities, but the basic idea is that one substance can increase or decrease the levels of a second substance by inhibiting or enhancing the actions of these enzymes. This means that substance “X” may effectively increase the level of Drug “Y” by inhibiting the actions of the enzyme that detoxifies Drug “Y”. This is the basis for drug interactions—some of which can be very problematic. As an example, if Drug “Y” reduces the risk of a heart attack and Substance “X” increases its excretion from the body resulting in a lower blood level, using the two together could result in a heart attack.
In Phase 2, substances are made more water soluble to be excreted by the kidney. Some substances “skip” Phase 1 and go directly into Phase 2. Some people may lack or be deficient in some of the enzymes of Phase 2 and can have toxic responses to some drugs.
CBD interacts with several CYP450 enzymes, most importantly with CYP450 forms 3A4, 2C9, 2C19, 1A2, 2C8, 2B6, and 2E1. To give you an idea of how this might affect you, the 3A4 enzyme family is involved in the metabolism of many antidepressant drugs. If you combine CBD with one of these antidepressant drugs, you may experience an increased risk of side effects caused by the antidepressant medication because CBD can increase the blood levels of these antidepressant drugs. In other words, the antidepressant drug may be safe on its own and CBD is safe used alone—but the combination could increase the risk of adverse effects.[5]
And THAT is why it is important that you ask your pharmacist and physician these questions and why it is important that you come prepared to ask these questions!
Important Questions to Ask
Some of your questions will be specific to your own health and what you hope to achieve using CBD. Use these questions as a template/guide to develop your own.
- What is your experience with CBD? Have you helped other patients use it successfully?
- Are you comfortable recommending CBD? Why or why not?
- Do you believe CBD would be beneficial for my health? Why or why not?
- I would like to try and use CBD to benefit my ___________ (your own condition). Do you think it would be helpful for me? Why or why not?
- Here is my list of current medications and supplements. I have talked to my pharmacist and they have checked for any known interactions with CBD—they have told me that there are no known interactions with these medications/supplements. I have also checked online. Would you feel comfortable if I added CBD? Why or why not?
- I would like to try and replace or decrease my medication by adding CBD. Would you work with me on this? Why or why not?
Open Communication is in Your Best Interest
While it is not always easy to discuss some topics with your healthcare provider, open and honest communication is always the best policy for your best health and wellness. Your physician cannot help you if you don’t tell them where you need or want help! And—if you never ask the questions, the only thing you can be certain of is that you won’t get the answers! So, be prepared to ask the most important and pertinent questions—and if your questions don’t get answered, consider getting a second opinion!
Reference:
[1] Herman TF, Santos C. First Pass Effect. 2020 Sep 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31869143. https://pubmed.ncbi.nlm.nih.gov/31869143/
[2] Tam YK. Individual variation in first-pass metabolism. Clin Pharmacokinet. 1993 Oct;25(4):300-28. https://www.ncbi.nlm.nih.gov/pubmed/8261714
[3] Baraona E, Abittan CS, Dohmen K, Moretti M, Pozzato G, Chayes ZW, Schaefer C, Lieber CS. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res. 2001 Apr;25(4):502-7. https://www.ncbi.nlm.nih.gov/pubmed/11329488
[4] Wynne H. Drug metabolism and ageing. J Br Menopause Soc. 2005 Jun;11(2):51-6. https://www.ncbi.nlm.nih.gov/pubmed/15970015
[5] Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019 Jul 8;8(7):989. doi: 10.3390/jcm8070989. PMID: 31288397; PMCID: PMC6678684.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/
