By Earl Vaughan Jr.
With America in the grip of an addiction to opioid-related pain medications, the medical community has been trying to limit access to the painkillers in an attempt to help curb the problem.
That’s left many people suffering from chronic pain searching for alternatives, some of them unconventional, to cope with their ailments.
In recent years, a popular option for many has been cannabidiol, better known as CBD.
According to a post in August on the Harvard Medical School blog, CBD is the second-most prevalent active ingredient in cannabis plants like marijuana or hemp.
There is a significant difference between hemp and marijuana, which is why it’s legal to take CBD that is extracted primarily from the hemp plant.
Both plants contain a chemical called THC, which is short for tetrahydrocannabinol. That’s the active ingredient in marijuana that gives people who use it a high.
To be legal to take, the amount of THC in any extract has to be 0.3 percent or less. That’s the concentration in hemp, from which CBD is usually extracted. In marijuana, the THC concentration is a much higher range – from 15 to 40 percent.
Because of the low concentration of THC, CBD doesn’t cause the same high that marijuana does. The Harvard blog post cited a World Health Organization report that says humans who use CBD show no effects of abuse or dependence potential, adding there are no public health related problems with the use of pure CBD.
People can go online right now and buy CBD in all 50 states, where laws are in place that make it legal with differing levels of restriction.
It was three years ago in December that the Food and Drug Administration eased regulations on CBD, permitting research trials. The key issue for the government, according to the Harvard blog post, is whether the CBD being used is extracted from hemp or marijuana, with hemp being the preferred source for the extract.
So why all the interest in CBD? Again, according to the Harvard article, it’s been used by people dealing with an assortment of ailments, from certain types of epilepsy-related seizures to people dealing with insomnia and chronic pain.
Dr. Sanjay B. Shah, who operates the Premier Pain Practice in Fayetteville, cannot and does not prescribe the use of CBD to his patients, but he knows many of them are using it because they talk about the experience.
In pain management, Shah said CBD has an anti-inflammatory effect. “They apply it on affected areas and for whatever reason, they feel much better,” he said.
Direct application of the product to areas of pain is one method of delivery Shah is aware of. Others include putting drops of CBD oil underneath the tongue or smoking it in an electronic cigarette. Shah said of the three methods, from what he’s heard from those who use CBD, the people who ingest CBD via vaping seem to get the most benefit.
Shah said his opinion on the use of CBD, as well as medical marijuana, has changed over the past three years and he’s now more in favor of seeing the laws in North Carolina change to permit people who are interested to be able to legally purchase and use medical marijuana.
He thinks the key decisions that need to be made are who are the right candidates to use legal medical marijuana and what limits should be set on dosage.
He sees both CBD and medical marijuana, if approved, as better alternatives to dealing with pain than opioids.
“They are using it whether I agree with it or not,” Shah said of those opting to try CBD and medical marijuana. “The problem is, people do things in excess and they come back worse.”
Another issue, both for CBD oil now and medical marijuana should it be approved in North Carolina, is how to establish quality control rules for the companies that sell it.
“I don’t even know who’s making it,” Shah said. “I don’t know who’s controlling it.”
Another issue: What’s a safe dose? While he can’t prescribe it and doesn’t, Shah said he gives anyone who might be using CBD generic advice if they are using it. “I tell them don’t drive, don’t drink alcohol,” he said. “Be careful when taking narcotic medicine.”
Shah advocates more research into both CBD and medical marijuana use, so that both can be properly regulated if they become fully legal to use.
Those interested in giving CBD a try for their various ills can purchase it locally from merchants like The Apple Crate Natural Market and the Hemp Farmacy. Apple Crate, which has been in business in Fayetteville for 21 years, has locations on Raeford Road and Camden Road. There are two separate franchises of the Hemp Farmacy in Fayetteville, on Person Street and on Brighton Road.
Brenda Harris, Apple Crate’s owner, added CBD products to her store’s array of natural foods, supplements, health and beauty items and other products in 2015. She started with liquids and pills and expanded to options including flowers, creams, teas, honeys, gummies, patches, bath bombs, steam-distilled essential oils and clean ingredient vape cartridges.
Raymond and Tiffany Toler opened the city’s first Hemp Farmacy on Person Street last summer. Part of a small but growing North Carolina-based chain, its entire focus is on hemp-based products, including hemp extracts in tinctures, topicals, edibles, flowers, shatter, dabs, wax and more.
Both businesses say their CBD products have undergone testing and been proven safe.
Allison Davis, the wellness manager at Apple Crate, said that while CBD products aren’t regulated by the FDA, everything sold at Apple Crate goes through third-party testing. “The goal of third-party testing is to have a neutral, unbiased company test CBD extracts and finished products for CBD content as well as THC content,” she said.
Davis said Apple Crate has studied the companies it gets its CBD products from, along with their growing, extracting and testing methods, while also trying the products themselves. “You can call the company and request a certificate of analysis for the batch of CBD your bottle came from,” Davis said.
Harris said the question she gets most from people buying CBD is how much they should take.
“People take CBDs for a wide variety of conditions and there is no one best dose for an issue or person,” she said. “We recommend people start with a liquid and take it low and slow to find the dose that is right for them.”
Raymond Toler said it’s important to have discussions with customers to find out how much knowledge they have about CBDs, what condition they’re looking to treat and whether they’ve talked to their physician and their employer about their possible use of CBDs. Even though CBDs don’t contain enough THC to induce a high, some employers may have a zero-tolerance policy that applies to even those trace amounts, he said.
“Most companies are OK with CBDs,” he said. “But we don’t want to take chances with anyone’s jobs so we ask.”
Both Harris and Toler, as well as Shah, said reports of side effects from using CBD are minimal. Harris and Toler said there are no known hospitalizations due to contraindications.
“We do have a suggested guide for how to increase your dose slowly over a period of time that is available to all customers,” Harris said. “We also suggest that customers who are on blood thinners or have a medical condition consult with their doctor.”
Harris said feedback from customers using CBD products is overwhelmingly supportive. “Like any product, it may not be a right fit for everyone,” she said. “We have started carrying trial sizes of many products so customers can experience different methods, companies and doses without investing a lot.”
Toler said his business has done so well that he and his wife hope to open a second Hemp Farmacy in the spring. “We’re getting more and more ppl coming in,” he said, “and they know exactly what they want.”