Cannabidiol (CBD) use among cancer survivors.

Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia

173 Industry perceptions of cannabidiol use in horses

The aim of this study was to evaluate the prevalence and perceived efficacy of cannabidiol (CBD) products in patients presenting to an orthopedic hand and upper extremity clinic. New patients seen for an initial surgical consultation between July and December 2022 were surveyed regarding CBD use, pain, and function. Pain was measured with the Numeric Pain Rating Scale (NPRS, 0-10) and function with the Single Assessment Numeric Evaluation (SANE, 0-100). Demographic and clinical factors were collected via chart review. A total of 918 patients completed the survey (53% female; mean age 63 years, range 18-97). Joints involved included elbows (106), wrists (335), and hands/fingers (667). Common diagnoses included arthritis (199), tendinopathy (273), and nerve-related conditions (160). Overall, 15% (135/918) reported prior CBD use, and 39% (53/135) perceived pain relief. CBD users were more likely to be female (65% vs 51%; P=0.003), to present with wrist pathology (44% vs 35%; P=0.038), and to have arthritis (36% vs 19%; P<0.001). Compared to non-users, CBD users reported higher pain scores (mean NPRS 6.2 vs 5.1; P<0.001) and lower contralateral function (mean SANE 77.3 vs 87.4; P<0.001). In this cohort, CBD use was uncommon, and only a minority of users reported subjective benefit. CBD users tended to report higher pain and worse function, particularly in the setting of wrist arthritis. CBD products did not appear to provide measurable objective improvement in pain or function. Further studies are needed to clarify optimal dosing, administration, and potential role in upper extremity care.

Background: Cannabidiol (CBD), a non-psychoactive component of cannabis is marketed as a potential treatment for many conditions and widely available to purchase as a dietary supplement. In 2017, sales of CBD exceeded 820 million dollars despite many unconfirmed health claims, murky legality, and limited product efficacy and safety testing.Purpose/Objectives: This study aims to explore cannabidiol (CBD) knowledge, attitudes, and use among young adults.Methods: The anonymous 36-item survey developed using Qualtrics was distributed via social media from November 2018 to January 2019 with 340 respondents.Results: Of the 340 respondents, 242 reported they had heard of CBD, and 135 reported using CBD products. CBD users were primarily white, female, without children, made less than $25,000 per year, and unmarried. Most commonly used CBD products were edibles (56.30%), tinctures (54.07%), and vape (38.52%). Top reasons for use included stress relief (65.39%), relaxation (54.81%), and sleep improvement (42.22%). Many respondents reported using guesswork to determine dosage, and over half of respondents reported at least one unanticipated side effect.Conclusions/Importance: This study revealed that many users are not responsibly using CBD products, many believe CBD products provide health benefits that are not yet scientifically proven, and they are not knowledgeable about legal and regulatory issues. Until CBD use is more thoroughly researched and has more comprehensive regulation, public health professionals should address alternative stress and anxiety treatment methods.

Introduction: Cannabidiol (CBD) is a cannabinoid compound found in cannabis that has been gaining attention over the past few years in the medical community. Unlike tetrahydrocannabinol, also found in cannabis, it does not have psychoactive effects. It is easily obtainable, mixed in an oil or gummy form, and available in different strengths and flavors. CBD is used for pain, anxiety, depression and insomnia. While marijuana use has been widely studied in patients with Inflammatory Bowel Disease (IBD), there are few studies on the use and effects of CBD in this population. The purpose of this survey based study is to determine the number of IBD patients using CBD products, why they use them and if they perceive any benefits. Methods: 229 patients over the age of 18 with a diagnosis of IBD, from two gastroenterology outpatient clinics in Suffolk county, NY were invited to participate in an anonymous survey from June 1st to June 16th, 2022. The survey consisted of 13 questions pertaining to demographics, IBD related history, cancer history and CBD use. The surveys were completed in the office or by telephone. Data was entered into an anonymous database for interpretation. Results: Of the 229 patients, 10.5% used CBD products (n=24). Of the CBD users, more than half (66.7%, n=11) were female, 14 had Crohn’s disease while the rest had Ulcerative colitis, 37.5% (n=9) were on biologic therapy, and 9 (37.5%) had an IBD related surgery. Anxiety (62.5%, n=15), insomnia (54.2%, n=13) and pain (41.7%, n=10) were the most commonly reported reasons for use of CBD. Increase in appetite (25%, n=6) and nausea and vomiting (20.8%, n=5) were also reasons for use but were not reported as frequently. The majority of patients (87.5 %, n=21) felt that CBD helped their symptoms. Conclusion: IBD patients frequently suffer from pain, anxiety, insomnia and depression. There has been a rise in the use of CBD products in patients with various medical conditions. In our small study, we found that only 10.5% of IBD patients use CBD products, mainly for anxiety, insomnia and pain, compared with arthritis where reported use is 50% or more. Patients with IBD who have a complicated disease process often seek alternative therapies and are therefore at risk for substance use. Until there are large clinical trials to assess the role and safety profile of CBD in IBD patients, clinicians should be aware of its use in this population.Figure 1. : Cannabidiol (CBD) use in Inflammatory Bowel Disease Patients

BackgroundJuvenile idiopathic arthritis (JIA) is common and difficult to treat. Cannabidiol (CBD) is now widely available, but no studies to date have investigated the use of CBD for JIA.MethodsWe performed a chart review to identify patients with JIA at a Midwestern medical institution between 2017 and 2019. We surveyed primary caregivers of JIA patients using an anonymous, online survey with questions on caregiver knowledge and attitudes towards CBD. We compared respondents with no interest in CBD use vs. those contemplating or currently using CBD using descriptive statistics.ResultsOf 900 reviewed charts, 422 met inclusion criteria. Of these, 236 consented to be sent a survey link, and n=136 (58%) completed surveys. Overall, 34.5% (n=47) of respondents reported no interest in using a CBD product for their child’s JIA, while 54% (n=79) reported contemplating using CBD and 7% (n=10) reported currently giving their child CBD. Only 2% of respondents contemplating or actively using a CBD product learned about CBD from their child’s rheumatologist, compared with television (70%) or a friend (50%). Most respondents had not talked to their child’s rheumatologist about using CBD. Of those currently using CBD, most used oral or topical products, and only 10% of respondents (n=1) knew what dose they were giving their child.ConclusionsOur results show infrequent use but a large interest in CBD among caregivers of children with JIA. Given CBD’s unknown safety profile in children with JIA, this study highlights a need for better studies and education around CBD for pediatric rheumatologists.

Legalization of cannabidiol (CBD) products has ignited interest in clinical practice and research. One desired indication includes possible pain-relieving effects of CBD. The purposes of the current article are to (1) clarify terminology relevant to cannabinoids; (2) explain and understand the pharmacotherapeutics of CBD; (3) examine research of the current use of CBD by older adults for treating pain; (4) discuss safety considerations with using CBD products; and (5) provide best practice recommendations for clinicians as they advise their older adult patients. A review of the literature demonstrated mixed results on the efficacy of CBD in relieving pain in older adults. There is inconsistency in the labeling of over-the-counter CBD products that can result in safety issues and will require more federal quality control. Likewise, gaps in knowledge regarding safety and efficacy of CBD use in older adults are vast and require further research. [Journal of Gerontological Nursing, 47(7), 6-15.].

e18829 Background: CBD is derived from cannabis and has minimal psychoactive effect. We sought to evaluate factors associated with CBD use among patients who received cancer treatment and elucidate the reasons for use, and perceived benefits of CBD. Methods: An anonymous online or phone survey was administered to patients treated for cancer between 3/2021-8/2021 at a comprehensive cancer center; only patients residing in states where cannabis is legal were contacted. Surveys were completed 8/2021-4/2022. Patient-reported use of cannabis and CBD products was assessed, as well as beliefs and perceptions regarding CBD. Unadjusted and weighted multivariable logistic regression (MVA) was used to assess factors associated with CBD use after diagnosis. Results: Among 1258 patients (35% response rate), 41% knew either “a lot” or “some” about CBD, 44% knew “a little”, 15% knew nothing or were unsure. Of those who had heard about CBD, 69% felt there were no risks of taking CBD. 370 patients (29%) both knew of CBD and endorsed cannabis use after diagnosis; 61% of that group, 226 (18% of all surveyed) specifically reported CBD use. Those who reported CBD use were 54% women, 83% white, and 88% non-Hispanic, with a median age of 63 (IQR 52-71). 75% of CBD users had used any cannabis product at least once prior to diagnosis and 40% of CBD users had used cannabis in the year prior to diagnosis. Among the 150 patients who used CBD during treatment, 54% used it several times a week or more; 49% used CBD after treatment completion. Among CBD users, common reasons for CBD use were pain (56%, n = 125), sleep (48%, n = 107), mood (36%, n = 80), or neuropathy (18%, n = 40). Symptom benefit from CBD (improved “somewhat” or “quite a bit”) was reported for pain (71%), sleep (71%), mood (74%), and neuropathy (60%). Only 1% reported worsening of non-target symptoms or side effects with CBD; 3% felt it worsened neuropathy. Overall, 47% either stopped using CBD or used it less than they would prefer due to no benefit (30%), high cost (25%), or lack of insurance coverage (21%). On weighted MVA, patients who were ≤45 (OR 1.16, 95%CI 1.06-1.26, p &lt; 0.01) or 46-64 (OR 1.10, 95%CI 1.04-1.27, p &lt; 0.01) were more likely to use CBD after diagnosis than those ≥65. Prior cannabis use, compared to no prior cannabis use, was associated with CBD use after diagnosis (OR 1.13, 95%CI 1.08-1.19, p &lt; 0.01). Compared to patients with lung cancer, patients with gastrointestinal cancer were more likely to use CBD after diagnosis (OR 1.11, 95%CI 1.00-1.22, p = 0.04). Conclusions: Fewer than half of surveyed patients treated for cancer had good knowledge of CBD, however most felt it was safe to use without any risks. Almost one in five surveyed had used CBD after diagnosis for a variety of symptoms. Patient-reported benefits were high and negative side effects were rare except for cost. Additional research is needed to help guide patient use of CBD given weak evidence of benefits.

The market value of cannabidiol (CBD) is growing as people seek holistic ways of managing their health. The aim of this study was to explore the public's perceptions and use of CBD products, including where products were sourced, knowledge transfer and opinions on quality, safety and efficacy of CBD products. An online questionnaire was distributed via social and professional networks, in addition to face-to-face data collection days, which employed convenience and snowball sampling methods. A total of 597 participant responses were analysed, of which 10.9% (n=65) claimed to use CBD products for a range of ailments, including anxiety and pain. CBD products were bought from healthcare stores, vape stores, pharmacies and online. Of those who did not personally use CBD (n=532), 35% claimed they would like to try it. A positive attitude towards the safety and efficacy of CBD was attributed to CBD being a natural product. The study highlighted that the public continue to seek natural alternatives to supplement and maintain their health; hence, the popularity of CBD continues to rise. The lack of clinical evidence and regulation of CBD needs to be addressed to facilitate safe and effective use of CBD.

To CBD or not to CBD?: What pharmacists need to know

In Switzerland, there has been a boom in the market for cannabidiol (CBD) products in recent years. However, little is known on the prevalence, modes of administration and motives for use of CBD products. The aim of the present study was to fill this gap using recent (2019) data from the Cohort Study on Substance Use Risk Factors (C-SURF). Between April and December 2019, an unselected sample of 5233 Swiss young men from the French- and German-speaking regions (mean age 28.2 years, standard deviation 1.3) completed a self-report questionnaire covering measures of use of CBD products, modes of administration and motives to use of CBD, tetrahydrocannabinol (THC) and cigarettes. Descriptive statistics were used to estimate prevalence of self-reported use, modes of administration and motives to use CBD, whereas logistic regression models were used to test the associations of linguistic region, THC and tobacco use with use of CBD. Lifetime and 12-month prevalence of self-reported use of CBD were 32.4% and 18.5%, respectively. Among past 12-month CBD users, 79.4% used CBD once a month or less often, whereas 20.6% used it more than once a month. The most often reported modes of administration of CBD were in association with tobacco: flowers mixed with tobacco (67.5%), and CBD cigarettes with tobacco (37.1%), while 18.6% used flowers without tobacco. The three most reported reasons for using CBD were: out of curiosity (74.0%), to feel the effects of THC (38.1%) and for well-being and health (37.5%). In multivariable models, CBD use was associated with use of THC (odds ratio [OR] 9.85, 95% confidence interval [CI] 8.28-11.73), cigarettes (OR 2.74, 95% CI 2.28-3.29) or e-cigarettes (OR 1.5795% CI 1.27-1.95), as well as for the linguistic region (French-speaking vs German-speaking region OR 1.3895% CI 1.15-1.65). Self-reported use of CBD is common among young Swiss men: about one third used CBD in their life and about one in five in the previous 12 months. However, the vast majority of CBD users used it infrequently and out of curiosity. CBD use was particularly prevalent among users of THC and cigarette smokers. CBD was most often used in combination with tobacco, thus exposing users to risks associated with smoking tobacco products.

Due to the myriad of laws concerning cannabis, there is little empirical research regarding the veterinary use of cannabidiol (CBD). This study used the Veterinary Information Network (VIN) to gauge US veterinarians' knowledge level, views and experiences related to the use of cannabinoids in the medical treatment of dogs. Participants (n = 2130) completed an anonymous, online survey. Results were analyzed based on legal status of recreational marijuana in the participants' state of practice, and year of graduation from veterinary school. Participants felt comfortable in their knowledge of the differences between Δ9-tetrahydrocannabinol (THC) and marijuana, as well as the toxic effects of marijuana in dogs. Most veterinarians (61.5%) felt comfortable discussing the use of CBD with their colleagues, but only 45.5% felt comfortable discussing this topic with clients. No differences were found based on state of practice, but recent graduates were less comfortable discussing the topic. Veterinarians and clients in states with legalized recreational marijuana were more likely to talk about the use of CBD products to treat canine ailments than those in other states. Overall, CBD was most frequently discussed as a potential treatment for pain management, anxiety and seizures. Veterinarians practicing in states with legalized recreational marijuana were more likely to advise their clients and recommend the use of CBD, while there was no difference in the likelihood of prescribing CBD products. Recent veterinary graduates were less likely to recommend or prescribe CBD. The most commonly used CBD formulations were oil/extract and edibles. These were most helpful in providing analgesia for chronic and acute pain, relieving anxiety and decreasing seizure frequency/severity. The most commonly reported side-effect was sedation. Participants felt their state veterinary associations and veterinary boards did not provide sufficient guidance for them to practice within applicable laws. Recent graduates and those practicing in states with legalized recreational marijuana were more likely to agree that research regarding the use of CBD in dogs is needed. These same groups also felt that marijuana and CBD should not remain classified as Schedule I drugs. Most participants agreed that both marijuana and CBD products offer benefits for humans and expressed support for use of CBD products for animals.

Cannabidiol (CBD) is a natural phytochemical agent and one of the most abundant found in Cannabis sativa. It is known to exhibit pharmacological properties on various condition such as relieving-inflammation, pain, epilepsy, and anxiety effect. There has been an increasing trend globally in the use of CBD as a supplement in pets. Consequently, there are various CBD products being marketed that are specifically available for pets. Veterinarians and pet owners are concerned that following ingestion, different CBD formulations may result in a CBD level circulating in the blood that may affect the safe use and efficacy of CBD in pets. Several pharmacokinetics studies in animals have been mainly conducted with an oily form of CBD. To date, there is a lack of data regarding direct comparisons in animals among the CBD plasma kinetic profiles from an oral administration of the various preparation forms. Therefore, the current study evaluated and compared the plasma CBD levels from a single oral administration using four different CBD preparations-liquid (an oil-based form, a nanoemulsion form, or a water-soluble form) or a semi-solid form (as CBD mixed in a treat) in dogs. In total, 32 healthy, crossbreed dogs were randomly assigned into 4 groups and treated according to a 1-period, 4-treatment parallel-design. The three liquid forms were dosed at 5 mg/kg body weight, while the single semi-solid form was given at 50 mg/treat/dog. The results showed that the CBD plasma profile from the administration of a water-soluble form was comparable to that of the oil-based group. The nanoemulsion-based form tended to be rapidly absorbed and reached its peak sooner than the others. However, the CBD in all preparations reached the maximum plasma concentration within 3 h post-dose, with an average range of 92-314 μg/L. There were significant differences among certain parameters between the liquid and semi-solid forms. This was the first study to provide pharmacokinetics data regarding CBD in water soluble, nanoemulsion-based, and semi-solid forms for dogs as companion animals. The current data should facilitate the scrutiny of CBD plasma profiles based on different formulations via an oral route in dogs.

<h3>Objective:</h3> To perform a retrospective cohort study describing Cannabidiol (CBD) use in a concussion clinic. <h3>Background:</h3> People report using CBD for a range of symptoms, many of which overlap with post-concussion symptoms. CBD use has not been assessed in a concussed population. We performed a retrospective cohort study to describe CBD use in a concussion clinic. We hypothesized CBD use would be more likely in patients with psychiatric diagnoses, headaches, cannabis use, and greater post-concussion symptoms and concussion chronicity. We assessed whether cannabis use could account for any of the findings. <h3>Design/Methods:</h3> We reviewed medical notes from 567 selected patients aged &gt;=18 from 07/26/2018 to 07/27/2021 and extracted self-reported CBD use and demographics, medical history, and post-concussion symptoms (via Graded Symptom Checklist (GSC)). We used descriptive and non-parametric statistics to test our hypotheses. <h3>Results:</h3> CBD users made up 11% of the cohort and did not differ on demographic variables (e.g., age, sex, injury acuity) from non-users. After adjusting for age, sex, injury acuity, and cannabis use, CBD users had a 3.48 (1.80, 6.75) (<i>p</i> &lt; 0.001) and 1.99 (1.04, 3.99) (<i>p</i> = 0.04) times higher odds of reporting cannabis use and a psychiatric diagnosis, respectively, but no difference in headaches (<i>p</i> = 0.61). CBD users relative to non-users reported greater total post-concussion symptoms (CBD users GSC = 58.59, Non-users GSC = 45.73, <i>p</i> = 0.04), which was driven by cognitive (<i>p</i>=0.03) and physical (<i>p</i>=0.05) symptoms. Despite the correlation between cannabis and CBD use, cannabis use did not correlate with greater post-concussion symptoms. <h3>Conclusions:</h3> This study is the first to describe CBD use in concussed patients. CBD use was more common in concussed patients with premorbid psychiatric diagnoses and greater post-concussive symptoms, and this was not influenced by cannabis use. Prospective studies are necessary to assess the safety and efficacy of CBD in concussion. <b>Disclosure:</b> Dr. Rafie has nothing to disclose. Mr. Rosenbaum has received research support from Region IV Training Center. Dr. Bickart has nothing to disclose. Neil Avinash Bhathela, MD has nothing to disclose. Mr. Chung has nothing to disclose. Dr. Giza has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Highmark Interactive. Dr. Giza has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis Pharmaceutical. Dr. Giza has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Lewitt, Hackman, Shapiro, Marshall &amp; Harlan. Dr. Giza has received stock or an ownership interest from Highmark Interactive. The institution of Dr. Giza has received research support from NCAA. The institution of Dr. Giza has received research support from US Department of Defense. The institution of Dr. Giza has received research support from UCLA: Brain Injury Research Center, Steve Tisch BrainSPORT Program, Easton Clinic for Brain Health. Dr. Giza has received publishing royalties from a publication relating to health care. Dr. Choe has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Cases. The institution of Dr. Choe has received research support from NIH. The institution of Dr. Choe has received research support from AIR-P. Dr. Choe has a non-compensated relationship as a Board of Directors with NABIS that is relevant to AAN interests or activities. Dr. Choe has a non-compensated relationship as a Consultant with USA Swimming Concussion Task Force that is relevant to AAN interests or activities.

Introduction: Cannabidiol (CBD) is widely available over the counter for presumed medical and recreational purposes. Despite its non-psychoactive nature, CBD exhibits intrinsic pharmacological activity that may lead to potential adverse drug events (ADEs) and drug–drug interactions (DDI) with common prescription medications through cytochrome P450 inhibition. Due to their largely unregulated nature and widespread advertising, consumers who use CBD products may not be aware of these potential negative drug interactions. The purpose of this study was to determine how frequently patients who use CBD products concurrently take prescription medication with known drug–drug interaction (DDI) potential, and to identify specific therapeutic classes most commonly involved. Methods: In this cross-sectional study, a survey was distributed to patients and family members in the adult and pediatric Emergency Departments of a Level 1 Trauma Center in eastern North Carolina. Respondents reported household CBD use and selected from a list of conditions for which they take prescription medications. Results: Of 681 eligible respondents, 254 (37.3%) reported CBD use in their household (CBDUIH). Among those with CBDUIH, 69.7% reported concurrent use of 1 or more medications with a potential DDI risk. The most common categories of prescriptions were antidepressants (64.4%) and antihypertensives (41.8%), followed by agents for diabetes, hyperlipidemia, and immune disorders. Conclusions: The majority of CBD users in this population are concurrently taking medications with DDI potential, highlighting the need for patient and provider education, and improved labeling of CBD-based products to accurately reflect risks. Further study of clinically significant interactions is needed to determine which medications within these common categories have the most substantial risk of DDI.