CBD oil and physician liability
Cannabidiol oil (CBD), a cannabinoid derived from cannabis that doesn’t create the “high” associated with marijuana since it lacks the cannabinoid THC, is gaining interest among health practitioners for its long list of potential benefits.
CBD oil for pain is one of the most widely discussed medical uses for the oil, although the list is much longer and includes seizure reduction, cancer treatment, anxiety relief and more cosmetic purposes such as acne reduction, among others.
There are three main issues with CBD oil for physicians who might prescribe it, however. First, cannabis and CBD oil remain illegal under federal law since it is classified as a schedule 1 drug under the Controlled Substances Act. More than 23 states have decriminalized its use for medical purposes, but this still comes in conflict with federal law and the Drug Enforcement Agency. Going near CBD oil in a healthcare setting is tricky.
Second, its status as an illegal substance makes it hard to test and run clinical trials that definitively prove its medical efficacy. This creates a vicious circle where marijuana and CBD are not fully legal because there is no data on its safety and efficacy, and its medical use in not proven because there is not enough testing due to being illegal.
Then there’s the liability of prescribing CBD oil and any product related to cannabis. Does the regulatory environment and the risk of malpractice outweigh the benefits for patients? This article will focus on this third challenge related to CBD oil for medical use.
Currently, prescribing CBD oil still is relatively unexplored territory for physicians in terms of legal liability. But medical boards want clarity.
In 2016, the Federation of State Medical Boards (FSMB) surveyed member boards regarding the issues related to cannabis and medical regulation. The survey found that the issues most important to board about CBD and marijuana included guidance on handling recreational use by physicians (31.4%), guidance on handling marijuana products for medical use by physicians (47.1%), and model guidelines for recommending marijuana products for medical purposes to patients (49.0%).
The trouble is that CBD oil, despite its potential medical benefits, lacks the certainty of an FDA-approved drug. The legal framework for that just isn’t there yet, which puts physicians in a bind.
To reduce the risk of liability, however, the FSMB has developed some guidelines for the recommendation of cannabis and cannabinoids such as CBD oil in medical settings as part of its Workgroup on Marijuana and Medical Regulation.
Guidelines for Minimizing Liability Around CBD Oil Recommendation
The FSMB workgroup recommends several conditions for safeguarding the ethical recommendation of cannabis-based products such as CBD oil for medical use.
1. Establish a Preexisting Medical Relationship with the Patient
To avoid questions of inappropriate prescription of CBD oil for medical conditions, the FSMB recommends that physicians first make sure they have a documented, existing medical relationship with the patient before recommending products such as CBD oil.
Consistent with prevailing ethical standards, physicians also should not recommend, attest or authorize CBD oil for themselves or family members.
2. Documented Patient Evaluation
A second key to reducing liability around recommending CBD oil for medical use suggested by the workgroup is taking extra pains to document that an in-person medical evaluation and collection of relevant medical history is performed before considering if CBD oil is appropriate for the patient.
While less applicable to CBD oil because it lacks the high of THC that is present in medical marijuana prescriptions, physicians should nonetheless also ensure the patient does not have a history of substance abuse. This ensures that physicians are covering their bases even if THC is not present in CBD oil.
3. Advise and Decide Together with the Patient
Physicians should discuss the risks and benefits of CBD oil with the patient before making a recommendation because CBD oil is clinically unproven and lacks the standardization present with many other potential treatments, according the FSMB workgroup.
This is key for minimizing the potential for liability because then the choice is not made by the doctor alone, shifting responsibility. It also is important because due to the current legalities of cannabis-related treatments, physicians cannot actually prescribe CBD oil—they can only recommend it as a possible treatment.
4. Include a Treatment Agreement
Physicians that recommend CBD oil should also document alternative options available to the patient in the form of a treatment agreement.
- Review of other measures attempted to ease the suffering caused by the terminal or debilitating medical condition that do not involve the recommendation of CBD oil.
- Advice about other options for managing the terminal or debilitating medical condition.
- Determination that the patient with a terminal or debilitating medical condition may benefit from the recommendation of CBD oil.
- Advice about the potential risks of the medical use of CBD oil, including the variability of quality and concentration of CBD oil.
- Additional diagnostic evaluations or other planned treatments.
- A specific duration for the CBD oil authorization for a period.
- A specific ongoing treatment plan as medically appropriate.
5. Avoid Any Other Relationship with Cannabis-based Products
Finally, one of the most important ways that physicians can reduce the potential liability from recommending CBD oil is by having a clear and impartial relationship to CBD oil and marijuana in general.
That means that doctors should not have a professional office at or near a marijuana dispensary or cultivation center, or receive compensation from or hold a financial interest in a CBD-related business.
By clearly demonstrating that the recommendation of CBD oil is for medical purposes and not based on personal considerations, physicians will help cut the liability associated with CBD recommendation.
That noted, there is no clear-cut way to completely reduce liability when recommending CBD oil to a patient any more than there is a way to completely eliminate the chances of malpractice when advising patients. Some potential for liability is inherent.
As the use of CBD oil and marijuana for medical purposes increased, and further standards and regulations develop, recommending it should become less legally fraught. Until then, reducing the potential risk of liability is the best that physicians can do in the case of CBD oil.
This article is for information only, and does not constitute legal advice.
How to Talk to Your Doctor About CBD
Interested in using CBD to help manage your symptoms?
Learn how to speak with your doctor about using CBD, what to ask, and why your doctor may hesitate in recommending it.
If you’re reading this article, you’ve likely heard about all the amazing benefits of CBD.
Sure, CBD has shown great promise for a wide range of medical conditions and symptoms — we can certainly attest to that.
With that said, it’s wise to discuss your plans to use CBD with your doctor before blindly jumping on the new trend.
There are many reasons you may want to start using CBD. Many people opt for the supplement over addictive painkillers or anxiety medications. Others are using CBD because they prefer natural ingredients rather than synthetic pharmaceuticals.
No matter your motivation for taking CBD, you should know how to discuss it with your doctor first.
Here, we’ll give you some tips on how to talk to your doctor about using CBD for your condition. We’ll also cover some of the most common reasons why your doctor might not be on board.
Let’s get into it.
Table of Contents
- What Are The Health Benefits of CBD? What’s It Used For?
- Negative Drug Interactions
What Are The Health Benefits of CBD? What’s It Used For?
Cannabidiol (CBD) has many benefits. The compound works through a complex set of receptors present in all mammals known as the endocannabinoid system.
This system is made up of tiny receptors located in our cells tasked with regulating balance throughout the body — known as homeostasis.
Homeostasis is essential. All of our body systems rely on a careful balance to keep us alive and healthy. If something falls out of balance, it will ultimately lead to illness.
CBD also has some specific effects of its own, including:
- Mild appetite suppressant
- Lowers stress
- Mild sedative
People are using CBD to provide relief from a wide range of health conditions, from inflammation to insomnia.
Conditions People Are using CBD For:
A Note on Using CBD Instead of Prescription Painkillers
Living with chronic pain is challenging, especially since the Center for Disease Control (CDC) recently changed its official dosage recommendations for opiate pain medications.
The change came for a good reason — opiate addiction is both common and incredibly debilitating, especially for long-term patients.
CBD is being touted as a new and improved option for people with chronic pain. It’s non-addictive and has its own set of painkilling and anti-inflammatory effects. Some of the effects work through the same mechanisms as opiate painkillers — opioid receptor agonism (activation) .
It doesn’t stop there. CBD also activates the vanilloid (TRPV1) receptors  — which are also involved in pain transmission. The combined interaction with these pain transmission pathways effectively reduces the signal reaching the brain — thereby reducing the intensity of pain we perceive in the brain.
On top of directly inhibiting pain, CBD is well-known for its powerful anti-inflammatory effects. Chronic inflammation is one of the key drivers of pain, making CBD effective in addressing long-term pain. This is something prescription opioids don’t offer.
The most important point in all of this is that CBD is an effective painkiller, without the negative consequences. CBD is much safer than opioid painkillers, which are the leading cause of overdose-related death around the world . CBD lacks the addictive potential of opioids, isn’t psychoactive, and won’t cause an overdose, even in very high doses .
Tips: Talking to Your Doctor About CBD
So you’ve decided you’d like to give CBD a try — now what?
We highly recommend speaking with your doctor before using CBD, especially if your goal is to treat an existing medical condition.
It’s important to talk to your doctor before starting to take the supplement to make sure there isn’t a good reason to avoid it (more on this later).
Most doctors aren’t well-versed in the endocannabinoid system or cannabinoids because they’re not part of a conventional form of medicine taught in medical schools.
The best way to find out if your doctor will give you a recommendation or not is to bring it up in your next appointment.
Ultimately, your health is your responsibility, so don’t be afraid to ask for what you want — even if you think your doctor might not be very excited about swapping your medications for something such as CBD.
1. Check the Legal Status of CBD in Your Country and State
Before you speak with your doctor, make sure you understand the laws in your area.
The regulations for CBD can vary from one country to the next. Even within the United States, different states can have radically different laws from one another.
Depending on the local laws, there may be medical programs available for which you need to have a doctor’s prescription or recommendation to buy and use CBD products.
Other countries, such as the United States and Canada, consider CBD a nutritional supplement. In these places, you can buy CBD from local shops or online without needing a prescription.
Always check the local laws before buying CBD.
2. Prepare for Your Appointment
Doctors are busy and don’t have time for a long conversation about your curiosity to try CBD.
To save time, take notes about your symptoms and research how CBD can be used for alleviating them. This will show your doctor that you’re serious about giving it a try and have done your research.
Write down any questions you might have beforehand, so you can be prepared when seeing the doctor.
Additionally, it’s useful to have an understanding of what the general dose of CBD would be for your bodyweight. In general, the most common dose for therapeutic effects of CBD is around 50 mg to 100 mg per day. However, this can vary a lot from one person to the next.
3. Don’t Hesitate to Get a Second Opinion
Some doctors don’t stay up to date with current research. Even those who do can’t possibly read every piece of new research published.
If your doctor doesn’t know enough about CBD to make a recommendation or isn’t open to talking about it, you may want to find another for a second opinion. There’s nothing wrong with this.
Even doctors will often get a second opinion from other health professionals for some of their patients. Nobody knows everything, so you should be able to ask for a second opinion whenever you want to compare results.
4. Forget About the Stigma
For decades, there’s been a negative stigma around medicinal cannabis, including CBD.
People associate the plant with psychoactive effects — even though CBD doesn’t have any.
However, in recent years, information surrounding CBD has become widely available.
Most people these days understand the differences between using CBD medicinally and the intoxicating effects of THC. Therefore, if you think you should give CBD a try, don’t hesitate to mention it to your doctor.
5. Find a Doctor Familiar With Medical Cannabis
There are doctors around the world that are well-educated on cannabis. There’s a ton of research on the compound’s uses for treating all kinds of different medical conditions. Most of these studies have a team of doctors behind them to oversee the study.
Many doctors involved with this research also run clinics. You can usually find these doctors through some simple Google searches or by contacting a local company that specializes in connecting doctors with patients.
Leafly offers an excellent tool for finding cannabis-friendly doctors in the United States.
Why Your Doctor May Not Approve of Using CBD
There are a few situations when a doctor will disapprove of CBD for medical reasons.
Although CBD has a high level of safety, is nearly impossible to overdose on, and isn’t physically addictive, there are some instances when it shouldn’t be used.
Negative Drug Interactions
The main reason why your doctor might not approve the use of CBD is due to the potential for interactions with some of your other medications.
- Antagonistic interactions (inhibition) — this type of interaction means the CBD has the opposite effect to the medication you’re already taking, which can reduce the latter’s effectiveness on the condition it’s meant to treat.
- Agonistic interactions (potentiation) — this interaction involves CBD producing similar effects to the medication you’re already taking, causing the overall effects to become too strong.
- CYP450 liver metabolism — all drugs are metabolized by the liver through specific enzymes. If CBD shares too many of the same enzymes as another drug, it can hinder their breakdown, potentially causing a buildup in the bloodstream — sometimes to dangerous levels.
Drug Classes That May Negatively Interact With CBD:
|Drug Class||Antagonistic Interaction (Lowers Effects)||Agonistic Interaction (Increases Effects)||Liver Metabolism (Slows Metabolism)|
|Angiotensin II blockers||✓||✓|
|Calcium channel blockers||✓||✓|
|HMG CoA reductase inhibitors||✓|
Key Takeaways: Talking to Your Doctor About CBD
CBD is a popular natural supplement for alleviating a wide spectrum of symptoms and medical disorders. It’s especially useful for anything involving pain, inflammation, hyperactivity in the nervous system, and immune problems.
Many people may be eligible to use CBD to help manage their symptoms instead of addictive or dangerous pharmaceuticals. However, before using CBD for any medical condition, it’s crucial that you first speak with your doctor.
We recommend taking the time first to learn how to talk about CBD with your doctor and understand why they may disapprove of you using CBD alongside or instead of other prescription medications.
Have you had a discussion with your doctor about using CBD? Is there anything on this list that we may have missed? Leave your comments below.