Cannabis in veterinary medicine: The other “Wild West”

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Veterinarians prescribe all kinds of treatments for their patients, from medications (both on and off label) to supplements to devices and more. As practitioners and consumers, we put a certain amount of trust in manufacturers and regulatory agencies that the products we provide to our patients are what they say they are. But when it comes to cannabidiol (CBD), hemp, and marijuana, however, that trust may be misplaced.

The FDA approves and regulates prescription drugs for animals (and people) but only monitors the unregulated veterinary supplement industry for egregious medical claims, illegal substances, and misleading marketing. The FDA has “discretionary enforcement” on whether to pursue action against an animal supplement company for any of these offenses.

Just as with the products we use to help our patients, we assume similar monitoring or vetting is happening with what we read in trade publications, hear at lectures, and see in online forums. But again, this is not necessarily the case.

A booming industry begets many “experts”

The cannabis industry is estimated to hit $25 billion by 2021, and credible research is finding more and more promise for therapeutic application. The industry also spends billions of dollars to keep this topic relevant in the media, and I do not see this stopping anytime soon. In fact, CBD may soon become part of our “normalized” mainstream culture.

As someone who has lectured on this topic for the past handful of years (both on behalf of industry and independently), I am concerned about the influx of passengers I am seeing on the CBD bandwagon and the quality of the content being shared.

Distinguishing novices from true authorities

By and large, today’s CBD experts are self-driven pioneers and academics. Some are practitioners who have used these products extensively on their patients, are well informed about current research efforts, and/or are part of clinical trials. Others, however, have simply read a few papers on the pharmacology and clinical efficacy of CBD in companion animals, and then regurgitate that information to an unknowing audience. I fear that this latter type of “expert” is becoming more common.

Determining who is a credible speaker or author on cannabis-related topics in animals can be tricky and nuanced. To help you decide whether an “expert” is going to provide accurate, timely information about a topic that many of your clients are sure to ask about, ask yourself these questions before reading that article or attending that lecture.

Is the speaker/author biased?

One of the easiest ways to uncover bias is to learn more about the speaker or author. Check to see whether they are affiliated with, or if the lecture or article is sponsored by, a CBD manufacturer. Veterinary professionals who attend conferences or read trade publications expect a certain amount of bias from affiliated or sponsored speakers and authors. In general, however, information should be considered trustworthy if the speaker or author provides references and summarizes studies or data in ways that agree with the conclusion. Opinions about the data should be evaluated with a bit more caution.

Are they talking about marijuana or hemp?

It is incumbent on the expert to explain at the beginning of the article or lecture whether marijuana or hemp is being discussed because the two are vastly different when it comes to the law and therapeutic manifestations.

The industrial hemp plant is in the same family as the marijuana plant. Hemp contains less than 0.3% delta-9 tetrahydrocannabinol (THC, the psychoactive portion of the compound)by dry weight, whereas the marijuana plant contains more than 0.3% THC by dry weight. Therefore, these plants fall under completely different federal and state legislation.

Marijuana, also referred to as cannabis in many pieces of legislation, remains a Schedule 1 drug, which means all use is illegal at the federal level. While it is important to learn about how some people are using marijuana in pets, any suggestion of use in your practice could be considered not only unethical but illegal.

Do credentials matter?

Yes and no. Keep in mind that CBD products work on the endocannabinoid system, yet 99% of veterinarians did not learn about this physiologic system or these products in school. Until recently, it was not possible to earn a degree to define yourself as a CBD expert. Today, multiple universities offer a variety of degrees related to the topic of cannabis.

Specialty credentials do come in handy, especially depending on what the topic is about. For instance, a licensed pharmacologist speaking or writing about CBD may provide a deeper understanding of pharmacology than someone who is not a pharmacologist. However, the same in-depth information could be provided by someone who is not a pharmacologist but has lots of practical experience using these types of molecules in practice.

You see how choppy this line can get?

What is their practical experience or knowledge?

This is a probably one of the most critical questions to ask. I take my credibility and integrity as an educator very seriously and would never lecture on a topic for which I had no practical experience. Yet I have seen several colleagues speaking about cannabinoids with no practical experience using them, outside of THC toxicity cases. Unless their lack of practical experience is plainly noted at the beginning of the article or lecture, take the information they provide with a grain of salt and understand that they may not be fully informed.

Citing studies or anecdotes?

When it comes to providing information, references are crucial. It is time we finally put to rest the “we do not have any research” argument. We have pharmacokinetic studies, efficacy studies, and hundreds of translational studies available on this topic. We just have to look for them.

The second argument that regularly comes up is “those studies were done in lab animals or humans, not companion animals.” I challenge all readers to take any medication or supplement off the shelf and look for specific data on that product for the indication, dose, and species you use it for.

The other nuance to discussing and citing clinical efficacy studies is understanding what was actually used in that study. Because CBD products come from plants, it is unlikely that any two products are exactly the same. In fact, both the FDA and independent research¹ show that some CBD products labeled for pets contained no CBD at all. Understanding this will change any anticipated outcome in our patients.

Final thoughts

It is important to understand that the AVMA and most state veterinary medical associations are not regulatory bodies. Lectures or publications on cannabis, hemp, and CBD from these associations take largely the most conservative approach, so they may not provide pragmatic answers to real-life questions about these products in veterinary medicine.

Now that you have a few tools to help guide you in learning about this hot topic, start engaging yourself. Regardless of whether large veterinary medical boards and associations agree with using these products, it is the veterinarian’s duty to at least know about them and their potential to help or harm patients. Your clients are going to use these products with or without your blessing, and they should get their information from you, not the gas station attendant. Finally, keep in mind that simply having a conversation with clients about what you do (and do not) know, the science behind these products, and which products are backed by clinical safety and efficacy data is not the same as you recommending them.

Stephen Cital is an independent cannabis researcher and lab manager at Stanford University. He is also the co-founder of the Veterinary Cannabinoid Academy.

Legal cautions

As intelligent as the speaker or author may be, veterinarians and veterinary technicians are not attorneys. Opinions are founded either in fact or misunderstanding, so use caution when a non-attorney discusses the legal aspects of CBD in veterinary medicine. For a clear and accurate understanding of the legal ramifications involved, consult with a knowledgeable cannabis/hemp attorney who is also familiar with veterinary malpractice law.

Reference

1. Wakshlag JJ, Cital S, Eaton SJ, et al. Cannabinoid, terpene, and heavy metal analysis of 29 over-the-counter commercial veterinary hemp supplements. Vet Med (Auckl). 2020;11:45-55.
doi: 10.2147/VMRR.S248712