Talking CBD with your veterinary clients

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The United States appears to be growing increasingly comfortable with the recreational use of cannabis, as evidenced by the fact that 4 more states legalized its use during the November elections, bringing the total to 15, plus the District of Columbia. With this acceptance has come increased interest in the medicinal use of cannabidiol (CBD), a nonpsychotropic compound derived from hemp that is often used to treat issues such as pain, anxiety, and insomnia.

What your clients want

Interest in CBD also continues to grow among pet owners. Stephen Cital, RVT, RLAT, SRA, VCCS, CVPP, VTS-LAM, laboratory manager in the Department of Neurobiology at Stanford University, cofounder of the Facebook group Veterinary Cannabinoid Academy, and member of the dvm360^® Editorial Advisory Board, cites results of a recent survey in which nearly 70% of veterinary clients brought up the issue of CBD use during consultations with their veterinarian.¹

A variety of factors appear to be driving client interest, including the fact that cannabis has become more mainstream, says Stephanie McGrath, DVM, PhD, assistant professor of neurology at Colorado State University College of Veterinary Medicine and Biomedical Sciences. “I also think pet owners and families are using it more for their own ailments, so it’s becoming more enticing to try it on their dogs,” she adds. “And lastly, I think the fact that there is some research out there now has helped veterinarians and pet owners feel a bit more comfortable with its use.”

What the data show

Studies in the United States and abroad have examined the use of CBD to treat a variety of conditions in animals, including seizures in dogs with intractable idiopathic epilepsy, osteoarthritis (OA) pain in dogs, noise-induced fear in dogs, and more.^2-5 Many studies found CBD to be effective with minimal to no adverse effects.

A study on canine OA pain, for example, concluded that CBD “exerts robust and quantifiable anti-inflammatory properties in experimental systems” that were translatable in a randomized, double-blind, placebo-controlled trial in a spontaneous canine model of OA.² Another study on OA pain in dogs, published in Frontiers in Veterinary Science, reported a similar reduction in signs.³ Efficacy was also indicated in a study on the use of CBD, in conjunction with conventional antiepileptic treatment, to reduce seizure frequency in dogs.⁴

Such results are promising, but Cital notes that there are some important nuances to CBD research that must be considered. “CBD comes from a plant that contains more than 500 compounds,” he explains. “Everyone focuses on CBD and THC [tetrahydrocannabinol, the psychotropic compound found in marijuana], but there are hundreds of different things in these products. A variety of factors can change the cannabinoid or terpene profile, for instance, so every product really is different. When you have a success or a failure of a particular product in a study, those data are really specific to that particular product, so we can’t easily extrapolate that another product is going to work the same.”

McGrath confirms: “We are still at the beginning of figuring this drug out. We had to start with the foundation—the pharmacology and safety studies. We are just getting started with some small clinical trials. And while some of the studies are encouraging, we have a long way to go.”

What to talk about

Although clients are increasingly turning to CBD for themselves and their pets, the legality of CBD can be confusing for veterinary team members, many of whom may avoid discussing CBD with clients out of fear. But there’s good news: In 2018, the US Department of Agriculture declared hemp—which contains a THC concentration of less than 0.3% by dry weight—to be legal. “The federal government decriminalized hemp and legalized the CBD molecule as long as it is derived from a particular plant, but it also gave states individual power to regulate it as they see fit,” Cital reports. “To my knowledge, there are only a handful of states that don’t allow CBD use, even if it’s derived from legal hemp.”

Cital says veterinary team members shouldn’t feel nervous about discussing CBD with interested clients, even in states where CBD is illegal, because such conversations fall under harm reduction. “People keep saying, I can’t even use the word CBD in my clinic, which is not true,” he states. “I would actually say [not discussing CBD] goes against the oath they took as veterinarians or technicians to do no harm, because you are not informing the client about safety and efficacy. It’s all about education.”

However, Cital encourages practices to avoid words such as prescribing or dispensing. “Those are words specific to FDA-approved medications or devices and many state pharmacy acts,” he explains. “Because hemp is in a weird gray area as an animal supplement, it does not require FDA approval, just like you don’t need FDA approval for glucosamine/chondroitin. As long as these products are not making medical claims on their packaging or in their advertisements, they are considered an animal supplement and are legal.”

When it comes to client education, McGrath suggests focusing on the potential adverse effects and drug interactions. “CBD is likely not safe for every animal at every dose,” she says. “We are still learning a lot about this drug, but we do know there are some precautions that should be taken. And pet owners should know to the best of their ability what product they are purchasing. There are a lot of concerning products on the internet and on store shelves whose claims may not be founded. Therefore, researching a company and its products is imperative.”

CBD is available in a variety of forms, with liquid being the most common, Cital says. CBD-infused dog chews are also popular. Like McGrath, Cital encourages veterinary professionals and clients to make sure they are using a quality product. “I do not support companies that refuse to offer a certificate of analysis,” he says. “We tested nearly 30 veterinary products, and found some with no CBD at all. Others also had high levels of led and arsenic.”⁶

With thousands of members, the Veterinary Cannabinoid Academy is a good source of information on the veterinary use of CBD and other cannabis compounds, and offers a variety of resources for office educators. In addition, Springer Nature is in the production phase of a textbook that summarizes current studies on CBD, along with additional information. It will be available in both e-book and print editions.

Don Vaughan is a freelance writer based in Raleigh, North Carolina.

References

1. Wuest P. Poll: Are you being asked about CBD products in your practice? Today’s Veterinary Nurse. Accessed December 15, 2020. https://todaysveterinarynurse.com/articles/poll-are-you-being-asked-about-cbd--products-in-your-practice/

2. Verrico C, Wesson S, Konduri V, et al. A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain. Pain. 2020;161(9):2191-2202. doi:10.1097/j.pain.0000000000001896

3. Gamble LJ, Boesch JM, Frye CW, et al. Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs. Front Vet Sci. 2018;5:165. doi:10.3389/fvets.2018.00165

4. McGrath S, Bartner LR, Rao S, Packer RA, Gustafson DL. Randomized blinded controlled clinical trial to assess the effect of oral cannabidiol administration in addition to conventional antiepileptic treatment on seizure frequency in dogs with intractable idiopathic epilepsy. J Am Vet Med Assoc. 2019;254(11):1301-1308. doi:10.2460/javma.254.11.1301

5. Morris EM, Kitts-Morgan SE, Spangler DM, McLeod KR, Costa JHC, Harmon DL. The impact of feeding cannabidiol (CBD) containing treats on canine response to a noise-induced fear response test. Front Vet Sci. 2020;7:569565. doi:10.3389/fvets.2020.569565

6. Wakshlag JJ, Cital S, Eaton SJ, Prussin R, Hudalla C. 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