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.
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.
Consistent with prevailing ethical standards, physicians also should not recommend, attest or authorize CBD oil for themselves or family members.
2. Documented Patient Evaluation
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.
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.
The FSMB workgroup recommends several conditions for safeguarding the ethical recommendation of cannabis-based products such as CBD oil for medical use.
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.
In the interim to this guidance being published the British Paediatric Neurology Association (BPNA) had developed clinical advice on the use of cannabis-based products for medicinal use in paediatric patients with certain forms of severe epilepsy, and the Royal College of Physicians (RCP) had developed additional advice around prescribing of cannabis-based products for medicinal use in intractable chemotherapy induced nausea and vomiting, and chronic cancer pain.
The Advisory Council on the Misuse of Drugs (ACMD) has particular concerns with compounds falling within group 3 and others within group 2, with the exception of Nabilone, and is of the view that further research into this complex group of diverse substances is important, given the associated potency and harms.
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A recent Cochrane review for neuropathic pain states that ‘there is a lack of good evidence that any cannabis-derived product works for any chronic neuropathic pain’
There is also some evidence for use of cannabis-based products for MS related spasticity, as outlined in the CMO report. There is a licensed product available in the UK for use in MS related spasticity – Sativex®. This has been through the licensing process and should be used over any unlicensed cannabis-based products for medicinal use; NICE have now published a guideline on Cannabis-Based Medicinal Products. The guideline recommends offering a 4-week trial of THC:CBD spray (Sativex®) to treat moderate to severe spasticity in adults with multiple sclerosis, if other pharmacological treatments for spasticity are not effective.