How confident do you feel about holding an informed discussion with a client about CBD products?
A Guilty Secret
I find CBD oil is one of those topics, like raw feeding or coconut oil that clients only admit to using when asked a direct question. It’s like their guilty secret, as if they don’t want to ‘confess’ because they assume their vet will disapprove.
Thinking of CBD specifically, this response is interesting on a number of levels. To me it hints that that clients aren’t happy with their pet’s therapy, they feel the animal could do better, and don’t lose sleep over a lack of scientific evidence of efficacy.
A Double Irony
Of course, as vets we need evidence, and need positive proof of benefit before recommending a product. But therein lays a double irony for CBD because firstly we need to know if it actually does any good, and secondly not all CBD oil products are the same in terms of ‘efficacy’. So even if we get proof of benefits, we still need a proven veterinary product with a guaranteed composition in order to recommend it.
A Thought-Provoking Experience
Until a few months ago, I thought of CBD oil much like coconut oil or turmeric, as a fad. But now I’m inclined to be more cautious. My concern is it has the potential to do harm, rather than a placebo.
The case involved a Belgian Shepherd dog with seizures due to an intra-cranial cyst. This dog has intermittent seizures that were moderately well-controlled with phenobarbitone. At a routine meds check, when reviewing the dosage, I found the owner had reduced the dose. However, the seizures had lessened. Only when directly asked if they were giving any supplements, the owner revealed they had added CBD oil to the dog’s therapy.
We decided to check serum phenobarb levels. Guess what? Despite the reduced dose the levels had shot up to almost toxic proportions. OK, there is no direct proof this was down to CBD oil, but it was the only change. Could it be that somehow CBD oil reduced the phenobarb breakdown or somehow potentiated its effect?
Obviously, this could be a huge over-simplification and there could be other explanations, but it’s a thought. If CBD oil does work, might it not also cause harm?
I needed to know more.
The Search for Evidence
Let’s turn to RCVS Knowledge. A quick search for ‘Hemp’ turns up an article about intestinal parasites in UK tortoises. That’s it. Search “CBD”, “Cannibidiols” etc. and nothing. OK, this isn’t a surprise because of the lack of veterinary scientific papers.
So what evidence is there?
Search PubMed and there’s a return of 330 papers…but all in the human field. Do the same search adding on “Canine” and there are just six papers.
Most promising is the Cornell CBD Study which looks at pharmacokinetics, and suggests a dose of 2mg/kg bid for dogs may be beneficial for arthritic pain in dogs. Indeed, Colorado State University are recruiting for canine patients for a study looking at the Efficacy for CBD for Treatment of Epilepsy in Dogs. To quote Dr. Stephanie McGrath, a neurologist on the study: “Overall, what we found seems very promising”. But as yet none of this is a great help when discussing CBD, cannibidiols, or hemp oil with clients.
The Marijuana Minefield
To make matters even more complicated, there’s the question of where the CBD originated from.
Bear in mind the CBD can be derived from marijuana (illegal) or hemp (legal) based products. So even when we have the evidence, vets need to be very careful about exactly which product they recommend.
So if you’re anything like me and don’t feel well-enough informed when holding those CBD conversations with clients then Joseph Wakshlag’s webinar on “Hemp extracts in veterinary medicine: What do we know and where is all this going?” is definitely worth checking out.