In Part 2 of this Hope With Answers series on CBD, Cannabis, and Lung Cancer, we discuss the differences between CBD oil and hemp oil and what’s happening on the CBD clinical trials horizon. Once again, Jacquelyn Bainbridge, a clinical pharmacist at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus, joins us to talk about her clinical research, including work on cannabis clinical trials with hopes that CBD could help lung cancer patients.

“CBD potentially, or has a potential, to alter the immune environment and stimulate a response. So where that may be helpful is in patients with non-small cell lung cancer because it seems to be more responsive to immunotherapy. So it might be more likely to help that population.”

What is CBD oil exactly?

CBD doesn’t contain tetrahydrocannabinol (THC), the ingredient found in marijuana that produces a high. Currently there is only one FDA-approved CBD product, Epidiolex cannabidiol, to treat two types of epilepsy. So CBD oil can mean many different things. The usual CBD formulation is oil that you get from a dispensary but many CBD-infused products are available online, such as:

• drops or tinctures
• extracts
• vaporized liquid
• oil-based capsules
• food, drinks, and beauty products

While CBD is being studied as a treatment for a wide range of conditions, including Parkinson’s disease, schizophrenia, diabetes, multiple sclerosis and anxiety, research supporting the drug’s benefits is still limited.

“So when you talk about the lung cancer patients and, again, there’s clinical evidence, clinical trials need to be run on using CBD for lung cancer patients. As we were chatting earlier, there is a few case reports out there where people have used CBD.

But, again, that needs to be sorted out in clinical trials to really see what the effects are and what the side effects are. And I certainly, as a patient, would not stop my chemotherapy or immunotherapy or radiation or surgery just to take a cannabinoid. I would definitely talk to their oncologist, their clinical pharmacists that they’re working with in the oncology environment to help navigate that scenario.” – Jacquelyn Bainbridge, PharmD, FCCP

What is that difference between hemp seed oil and CBD oil?

Hemp seed oil and CBD oil are very different products. Processed from the seeds of the Cannabis sativa plant, hemp seed oil does not contain CBD, but has nutrients, fatty acids, and healthy components. Hemp can contain no more than 0.3% of tetrahydrocannabinol (THC) by dry weight. People will not get high when using hemp seed oil, as it contains no THC and little to no CBD. Hemp seed oil could have CBD but you need to check the Certificate of Analysis to really know what you are getting.

CBD oil uses the stalks, leaves, and flowers of the hemp plant, which contain a higher concentration of CBD. The three different types of CBD oil on the market:

• CBD oil made using CBD isolate, which contains only CBD
• broad-spectrum CBD oil, which contains several compounds but not THC
• full-spectrum CBD oil, which contains all compounds of the cannabis plant, including THC (but at a very low level)

Using CBD Safely Means Looking at the Label

And it’s important for consumers to know because, again, this is a very unregulated science. So what’s on the label necessarily isn’t what’s in the body and consumers need to do research, they need to go to the product website, look for a certificate of analysis because there should be a batch number on whatever they have purchased.

Or if they go to a dispensary, they can ask for a certificate of analysis. Sometimes you’ll find that with hemp seed oil. Sometimes you can see that a product might be labeled as CBD oil, but it’s really hemp seed oil. A recent study of 84 CBD products bought online showed that more than a quarter of the products contained less CBD than labeled. In addition, THC was found in 18 products.

“So people need to do their research and figure out what’s really in the bottle. And that goes with THC as well. So oftentimes something is labeled as being a CBD product, but there could be a lot of THC in a particular product. It’s just not listed on the label.” – Jacquelyn Bainbridge, PharmD, FCCP

What are the dangers of taking CBD products?

CBD can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications such as blood thinners. One thing to know about CBD is that it can increase liver function tests, so it can affect the liver.

“But the side effect profile that we see with CBD, which is usually why people take CBD, is for sedation. So we know that patients will become sedated with CBD, or sleepy. So that is a side effect that we see. We also can see that there is gastrointestinal issues that we can see with those CBD products. So when we’re talking about nausea, vomiting, diarrhea, those are all side effects.” – Jacquelyn Bainbridge, PharmD, FCCP

More Well-Controlled Trials Are Needed

At the 47th Annual Oncology Nursing Society (ONS) Congress, a total of 8 studies were included in the review. Some of the studies evaluated tetrahydrocannabinol (THC), which produces the psychological effects of cannabis, some evaluated CBD (cannabidiol), which produces the physiological effects, and some evaluated both. Their findings were a mix of support for cannabis use and cautions regarding its effects on patients.

Resources:
https://www.projectcbd.org/medicine/encouraging-cancer-research

https://www.oncologynurseadvisor.com/home/headlines/conference-coverage/ons-annual-congress-2022/cannabis-potential-cannabinoid-products-cancer-management
https://www.ctvnews.ca/health/woman-s-tumour-shrank-after-taking-cbd-oil-daily-for-more-than-two-years-case-study-1.5652981

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