CBD in Emergency Medicine: Potential Applications and Patient Safety

Cannabidiol (CBD), a non-psychoactive compound extracted from cannabis, has surged into the spotlight for its potential therapeutic applications. This rise in popularity has led to increased patient use and inquiries, making it essential for ED clinicians to understand the current state of CBD research and its implications for emergency care. Here’s an overview of CBD’s applications relevant to acute care settings, as well as important considerations for patient safety and education.

Potential CBD applications in the ED

CBD has shown promise in treating various conditions encountered in the emergency department. Here’s an overview of the most relevant evidence-based applications:

1. Pain Management: A 2020 review in Frontiers in Pharmacology suggests that CBD may be effective in managing chronic pain, particularly neuropathic pain. While more research is needed, CBD could potentially offer an alternative to opioids for certain patients.
2. Anxiety Disorders: As ED providers, we frequently see patients with acute anxiety. The journal Neurotherapeutics highlights current evidence that indicates CBD has potential as a treatment for anxiety.
3. Seizure Disorders: In 2018, the FDA approved Epidiolex, a CBD-based medication, for treating certain forms of epilepsy. In emergency situations involving status epilepticus, CBD could be considered as an adjunct therapy per Medical Journal of Managed Care, though more research is needed to establish its efficacy in acute settings.
4. Nausea and Vomiting: While THC is more commonly associated with antiemetic effects, the British Journal of Pharmacology cites preclinical research suggesting CBD may also help reduce nausea and vomiting. This could be beneficial for patients presenting with these symptoms, particularly those undergoing chemotherapy.

Considerations and Cautions

In addition to the need for more research in the use of CBD in many cases, there are important considerations providers need to be aware of:

1. Legal Status: While CBD derived from hemp (containing <0.3% THC) is federally legal, regulations vary by state. Check out this state-by-state guide to CBD legalization.
2. Quality Control: CBD products are not well-regulated and Epidiolex is the only FDA-approved prescription CBD medicine. It’s important for patients to understand that if they choose to take CBD, they should use products that have been third-party tested for purity and potency. Here’s an article from Healthline on how to determine if a CBD product has been tested by a third party.
3. Side Effects: While generally well-tolerated, CBD can cause side effects like fatigue, drowsiness, dry mouth, and diarrhea per Mayo Clinic.
4. Drug Interactions: Patients must be cautious when using CBD as it can interact with various medications including blood thinners, anti-epileptics, and even acetaminophen according to Journal of General Internal Medicine.
5. Child CBD Exposure Risk: Over 36% of 6,496 CBD exposure cases documented in the US National Poison Data System (2014-2021) involved children aged 2-12. Common symptoms include tachycardia, CNS depression, confusion, and vomiting. ED providers should: a) Recognize the potential for CBD ingestion when children present with these symptoms b) Educate adults on securing CBD products, especially child-appealing forms like gummies.

Recap

As emergency medicine providers, it’s crucial to stay informed about CBD’s potential medical uses and associated risks. While research is ongoing, CBD has shown relevance in areas like pain management, anxiety, and seizure disorders – conditions we often encounter in the ED. Our role is to recognize CBD use among patients, understand potential interactions and side effects, and be aware of exposure risks, particularly in children. By maintaining current knowledge on CBD, we can better navigate patient inquiries, augment patient safety and education, and recognize its impact on clinical presentations.