This post was originally published on TribTalk, a publication of The Texas Tribune
A crucial component of helping my patients is guiding them toward realistic expectations so that we not only avoid disappointment but also prepare for the best possible outcome.
When it comes to the healing potential of cannabis, I have been focused on figuring out what cannabis can do for people suffering from epilepsy, rather than what it might be able to do. I believe cannabis is medicine, a conviction I developed gradually based on cumulative anecdotal evidence, but now more firmly
rooted in recent research. Like all medicine, cannabis must be subjected to rigorous, double-blind, placebo-controlled, peer-reviewed studies so that we can best ascertain how to integrate cannabis-containing products into our treatment regimens in the most responsible way.
But I didn’t always see cannabis this way. When you’re entrenched in the treatment of epilepsy, it’s inevitable that you’ll encounter CBD – also known as cannabidiol, one of the active cannabinoid compounds found in cannabis. But when my patients first came to me years ago with the idea that CBD could be a game-changer, my initial reaction was to tell them, “Don’t believe what you’re seeing on the news.”
I was skeptical, and I didn’t expect much to come of it.
When Compassionate Cultivation – one of only three businesses awarded a license in Texas to grow CBD-rich, low-THC cannabis – approached me in early 2017 to ask if I would work with them, I immediately agreed to offer input, but I had to dig deeper on the question of a more public declaration of support.
There’s still a fair bit of stigma regarding cannabis in the medical world, much more so than in the public realm, and I had to better understand what was known, and what was not yet known. I had to convince myself that I could stand behind advocating for CBD as an option for therapy, regardless of how that might impact my professional reputation. After doing more research and discussing the idea with my partners at Child Neurology Consultants of Austin, I came to the conclusion that I did very much want to be involved.
The good news is that in the process of assisting Compassionate Cultivation with its license application, the legitimacy of this endeavor became much clearer to me. Coincidentally, and concurrently, more rigorous data have finally started trickling out, including trial results on drug-resistant seizures published in the New England Journal of Medicine. The timing of this publication was quite fortuitous since this is exactly the condition we will be legally able to treat with CBD in Texas starting in 2018.
In the study, GW Pharmaceuticals proposed Epidiolex, a CBD product, for approval by the Food and Drug Administration, and published results for 120 patients with a genetic form of epilepsy called Dravet syndrome. During the 14-week trial, 43 percent of the patients reported a reduction in seizures of more than 50 percent, versus only 27 percent of the placebo group. And 5 percent of the CBD-treated patients became seizure-free.
Fortunately, the medication was also very well tolerated, with mostly minor side effects. Adverse events that occurred more frequently in the cannabidiol group than in the placebo group included occasional reports of diarrhea, vomiting, fatigue, fever, sleepiness and three cases of abnormal results on liver-function tests.
That publication meant everything because it was a legitimization of the effectiveness of CBD for the treatment of epilepsy at a level of scientific proof that hadn’t been there before. Given promising case reports and successful results in groups of patients treated in open trials without placebo controls, there are many controlled studies being initiated in the effort to confirm the efficacy of CBD,
including a collaboration between the National Institute on Neurological Disorders and Stroke and the National Institute on Drug Abuse. Their combined research will evaluate how CBD operates in animal models of epilepsy so we can better understand how it works, as well as how to optimize CBD’s efficacy and to evaluate under what optimal conditions CBD might treat seizure disorders.
It helps, too, that Colorado and California are channeling cannabis tax revenues to fund high-level studies on the use of cannabis as a treatment to a variety of conditions.
I now serve as the Chief Medical Officer for Compassionate Cultivation, and my role includes addressing the concerns and questions medical providers have about CBD. As a board-certified pediatrician, child neurologist and epilepsy specialist, I understand better than most that you can write anecdotal reports until the cows come home, but physicians won’t give that any credence until there’s more controlled data out there.
Although there is growing public acceptance of cannabis use, particularly in the medical marijuana community, it hasn’t yet been embraced by the medical profession. Cannabis, and CBD, still need to prove themselves.
Clearly, I’ve had a crash course on CBD through my work with Compassionate Cultivation. I have enough confidence on the current evidence to formulate a responsible plan to manage its integration into patients’ seizure-management protocols, and those experiences will be further informed by subsequent trials. The demand for CBD has preceded the production of wide-scale data, but now that we have a better understanding of its potential, we’re coming around to the idea that it will indeed be helpful.
We also need to be realistic about what the limitations might be, and so, to the Texas doctors who will write recommendations for their patients partaking in the state's limited medical cannabis program, I offer this: CBD is a pharmaceutical, and while it is not a cure-all or a one-size-fits-all remedy, it does offer the possibility of relief for many patients.
So please, fellow physicians and prescribers, I encourage you to review the data.
As for the patients who are looking for alternatives, know that CBD helps people to varying degrees, and some people not at all, and until you try it, you don’t know where you’ll be on that spectrum. Work with your doctor to explore all potential results, because what you see on the news is the best-case scenario.
Also, remember that all drugs have side effects, so it’s important to know what they might be.
Meanwhile, I’m excited to be able to talk with patients in a clear way about CBD, knowing from working from the ground up in the Texas CBD implementation process that I have confidence in the products finally becoming available in Texas. I’ve gone from cautioning patients not to expect too much from CBD to saying “Let’s see what happens” to realizing that, for many patients, CBD not only meets their needs but exceeds all of our expectations.
