What Should Pharmacists Consider About Cannabis-Based Compounding Ingredients?
In a historic case this week, the Senate took its first vote on medical marijuana reform and, with bipartisan support, allowed Veteran’s Administration doctors to prescribe marijuana in states where medical marijuana is legal. Medical marijuana is a big issue in the U.S. Only twenty-three states — as well as D.C. and Guam — currently approve the use of medical marijuana. The rules and process differ by state, making the Senate vote the first time federal approval has been pursued for medicinal cannabis.
On the heels of the FDA’s announcement giving cannabidiol (CBD) orphan drug status for treating acute and sub-acute brain injury due to oxygen deprivation during birth, the Senate vote ought to make healthcare professionals take notice.
What is the status of cannabis-based compounding ingredients?
The FDA has currently not approved any cannabis-based compounding ingredients for medical use. CBD research is in its infancy in terms of marketplace approval, and its use has only been hastened to orphan drug status because CBD has no psychotropic properties. However, another marijuana derivative called tetrahydrocannabinol (THC), does have psychotropic activity and is included in three drugs available outside of the U.S.
Although we lag behind other countries is accepting (medical) marijuana, that isn’t to say the government is opposed to research into such drugs. In fact, there are quite a few in the pipeline at various stages, including cancer-based studies on anti-tumor therapy, pain relief, and appetite stimulant.
There is also a number of disease states that are often treated with medical marijuana, including:
- Multiple Sclerosis; and
Although there remains much controversy as to whether a recreational drug should be treated as a medicine, the facts are that patients find much relief from the plants and its derivative compounding ingredients, and states are increasingly realizing that. It seems likely that both CBD and THC-based medications will enter the marketplace in due time.
What is the Pharmacist’s Role Now and What Should It Be?
Marijuana is not a new drug — many of our patients have been using it for some time without requesting the advice of physicians or pharmacists as to how it and its derivative compounding ingredients might affect their health or interact with other medications they are taking. We are tasked with dispensing and understanding a large number of drugs. However, medical marijuana poses complications we don’t often see with other drugs.
- First of all, there are few controlled studies looking at marijuana treatment by disease. Without well-designed studies in large populations, it’s impossible to advise patients on what drug interactions they should expect.
- Quality control of the drug is lacking. Pharmacists rely on safe and effective drug and compounding ingredients to keep their patients safe. If we can’t track and verify drug source, how can we prescribe it to our patients?
- We have to further consider that there are many ways of ingesting or inhaling medical marijuana, which makes dose control challenging.
- Finally, the short term and long terms effects of taking marijuana may not be issues the patient has considered. Patients may not know the right questions to ask, and frankly, we might not have the answers they need.
All of these concerns can be dealt with by pharmacists in the same way we address other drugs, but only if we take marijuana-based treatments seriously, beyond just approving its use for loose treatment for a variety of conditions. Regulations for medical marijuana dispensaries vary state by state. But what if pharmacists were the ones who distribute medical marijuana and with standardized guidelines, QC and education? One group, the National Association of Cannabis Pharmacy (NACP) wants to do just that, by tracking patient outcomes, monitoring safety and efficacy with measurable metrics, and providing educational materials. It’s not a full FDA suite of studies but in the interim, it’s a start.
Currently, pharmacists should encourage patients to discuss their marijuana intake and provide information on possible side effects and interactions. We should also work with physicians and dispensaries to provide feedback and compounding resources that will help maintain consistent dosage. Networking with other interested stakeholders will also help guide policies that include pharmacists as an expert in cannabis-related compounding ingredients, and develop a collaborative strategy on how to move forward with this highly controversial drug.
Pharmaceutica North America is committed to providing you with quality controlled compounding ingredients and information so you can prepare safe and effective medications for your patients. Please contact us today to see how we can help you.