A physician’s role in CBD education and patient guidance

This article was originally published on the Texas Academy of Family Physicians website here.

The knowledge gap in medicine

There is a distinct knowledge gap in the field of cannabis. As family physicians, we should always stay ahead of our patients’ therapy. This gap leaves patients to navigate a complex market alone, often seeking guidance from vape shop employees, social media, and various other unreliable sources.

Since the enacting of the 2018 Farm Bill, the use of cannabidiol (CBD) has emerged as a viable therapeutic compound. Thus, it behooves physicians to understand its mechanisms, benefits, and potential risks — so we can educate our patients with evidence-based recommendations.

Understanding cannabis, hemp, and extracted cannabinoids

Cannabis has been used medicinally for centuries, but modern research has only begun to uncover its full therapeutic potential. Out of the 113 cannabinoids yet discovered, the most well-known are CBD and tetrahydrocannabinol (THC).

CBD is non-intoxicating and is being studied for its anti-inflammatory, antiepileptic, anxiolytic, and analgesic properties. THC can be beneficial for pain relief, nausea reduction, and appetite stimulation. THC is classified as a controlled Schedule I drug by the DEA.

Legally, the difference between hemp and marijuana is based on THC content. Under the 2018 Farm Bill, hemp is defined as cannabis containing 0.3% THC or less by dry weight. Cannabis plants exceeding this THC threshold are classified as marijuana. This explains the strong association between THC and marijuana. Texas law aligns with federal regulations, allowing the sale of hemp-derived CBD products in the state within this legal framework.

The endocannabinoid system and CBD’s mechanism of action

The endocannabinoid system (ECS) is a regulatory network present in all vertebrates that maintains homeostasis throughout our bodily systems.

The ECS is composed of two primary receptors. Cannabinoid receptors 1 (CB1) are found mainly in the brain and central nervous system. They are primarily activated by THC, producing psychoactive effects. Cannabinoid receptors 2 (CB2), on the other hand, are located in the immune system and peripheral tissues. They play a positive role in anti-inflammatory responses, pain perception, immune function, and epilepsy.

Why physician guidance is crucial for patients

Patients lack the knowledge to choose safe and effective products. Unlike pharmaceuticals, CBD products are not FDA-regulated. Texas law mandates third-party lab testing, but enforcement is weak. Some products contain less CBD than advertised, while others exceed legal THC limits or contain harmful contaminants. Patients buying from gas stations, vape shops, or online may purchase tainted CBD products. As physicians, we need to educate ourselves on the safety of these products so we can assist our patients.

The difference between therapeutic and recreational use

The rise of recreational cannabis use has created a lot of confusion in the field of medicine and the wellness industry. It is crucial to distinguish therapeutic CBD use from recreational THC use. The goal of medical CBD is symptom relief, not intoxication. However, some patients self-medicate without understanding dosing, delivery methods, or potential drug interactions.

When patients express interest in CBD products, physicians should feel confident guiding them to safe, reliably sourced solutions rather than letting them rely on dubious or unregulated products.

How to identify and recommend reliable CBD products

For patients considering CBD, physicians can start by recommending third-party lab-tested products that verify cannabinoid content and purity. Certificates of authentication (COA) should be available to peruse for all products purchased in person or online. Physicians should guide patients with dosage. It’s also important to discuss potential drug interactions, especially with anticoagulants, sedatives, or seizure medications. Setting realistic expectations will help patients understand what CBD can do for them as an adjunct to conventional therapy.

In my own practice, I have seen countless patients benefit from CBD as part of a treatment plan. While CBD is not a replacement for conventional medicine, it can be a valuable tool for symptom management when used appropriately.

By taking the lead on patient education, safety, and product transparency, we can ensure that our patients make informed choices that support their health. I therefore encourage all my fellow physicians to educate themselves and to learn more about the science of cannabinoids and their use in the medical field. Reading studies and papers published by the NIH is a good place to start!

Garth O. Vaz, MD, is a practicing family physician and founder of The Vaz Clinic in Gonzales, Texas. He is also the founder of Jammin Canna, LLC, a company dedicated to producing third-party, lab-tested, physician-formulated CBD products for health. Dr. Vaz is eager to share his knowledge with his colleagues and invites all to reach out to him if they have any questions.