The Latest on CBD for Pet Anxiety and Pain
I am a veterinarian practicing in Madison, Wisconsin. For the record, I have never prescribed or used medical cannabis/hemp products on pets. I may not even be technically allowed to discuss medical hemp, which is legal in all 50 states, with pet parents for the pets in my care.
The Veterinary Examining Board of Wisconsin is preparing a statement as I write this to the effect of “there are no legal uses for cannabis and related products in veterinary medicine, in Wisconsin, by veterinarians or veterinary clinics.”
However, when it comes to veterinary practitioners, it is important to be knowledgeable of the academic and veterinary attitudes as well as the laws in place when it comes to CBD oil.
Recently, within the veterinary community, there has been an increase in discussion into the issue of using CBD oil to treat pets. Studies have even been published on what CBD oil may have to offer the veterinary community.
What Is CBD Oil, and Is It Legal?
Is medical hemp a product that is “related to cannabis”? It would seem to be.
Hemp is NOT cannabis, which is where much of the confusion lies. Hemp is a selectively bred variety of the cannabis sativa plant that contains less than 0.3% THC (per dry weight). Cannabidiol (CBD) comes from both hemp as well as from cannabis that has a much higher THC content.
Hemp is federally legal in all states, while CBD is still a Schedule I drug under federal law, although it is legal in some states. Products with less than 0.3% THC (like CBD oil, tinctures, gel capsules and treats) are legal in all 50 states, and our clients are buying them. This puts veterinarians in a bit of a catch-22 to be informed on CBD, but unable to provide consultation to our clients on the issue due to legal restrictions of cannabis in general.
The Veterinarian CBD Oil Conundrum
The AVMA explains, “To date, 29 states and the District of Columbia have legalized medical marijuana for people, yet veterinarians are prohibited from administering, prescribing, dispensing or recommending cannabis for their patients.”
Despite these current restrictions, it is still important for veterinarians to be informed about the scientific developments of CBD oil and other cannabis derivatives. This is because, as veterinarians, we are the only ones who are sufficiently trained to recognize the value and benefits of these products and to evaluate the possible side effects. Most importantly, we are, by oath, obligated to help your pet, but above all, “do no harm.”
Another reason why veterinarians should be informed is that regardless of the veterinary rules about CBD oil, pet parents are purchasing it in hopes of it offering health benefits for their pets.
To be clear: All that I am advocating at this juncture is education and becoming informed on the endocannabinoid system that all mammals possess, not the use of THC or CBD products, nor the prescribing of medical hemp (unless it is legal in your state).
The endocannabinoid system is a system of receptors that every organ has. These receptors affect a variety of physiological processes, including appetite, pain sensation, mood and memory.
Recent CBD Oil Developments
There are four recent developments that will hopefully lead to more clarity.
1. Cornell University published the first medical hemp veterinary study at a major teaching hospital on July 23, 2018. It was conducted by a very highly regarded team of experts and led by Joe Wakshlag MS, DVM, PhD, DACVN, DACVSMR. The study shows good results in treating canine osteoarthritis and notes that there were no real side effects, except for an increase in alkaline phosphatase during the CBD treatment.
2. Cornell University is currently conducting a study that will focus more on the interaction between CBD oil and felines, while Colorado State University is working on a study that will be examining the role of CBD oil in the treatment of anxiety and seizures in dogs. This will also bring a little more clarity to the dosing of CBD products.
3. The company behind ElleVet—the product used in the Cornell study—is also doing a feline osteoarthritis study. This study has my attention, as we have very few drugs safe for long-term use in cats with osteoarthritis, and with 90 percent of cats at 10 years of age suffering from this disease, this is a big deal! There are three more clinical trials starting this fall with Dr. Wakshlag and the University of Florida in seizures, oncology and post-operative (TPLO) pain.
4. Epidiolex, a hemp isolate, was just approved by the FDA for seizures in children on June 25, 2018. The FDA just recently (September 27, 2018) placed Epidiolex in Schedule V of the Controlled Substances Act, the least restrictive category. It is the first cannabis/hemp product to not fall under the Schedule I Controlled Substances category. This means that technically, veterinarians could enlist it for “off-label” use, as we do many other FDA medications.
While this means that we could prescribe a “cannabis-related product,” we likely wouldn’t because of the expense and because there is no published study using this isolate in pets.
But the fact is that we could, according to the FDA, except if it conflicts with our state licensing, which is on a state-by-state basis. This kind of confusion permeates most medical hemp-related discussions between veterinarians and other interested parties across the country at this moment.
So What Does This All Mean for Pet Parents?
Until we, as veterinarians, are allowed to openly discuss medical hemp, where can a consumer go to get reliable information on current CBD safety and research information in pets?
ConsumerLab.com has a longstanding commitment to impartiality and independent testing of any supplement. They have a full discussion, complete with references, which among other things, includes a strong warning to avoid synthetic forms. They also clearly state the huge variation in levels between products and the price of a “dose.”
As CBD is currently found in over-the-counter supplements that have no regulation, it is imperative to have third-party testing. That said, we have no way of knowing effective dosing unless a study is able to use a predictable product that can be mass-produced consistently. Thus, it seems the FDA’s trend towards favoring isolates over full-spectrum because they can be mass-produced consistently.
Things to Consider:
This is probably the most difficult issue, according to the formulators I spoke with at the AVMA conference in Denver in July 2018. There over a dozen CBD-related lectures that were very well attended and had lively discussion. They all explained that there are CBD isolates and full-spectrum products. Each product should have a certificate showing exactly where it was grown and what it contains. An Indiana law will soon require QR codes that link to a certificate.
Dosing and Safety
Full-spectrum is generally thought to be more powerful than isolates—which follows the trend of “start low and go slow.” Most products have a recommended starting “dose,” but without research, they are only guesses.
Cornell University did a long-term safety study and pharmacokinetic study on both dogs and cats to determine safety and accurate dosing. They determined the half-life in dogs and cats and are able to accurately dose.
Can Veterinarians Talk About It?
The Veterinary Information Network (VIN) has a long discussion on what veterinarians in other states can and cannot do regarding CBD.
The article states: “Of 2,131 respondents, 63 percent said they are asked by clients at least monthly—and some weekly or daily—about cannabis products for their pets. Most veterinarians answering the survey said they have never been the ones to initiate the discussion.”
On Sept 27, 2018, California became the first and only state where it is specifically legal for veterinarians to talk about cannabis. It does NOT allow veterinarians to administer or dispense it.
Meanwhile in Wisconsin, I am still not clear whether I am able to discuss OTC hemp products with less than 0.3% THC!
The DEA’s stance on classification, referenced from the Epidiolex classification press release, is:
“Marijuana and CBD derived from marijuana remain against the law, except for the limited circumstances that it has been determined there is a medically approved benefit. In those instances, such as here, the drug will be made appropriately available to the public for medical use.”
The FDA does not regulate supplements, so how will the issue of quality control be monitored for all of the other hemp-related products? Again, the only reliable resource I am aware of for quality control is ConsumerLab.com, and for effectiveness and duration of action, there are strong peer-reviewed veterinary studies.
The more we can collectively open up the channels of funding and research, the more quickly we will know about the benefits and side effects of CBD oil and hemp for pets.
Dispensaries in states where cannabis is legal must have “certified cannabis counselors.” In Washington State for example, these counselors are allowed to describe the risks and benefits of different methods for using products, show how to properly use products, and answer questions about the medical marijuana law.
They are NOT allowed to provide medical advice, diagnose any conditions or recommend changing current treatment(s) in place of marijuana. These people are NOT trained for veterinary use of these products.
Valerie Fenstermaker, executive director of California Veterinary Medical Association, says it best when she says (speaking before the vote on medicinal marijuana), "We have dispensaries selling these products … and nobody ... outside of a veterinary professional should be giving advice about using these products in animals."
A Veterinarian’s Advice
My advice is to schedule a pain-management, seizure or pet anxiety consultation with your veterinarian to discuss all options you have for those problems. For example, many chronic pain conditions can be treated very effectively with existing drugs and modalities. That includes integrative/alternative therapies like laser, acupuncture, off-label use of human medications (like gabapentin, amantadine and for short-term pain, tramadol) or sometimes just a good weight-management program. There are also fish oil supplements and glucosamine chondroitin sulfate supplements that have undergone independent testing for effectiveness.
Veterinarians are the only ones specifically trained to advise you on the safety of all modalities and drugs for your pets, their interactions and side effects, so they need to be informed to counsel you on anything you give to your pet.
Read all you can and share that information with your veterinarian. Help us fight for the ability to discuss openly and research hemp for pets in products with less than 0.3% THC.
Always be aware of the “wild west” aspect of this area right now. Look for references, follow the researchers I have named here and encourage new research, as that is the only way credibility can be assured. Stay tuned for developments, as they are happening almost daily.
By Dr. Ken Lambrecht, DVM
Dr. Ken Lambrecht is medical director and owner of West Towne Veterinary Center in Madison, Wisconsin, an AAHA-accredited and Gold-Level Cat-Friendly-certified practice.