Original posted on chiroeco.com and written by Amy Stankiewicz
These days, even if they haven’t tried it for themselves, almost everyone knows what cannabidiol (CBD) is, and that it’s derived from the hemp plant.
Increasingly, health care practitioners are suggesting this alternative supplement—whether it be in pill form, an oil tincture, topical salve, or a sublingual spray—to patients to help to alleviate pain, inflammation, anxiety and more. And many people are educating themselves about it and buying it online.
We wondered how chiropractors are embracing this potential revenue stream and if they are suggesting it to their patients as part of a course of healthy living. Here, we talk to various CBD experts about today’s state of the industry—including the latest legal issues and advancements in growing and extraction practices—as well as what chiropractors need to know when considering whether to offer this product in their offices.
Marijuana versus CBD—a quick primer
First, for those chiropractors who haven’t been introduced to the differences between tetrahydrocannabinol (THC) and CBD in the hemp plant, we offer this:
“CBD can be hemp- or marijuana-derived, but we use hemp to produce an undetectable amount of THC in our product,” says S. Michael Lioon, a supplier of various nutraceutical and CBD products based in Pittsburgh. “A good way to look at the difference between hemp and marijuana is that the two plants are cousins. Both hemp and marijuana originate from the same species of plant, Cannabis sativa, but they are different subspecies that differ in an important way. Hemp is low in THC (industrial hemp must contain less than 0.3 percent THC) and naturally contains significantly more CBD (up to 40 percent more). Marijuana has a high THC content and much lower CBD content, and it is primarily grown to maximize the THC content.”
Perhaps most importantly, unlike THC, CBD is not psychoactive.
“CBD works by interacting with the CB1 and CB2 receptors found on the cell surfaces of the human endocannabinoid system,” Lioon adds. “Since the majority of one’s CB2 receptors are found in the peripheral organs and cells associated with the immune system, CBD helps to support anti- inflammatory and immune-system responses. Some other uses for CBD include GI tract regulation, promoting healthy sleep patterns, reducing seizures and convulsions, regulating tremors in patients with Parkinson’s, reducing blood sugar levels, and promoting anti-aging.” Matt Storey, director of global business development for one of the first commercially available CBD products, reinforces the benefits that CBD can have on overall well-being.
“Since every mammal has an endocannabinoid system (ECS), just about everyone (including our four-legged friends) can derive some benefit from CBD as well as other phytocannabinoids,” Storey says. “When you talk with clinicians or even just see what people are talking about on social media, you’ll see very commonly people using CBD and hemp extracts for help with anxiety, sleep, pain and inflammation. When you understand the dispersion of the ECS throughout our immune and nervous systems, one can see how the impact can be far-reaching and useful for most of the population.”
There are many key points to look at when selecting a CBD hemp product for a chiropractic practice, Lioon says. “You want to look at where the hemp is being produced, how it is being grown (look for non-GMO) and the extraction method. A lot of products on the market use butane to extract the hemp because it is cheap and produces a higher yield but leaves behind a high and harmful solvent residue, so look for solvent-free extraction. You also want to look at the THC content and how you are absorbing the product. See if there is a delivery system to aid in absorption, as hemp is a fatty, oil-based ingredient that the body struggles to absorb on its own.”
Regarding the current laws governing CBD and related products, “There are different federal and state laws, which currently govern hemp products,” Lioon explains. “There is some gray area with regard to interpreting federal versus state laws and which law holds the higher jurisdiction. For this reason, I would recommend seeking advice on the laws from an experienced marijuana attorney.”
Storey agrees that the current legislation is confusing. “Up until this point, there has been a lot of confusion and the challenge of different government agencies operating with different interpretations of legality due to the ridiculous scheduling of cannabis,” he says. “The new bill being proposed in the house—HR 5485, The Hemp Farming Act of 2018—would be a huge win for the industry and people that want unrestricted access to CBD and other beneficial compounds derived from hemp, as it would classify hemp as an agricultural commodity and remove it from the federal scheduling. This would, in turn, remove the challenges from DEA and U.S. Customs and Border Protection that we currently face.
“I think that worldwide we are seeing a move toward more commonsense legislation around cannabis in general but hemp more specifically,” Storey adds. “Hundreds of thousands of people are finding benefit from phytocannabinoids like CBD, and they want to be able to have access to these kinds of products and not just a pharmaceutical.”
‘Swiss army knife’
Ultimately, the proof may lie in the experience of those who take CBD themselves.
CBD is literally the “Swiss army knife” to maintaining wellness, according to Brad Beegle, chief of staff for a Colorado-based supplier of CBD that also owns its own farms to grow hemp. His firm uses lipid infusion to extract CBD and other profiles of the hemp plant to create its product.
“I would say this—this product is the Swiss army knife of supplements because it does so many things to provide a healthy balance in a person’s body.
“This is the next big innovation in supplements,” he adds. “It is a relatively small business today due to misconceptions on legality, but once that all gets cleared up and once all of the hurdles fall, the category growth will be crazy.”
Beegle also stresses that growing practices are extremely important when it comes to extracting the best CBD and other profiles for a quality consumer product, and he says technology is advancing to ensure this process is as successful as possible.
“Breeding, genetics and strains mean everything,” he explains. “It’s about how you grow the plant and when to harvest at the optimal time to be at the maximum potency of CBD in the plant.
“A lot of the technology is around growing and the genetics of the plant to get higher CBD content, and the more you can get out of that plant, the more efficacious it’s going to be,” he adds.
Beegle says that he personally takes a CBD capsule each day to improve his cognitive process and maintain his already healthy lifestyle.
“We get out of balance with everyday living, and this helps to bring everything back into balance,” he says. “Cognitive processes improve, being able to problem solve, it is amazing.”
A recently conducted survey aimed to see how chiropractors are suggesting supplementation options in their practices. About 90 percent of the chiropractors who were surveyed are recommending supplements in their practice for pain relief, inflammation and anxiety, but many of them are waiting to stock CBD in their practices until they hear more about legality and safety, Beegle says.
But chiropractors should certainly pay attention to the benefits of CBD, specifically because “When people are going into their adjustments, they’re seeing they can get even greater benefits with the adjustments because CBD puts everything into homeostasis,” he explains.
When it comes to dosing, Beegle stresses that every person is different, and that everyone should start low and slow. “For dosing, it is generally good for people to start slow, take a lower dose,” he says. “For adults, that may mean starting at 15 to 25 milligrams to see how your body reacts, and then based on your needs and how you feel, you might want to ramp up a little higher.”
His company has recently released a professional line of CBD products specifically for chiropractors who want to stock and suggest CBD to their patients. This line delivers CBD in enteric capsules, which facilitate a slower release of CBD so it is longer-lasting.
“Our approach is to talk directly to practitioners and educate them,” Beegle says. “Chiropractors are our most focused channel—once they know how powerful this supplement can be, they will be amazed.”
According to John Thompson, CEO of a CBD supplier in Arizona, chiropractors are in a perfect position to take advantage of the booming CBD market. This is because the majority of their patients are already looking for alternative ways to live a healthy lifestyle—naturally.
His company does business in Canada with approximately 1,500 health food stores and, in the U.S., the company is mostly focused on educating chiropractors about the benefits of offering CBD products to their patients.
“This can represent a quantum shift in the definition of what chiropractic is,” he says. “This is going to be bigger than anything I’ve ever been involved with in my career.”
In addition to alleviating pain, anxiety and depression and promoting sharper thinking, CBD appears to be helping people caught in the midst of this nation’s opioid crisis as well, Thompson says.
“I have anecdotal evidence of patients choosing CBD to get off of opiates,” he says. “There are so many things a good-quality CBD product can do.”
Thompson also recognizes many chiropractors’ need for more information on CBD’s efficacy, dosing and quality before suggesting it to their patients as a supplement.
“My chiropractors are telling me they want efficacy and, almost as important, knowing the methods of dosing,” Thompson says. “They’re uncomfortable with taking this bottle of oil that has CBD in it, because if they are conscious of what is going into their patients’ bodies, they want to know what kind of oil it is.”
Thompson’s company’s CBD sublingual spray does not use any carrier oils—only purified water. The delivery system provides 240 metered doses from each tube.
“Although every person is different, we recommend starting with four sprays in the morning and four sprays at night,” Thompson says. “That would equal a daily measured dosing of 6.6 milligrams of CBD per day.
“There is no way to determine exact dosing,” he adds. “We suggest eight sprays per day. The good news is that there are no side effects from using the product, and you can’t overdose. People need to find their own correct number.”
Thompson also says he has definitely seen a rise in patient loyalty to specific quality CBD brands, giving chiropractors all the more reason to consider offering them to their patients.
“If there’s an issue with someone, whether it’s pain relief, anxiety, depression or sleep deprivation, and if there is a solution to that issue, these people are not going away, they become very brand loyal,” he says.
Thompson suggests all chiropractors continue to educate themselves on CBD products to be able to differentiate between the quality brands and the ones that most likely won’t stay the race.
“Chiropractors are really expanding their scope, and CBD presents a great opportunity to enhance their skill set and help to deliver many more positive outcomes,” he says.
According to Storey, CBD is just on the cusp of becoming a major player in the supplement market.
“I’m serious, I’ve been working in natural health and the practitioner space for the better part of 20 years and, in my opinion, phytocannabinoids are the most exciting tool to come along, nutritionally speaking, in quite some time,” he says. “Every patient can find some benefit from CBD, even if they don’t ‘feel’ it initially, especially when you consider the neuroprotective benefits.”