Educating Patients On Cannabidiol (CBD)

Educating
Patients on
Hinesburg, VT
Catherine Pratt, MS3
July-August 2019
Cannabidiol UVMMC Family Medicine

Hinesburg
(CBD)
 In 2016, the CDC reported an estimated 20.4% (50 million) of
U.S. adults had chronic pain [1]
 The American Academy of Sleep Medicine estimates
around 30% of U.S. adults have symptoms of insomnia [2]
 And 10% of U.S. adults have severe insomnia with daytime
consequences [2]
 Anxiety is estimated to affect 40 million U.S. adults
according to the Anxiety and Depression Association of
Problem America, making anxiety disorders the most common
mental illness in the U.S. [3]
Identification
(2A)
 In a 2017-2018 survey of CBD users, 62% identified using CBD
to treat a medical condition [6]
 The top three conditions listed were pain, anxiety, and
depression [6]
 The same survey found the odds of CBD use to treat a
medical condition were 1.44 times greater among non-
regular users of Cannabis compared to regular users [6]
 36% of respondents reported CBD as specific or sole therapy
for their identified medical condition [6]
 The demand for CBD products in increasing among
American consumers [5]
 Many companies producing and selling CBD products
have been making unsubstantiated drug claims about
their products – including that CBD can treat, or cure,
cancer [5]
 Due to a lack of FDA oversight and enforcement of CBD
Description products, an estimated 70% of CBD products offered
online could be mislabeled (with both under or over-
of Need (2B) labeling of the CBD and THC content) [5]
 The lack of meaningful regulation of cannabidiol
products leaves consumers at an increased risk of using
products with unspecified concentrations of CBD and
thus unknown therapeutic value [5]
 There is a lack of general knowledge and understanding
among consumers as to the scientifically substantiated
evidence behind CBD therapy [5]
Cost  Patients suffering from an anxiety disorder are 3-5
times more likely to go to the doctor and 6 times
Considerations more likely to be hospitalized for psychiatric

disorders [3]
 A 2016 Fiscal Report from the Vermont Agency of
Human Services Department of Mental Health
identified ‘anxiety and other nonpsychotic
disorders’ as the most common ICD-10 mental
health diagnosis code among outpatient services
(52%) and community rehabilitation programs
(29%) [13]
 In 2017, insufficient sleep among working adults in
the U.S. was estimated to generate an annual
economic loss between $280 billion and $411 billion
[11]
 This loss will range from $299 to $433 billion by 2020 [11]
 And $318 to $456 billion by 2030 [11]
 By 2020, it is projected that retail sales of CBD
products will have increased to $1.9 billion [5]
Community Perspective and Support
 “Patients often ask what CBD can be used for, what dose to take, if it
interacts with their other medications, if it could show up on a drug test,
and if I can write them a prescription…patients that are already on the VT
Medical Marijuana Registry can get access and expertise through
dispensaries…but I don’t really have any great resources and wish I was
better informed myself.” - Mick Graham, MD
 “I had other friends with chronic pain that tried CBD and it really worked for
them, so I figured I would try out what they had found helpful. I’m not sure
it’s working for me yet, but there’s so many options available that I’m
interested in trying something else. Most of my information has come from
my own research, but I still have a lot of questions about how it works and
why there are different formulations. I really like that it doesn’t give you the
‘high’ of THC though, so I’m hopeful I can find what is right for me.”
– Chittenden County resident and CBD user
 Created an educational trifold leaflet for patients to:
1. Identify the current medical understanding of CBD
2. Address its proven therapeutic potential to-date
3. Pinpoint what to look for when purchasing CBD
products
Intervention 4. Recommend dosing for specific medical conditions

5. Correct common myths about CBD
and 6. List local and online resources for more information
Methodology 7. Encourage conversations with health care providers
 Created a “dot phrase” (CBDPTINFO) on EPIC with

similar information and additional resources for patients
 Shared phrase with physicians at UVMC FMH to include

in patient’s “after visit summary”
Results/Responses
 Handout was offered for distribution at

the UVMMC Family Medicine Hinesburg
office, as well as to individual providers at
that location
 “dot phrase” was shared with UVMMC
FMH providers
 Response to handout and “dot phrase”
was positive among providers
 No formal response data was received
 Providers appreciated the compiled
resources in two formats to share with
patients
Evaluating this Intervention
Effectiveness Limitations
 Due to time constraints, the effectiveness  Limited follow-up to evaluate handout
of this intervention was not assessed utilization and response
 Future assessment could involve:  Effectiveness is dependent on
 A survey to patients at FMH regarding: adequate distribution to patients
 Ability to understand handout  Effectiveness is dependent on patient
 If handout provided new information
reading handout or after visit summary
 Whether handout resulted in change in  Effectiveness is dependent on English

CBD habits language literacy
 If they felt more confident finding  Handout and “dot phrase” limited to
information on CBD and purchasing CBD
introductory information on CBD
products
 If they were more likely to discuss CBD with  Impossible to know whether patients
their healthcare provider(s) would have found provided
information independently
 A survey to providers at FMH regarding:
 If patients questions/understanding of CBD
changed following handout distribution
 How frequently they were using the EPIC
“dot phrase”
Recommended Future Interventions
Update and expand handouts in 1 year - due to high turnover rate of
evidenced- base published studies on CBD
Distribute handout to other family medicine offices and providers in

Vermont
Distribute handout to other providers not associated with family medicine
Compile data regarding CBD use among Vermont patients
Connect more patients and providers with Paul Jerard at the Vermont
Cannabinoid Clinic and Ada Puches at the Champlain Valley Dispensaries
 [1]Abrams,D., Couey, P., Shade, S., Kelly, M., & Benowitz, N. (2011).
Cannabinoid-opioid interaction in chronic pain. Clinical Pharmacology and
Therapeutics, 90(6), 844-851.
 [2] American Academy of Sleep Medicine. (2019). Insomnia provider fact sheet.
Retrieved from https://aasm.org/resources/factsheets/insomnia.pdf
 [3] Anxiety
and Depression Association of America. (2019). Facts & statistics.
Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics
 [4] Committee on the Health Effects of Marijuana: An Evidence Review and
Research Agenda, Board on Population Health and Public Health Practice,
Health and Medicine Division, & National Academies of Sciences, Engineering,
and Medicine. (2017). The health effects of cannabis and cannabinoids: The
References
current state of evidence and recommendations for research. (). Washington
(DC): National Academies Press.
 [5] Corroon,J., & Kight, R. (2018). Regulatory status of cannabidiol in the united
9A states: A perspective. Cannabis and Cannabinoid Research, 3(1), 190-194.

doi:10.1089/can.2018.0030
[6] Corroon,
 J., & Phillips, J. (2018). A cross-sectional study of cannabidiol users.
Cannabis and Cannabinoid Research, 3(1), 152-161. doi:10.1089/can.2018.0006
 [7] CourtesyAdobe Stock. (2019, ). Community impact newspaper. Retrieved
from https://communityimpact.com/dallas-fort-
worth/mckinney/healthcare/2019/04/04/texas-legislature-looks-to-make-cbd-
law-more-clear/
 [8] CourtesyAdobe Stock. (2019, The torch. Retrieved from
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved
=2ahUKEwjEhqLRgfTjAhUkTt8KHf49BZAQjRx6BAgBEAQ&url=https%3A%2F%2Fohtor
ch.com%2F3717%2Ffeatures%2Fcannabas-based-cbd-becoming-a-part-of-
everyday-
life%2F&psig=AOvVaw3Jb58WWuW4RTbbUa73YgLf&ust=1565379070756710
 [9] Dahlhamer J, Lucas J, Zelaya, C, et al. (2018). Prevalence of chronic pain and
high-impact chronic pain among adults - united states 2016. ( No. 67:1001–
1006).MMWR Morb Mortal Wkly Rep.
doi:http://dx.doi.org/10.15585/mmwr.mm6736a2
 [10] Faraci,
S. (2018). Medical marijuana: An overview and potential use for family
medicine doctors. Unpublished manuscript. Retrieved 8/2019,
 [11] Hafner,
M., Stepanek, M., Taylor, J., Troxel, W., & van Stolk, C. (2017).
WhySleepMatters-the EconomicCosts of InsufficientSleep: A cross-
CountryComparativeAnalysis. Rand Health Quarterly, 6(4), 11.
 [12] Hande,K. (2019). Cannabidiol: The need for more information about its
potential benefits and side effects. Clinical Journal of Oncology Nursing, 23(2),
131-134. doi:10.1188/19.CJON.131-134.
 [13] Harrigan,E., Leno, S., Chornyak, C., Donnely, C., Horton, D., & Bailey, M.
References (2017). FY 2016 statistical report. ().Vermont Agency of Human Services

Department of Mental Health. Retrieved from
https://mentalhealth.vermont.gov/sites/dmh/files/documents/reports/DMH-
cont. 9B 
2016_Statistical_Report.pdf
[14] Iffland,
K., & Grotenhermen, F. (2017). An update on safety and side effects
of cannabidiol: A review of clinical data and relevant animal studies. Cannabis
and Cannabinoid Research, 2(1), 139-154.
 [15] Jerard,
P., & Barkuff, D. (2019). Vermont cannabinoid clinic. Retrieved from
https://www.vtcclinic.com/
 [16] Lee,
M., Sigman, Z. & Devit-Lee, A. (2019). Project CBD. Retrieved from
https://www.projectcbd.org/
 [17] Russo,
E., & Guy, G. (2006). A tale of two cannabinoids: The therapeutic
rationale for combining tetrahydrocannabinol and cannabidiol. Medical
Hypothesis, 66, 234-246.
 [18] Smith,
D. (2019). A provider's guide to medical cannabis: THC and CBD.
putting the evidence to work for improved patient care. ( No. 437).
Scholarworks: Family Medicine Clerkship Student Projects.

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Educating

Cannabidiol UVMMC Family Medicine

Considerations more likely to be hospitalized for psychiatric

Intervention 4. Recommend dosing for specific medical conditions

Methodology 7. Encourage conversations with health care providers

 Created a “dot phrase” (CBDPTINFO) on EPIC with

 Shared phrase with physicians at UVMC FMH to include

 Handout was offered for distribution at

 Whether handout resulted in change in  Effectiveness is dependent on English

Distribute handout to other family medicine offices and providers in

Distribute handout to other providers not associated with family medicine

Compile data regarding CBD use among Vermont patients

9A states: A perspective. Cannabis and Cannabinoid Research, 3(1), 190-194.

References (2017). FY 2016 statistical report. ().Vermont Agency of Human Services

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