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How should a veterinarian react when a customer asks about treating a dog with a cannabinoid tincture advertised as an analgesic? Is there any research to support this use, or underlying any of the claims made for the evaluation of cannabis and cannabinoid-based pet products? Can a doctor recommending such a product for a patient violate the State Licensing Authority, Food and Drug Administration, or Drug Enforcement Administration?
These were just a few of the sensitive topics covered during the first AVMA Cannabis Symposium from August 20-22 during the 2020 AVMA virtual convention. The speakers dealt with various aspects of cannabis as a veterinary therapeutic, such as: B. regulatory and toxicological concerns, as well as its potential as an analgesic or treatment for osteoarthritis in animal patients. Below are some of the speaker highlights.
Spirit at large
Thirty-three states have legalized human marijuana for medical or recreational uses – or both. Yet none of these laws are responsible for the use of cannabis in veterinary medicine. California is the only state specifically dedicated to veterinarians’ ability to connect with customers, which indicates that veterinarians can discuss the use of cannabis for medicinal purposes with customers without departing from veterinary discipline solely for that conversation to be disciplined. The same law prohibits veterinarians from prescribing, dispensing, or administering cannabis or cannabis-based products. The law does not regulate the therapeutic use of products made from industrial hemp, which falls under the provisions of the State Veterinary Act, which applies to the diagnosis, prescription, or administration of a drug for the prevention or treatment of an animal’s condition.
The Food and Drug Administration has only approved one drug made from cannabis and three synthetic drugs made from cannabis for human use. No other cannabis, cannabis, or cannabidiol product currently available is approved by the agency.
“We undoubtedly recognize the potential opportunities cannabis-derived compounds can offer and the significant interest in these opportunities,” said symposium spokesman Randall Gnatt, a senior legal advisor in the Office of Monitoring and Compliance at the FDA Center for Veterinary medicine.
“We also recognize that some companies market products in ways that violate federal food, drug and cosmetics law and can then endanger the health and safety of people and animals,” he said. “The agency is committed to protecting public health while taking steps to improve the efficiency of the regulatory pathways for lawful commercialization of suitable cannabis products.”
According to Gnatt, the FDA is conducting a comprehensive evaluation of CBD and related products, with an emphasis on educating the public about these products, informing the agency’s regulatory considerations regarding these products, and taking steps to protect public health if necessary.
“We know that consumer demand for these novel products is very high for various health and other reasons. But as the agency said, we are concerned that some people mistakenly believe that the myriad of CBD products on the market have been rated and deemed safe by the FDA, “which Gnatt explained is not the case.
“Aside from the approved human prescription drug, little is known about the potential effects of long-term or cumulative long-term use of CBD,” continued Gnatt. “We know nothing about the simultaneous use with other drugs or the risks for endangered human and animal populations. This does not mean that we know that CBD is categorically unsafe in all circumstances. However, given the gaps in our current knowledge and the known risks that have been identified, we have not come to a point where we can conclude that CBD products are safe to use. “
Little is known about the effects of cannabis and CBD on various non-human animal species, particularly with regard to the build-up of residues in the edible tissues of food-producing animals. “There is a great need for more rigorous scientific research into both the safety and potential therapeutic uses of cannabis products for animals,” said Gnatt.
Conflicting federal and state laws that prohibit or sanction medical marijuana or hemp-derived CBD can place veterinarians in a difficult position. “Customers can get these products directly on the street or online and seek advice from their veterinarian,” said Jim Penrod, executive director of the American Association of Veterinary State Boards.
Penrod spoke during the cannabis symposium about the differing views of U.S. veterinary regulators on the matter. Marijuana had been illegal for decades, he said, adding that the drug was difficult to test due to its classification as a List 1 substance. When California legalized medical marijuana in 2006, the state “let the ghost out of the bottle,” so to speak, and the decriminalization process quickly outpaced research.
“Because things are moving so quickly and decisions are being made so quickly… I’m not going to give you answers today. I’m not going to tell you, “Yes, it’s okay if you talk about cannabis” or “It’s okay if you donate.” I don’t have these answers, ”said Penrod.
In 2019, the AAVSB asked state veterinary licensing authorities whether it was legal for a veterinarian to discuss cannabis with a client. Penrod said the association recently reached out to these panels to see if they were still happy with the responses they gave in the 2019 survey, and several have changed their answers.
The reactions varied from extreme to extreme. Six states said veterinarians could lose their license if they talked about cannabis at all, four said veterinarians must obey federal law, seven said state agencies couldn’t even provide legal advice, seven said they didn’t have a formal opinion on this one On the matter, two said vets could talk about cannabis but only when the client starts the conversation, 18 replied that vets could discuss cannabis but couldn’t prescribe or dispense it, and four said vets could discuss the issue.
The AAVSB’s position is that veterinarians should be able to discuss CBD with a client to ensure the protection of animals and the public. “That just makes sense,” said Penrod. “If a customer walks in and says, ‘I’m going to use CBD on an animal,’ you should be able to talk to them about it, warn them of some side effects, watch out for them, make sure they have a product buy that has been analyzed and does not contain pesticides. “
The AAVSB has set up a task force to create guides for regulators on cannabis. “Because things change so quickly, it could be out of date for us to draft regulations or practice legal language once we publish them. The leadership is a little more flexible, ”said Penrod.
Cannabis in the clinic
Dr. Trina Hazzah is regularly interviewed about cannabis use, even though there are no cannabis products that are approved for therapeutic use in animals.
That said, customers often ask Dr. Hazzah, a Los Angeles veterinary oncologist whose interests are complementary and alternative medicine, after adding cannabis to their pets’ treatment protocols.
Dr. Hazzah, founder and co-president of the Veterinary Cannabis Society, offered her perspective on the therapeutic use of cannabis products at the AVMA Cannabis Symposium.
Like Dr. Hazzah explained, cannabis is used primarily in animals as an anti-inflammatory, analgesic, anxiolytic, or neoplastic. Before testing a cannabis product, the patient must first be examined to confirm that the animal may be responsive to cannabis.
“Does the patient have any contraindications or comorbidities that may prevent you from starting cannabis? Are there possible drug interactions you should know about? “Asked Dr. Hazzah. “The next step is to assess the actual product and product safety.”
Citing a 2015 study that rated 75 edible cannabis products available in various California cities, she found that only 7% of products were accurately labeled for cannabinoid content. In a follow-up session, Dr. Jack Henion, Professor Emeritus of Toxicology at Cornell University, also found results from a similar study that found 12 out of 13 animal products had higher levels of THC than Canada’s acceptable limits.
“It is really very important that customers do their due diligence and request a certificate of analysis,” said Dr. Hazzah discouraging customers from treating pets with cannabis products marketed for human diseases.
“They want to guide them through finding companies that are transparent, provide good customer service, and have an up-to-date COA (a Certificate of Analysis) that confirms that the product is contaminant free and very specific about what it contains Product, ”she said.
Talk to customers about possible side effects and what signs to look for in pets, added Dr. Hazzah added.
“Finally, you should have really clear expectations with a customer and make sure they know that cannabis isn’t necessarily a miracle drug,” said Dr. Hazzah.
Dr. Dharati Szymanski, deputy director of AVMA’s Animal and Public Health Department and organizer of the summit, summed up the event: “Our members hear different perspectives from cannabis manufacturers, their government bodies, regulators, colleagues and, of course, customers. Sometimes it is difficult to see where these perspectives intersect or how far apart they are. Practitioners want to have confidence in the safety and effectiveness of products. However, when the market has outperformed product ratings, veterinarians need to understand the potential benefits as well as the risks associated with these products for their patients and the liability risks for themselves. Much progress has been made in bridging these gaps, but we need more research, quality control and FDA assessment work so that veterinarians have general confidence in the products available. “