Cannabidiol (CBD) as a stand-alone product is becoming increasingly available world-wide and is perceived by many to have therapeutic potential in a wide range of conditions despite a relative paucity of scientific evidence outside of epilepsy. Overseas studies on CBD use are concentrated in the USA and primarily describe patients accessing CBD, often combined with delta-9-tetrahydrocannabinol (THC), independent of clinician input. New Zealand has limited CBD to a prescription only medication, with strict THC restrictions, presenting an opportunity to audit pure CBD prescriptions. This research adds further understanding to the use of CBD in the clinical setting, describing the patient population, indications for use, quality of life indices and perceived efficacy in returning patients, expanding on previous research published in 2020.
CBD is one of over 140 phytocannabinoids found across the Cannabis genus, others of which include delta-9-tetrahydrocannabinol (THC).1 CBD is considered a non-euphoriant component of cannabis. Recent randomised controlled trials (RCT) and subsequent open-label extension trials have demonstrated evidence for its adjunctive use in the management of severe refractory epileptic syndromes such as Lennox-Gastaut and Dravet syndromes.2–5 In addition, it is suggested that CBD may have further therapeutic potential, due to proposed anti-emetic, anti-inflammatory, analgesic and anxiolytic properties, however RCTs exploring these effects are scarce.6,7 The National Academies of Science, Engineering and Medicine (NASEM) report on the health effects of cannabis and cannabinoids in 2017 identified a gap in the evidence regarding the use of CBD in medical conditions.8
Despite this gap in the evidence for use, recent global changes have seen increased access to cannabis-based products such as CBD.9,10 Perceived as ‘natural’, with many health benefits, patients seek out cannabis-based products for management of a range of medical conditions.10 Such conditions are primarily difficult to treat and chronic in nature, for example, chronic pain, anxiety and depression.10,11 CBD offers hope of a treatment solution that will work where other medications have been deficient.12
Unlike THC, CBD-only products meeting specific criteria have been removed from the controlled drugs legislation in many countries, including New Zealand (NZ), Australia and the United Kingdom (UK).13,14 In NZ, CBD was removed from the Misuse of Drugs Act in 2017, allowing prescription by any medical practitioner in NZ for any medical condition but it cannot be sold over the counter. Those CBD products containing over 2% THC remain subject to more restrictive criteria, making them more difficult to prescribe.15 As of October 2021, there were two CBD-only products available through the country’s Medicinal Cannabis Scheme (MCS).16 This scheme requires products to meet a set of minimum quality standards but they are not required to be pharmaceutical grade medications.17 Despite their ability to prescribe CBD, many medical practitioners across specialties in NZ, such as general practice and oncology, still feel uncomfortable prescribing cannabis-based medical products, primarily due to lack of evidence and lack of understanding of the prescription process.18,19
Private clinics, whose clinicians have gained experience in prescribing cannabis-based products, offer opportunities for patients and medical practitioners to discuss the use of CBD for medical conditions. One such clinic, Cannabis Care, undertook an audit of the first 400 patients prescribed CBD in 2018.20 This paper is a follow-up to this original audit, and aims to describe the patient population seeking CBD prescriptions in NZ, including the indications for use and baseline quality of life indices across the population. Further description of changes in quality of life indices following prescription of CBD are provided in a subset of patients who returned for further consultation.