ASHP Midyear: Nearly Half of Adults With Epilepsy Use CBD Products

Nearly half of adults with epilepsy are currently using or have used cannabidiol (CBD) products to treat epilepsy and its associated effects, and attitudes toward CBD are largely positive, according to research presented at the American Society of Health-Systems Pharmacists (ASHP) 2024 Midyear Clinical Meeting.¹

Health professional holding a bottle of CBD oil | Image credit: © Tinnakorn | stock.adobe.com

CBD is the second most prevalent active ingredient in cannabis, although it does not cause a high by itself. Its effects have been touted for many health issues, but one area with particularly strong scientific evidence is childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome. Epidiolex (Jazz Pharmaceuticals) is the first and only cannabis-derived treatment approved by the FDA for these conditions.²

In findings from one study, researchers treated 214 pharmacoresistant child-onset epilepsy patients with an initial dose of 5 mg/kg/day of CBD, which was increased up to a maximum dose of 50 mg/kg/day if tolerated. Data showed that the median monthly frequency of motor seizures was 30 at baseline and was reduced to 15.8 over the 12-week treatment period, suggesting significant efficacy.³

The first randomized, double-blinded, placebo-controlled study evaluating high-purity CBD in patients with Dravet syndrome was published in 2017. In that study, the intervention group received a highly pure 100 mg/ml CBD solution, which was increased up to 20 mg/kg. According to the findings, 43% of patients had at least a 50% reduction in convulsive-seizure frequency after a 14-week treatment period with CBD, and 3 patients in the CBD group were seizure free.³

Despite data suggesting high efficacy, there has still been a lack of data on attitudes and perceptions toward CBD. Additionally, adults with epilepsy are underrepresented in most CBD trials, including common etiologies for focal epilepsy such as poststroke epilepsy, traumatic brain injury, and focal cortical dysplasia.³

In the study presented at ASHP Midyear, researchers conducted an online anonymous survey between September 30 to November 30, 2022, seeking patient perceptions and attitudes about the medical use of CBD products. Inclusion criteria required participants to be adults living within the US and medically diagnosed with epilepsy. The 6 sections of the survey were general demographics, knowledge about CBD, previous experience with CBD, perceived barriers of CBD use, perceived benefits, and intentions for CBD use.¹

Of the 100 respondents, 49 had previous experience with CBD. Among those 49 respondents, 90% reported anxiety relief and sleep improvements; 33% reported improvement in reducing seizure occurrences; and 7% reported success attempting to reduce their antiepileptic drug dose.¹

Those who did not use CBD were more likely to respond negatively to CBD use, believing it was potentially addictive, unhealthy, and could result in a positive drug test. These participants were therefore presumably deterred from using CBD products due to their beliefs and perceived legal status of CBD. In general nonusers were not inclined to try CBD for the treatment of epilepsy and associated side effects.¹

Patients may have questions about the legal status of CBD. All 50 states have laws legalizing CBD, although restrictions vary. In December 2015, the FDA eased regulatory requirements, allowing researchers to conduct CBD trials. The 2018 Farm Bill legalized hemp, removing all hemp-derived products from the Controlled Substances Act.²

With this legalization and widespread access, pharmacists are increasingly likely to encounter patients with questions about CBD. They should be counseled about potential adverse effects, which include nausea, diarrhea, headache, drowsiness or sedation, fatigue, and dry mouth. Importantly, it can also heighten the effects of alcohol, anti-epileptic medications, antipsychotics, benzodiazepines, beta-blockers, opioids, selective serotonin reuptake inhibitors, and warfarin.⁴

Pharmacists should also consider the various CBD delivery methods and their respective benefits and limitations. For instance, inhaled formulations have immediate onset and easier dosing, although vaporization is typically preferred over smoking. Other options include suppositories, oral tablets, sprays, and sublingual options.⁴

The study findings presented at ASHP Midyear demonstrate that many adults with epilepsy are currently using or have used CBD products to treat their epilepsy and its effects. Although not all patients are open to these products, providing accurate information and education can be beneficial both for users of CBD and for those with questions.

REFERENCES

1. Lovings JA, Wright N. Perceptions and attitudes regarding cannabidiol (CBD) use for epilepsy and associated side effects in adults within the United States of America: a national cross-sectional survey. Presented at: American Society of Health-Systems Pharmacists 2024 Midyear Clinical Meeting. New Orleans, LA. December 9, 2024.

2. Grinspoon P. Cannabidiol (CBD): what we know and what we don’t. Harvard Health Publishing. April 4, 2024. Accessed December 9, 2024. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

3. Silva GD, Del Guerra FB, Lelis MO, Pinto LF. Cannabidiol in the treatment of epilepsy: a focused review of evidence and gaps. Front Neurol. 2020;11:531939. doi:10.3389/fneur.2020.531939

4. Antrim A. Counseling Patients on Proper Use of CBD Products. Pharmacy Times. March 17, 2021. Accessed December 9, 2024. https://www.pharmacytimes.com/view/counseling-patients-on-proper-use-of-cbd-products