Fred Mayer, RPh, MPH, FACA

Most of us realize that the old image of stoner Jeff Spicoli in Fast Times at Ridgemont High is no longer the face of cannabis. Today, cannabis users are more likely to be average American grandparents seeking relief from arthritis or insomnia.

Whether or not we view this as progress, it is nonetheless extremely important that we as pharmacists accept the fact that cannabis-especially the nonhallucinogenic cannabidiol (CBD)-is in wide use among all age groups. It is difficult to ascertain its effectiveness as a pain reliever or anxiety-reducer, mainly due to the fact that, as a federally illegal substance, researchers run into layers of legal barriers to studying its use.

Regardless of what we know or don’t know scientifically, anecdotal and word-of-mouth evidence has fueled a dramatic surge in use. Products containing CBD are easy-and legal-to obtain either through local dispensaries or online. Regular, day-to-day conversations, especially among seniors, are increasingly likely to include comments about CBD in an ointment, tablets, or liquid that helps with muscle aches, relaxation, nausea, and a host of other common ailments.

It is not up to pharmacists to endorse or condemn the use of CBD. The critical role I believe we must assume is to assure the health and safety of our patients, as we have always done. Today this means asking them if they are using CBD or other cannabis products, and educating them and ourselves about potentially dangerous interactions between cannabis and other drugs, both prescription and over-the-counter.

This will require effort since this information is not always easy to get. Many physicians are unaware of such drug interactions. And, as I mentioned earlier, research by the usual people and institutions is often nonexistent. 

We have to use our training, instincts, and our networks to obtain the best, most current information. And we must regularly use our initiative to counsel our patients.

In addition to each pharmacist being mindful of the wide-spread use of CBD and the possible harmful interactions for each individual, I think it would be responsible and beneficial if each of the 33 states in which cannabis dispensaries operate pass laws requiring pharmacists be on site or available for consultation in these dispensaries. Five states have been wise enough to do this: Connecticut, Arkansas, Minnesota, New York, and Pennsylvania.

I would love to see my home state of California join this list. And I urge my fellow pharmacists to do what you can to bring this matter to your state board of pharmacy, and work to put pharmacists in this increasingly important position.

Cannabis is one of the most omnipresent drugs in our professional landscape. It is up to each of us to pay attention, educate ourselves, and find the time to make our patients aware and keep them safe.

Seniors comprise only 12% of the population but consume 42% of all medicine, herbal remedies, dietary supplements, and over-the-counter products in the United States. They deserve our professional support in the form of counseling after we have carefully reviewed the possibilities of drug interactions-especially concerning cannabis.

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Lack of regulation means protecting public health is pharmacist's duty. 

Author | Fred Mayer, RPh, MPH, FACA

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