CBD And Cannabinoid Medicine

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

History of CBD

Cannabidiol or CBD is one of hundreds of molecules that come from the cannabis plant. Substances from this plant have been used for thousands of years for medicinal purposes across the globe and the CBD molecule was first isolated in the 1940s. In 1996, with the legalization of medical cannabis use in California for people, the modern medical community began to accept and study these compounds for medical use. Since that time there has been a rapidly growing number of studies exploring the use of CBD for pain management, anxiety, seizures, cancer therapy and much more.

How Does CBD work?

The endocannabinoid system (ECS) is a complex network of chemicals and receptors in our bodies and our pets’ bodies that help regulate various physiological functions and maintain balance known as homeostasis. Think of it as a team of messengers and receivers working together to ensure everything runs smoothly. The messengers, called endocannabinoids, are naturally produced by our own bodies. They travel around and bind to specific receptors, known as cannabinoid receptors, which are found throughout our body, including our brain, immune system, organs, and other tissues. Researchers have also discovered these endocannabinoids also bind to several other receptors.

When endocannabinoids bind to these receptors, they send signals that can affect things like pain sensation, mood, appetite, memory, sleep, immune function, and more. Essentially, the endocannabinoid system helps regulate these processes and keep our bodies in homeostasis.

In addition to the messengers and receptors, there are also enzymes that break down the endocannabinoids once their job is done. This ensures that the system remains balanced and doesn’t go into overdrive.

Interestingly, the endocannabinoid system can also interact with phytocannabinoids (also known as cannabinoids) found in the cannabis plant, such as THC (tetrahydrocannabinol) and CBD (cannabidiol). These cannabinoids can mimic the effects of our natural messengers – to an extent- or interact with the receptors in different ways, leading to various effects on the body and mind.

The endocannabinoid system itself can sometimes dysfunction, which refers to a situation where the natural balance and function of the endocannabinoid system is disrupted or not working properly. Think of it like a miscommunication or a glitch in the system. Just like any other system in our body, the ECS can sometimes experience problems that can affect its ability to regulate different functions normally. This is where supporting the ECS with phytocannabinoids, things like CBD, come into play. By supporting the ECS with chemicals that are similar to the chemicals the body produces or offering more, we can supplement the ECS to hopefully create balance once again.ith other medications, this sedation may be excessive. Excessively sedate patients may seem dizzy or have trouble walking. If the sedation is severe, please skip the next dose of the medication and contact your veterinarian to discuss decreasing the dose.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

Treating Seizures with CBD

The idea of treating seizures with CBD was first popularized in 2013 by a CNN documentary about a young girl with severe seizures successfully treated with CBD. Since that time there has been an explosion of interest and science behind the use of CBD and other canninbinoids to manage the frequency, severity, and length of seizures in animals. In 2018 the first CBD product was FDA approved for the treatment of severe forms of epilepsy in children. Unfortunately this medication is currently too expensive for use in dogs.

Research around the use of CBD for seizures has also been started for dogs. So far, there are only two studies evaluating the efficacy of two different CBD products for managing seizure activity in dogs. Both studies were optimistic but not curative.

Can I Replace My Pet’s Seizure Medication with CBD?

While there have been encouraging results in early studies, we do not yet have enough information to comfortably use CBD on it’s own for seizures. In general we recommend this as an enhancement to your pet’s seizure medication, not a replacement. In general, it’s not safe to alter your pet’s seizure medications unless under the guidance of a doctor. If you would like to discuss your pet’s seizure medications, please reach out to our Neurology team for an appointment. We will work closely with the Neurology team to find the right treatment plan for your pet.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

Benzodiazepines– This is one of the most common drugs we see potentiating effects of even zero percent THC products. Animals may appear extremely lethargic or have symptoms similar to THC intoxication. While the idea of our animals being “high” may seem funny to some it is very stressful and potentially dangerous to animals.

Gabapentin, Acepromazine, Tramadol, Phenobarbital and Trazodone (or other behavioral drugs) – in some patients you may see lethargy, inappetence, abnormal behaviors and in severe cases urination. Dose de-escalating or escalating over time is usually warranted for the small percentage of animals that may experience these symptoms.

Theoretically, CBD may also induce changes in drug levels of medication like phenobarbital. However, so far studies have not found this to be true in dogs on CBC and phenobarbital together.

Side Effects and Monitoring
Studies as well as our clinical experience has found CBD to be safe and well tolerated in dogs and cats. Some pet’s may experience side effects like sedation or GI upset. Sedation is particularly common if products also contain THC, as dogs are very sensitive to this compound. If GI upset is experienced, it is usually transient.

Pets on CBD also have elevations in their liver enzymes. This has yet to be associated with significant liver problems, however we recommended routine monitoring of liver enzymes for any patient who is on CBD more than 3 months.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

There are two broad categories of pain, adaptive pain (acute pain) and maladaptive pain (chronic pain). Adaptive pain is typical with tissue trauma such as a bite wound or surgery. Maladaptive pain is a more difficult type of pain to manage, examples being osteoarthritis or nerve injury.

Utilizing phytocannabinoids, like CBD, to help decrease pain is an emerging field of study for both animals and humans. To date, there are multiple veterinary studies that have evaluated the efficacy of various formulas of CBD containing solutions to support the natural function of the endocannabinoid system to minimize pain specifically related to osteoarthritis in dogs. Acute pain studies in dogs were unsuccessful and no studies in cats. However, our clinical experience suggests supporting the ECS can  be advantageous for managing acute pain.

While it may seem like an easy option to administer CBD or other phytocannabinoids to our pets to decrease pain, there is a lot more to it than that. Each animal will respond differently to various phytocannabinoid-containing products. We must also be mindful of potential drug interactions that may occur if your animal is already on other medications.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

There is a lot of interest for the use of CBD or various other phytocannabinoids for a whole host of conditions. For some things like Irritable Bowel Syndrome (IBS), cancer, and dermatological conditions there is some scientific evidence. Others like canine and feline cognitive disorder, stomatitis in cats and immune system related disease there is less scientific evidence but an abundance of anecdote and successful clinical experience. At Remedy, we are one of the few veterinary hospitals in the world that are prepared to have these conversations.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

Long-term monitoring

We may suggest liver enzyme monitoring for patients that will be on the product long-term, >3 months.

Common drugs where interactions may occur

Benzodiazepines– This is one of the most common drugs we see potentiating effects of even zero percent THC products. Animals may appear extremely lethargic or have symptoms similar to THC intoxication. While the idea of our animals being “high” may seem funny to some it is very stressful and potentially dangerous to animals.

Gabapentin, Acepromazine, Tramadol, Phenobarbital and Trazodone (or other behavioral drugs)– in some patients you may see lethargy, inappetence, abnormal behaviors and in severe cases urination. Dose de-escalating or escalating over time is usually warranted for the small percentage of animals that may experience these symptoms.

Product quality

How the product is produced and the ingredients are of the upmost concern when using these types of products. Please see the “Choosing a Product” page.

All information obtained from RemedyVets and Stephen Nino Cital, RVT, VTS

Choosing a CBD Product

You would hope that you could pick up any CBD product off the shelf and it would be safe and effective for your pet. Unfortunatley this is not the case. There is a great deal of variation in the quality of products on the market. In a 2022 study, researchers at John Hopkins found that only 24% of CBD products correctly listed rhe amount of CBD contained in the product. Most products either had significantly more or less CBD than advertised. Even more concerning, 35% of products contained THC, even though many of them were labeled THC free. Dog’s are very senstitive to THC and can experience toxicity at far greater doses than humans. Therefore, we need to be very careful when choosing a product for our pet. But if we can’t trust the labels how do we go about that.

What to look for in a cannibinoid product

Many products, especially those high in CBD are readily available for the human market, many of them still contain levels of THC that may lead to toxicity in our patients (particularly dogs). This is especially true if a product is derived from marijuana, and not hemp. For this reason, products formulated specifically for veterinary species are better choices than those formulated for humans.

Because these products are not regulated by the FDA (just as human vitamins and supplements are unregulated), look for a company that adheres to current Good Manufacturing Practices, to ensure a clean supply chain and manufacturing environment.

The following things should be easily found either on the label or the product information:

• The type and amount of cannabinoids per mL
• A complete ingredient list
• Check for dangerous ingredients like xylitol or other flavoring
• Extraction method used

Review Certificate of Analysis

Finally, when evaluating a product we also want to see a Certificate of Analysis (CoA). This is a third-party, independent laboratory analysis of the product. While there are issues with testing facilities and standardization, this is currently the best (and only) way to evaluate the quality of a product.

The CoA should include:

• A breakdown of all cannabinoids present in the product
• We have good evidence that whole-plant (aka full-spectrum or broad-spectrum) products are more effective than products that contain ONLY CBD (such products are termed “isolates” and may require much higher doses to achieve the desired effect)
• The CBD:THC ratio in the product
• Terpene analysis
• Heavy Metal testing
• Herbicide / fungicide / insecticide testing
• Microbial testing
• Mycotoxin testing
• Residual solvent testing
• The company should also provide the following information:
  The amount of cannabinoids per mL
• A complete ingredient list
• Check for dangerous ingredients like xylitol or other flavoring
•  Extraction method used

A company should provide all the information listed above without hesitation and immediately upon request. As the market matures, purchasing a product that is backed by positive scientific studies using the product will be advisable.