Dr. Karen Keough on Prescription CBD Oil vs. Over-the-Counter CBD Products
If you’re looking for CBD oil products, there’s a good chance you can find a store selling some version in just about any direction you travel. CBD specialty stores have popped up throughout Austin with at least eight opening in 2018 alone.
The popularity of CBD oil is due to the vast number of suggested promises it can deliver — everything from easing achy joints to insomnia. Proof that it actually helps these issues is limited, however, there is data that shows it can be effective at managing seizures associated with epilepsy. We’ve seen some impressive benefits among children in our own practice since we began prescribing CBD in 2018. Importantly, the CBD oil used for epilepsy differs from over-the-counter and must be prescribed by a doctor — it’s not available over-the-counter.
So what’s the difference between CBD products you can buy off-the-shelf and ones which must be prescribed?
Child Neurology Consultants’ pediatric neurologist Dr. Karen Keough recently made comments in a story for Community Impact about the differences between over-the-counter CBD and prescription. She stresses that the prescription or medicinal CBD is formulated according to scientific research, where others are not.
Dr. Keough is also chief medical officer for Compassionate Cultivation which is one of only three companies in Texas licensed to produce medicinal CBD.
“This is legitimate medicine, and particularly in the world of epilepsy, it can be exceptionally effective for a small group of kids who try it, and it turns out to be extremely safe,” Dr. Keough said.
Some key differences between doctor-prescribed CBD and over-the-counter products include:
- CBD available in stores is produced from hemp which is an industrial crop in the state of Texas that can be legally grown and then widely distributed. The wide range of over-the-counter products have little quality control, and a large study by the Centers for Disease Control (CDC) showed that some of these products actually did not contain any medication at all.
- Medical CBD, only available with a prescription, is derived from cannabis, not hemp. Its use and distribution is limited and heavily regulated via the Texas Compassionate Use Program (TCUP) because the THC content of medicinal CBD is higher than in over-the-counter products. The regulation and oversight of the TCUP means reliable, high-quality medication.
- While the benefits of over-the-counter, hemp-derived CBD products are based on lots of Internet testimonials, larger scale medical studies show the positive benefits of doctor-prescribed CBD oil on epilepsy patients.
Both retailers who sell CBD products and doctors who prescribe it agree though that there needs to be continued funding and research devoted to the medical use of CBD so that patients can know more about how it will affect them.
This year the Texas Legislature passed a bill that expands the TCUP to many other conditions, including other forms of epilepsy, autism, spasticity due to cerebral palsy and others like multiple sclerosis, and additional progressive neurological diseases. These changes will start within the next month, and many more patients will have access to medical CBD through the TCUP.
How to get a CBD oil prescription or medical cannabis prescription
There are four ways to get a prescription for CBD oil or other medical cannabis products:
- From your doctor or specialist
- From a cannabis nursing service
- From a cannabis clinic (“canna clinic”)
- From a cannabis telemedicine service
Here’s what you can expect from each of these approaches.
Your doctor or specialist
Very few doctors and specialists are readily prescribing cannabis, for a variety of reasons. Many will simply refer you to a cannabis clinic, or even suggest you go buy it from a retail store.
If your doctor is knowledgeable and willing, count yourself lucky. That said, they are unlikely to have time to educate you on all of the ins-and-outs of medical cannabis, or help you decide which licensed producer to register with. Nor are they likely to have staff at their clinic who can help.
Some doctors may have a single licensed producer that they have a relationship with. They will forward your prescription to that producer, who will then call you to help you choose a product. It’s convenient for the doctor, but it doesn’t leave the patient with any choice of producer. This is unfortunate because no single producer can meet the diversity of needs that patients have.
[By the way, Wayfare works with quite a few doctors who are prescribing cannabis but count on us to provide educational support to their patients. We can even help prepare documents you can take to your doctor.]
Cannabis nursing service
You can think of this service as a mobile clinic. The nurse will come to your home, provide education, take a medical history and connect with a doctor or Nurse Practitioner to obtain the authorization. She will also help you select an appropriate product and develop a detailed treatment plan and dosing schedule. She will then help register you with a licensed producer so you can order products by phone or on-line, and will follow up with you semi-weekly while you work toward your goal.
The cost for this service is usually fully-covered by insurance as a home nursing expense.
Wayfare falls into this category, although we do often work with patients’ own doctors, and there are some cannabis clinics who refer to us to provide extra support for patients. We are now also providing a telehealth option as well.
Over the past few years a number of specialized cannabis clinics have opened up. These are typically staffed by doctors who work there on a part-time basis. These doctors may come from specialties including psychiatry, surgery, and anesthesiology. This means that some patients may see a heart surgeon for their arthritis! But really, bless these doctors for making time to learn about cannabis and help people.
The educational portion of your visit, where you select a licensed producer and product, is quite often handled by a lay person who may have the title of “cannabis educator”, “canna counsellor”, or “patient educator”. These people rarely have medical training, although they may be knowledgable about particular strains, the pricing programs of the various producers, and how to use a vaporizer.
Cannabis telemedicine services
You can get on a video conference with a doctor or Nurse Practitioner, who will assess you and provide an authorization for medical cannabis. Some of these services are stand-alone whereas others are provided by cannabis clinics as described above.
The educational component of the service may again be handled by a lay person, sometimes via a separate video call or by telephone through a call centre.