For patients who are interested in trying cannabidiol treatment, it is imperative for the clinician to set realistic expectations about this treatment. The efficacy of cannabidiol can vary among patients, which has been demonstrated in epilepsy clinical trials in which individual responses to cannabidiol varied and not all patients experienced clinical benefit.1 With regard to safety, one patient survey found that individuals may perceive the safety profile of cannabidiol to be more severe than demonstrated in clinical trials due to overlapping perceptions about the safety of marijuana and THC.2 They may think cannabidiol can induce anxiety similar to THC, though the opposite is true—cannabidiol is actually being studied as a treatment for anxiety.2,3 As a result, it is essential for clinicians to provide evidence-based information about cannabidiol to set realistic expectations with their patients.
SDM about cannabis products between patients and providers is encouraged to formulate and maintain safe and effective treatment plans.4 In addition to a lack of knowledge about cannabidiol and time constraints, a lack of specific data and talking points about cannabidiol contribute to barriers to clinician and patient communication about cannabidiol.5 Overcoming these barriers is key to open discussions on the appropriateness of cannabidiol for a given patient.
Potential side effects of CBD include drowsiness, changes in mood (irritability, agitation), decreased appetite, and gastrointestinal symptoms/distress. CBD may also produce psychotic effects or cognitive impairment in individuals who also regularly use delta-9 THC products such as marijuana. CBD use has been associated with adverse events such as liver injury, interactions with other drugs, injuries following periods of sedation or drowsiness, and male reproductive harm. Clinicians need to be aware of factors influencing the likelihood of CBD-associated adverse events and/or side effects, which include the strength and purity of the product, amount used, mode of administration, concurrent substance use and misuse, and interactions with prescribed medications.6
