Cannabis is used commonly among patients with CVS-patients report relief of symptoms with use. We found 21% of patients with CVS to be regular users, but only 1 met the Rome IV criteria for CHS. Longitudinal studies are needed to determine the relationships among cannabis use, hyperemesis, and mood … CVS Health Corp. has debuted cannabidiol (CBD) products in select stores in eight states. The products, which include topical creams, In the 2018 Farm Bill, Congress removed hemp from the Controlled Substances Act’s drug schedules, legalizing hemp-derived cannabidiol (CBD). With consumer demand for CBD on the rise, CVS and Walgreens both recently announced that topical applications containing CBD would soon be on their shelves.
Patterns of Cannabis Use in Patients With Cyclic Vomiting Syndrome
Background & aims: Some patients with cyclic vomiting syndrome (CVS) use cannabis to relieve stress and for its antiemetic properties. However, chronic cannabis use has been associated paradoxically with cannabinoid hyperemesis syndrome (CHS) and some patients with CVS are thought to have CHS. We sought to characterize patterns of cannabis use by patients with CVS and identify those who could be reclassified as having CHS.
Methods: We performed a cross-sectional study of 140 patients with CVS (72% female; mean age, 37 ± 13 y) seen at a specialized clinic. Patients were screened for cannabis use with the cannabis use disorder identification test. Patients were classified as regular (use ≥4 times/wk) or occasional users (
Results: Forty-one percent of patients were current cannabis users, with 21% reporting regular use. Regular users were more likely to be male and to report an anxiety diagnosis, and smoked cannabis with higher tetrahydrocannabinol content and for a longer duration. Most users reported that cannabis helped control CVS symptoms. Among all cannabis users, 50 of 57 (88%) reported that they had abstained for longer than 1 month, but only 1 user reported resolution of CVS episodes during the abstinence period. This patient subsequently resumed using cannabis but remains free of symptoms.
Conclusions: Cannabis is used commonly among patients with CVS-patients report relief of symptoms with use. We found 21% of patients with CVS to be regular users, but only 1 met the Rome IV criteria for CHS. Longitudinal studies are needed to determine the relationships among cannabis use, hyperemesis, and mood symptoms.
Keywords: CUDIT; Cannabinoid Hyperemesis; Nausea; THC.
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
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CVS Begins Selling CBD Products in 8 States
WOONSOCKET, R.I. — CVS Health Corp. has debuted cannabidiol (CBD) products in select stores in eight states. The products, which include topical creams, sprays, roll-ons, lotions and salves, are available in various CVS stores in Alabama, California, Colorado, Illinois, Indiana, Kentucky, Maryland and Tennessee, a spokesperson for the company told CSP Daily News.
CVS is not selling CBD-infused supplements, food additives or edibles, the company said.
“Cannabidiol (CBD) is gaining popularity among consumers,” the spokesperson said. “Anecdotally, we’ve heard from our customers that these products have helped with pain relief for arthritis and other ailments.”
In late 2018, the U.S. Farm Bill essentially legalized products made from hemp that contain CBD oils, so long as they contain less than 0.3% tetrahydrocannabinol (THC), the psychoactive chemical in marijuana.
CBD has enjoyed rapid market growth due to its alleged medicinal qualities and the product category is expected to reach $5 billion in sales by 2027, according to CBD research firm New Frontier Data, Washington; however, there are still plenty of questions regarding its safety and legality, causing concern and hesitation among retailers to get involved.
CVS began selling the CBD products in mid-March.
“This is our initial entry into this emerging product category that we think is something consumers are going to be looking for as part of their health care offering,” the CVS spokesperson said. “We’re going to walk slowly into this new category and continue to actively monitor the regulatory landscape for CBD products, and will expand product availability as appropriate and in compliance with applicable laws.”
Woonsocket, R.I.-based CVS Health has nearly 10,000 retail drugstores and more than 1,100 walk-in medical clinics nationwide. The company is a leading pharmacy benefits manager with more than 22 million medical benefit members and 68,000 retail network pharmacies.
ORLANDO, Fla. — Mitch Morrison asked the room of retailers one question as the final panel of this year’s Convenience Retailing University commenced: “How many of you know what CBD is?” Roughly half the room raised their hands.
“Now, how many of you are selling CBD in your stores?” asked Morrison, vice president of retailer relations for Winsight Media, CSP’s parent company. Crickets.
CBD—the nonpsychoactive ingredient in marijuana or hemp—was one of the hottest topics at this year’s event in Orlando, Fla. The final panel, which featured experts in retail and cannabis, offered insights into what the product is, market opportunities, the regulatory landscape and merchandising strategies for convenience stores.
Here’s how retailers can approach CBD and what they can expect in the upcoming months regarding its regulations …
The U.S. Department of Agriculture (USDA), the agency that crafted last year’s Farm Bill, is making guidelines for various states to cultivate hemp and make it legal, said Rachel Gillette, partner and chair of the cannabis law practice firm Greenspoon Marder LLP, Fort Lauderdale, Fla. This means retailers will have to craft their CBD plan-o-grams around these regulations, especially for CBD edibles, which have been forcibly removed from certain states over the past few months.
“The FDA will come out with a pathway for us to see CBD in foods or as a dietary supplement,” she said. “That would give a lot of states and retailers clarity and cure any confusion.”
These programs are also essential for law enforcement officials, who often ignore or confuse the difference between CBD and tetrahydrocannabinol (THC), the psychoactive component of cannabis .
“If we have this conversation a year from now, it’ll be a very different legal environment,” she said.
There appears to be a combination of excitement and caution regarding CBD among retailers. Erin Butler, senior category manager for West Des Moines, Iowa-based Kum & Go LC, said that although she hopes the chain is selling CBDs within the next year, it is still a hypothetical situation until the regulations unfold.
“We don’t want to risk any legal ramifications,” she said. “We’re exploring, talking with suppliers and making plan-o-grams for our stores. But we won’t act until we know that we can, legally.”
Although there is no age restriction for CBD yet, many retailers plan to display the product behind the counter like tobacco products. This is exactly how Kum & Go will approach the category, Butler said.
“We’ll have it behind the counter in a display and have educational materials, similar to buying Sudafed at a drugstore,” she said.
Nik Modi, managing director for RBC Capital Markets, New York, compared today’s CBD hype to the early stages of e-cigarettes: people are talking, they’re excited, but they don’t know how to approach it.
The lesson retailers can learn from this comparison is that research is critical, he said. Such research includes diving into the manufacturer’s history, what their products are and if they’re well-capitalized.
“Everyone wants to chase the trend, but there’s no guidance and infrastructure,” he said. “I’d urge everyone to take your time about how you approach the category.”
Gillette concurred, also suggesting retailers question their CBD suppliers on where their products are manufactured, their general production process, and, most importantly, on lab results. Confirming that CBD products don’t contain more than 0.3% THC—the legal limit per product, according to the Farm Bill—goes a long way, she said.
“There are labs that are certified to test CBD, and you’ll want to call and verify those test results,” she said. “Even if you’re unknowingly selling CBD oil that contains more than 0.3% THC, you can be arrested.”
Despite the murky waters, suppliers can still help retailers make CBD distribution a seamless process. Such support includes offering as many educational tools as possible, including pamphlets and brochures, and ensuring their products contain absolutely zero THC, said Floyd Landis, founder of Floyd’s of Leadville, Leadville, Colo.
“Some companies, even if they don’t say it, are selling hemp-derived products with more THC than considered safe,” he said. “The safest thing we can do is remove THC entirely and educate consumers. It’s an unnecessary risk to have any levels of THC at all in these products.”
CBD has been touted as a budding product and surging category for retailers. But is that what it really is? Modi argues that retailers shouldn’t think of CBD as a product or a category, but as an ingredient—and one that will emerge in nearly every area of the store, he said.
“CBD is like nicotine and caffeine: It has functional benefits and will be placed in many products in your stores,” he said. “That’s how this category is going to evolve. Don’t pigeonhole yourself into thinking this is its own category—it’s an ingredient that will arrive in every category.”
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CVS And Walgreens Bet On Cannabis, Testing The Market And Responding To Consumer Demand For CBD
Cannabidiol, or CBD, seems to be everywhere these days. Trendy lunch spots are drizzling CBD oil on salads, bartenders and mixologists are adding it to cocktails, juice bars are adding it to their smoothies alongside wheatgrass and ginger, and coffee shops are adding it to their lattes. Even Bon Appetit is adding it to their arsenal of ingredients, promoting recipes like CBD Caramel Sauce, which they suggest serving “over ice cream, stirred into yogurt, or drizzled over a brownie or slice of pound cake.”
That’s a lot of hype for a compound that is one of more than a hundred cannabinoids found in the cannabis plant, and for one that causes absolutely no psychoactive effects. After all, for decades, psychoactive effects have been what many cannabis users have sought, leading to strains that had been specifically bred to diminish the amount of naturally occurring CBD.
Product on display (Leef Organics) at the ECO Cannabis Oakland Grand Opening Media Event at ECO . [+] Cannabis on March 28, 2019 in Oakland, California. Photo: imageSPACE for ECO Cannabis/MediaPunch /IPX
Many people, though, have found CBD to be helpful in providing relief for a wide range of symptoms, including chronic pain, anxiety, inflammation, gut disorders, and neurological conditions. And last January, the Food and Drug Administration (FDA) approved Epidiolex, a CBD oral solution, as a treatment for seizures associated with two rare and severe forms of epilepsy.
While this application has been approved for a very specific and limited use, further research and clinical trials may lead to approval for other drugs and for other uses. In the 2018 Farm Bill, Congress removed hemp from the drug schedules outlined in the Controlled Substances Act, legalizing it under federal law. But even though this made CBD derived from hemp legal, it was still subject to FDA regulations when used in applications under the FDA’s purview. What this means, most notably, is that selling CBD as a food additive or dietary supplement gets tricky.
So how do companies respond to market demands while also not getting themselves crosswise with federal regulators?
We saw one solution recently, as the two biggest pharmacy chains in the United States decided that CBD was worth exploring. Both CVS and Walgreens announced – within days of each other – that they would begin selling hemp-derived CBD products in 2,300 stores between the two nationwide chains. While you won’t find the trendy CBD products listed above at these drugstores, their shelves will soon contain a variety of topical applications like creams, lotions, salves, patches, and sprays.
Let’s be clear here: this is a big step and a major development for the cannabis industry. The fact that nationally recognized brands are putting their weight behind cannabis-tangential products is almost certainly a harbinger of things to come – even if the complex reality of FDA regulations forces the drugstore chains to limit their CBD product lines to topical applications for practical and legal reasons.
In a December 20, 2018 statement after the signing of the Farm Bill, FDA Commissioner Scott Gottlieb asserted as much, saying “It’s unlawful under the [Federal Food, Drug, and Cosmetic Act] to introduce food or food containing added CBD or THC into interstate commerce, or to market CBD or THC products as, or in, dietary supplements, regardless of whether the substances are hemp-derived. This is because both CBD and THC are active ingredients in FDA-approved drugs and were the subject of substantial clinical investigations before they were marketed as foods or dietary supplements.”
This means that before we see these chains really double down on the new cannabis landscape, a new regulatory framework will have to be developed and implemented, providing guidance for what they can – and, importantly, what they can’t – do. We may still be a long way off from that framework coming into place, but as with other developments, it is encouraging to see a willingness to explore and take action where possible.
What we do know is that the demand is there. Until the regulations catch up, retailers looking to test the market may find lotions and salves to be a safer bet. And if consumers meet or exceed retailers’ projections, then we will almost certainly see other retailers follow suit.