CBD: What You Need to Know in the Era of Commercial Cannabis

Presenters:

Scott Gagnon, Associate Executive Director of AdCare Education Institute of Maine, Inc. & Director of SAMHSA’s New England Prevention Technology Transfer Center (PTTC) – Presentation Slides

Transcript:

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Michelle Wagner, NAMI NH (she/her): Good afternoon, I am Michelle Wagner with NAMI, New Hampshire, and I work on the First Episode Psychosis Early Serious Mental Illness Initiative. Thank you for joining us for today’s webinar, titled CBD. What You Need to Know in An Era of Commercial Cannabis.

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Michelle Wagner, NAMI NH (she/her): This presentation is being recorded, and you’ll be able to find it on the education page of Onwardnh.org. In the next couple of days, you’ll receive a follow-up email with links to both an evaluation and the recording.

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Michelle Wagner, NAMI NH (she/her): This is a Zoom Webinar that means your camera and microphone are off. The chat is working, pardon me, the Q&A is working. So, please enter any comments or questions you have there. My colleague, Karen Prevay, is with us, and she will help field your questions.

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Michelle Wagner, NAMI NH (she/her): So, today we’re talking about an important topic CBD. Which is short for Cannabidiol. Joining us to talk about this substance is Scott Gagnon.

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Michelle Wagner, NAMI NH (she/her): He’s the director of SAMHAS that the Substance Abuse and Mental Health Services Administration. He’s with the New England Prevention Technology Transfer Center, the NETTC. He is a Certified Prevention Specialist and also the Associate Director of Adult Care at Educational Institute of Maine. He’s a national speaker and trainer on cannabis policy and prevention.

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Michelle Wagner, NAMI NH (she/her): Scott also serves as a Board Member of The Maine Recovery Coach Certification Board and is a member representing public health, A main Cannabis Advisory Commission, and with that, Scott, I’m going to turn it over to you.

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Scott Gagnon: Alright. Well, thank you, and thank you everyone for joining. Let me pop up my

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Scott Gagnon: slides here for today.

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Scott Gagnon: So, the title for our, for my presentation is CBD, What You Need to Know in The Era

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Scott Gagnon: of Commercial Cannabis. And so, that’s really what I hope to accomplish over the next hour is to provide you some information.

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Scott Gagnon: So, that’s what we’ve been put together just to give, give, you some, maybe another lens into what we know, or don’t know,

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Scott Gagnon: around CBD in terms of potential different impacts, and maybe, and, also just to talk a little bit about how it’s,

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Scott Gagnon: it’s handled kind of regulatory,

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Scott Gagnon: kind of why, before launching the content. I do have cause couple of disclaimers. On one, is that this presentation is

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Scott Gagnon: provided or been prepared through our New England Prevention Technology Transfer Center Program.

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Scott Gagnon: doing on PTC, which is a cooperative agreement we have with SAMHSA, and you can see our cooperative agreement number there. But, also just to stress that the views and opinions that I present in this presentation are those of the presenter and myself, and do not necessarily reflect the views and opinions of the US. Department of Health and Human Services, or SAMHSA.

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Scott Gagnon: I guess a couple of words about the New England PTC. For folks who may not have heard of us or what we do. And so, we are as I mentioned a cooperative agreement. There are actually 3 partners ourselves, Medicare, and then also our partners, that the co-curring, collaborative serving main

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Scott Gagnon: in public consulting group who are evaluators.

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Scott Gagnon: We’re one of 10 regional centers across the country, and our charge from SAMHSA is to provide training and technical assistance in the realm of Substance Use

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Scott Gagnon: Prevention, and really, that means that we can provide training today to anyone that’s in the business or working on any kind of initiatives or strategies related to preventing substance misuse. So, my large part of our audience is

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Scott Gagnon: folks who are in prevention coalitions or funded per-state or Federally Funded Prevention Roles, But it can really be very broad. So, folks who are on this call who may have interest or initiatives around

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Scott Gagnon: prevention, you know, we can, we can work with you as well. So, really, we’re, we’re, all about getting that prevention science into practice. Just to make sure that everything that’s being implemented

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and prevention is science-based.

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Scott Gagnon: and, and, leveraging also some of the expertise and resources that we have available

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Scott Gagnon: to the Federal Government and other partners in the region.

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Scott Gagnon: And so, we do that through a lot of different modalities in-person, trainings, webinars such as this, some self-paced courses and learning communities, and a bunch of other different types of products.

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Scott Gagnon: So, I will have my contact information at the end. So, as we go through this, and you think, oh, we have an idea of some help we need.

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Scott Gagnon: You’ll know how to get in touch with us to request assistance.

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Scott Gagnon: Finally, one other disclaimer is as a PTC Network, we believe, very strongly in using affirmative language, the person’s first language. So, that’s something I will strive for

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Scott Gagnon: in my presentation today, and as we discuss this content together.

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Scott Gagnon: One other little terminology piece. I do want to start with as well is that when it comes to this topic, and of course, you know CBD is related to cannabis and marijuana. That is a sort of a terminology thing that is still a little murky right now.

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Scott Gagnon: When I say the field, I mean, I, I, I’m largely talking about prevention field, but probably even larger to the behavioral field,

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Scott Gagnon: In the behavioral health field and beyond. We’re not really quite settled yet on what terminology we should be using should we say Cannabis? Should we say Marijuana?

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Scott Gagnon: What makes it even trickier is that policy in some policies, whether it’s a state level policy, or certainly at the Federal level. The word Marijuana can be enshrined in the policy. So, that’s a term that’s used.

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Scott Gagnon: or vice versa Cannabis could be.

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Scott Gagnon: And, we also have to acknowledge that not every audience we’re speaking to will understand what Cannabis means. But, they may understand what Marijuana means.

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Scott Gagnon: So, this is just all to say that we’re not quite in a settled place with the terminology. But why I wanted to bring it up is for me as a presenter, I will tend to use the word Cannabis versus Marijuana. That’s just

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Scott Gagnon: kind of what I’ve come to as a professional in terms of the

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Scott Gagnon: terminology I want to use, but just wanted to kind of clear. Put that at the top, So, if you hear me use one versus the other that’s why. Now that said, I do also have a lot of material that I pulled from SAMHSA For this. Really for this webinar, and they do tend to use

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Scott Gagnon: still uses the term, Marijuana. So, if you do see references to Marijuana, it’s because of sources. I’m citing.

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Scott Gagnon: One other acknowledgement is, as I mentioned, there’s a lot of content here that I’m

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Scott Gagnon: bringing in that was developed by SAMASA National Mental Health and Substance use policy labels.

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Scott Gagnon: From a webinar that we co-sponsored back in August, and the leads on that were Krishnan.

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Scott Gagnon: Radha, Krishnan, and Amy Barringer. So, I just want to acknowledge the work that they did on some of these materials.

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Scott Gagnon: So, what are we going to cover today? So first, we’ll talk about just a kind of introduction, or maybe reintroduction to the, canvas plan terms of what is CBD. And how does it differ from THC. Which are two of the sort of the most

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Scott Gagnon: popular or well-known part components of

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Scott Gagnon: the canvas plan. Talk a little bit about what started for the CBD explosion. Why, you see so many products in stores.

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Scott Gagnon: How did that all come about?

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Scott Gagnon: Talk a little bit about the marketing and availability around CBD.

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Scott Gagnon: Little bits of data to talk about what we, we, know currently, around some of the prevalence rates and demographics of CBD use.

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Scott Gagnon: Some of the ways that CBD is used in terms of the over-counter

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Scott Gagnon: products.

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Scott Gagnon: We know about some of the adverse effects, effects, of pure CBD, some of the potential harms of over-the-counter CBD, and then talk a bit about some populations.

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Scott Gagnon: A special concern, and then we’ll wrap it up with a, a, few slides, with some tips, and actually steps at different

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Scott Gagnon: audiences or different sectors can take around, you know, having this information, what can you do with it?

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Scott Gagnon: So, a lot of this content I’m going to be talking about did come from this SAMHSA advisory that was put together. So, they did a lot of work and research to pull together a lot of this.

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Scott Gagnon: This research, and in, in data and information. So, that’s a lot of where this will come from. And I have a link at the end where you’ll be able to download

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Scott Gagnon: the Advisory, which has more detailed information. Then we’ll go over it in the next hour.

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Scott Gagnon: So, starting with, you know, kind of again an introduction or reintroduction of, of, the Cannabis plant. And where does CBD come from? And how does it all fit in? So, when we so scientifically, Cannabis really belongs to the small family.

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Scott Gagnon: a flowering plant it’s called Cannabis, if I’m pronouncing that correctly. It’s also known as the Hemp Family. So, when you hear about the Hemp Plant. That’s kind of what

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Scott Gagnon: people are usually referring to. Now, the Cannabis plant has a lot of chemicals in it, so as, as, we see here, 500 chemicals. About a hundred of those approximately that we know so far.

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Scott Gagnon: or Phyto Cannabinoids are commonly referred to as Cannabinoids.

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Scott Gagnon: and those are in Trichome. Trichomes of the female flowers of, of, the plant. That’s where those, those, are found. So, again, 2 of the more commonly understood, or, you know, sort of popular or discussed

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Scott Gagnon: cannonades or delta. 9. Tet cannabinoid or THC or Delta 9 THC. And can’t cannabidiol, or CBD.

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Scott Gagnon: There’s also a third one. That’s Delta 8 THC which is also being marketed, and I’ll talk a little bit more about that when we talk about

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Scott Gagnon: The policy piece on the Farm Bill.

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Scott Gagnon: So, you do see on this slide, just in case if you are a chemistry geek, that what actual the actual molecules look like for these three,

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Scott Gagnon: three chemicals. I do want to note, because this came up before when I in the past, when I said, provided this information, you’ll see that

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Scott Gagnon: The Wikipedia Site Citation. I just want to make sure that’s only for the photos. It’s not for the actual content. The content came from

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Scott Gagnon: from other places. Let me show you we’re not. Folks know we’re not pulling our, we’re not citing Wikipedia for the actual information. It was just, for them, just to cite where these photos came from. So, as you can see, though, when you look at it, the structure of these 3 chemicals are very similar, but those small differences make a big difference in terms of how they interact with the body, and then, therefore, some of the adverse effects.

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Scott Gagnon: or other kinds of effects that we can observe for the research.

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Scott Gagnon: So, talking about hemp versus marijuana, or, or, cannabis.

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Scott Gagnon: So, under the Agricultural Marketing Act of 146. There was there was an amendment in 2018, which is commonly referred to as a Farm Bill.

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Scott Gagnon: So, there are a lot of changes made to that Agricultural Act in the Farm Bill.

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Scott Gagnon: One of those had to deal with Hemp

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Scott Gagnon: and so again, with the terminology of Hemp. Hemp means a Cannabis plant, or any part of the plant,

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Scott Gagnon: with a Delta, 9 THC concentration of less than .03%

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Scott Gagnon: on a dry weight basis. And so, that’s important. So, anything less than that amount is commonly referred to as Hemp. Anything more than that at the Federal level is, is, called Marijuana. So that’s one. That’s how the Federal Government kind of did distinguishes between, between, the two. There are other botanical differences between the plants, But in terms of the chemical content,

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Scott Gagnon: in terms of

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Scott Gagnon: Hemp Policy and Marijuana Policy at the Federal level. That’s an important dividing line.

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Scott Gagnon: So, if you have something that’s one THC, that’s not going to be called Hemp, but it’s going to be called Marijuana, or, or, Cannabis

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Scott Gagnon: much where we, we, see here. So, anything above .03% Delta 9 THC on a dry weight, Dry weight basis is gonna be called Marijuana

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Scott Gagnon: so, before I go into the next slide. So, I do just want to talk a little bit more about the Delta E, so we don’t really have lot of information here. But so, one of the side effects. You of the Farm Bill was this kind of loophole that was created, that essentially allowed for

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Scott Gagnon: which we’ll talk about a little bit had something to do with the explosion of the CBD Products. But it’s also led to this unintended consequence of Proliferation, Proliferation of Delta 8 THC Products

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Scott Gagnon: and so really, the issues that the language in this Farm Act wasn’t really specific enough to, to, not

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Scott Gagnon: to, to, prohibit the sale of any THC products that were derived from these hemp plants. So, what that means is

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Scott Gagnon: The, the, Feds legalized, the

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Scott Gagnon: cultivation, agricultural and, and, and development of products from H3emp plants, so, less than .03%

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Scott Gagnon: Delta 9 THC. But didn’t really speak to

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Scott Gagnon: regulation or sales or products of Delta 8 THC. So, that’s where the kind of loophole emerges. So, what ,we’re so, we don’t have a lot of content on the Delta. 8 stuff here. But I did just wanna reference, and folks for case folks on the call are aware of this kind of emerging issue. That is, something that is, is, become has become a bit of an issue, that where there’s not a really

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Scott Gagnon: clear oversight, neither from the Federal Government, or really at, at, State levels, to deal with the Delta 8 Products. Again, because of the Farm Bill. I do know that there are different

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Scott Gagnon: discussions and potential Bills that may be introduced in Congress to deal with the Delta 8 loophole. because, again, the intent of it wasn’t necessarily to allow for

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Scott Gagnon: this explosion of Delta 8 products. It’s just. Again, there was no specific language

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Scott Gagnon: that dealt with regulating whether or not those products could be sold. And, therefore, there’s a lot of other regulation things that don’t happen, instances like how they can be marketed, how they can advertise, and, and, those kind of things.

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Scott Gagnon: Oh, I should excuse me, I should mention at the.

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Scott Gagnon: and I think it was mentioned. So, if you have questions as we go along the way

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Scott Gagnon: definitely put in the Q&A. Box, because I know like that whole Delta 8 thing I just said might be very confusing. So, if you have any questions around that around that, please feel free to, to, put those in the chat.

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Scott Gagnon: So again, I don’t have a lot of other content about the Delta 8, but again, because it’s an emerging issue. I just wanted to spend a couple of minutes just to talk about it, and where that emerged from?

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Scott Gagnon: So, looking at the difference between CBD and Delta 9. So, there’s really some major differences. So CBD is again typically being derived from the hemp plant. So again, those plants that are less than

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Scott Gagnon: .03%, but not exclusively. So, there are CBD Products or CVD, CBD containing products that can be derived from the Marijuana plant and I’ll talk a little bit more about that when I talk about,

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Scott Gagnon: kind of state level, kind of policy, kind of thing.

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Scott Gagnon: So, but again, CBD, but commonly, especially when we’re talking about the over-the-counter products that we’ll talk about later. And the FDA Approved CBD products, We’re talking about CBD, that’s been derived from the hemp plant.

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Scott Gagnon: Now, and with the CBD, there is no psychoactive effect. So, it’s not. And it’s not a chemical that’s intoxicating when it’s taken into the body, whereas Delta 9 THC does have a psychoactive effect.

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Scott Gagnon: Delta E does as well. Delta E THC does also have a psychoactive effect

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Scott Gagnon: the mechanism of action. How these chemicals bond and, and, our

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Scott Gagnon: processed in our brain and our bodies are a little different. So, the mechanism of action for CBD is, it interacts weekly with our Endocannabinoid Receptors. So specifically those CB 1 receptor and the CB 2.

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Scott Gagnon: Meanwhile, with a THC It does. It binds very strongly

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Scott Gagnon: with those. And so, that’s one of the reasons we see the difference in terms, how it affects intoxication because of the

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Scott Gagnon: that’s one of the reasons we don’t see intoxication with CBD, because it’s not because of the binding properties, whereas THC binds very well.

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Scott Gagnon: because THC actually is very the, the, structure of THC is also very similar to the natural cannabinoid that we have

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Scott Gagnon: in our brain. And in the ecdemite, which is sort of the natural endogenous chemical that tends to bind with our Endocannabinoid Receptors.

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Scott Gagnon: The Delta 9 C molecule is so similar enough that it can have that strong bond, that strong bond.

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Scott Gagnon: another difference. So, CBD inhibits the breakdown of natural in the into Cabinet Endocannabinoids, and possibly

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Scott Gagnon: THC. So, in some ways it can act as a, as an inhibitor of some of the TAC effects I mean, a lot of again has to do with ratios. So, it’s not really super. So there, you know, there’s a lot of. There’s a lot of caveats sort of with that statement.

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Scott Gagnon: and with a CB 1 is something that’s prominent in our central nervous system that’s the receptor our brain and our spinal cord. But that CBD, CB 2 receptor that

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Scott Gagnon: ThC binds can be found on lots of parts of our body. It can be found in our stomach and it can, it’s present in an immune cell. So, it’s in a lot of different parts of the body compared to that CB. One receptor.

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Scott Gagnon: So, these are kind of again, the major kind of differences and intricacies between

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Scott Gagnon: CBD and THC. Now generally sort of in the general public and, and, broadly people again, think of CBD as the one that doesn’t give me high, and the THC as one that does right. But as we can see here, there’s a lot more

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Scott Gagnon: to it than that.

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Scott Gagnon: So, talk a little bit more like, how did we see this explosion and sort of proliferation of CBD products across the country.

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Scott Gagnon: So, again, going back to that Farm Bill, so that was that Farm Bill was passed in 2018, signed in

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Scott Gagnon: late December. And that’s really what legalized the commercial production of Hemp by amending the Agricultural Marketing Act. So that’s really what opened the door to allow

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Scott Gagnon: for these products to be developed and sold commercially.

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Scott Gagnon: Now, this is where I do want to make a distinction between really 3 different sources. So, in, in a lot of the slides going forward. We’re gonna talk about

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Scott Gagnon: FDA approved CBD products. Which really there’s only one which is separate dialects, and then over the calendar CBD products. And those are the products again that you’re gonna be able to buy in lots of different settings. You can see them in gas stations. You can see them in

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Scott Gagnon: pharmacy stores like Walgreens places like that. I mean, it’s like a lot a lot of retail places.

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Scott Gagnon: These over to counter CBD products can be sold and marketed because of

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Scott Gagnon: because of the Farm Act. There’s really a third set of CBD

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Scott Gagnon: products or CBD containing products. Which are those products that are regulated or have been legalized in states

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Scott Gagnon: across the country. And so, those products that are in dispensaries may be more and often than not are gonna have a mix may contain CBD, but they’re also gonna have THC.

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Scott Gagnon: So, when we’re talking about a dialogue. We’re talking about a pure CBD product. There’s no THC in there at all, same with,

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Scott Gagnon: but it’s in with over the counter. There should be minimal THC, we’ll talk a little bit more later about how there could actually be

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Scott Gagnon: a little bit of THC in some of these products which can pose some, some, issues. But we’re talking about the state sanction or regulate dispensaries. They also can have some products.

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Scott Gagnon: That contain CBD, so we don’t have a lot of content specific for those products, just because there’s a lot of more unknowns there, because

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Scott Gagnon: where they are regulated and sanctioned on a state-by-state basis.

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Scott Gagnon: And there’s different regulations and, and, intricacies behind that. There’s it’s, it’s, a little harder to get the

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Scott Gagnon: kind of themes or consistent across the board. Information on those kind of products. But, I did think it was important to note that there’s really kind of 3 groups or classes of

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Scott Gagnon: CBD products we could be talking about when we talk about CBD.

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Scott Gagnon: So, you know, again we go, go, back to the policy

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Scott Gagnon: part of it. And just so, just again to remind folks where we’re New Hampshire is compared to the rest of the country. So, you know, in, in New England we have most of our States that have legalized both

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Scott Gagnon: what we call adult use marijuana. Which is sometimes, or cannabis, sometimes referred to as “Recreational” and then currently New Hampshire has just a medical, or I know it’s called a Therapeutic

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Scott Gagnon: Cannabis Program.

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Scott Gagnon: Just in case folks are wondering what that looks like.

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Scott Gagnon: So, I was talking a little bit about Pharmaceutical and Commercial Grade CBD. So, there’s really, as I mentioned, there’s really only one CBD project at this point. That is, FDA approved and that’s Epidialects.

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Scott Gagnon: So, this is pharmaceutical grade CBD, and it’s a sanction for the treatment of, of, epile, epileps. Excuse me, Epilepsy.

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Scott Gagnon: It’s only available with a, a, valid prescription. And normally, it’s and it’s an it’s administered orally

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Scott Gagnon: with an oral syringe. So, that’s currently the only you know, Federally, or FDA approved

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Scott Gagnon: pure CBD product that doesn’t. There may be that others there may be others that are being researched

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Scott Gagnon: currently, but that’s the only one that’s actually approved and available in pharmacies.

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Scott Gagnon: With over the counter commercial and so important part. Important distinction here is because epidiax is FDA approved, and you know they have oversight in terms of regulations

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Scott Gagnon: around that product when we’re talking about the over the counter product. So, those

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Scott Gagnon: Commercial Grade CBD products. Those are not FDA approves, which means FDA really has not the same level of oversight, or really interaction with

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Scott Gagnon: with those kind of products?

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Scott Gagnon: So, when it comes to the marketing and availability of over the counter. CBD products.

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Scott Gagnon: there’s you know, as I’m sure folks have seen. There’s, you know, they can be marketed in a lot of different ways. As therapies to treat a lot of many a lot of different types of

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Scott Gagnon: health conditions.

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Scott Gagnon: The, the, thing to understand, though, is that when it comes to terms of rigorous research. On. On this there really is a lack of

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Scott Gagnon: a, a, rigorous research really back up some of the or most, if not all, of the claims that are made for these commercial over the counter product. So, that’s important for, for, us to understand. But important for really the public to understand is that

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Scott Gagnon: just because something is marketed in a certain way doesn’t necessarily mean that there’s rigorous, you know, and strong science to to back up those claims.

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Scott Gagnon: So, the FDA, you know, to this point has been and able to evaluate and approve these products, for you know the usage for which that they’re being marketed. So, there’s a limit. There’s really limited data.

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Scott Gagnon: As far as the effectiveness of the product for these different claims. The other thing that’s important to understand is that THC. And CBD products are also currently excluded from the dietary

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Scott Gagnon: supplement definitions. Which is another reason, you know, FTA doesn’t really have. You know, Elaine, here

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Scott Gagnon: here for regulations. So, what it really means is we as a, as a, as a country, and as a nation, we really need to

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Scott Gagnon: look at finding a new regulatory pathway for CBD. So, we can do that research. So, we can better understand sort of the veracity of

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Scott Gagnon: these different claims that that we see in in marketing.

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Scott Gagnon: Yeah so, the Bill. This is where it does kind of dial a little bit into the to what’s legalized or what-not and, and, State. So, the availability will vary a lot by State depending on

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Scott Gagnon: regulations.

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Scott Gagnon: Over the counter. CBD products are available throughout the United States. So, through a couple of different main venues. One is through online retails, and then, as mentioned before, different types of brick and mortar retailers, so that could

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Scott Gagnon: include drug stores, grocery stores, convenience stores, gas stations you probably think of.

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Scott Gagnon: of, of many others

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Scott Gagnon: based on, you know, the data that we have available. It seems like most CBD sales are happening online. So, about greater than 60% but that is still 40% that are these sales that are happening through brick and mortar.

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Scott Gagnon: locations. But there are a lot of the sales

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Scott Gagnon: are, are happening online. So, I mean, it doesn’t really take a lot to Google to be able to find different places where you can order and purchase a CBD. These over the counter. CBD products

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Michelle Wagner, NAMI NH (she/her): and Scott, can I just bring up a question that Robert has shared with us. So, unless the product says FDA approved, we can’t really trust the claims made by marketers.

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Scott Gagnon: I mean, what I would say is, we just don’t have the science. We don’t have the drive, or the data to, to, back it up. So, I mean, yeah, I would be skeptical of of if it’s not, FDA approved. And honestly, I mean, you could say that with a lot of supplemental

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Scott Gagnon: or kind of help marketed products, it’s not exclusive to CBD, but yeah, if it’s not, FDA approved, and something is claiming to do something.

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Scott Gagnon: I mean, generally I would. I’d be skeptical. But specifically, we know when it comes to Cbd that there really isn’t. Again, we’re we’re talking about rigorous research. That’s one of the challenges, sometimes with marketing, sometimes marketers, and I’ve seen this.

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Scott Gagnon: They’ll, they’ll, they’ll say something is supported by a study. But sometimes, when they say the word study, what they mean is a survey that went out to customers which is different than like a you know, a peer reviewed research article. So, that’s another place to be skeptical is when someone, even if they do say it’s based on studies like, well, what are those studies? How are they designed? Who funded them?

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Scott Gagnon: Is it a survey. Is it double blind, like, you know, all those kind of things? So, that’s so, The devil’s in the details a lot when it comes to

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Scott Gagnon: that kind of marketing.

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Scott Gagnon: Not bad but, good question. Thank you.

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Scott Gagnon: So, again, what do we have for statistics in terms of the usage of the over-the-counter products? So, you can see here, some, some demographics that we have. So, we have about 25% of adults who said that they’ve used CBD

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Scott Gagnon: in the last 2. In the last 2 years, and about 33%. Who say that they’ve ever used CBD.

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Scott Gagnon: looking at some of the other direct demographics. So, for 18 to 29 year olds, you get about 20% that they see used in the last 2 years. 40% that have ever used it

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Scott Gagnon: with 30 to 49 year olds, 16%. That used it in the last 2 years, 32%. And then so on.

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Scott Gagnon: Broadly, we’ve got a, a large part of the population that is least familiar with CBD or CBD products. So, 64% say, you know, they’ve heard of that in some way.

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Scott Gagnon: Nearly half of the CBD users, about 46%, are millennials.

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Scott Gagnon: Women use CBD slightly more than men. So about 52% of consumption is is with females. Over half of users, or I’m not. Excuse me, almost half of users. 48%.

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Scott Gagnon: I’ll leave it with children under 18

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Scott Gagnon: 47%. So, almost half of the the population, 47% think the government regulates. CBD, so, that’s a big

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Scott Gagnon: misconception there. And obviously they do regulate epidialect when we’re talking about those again, those over the counter

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Scott Gagnon: medications. Not so much. There’s about 22% who do not trust CBD, so there is about a fifth of the population that does have some skepticism with CBD products

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Scott Gagnon: and then hit. This is really kind of mind boggling. And in 2020 CBD products generate over 5 billion dollars in sales. So, it’s definitely a big you know, it’s definitely generating a lot of sales

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Scott Gagnon: across the country.

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Scott Gagnon: So, how does CBD get used to it? And so, it can come in a lot of different forms. So, it can come in food items. So, things like chocolates, gummies and candies, other, other kind of products like that. It could come in beverage items. So, you can see things like CBD and infused sodas, waters, teas.

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Scott Gagnon: smokable items, so smokable flour, vapes, cartridges, e-cigarettes.

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Scott Gagnon: You can see it on topical, such as lotions, bombs, gels.

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Scott Gagnon: cosmetics, things like that

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Scott Gagnon: in oil such as tinctures with a dropper or a gel cap. Trans-demersal through a skin patch. Eye drops, suppositories, and pet products. You can see that there’s just a wide variety.

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Scott Gagnon: A product that, that can be out there that contain

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Scott Gagnon: CBD, and you know folks have heard of other things feel free to put those in the chat. If you’ve seen anything novel that you haven’t seen

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Scott Gagnon: you don’t see in this less so really, the you know, it’s really wide open again in terms of what can be created and marketed with, with CBD.

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Scott Gagnon: So, what do we know about some of potential adverse effects of pure CBD, So. And this comes from the research that really went into the development of epidia. So, as with any. you know, as with many FDA approved medicines, you know, one of the things they look at are what are some of the potential side effects or reverse reactions.

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Scott Gagnon: That comes from, from using the, the medication. So, that’s, that’s where this list comes from. And so what’s been observed is the following types of adverse reaction. So, the sleepiness

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Scott Gagnon: which can be worse under exacerbated with the Co-use of alcohol. you can see decreased appetite.

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Scott Gagnon: Diarrhea, increased liver, enzymes which can be dose related, especially if also taking fatigue, malaise, and weakness, rash insomnia, sleep, disorder

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Scott Gagnon: and poor quality, sleep and infections.

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Scott Gagnon: other things. Another, other couple of considerations is we also can see some and increased risk of drug, drug interactions. So, interactions between epidilex and other medications.

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Scott Gagnon: And then some additional information that we’ll, we’ll talk about in a minute and a minute that can apply to pregnant breastfeeding moment. Women. So, you can see again. you know again, I think there’s a common understanding around CBD again about it not being psychoactive, and then not having some of the addictive kind of

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Scott Gagnon: pro-

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Scott Gagnon: components, or like THC. But again, looking at this list, we can’t see that it isn’t. That’s not the all the story that there are some adverse effects that we are observing that we also kind of need to pay attention to.

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Scott Gagnon: So, what are some of the potential harms that are associated with use of over the counter? CBD products?

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Scott Gagnon: So, something again. So, this is what we’ve observed so far, and you know research is ongoing, and this list may change, and and adapt as we move forward.

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Scott Gagnon: So, again, we are, observing some adverse events and a lot of the seriousness. How serious those adverse effects

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Scott Gagnon: can depend on a lot of different

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Scott Gagnon: different factors. So, whether there’s other drugs being used whether alcohol is being used. You know there can be some other just individual health conditions that could exacerbate

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Scott Gagnon: adverse events.

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Scott Gagnon: The other piece with this is, there can be a lot unreliable labeling when it comes to over the counter CBD products. So, research has found that

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Scott Gagnon: some CBD products are not accurately labeled in terms of the content; the amount of CBD that’s in the product. So, I’ve seen these studies myself, where you know, they’ll go in and test

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Scott Gagnon: different products. And either the the percentage is a lot higher than was on the label or lower,

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Scott Gagnon: So, and that’s one of the challenges. Again, with a lack of sort of Federal Regulation

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Scott Gagnon: or the ability to federally regulate these products is.

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Scott Gagnon: You know, standard not having strong standards to have more reliable

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Scott Gagnon: labeling on a product.

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Scott Gagnon: Unreliable purity with harmful, harmful contaminants.

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Scott Gagnon: So, there can be some purity concerns due to some of the unsafe manufacturing process. Practices have observed, and some of the over the counter products. It can be contaminated with THC.

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Scott Gagnon: So, I either unlabeled Delta 9 or Delta 8 THC

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Scott Gagnon: components

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Scott Gagnon: or potency in the product. And this is an important point to or actually, I think it might be in the next.

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Scott Gagnon: This is a good place to point out that again. So, when these products are derived from the hem plant.

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Scott Gagnon: Then you know that

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Scott Gagnon: that is less than .03% TCH. However, through the manufacturing process that percentage could increase a little bit. There could be some concentration of THC just through the processing and manufacturing of the product. So, what’s important about that is why it might well, may not be enough

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Scott Gagnon: to

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Scott Gagnon: be impairing or cause intoxication. It could be enough to pop-up on a drug test. So, so, for someone in a particular job where there’s drug testing or pre-employment screening. And that’s something that’s gonna happen. It’s just a consideration for folks and something to important to understand. And actually, I saw, we saw a case of this here in Maine, although it wasn’t an over-the-counter product. It was,

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Scott Gagnon: I don’t think it was over the counter brought. I think it was in one of our dispensaries, but it was marketed as a mostly CBD product that didn’t really have,

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Scott Gagnon: it wasn’t marketed as containing THC. But for whatever reason, again, whether it was through the manufacturing process or some other

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Scott Gagnon: other factors. It was enough. There was enough THC. In the product that when this individual had to go through mandatory drug testing they tested positive, and then they lost their job.

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Scott Gagnon: Now, you know, there’s a policy discussion and debate there about whether or not that should happen. But, until there is policy change, you know, with different employers and whatnot, that it’s again, it’s just a point of awareness.

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Scott Gagnon: For, you know, working with individuals who are in a job where there’s there’s drug testing and they are using CBD products. I think it just could be an, an important educational

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Scott Gagnon: point that even though it’s not on the label

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Scott Gagnon: base. It is still possible that it could be enough THC in there again, maybe not to

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Scott Gagnon: cause intoxication. But if it

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Scott Gagnon: pops up in a drug screening test. It could cause some problems. And that was one of our questions. So, thank you very much for that.

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Scott Gagnon: Yeah, it’s, it’s a trick again. It’s and it look, you can see a lot of themes. And I love how these things tie together, you know, with the, the lack of, lack of ability. Probably, FDA would say, to regulate

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Scott Gagnon: these, especially the over-the-counter products. It just opens up a lot of possibilities for, for problems.

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Scott Gagnon: And then, you know again, one of the other harms again, is the the unproven health claims.

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Scott Gagnon: They may delay, delay a right diagnosis and treatment. So, even if a use usage of a CBD product doesn’t necessarily harm someone like physically like the, the hemp, it doesn’t actually produce health harms.

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Scott Gagnon: Because of usage of the project. If it does delay access to a a better treatment, a science-based treatment and evidence based treatment for whatever’s being treated, that is, in another way, a kind of harm.

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Scott Gagnon: So, it may not directly harm you or your health, but it may indirectly harm by preventing you from using something that could be more. Be more helpful.

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Scott Gagnon: There have been increasing reports of emergency visits related to CBD, and some of these can be intentional or unintentional.

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Scott Gagnon: An unattentional use.

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Scott Gagnon: So, talking a little bit about populations of special concern. So, you know, one big population, you know, we were concerned about, of course, is pregnant and breastfeeding women. And this is really the case with both

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Scott Gagnon: CBD and THC. But of course, today we’re focusing on,

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Scott Gagnon: on CBD, but so, I mean one of the things again is the lack of human research.

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Scott Gagnon: So, while there is research ongoing, and you know, we again, we’ve already talked a little bit about some of the harmful effects. We know there are still a lot of unknowns.

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Scott Gagnon: And I think sometimes, unfortunately.

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Scott Gagnon: when you see this, even, you can see this even with marketing that the

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Scott Gagnon: The amount of unknowns can sometimes be spun in marketing to mean it’s safe. Just because we don’t know something as harmful in a certain way.

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Scott Gagnon: But I think it’s important to really in terms of again, especially with education, that the absence of information doesn’t mean

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Scott Gagnon: we know there’s no harm right. Like the the absence information shouldn’t be confirmation of either efficacy or safety. And so, especially with pregnant and breast feeding women. I think that’s a you know we want. We wanna take a risk adverse you know, kind of posture, without which I think we do.

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Scott Gagnon: I think again, it’s just important to. It’s important thing to highlight that while there’s there’s some known, there’s enough unknowns where caution is, is definitely warranted. I think, with usage of these products during, during pregnancy and breastfeeding.

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Scott Gagnon: There are some animal studies that are suggesting a high dose of CBD can cause some reproductive issues.

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Scott Gagnon: So again, that’s not human research. It’s, it’s animal research. So, we can’t 100%

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Scott Gagnon: draw conclusions from that. But it’s enough, I guess, to put it on the radar right. There’s enough of a red flag

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Scott Gagnon: to, to have it on our radar.

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Scott Gagnon: CBD contaminants, especially THC can pose risk to the developing fetus or, or breast fed babies. So, again, we’re, we’re not spending a lot of time talking about THC in this particular webinar. But it would tell you that there is gathering research.

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Scott Gagnon: you know, suggesting that THC use during pregnancy is, is not a good thing. That pregnant breastfeeding women should avoid and abstain from THC use because it can cross, it does cross the placenta, and it can accumulate in the brain

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Scott Gagnon: of of the unborn child. Which means that there could be some brain development impact and some other health impacts.

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Scott Gagnon: So,

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Scott Gagnon: so, that the THC, the potential THC can cause contamination of CBD products is another reason, I think, for, for concern and caution

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Scott Gagnon: of usage of CBD products amongst this population. So, therefore, the FDA. At this point does strongly advise against the use of any CBD products in any form

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Scott Gagnon: during pregnancy, or while breastfeeding.

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Scott Gagnon: with children oops with children. You know, one of the things we’re again related to that THC content.

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Scott Gagnon: Contamination is the concern around unintended

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Scott Gagnon: intoxication, and I think this would probably be could be, more of a concern. Some of the State

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Scott Gagnon: Regulated Products, because.

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Scott Gagnon: you know, states largely don’t get involved with the products that are in dispensaries. They largely don’t get into the content of products. They don’t stipulate that there has to be certain ratios

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Scott Gagnon: or like products will have to be a certain percentage of CBD versus THC, so again, because of labeling and a lot of different issues. There can be some unintended intoxication that could happen.

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Scott Gagnon: you know. You know, if a parent leaves a medication out, a CBD or THC Medication out, or something like that. So, you know, unintended toxication is, is something we’re mainly concerned with, with, with children.

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Scott Gagnon: So, just kind of wrap up of what we’ve talked about. So far, so CBD is increasingly available in many, many different forms.

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Scott Gagnon: But as, as I talked about, there’s really only one FDA, I mean, there is only one FDA regulated product at this point, which is EPA dialects approved for treating seizures.

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Scott Gagnon: The FDA does not approve, and has not approved at this point any of the over-the- counter

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Scott Gagnon: CBD products, and also any of the products that are in the State Regulated

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Scott Gagnon: Dispensaries. So that means. The CBD marketplace is largely

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Scott Gagnon: unregulated.

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Scott Gagnon: But as, as we’ve talked about, CBD is still being marketed for a lot of different types of element or ailments.

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Scott Gagnon: Despite limited evidence of of effectiveness

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Scott Gagnon: over the counter, CBD. Is widely missed, can be widely mislabeled, and can be of questionable purity.

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Scott Gagnon: We again have observed from research that there can be some biological and chemical, chemical contaminants found in some of the CBD samples it can contain Delta 8 or Delta 9 THC. And we’ve talked about some of the implications of that.

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Scott Gagnon: Children can be especially vulnerable to CBD and should not be given over the counter CBD products.

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Scott Gagnon: Pregnant and breast feeding women should also be avoiding CBD products as we, we kind of just discussed.

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Scott Gagnon: So, as I mentioned, this does come from across content, comes from an advisory that SAMHSA put together. There’s a lot more detailed information than

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Scott Gagnon: I have in these slides. Where you can get more information on, on

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Scott Gagnon: or more extensive information on some of the points

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Scott Gagnon: We talked about? So as, as with any Samhsa resource, it is free to download and use

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Scott Gagnon: So, we definitely encourage you to check that out. There’s also a web email address where the folks that developed the advisory. You can feel free to contact them as well. If you have any questions about the

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Scott Gagnon: the product.

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Scott Gagnon: So, next I’m gonna to talk about some some tips and action steps that we can take, knowing with this information that we have.

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Scott Gagnon: and then we can open up to some Q&A and discussion.

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Scott Gagnon: So this. So we’re, you know, provide a lot of information here. So then, that’s sort of that question is now, what like? How can we use this? And so, in this advisory that SAMSA

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Scott Gagnon: put out. They did put together some recommendations for different audiences of, of the advisory and what they can do

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Scott Gagnon: with this information. So, for those community coalitions, prevention coalitions, treatment leaders, folks in the behavioral health sphere. So, one of the things we can do is work with local health departments, regulatory agencies

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Scott Gagnon: and medical providers to disseminate the latest evidence on the risks and therapeutic potential of CBD, including that which is unknown. So, it’s really an opportunity for us to do this education

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Scott Gagnon: with our partners? In our, in our state and our communities.

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Scott Gagnon: We can educate the community partners and community members, including adolescents and young adults about some of this short and possible

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Scott Gagnon: long-term effects that we’ve seen associated with CBD use.

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Scott Gagnon: And I think also, you know, it’s in a place where we can talk about some of these distinctions we talked about. So the FDA,

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Scott Gagnon: you know, epidile X versus the over the counter products versus what is available and sold in state regulated dispensaries.

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Scott Gagnon: The other thing that we can do in our communities is implement evidence-based programs to prevent the non-FDA-approved CBD use by youth and young adults. And really, you know, we can even look at other populations as well where we see

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Scott Gagnon: some issues with that. So you know, with this information, you know, it’s it’s just again, it’s a, I think it can provide an opportunity to think about like, what kind of prevention programs and other educational

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Scott Gagnon: programs can we bring on board to to do this education and make sure we prevent and mitigate any potential risks and harms for

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Scott Gagnon: for these populations and and others

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Scott Gagnon: for healthcare providers. So we can encourage additional clinical research on the effects of CBD.

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Scott Gagnon: so we’ve talked here a lot about some of the knowns around adverse effects. But there’s still a lot of unknowns.

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Scott Gagnon: So you know, as really, I probably not just healthcare providers. But really lots of folks can can do this kind of encouragement and advocacy like, how do we expand clinical research

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Scott Gagnon: on the effects of Cbd

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Scott Gagnon: healthcare providers can also learn about some of those potential interactions of CBD with alcohol prescription. And over the counter medications which will, will just help increase.

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Scott Gagnon: You know, skills around being able to provide good advice around those things. Educating patients on the potential risks and harms associated with CDB use. including interactions with prescription drugs

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Scott Gagnon: dietary supplements alcohol, and illicit drugs.

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Scott Gagnon: So for parents, caregivers, and the general public. So, one thing we can do, and and particularly, I think.

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Scott Gagnon: for those coalitions and entities that are doing education with, with children is talk about risks and harms of using

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Scott Gagnon: products that contain CBD. Now, I don’t know. This is necessarily like a universal strategy. So, you know, kids who are not aware of CBD products, I don’t know. We know that we need to go out of our way to address that. I think it, it really could be more of a targeted thing like if we are aware of

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Scott Gagnon: students that are maybe bringing product. I mean, I don’t know if that’s allowed to bring over the counter products

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Scott Gagnon: in schools or not. That may be a case by case basis. But

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Scott Gagnon: but I think again, not necessarily universal program. But where we do know that there’s CBD products being used either within a family or certain certain youth. It’s it’s just, I think, an opportunity to do to have those discussions, to make sure there’s understandings about what the

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Scott Gagnon: risks and harms can be around that. and then I think, generally not allowing children to use over the counter.

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Scott Gagnon: CBD use again getting past the fact that just because it doesn’t make you high doesn’t mean there aren’t other implications for it. As we’ve discussed so far in the Webinar

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Scott Gagnon: consulting a health care provider before using any

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Scott Gagnon: CBD products. So I think as much as we can courage that even though these are over the counter products and are widely available

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Scott Gagnon: in stores and a lot of different venues, like encouraging. It’s still good

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Scott Gagnon: to talk with providers and have discussions about these products because of the potential drug interactions and other

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Scott Gagnon: kind of health effects.

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Scott Gagnon: Having an awareness at the risk of CBD products containing Delta 9 or Delta 8 THC is still unknown, and that use of these products could impact

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Scott Gagnon: employment drug screening as we talked about before.

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Scott Gagnon: So, I think that’s an can be an important educational piece again, especially with adults, right? And and young adults who are

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Scott Gagnon: either in employment or looking for employment. We know, maybe using some of these products. I think it’s just a

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Scott Gagnon: good opportunity just to make sure there’s some awareness about that. Potentially, there could be enough THC to pop up a drug screening test. So, I think

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Scott Gagnon: informational opportunity there

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Scott Gagnon: and then to encourage not the, or to discourage the concurrent use of CBD medications, alcohol and illicit drugs again, because of the knowns and the unknown. So, it’s really against having a kind of risk averse

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Scott Gagnon: approach to that.

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Scott Gagnon: So, the FDA does have a website and you’ll get the slides. So you’ll have a link to this. If if it’s something that’s helpful for you.

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Scott Gagnon: But for the FDA, it is helpful for them to get reports for folks who do experience adverse events related to a CBD product, not so much in a sort of

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Scott Gagnon: punitive kind of way, but I think this helps them gather information.

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Scott Gagnon: To just have a more clear, robust understanding of these products and what they’re doing.

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Scott Gagnon: And some of the various health effects. So, it just kind of helps build the evidence base for it.

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Scott Gagnon: So, I just want to thumb through a couple quick resources from PTCS. This is more broadly with, with terms of cannabis. Not necessarily CBD specific, But just so you’re aware of some of the things that we have

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Scott Gagnon: of our PDC. And then we’ll go to some

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Scott Gagnon: some Q&A. So, we do have at our New England PDC, a cannabis sort of library which we call focus on cannabis prevention, and has a lot of different

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Scott Gagnon: resources resources available there. Such as tool kits. Some national resources,

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Scott Gagnon: recent journal research articles, social media kits and posts related to different prevention, data and information. Really, the cannabis and, and some other

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Scott Gagnon: resources. There we have a couple micro learning cert series that we developed. One is specific to vaping, and

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Scott Gagnon: more cannabis prevention. And so, what they are, they’re short videos or like 5 to 7 min videos.

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Scott Gagnon: It has a couple like content questions at the end. So, these can be helpful for yourself.

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Scott Gagnon: You wanna learn about more about some of these different topic areas. But it can also be helpful for maybe coalition members or other partners who don’t have the time, maybe to sit through long to longer webinars, but still a good opportunity to raise some kind of education awareness amongst different

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Scott Gagnon: populations we’re working with.

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Scott Gagnon: We have a couple of self-piece courses that are on our healthy knowledge learning platform. So, one is a 3 module

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Scott Gagnon: course on canvas pharmacology.

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Scott Gagnon: The other one is on preventing underage cannabis, use looking at risk and protective factors and effective communication.

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Scott Gagnon: And so with that, we have about

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Scott Gagnon: 12 min for for Q&A, and

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Scott Gagnon: so I can. I know you. do you have any. You want me to

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Scott Gagnon: prioritize here.

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Michelle Wagner, NAMI NH (she/her): I do have some questions. Let’s see.

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Michelle Wagner, NAMI NH (she/her): Other than epilepsy, do you know of any other conditions that CBD has helped with?

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Scott Gagnon: So nothing, no nothing has been established through, through the FDA process.

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Scott Gagnon: that’s really the using CBD for, for absolutely. Let’s see, is, you know, there have been different studies looking at things like pain, relief.

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Scott Gagnon: and

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Scott Gagnon: pain. Relief is is one but in terms of like really having a a strong level of evidence behind it. That meets FDA approval. That’s the only one that we have.

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Michelle Wagner, NAMI NH (she/her): What about appetite? Stimulation?

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Scott Gagnon: I think again, I think that’s one that’s being that’s been researched.

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Scott Gagnon: I might actually, I think, for both actually, CBD and THC, they have seen there has been some research into that. It’s just again just trying to be careful about how I say it is that it’s, it’s not. It’s just again, not an FTA

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Scott Gagnon: level of approval. So, it doesn’t necessarily mean that research isn’t happening and that there isn’t some promising

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Scott Gagnon: things emerging or evidence emerging in those areas. We just don’t. We just don’t have the

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Scott Gagnon: the, the, the size or body of evidence really.

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Scott Gagnon: Comfortably, say that it can reliably treat that condition.

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Scott Gagnon: That doesn’t mean that won’t happen. I mean, I know one thing I didn’t talk about

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Scott Gagnon: is there? I mean, folks may be aware that there are. The Biden Administration is looking at potential rescheduling of cannabis

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Scott Gagnon: right now it’s schedule one and that could potentially go to like schedule 2 or schedule 3 that could open up different avenues of research. So,

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Scott Gagnon: I would be surprised if eventually we don’t see other sort of FDA-approved medications. Just we don’t have anything else at this point.

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Michelle Wagner, NAMI NH (she/her): Okay. So being cautious, yeah, yeah, Paula did share with us. It’s not allowed in school as it is not. FDA approved.

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Scott Gagnon: Okay, yeah, I wasn’t sure. I mean, I know

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Scott Gagnon: with THC. It’s pretty clear because that because it is schedule one that’s but with over the counter stuff like in retail stores. I wasn’t as clear on the policy on that.

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Michelle Wagner, NAMI NH (she/her): Robert had gone back to. Your comment about the devil is in the details.

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Michelle Wagner, NAMI NH (she/her): and he just made a comment. We would need to reach out directly to the supplier and hope they are telling the truth.

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Scott Gagnon: Yeah. And you know, I mean then, that I mean, that’s probably not. A bad thing to do is again, if you do. And if

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Scott Gagnon: there is questions about the product, and you’re seeing marketing claims, I mean, I think it’s fair game to

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Scott Gagnon: to ask like, you know, where does this? Where does this come from? And you may have some.

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Scott Gagnon: Some manufacturers may provide that semi-autom. But it’s it’s a good, I mean. Again, it’s a good question to ask. Probably with a lot, of lot, of health products. Not just CBD, but but especially with CBD, just because of how popular it is and how widespread it is marketed.

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Scott Gagnon: I think it’s important to and because of lack of regulation on the marketing. There’s like there’s just really no parameters or guidelines on how

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Scott Gagnon: companies can or cannot or should or should not market. I mean, I’m sure you know, there may be like

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Scott Gagnon: sort of associations of CBD marketers, and, and they may develop amongst themselves some kind of

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Scott Gagnon: guidelines, or whatever, but like from a regulatory standpoint. There’s just really isn’t any good guard rails around that.

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Are they working on that? Are we gonna have some guardrails.

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Scott Gagnon: I mean, I think if you see changes to the Farm Bill Act, and I think if you see changes in rescheduling.

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Scott Gagnon: I mean, I mean, I think if cannabis come rescheduled, I think that’s gonna set off a lot of things. I mean, I think it’s gonna

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Scott Gagnon: and I want to be clear. I’m not advocating one side of the other on on the rescheduling, but just like factually, I think if it were to be rescheduled to either 2 or 3. It does open up things like more research, both

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Scott Gagnon: THC, CBD, And then so, there’s more CBD, so that probably does open up some regulation lanes

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Scott Gagnon: for CBD, we’re looking at more, either. If medications to be approved by FDA or over the counter products the FDA could approve.

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Scott Gagnon: So, so, I don’t know if they’re actively working on. I’m sure they’re actively monitoring whether or not there are going to be any sort of

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Scott Gagnon: changes by Congress to or by the administration to the rescheduling. I’m sure there’s making. I’m sure there’s contingency, contingency plans being made, if and when that happens.

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Michelle Wagner, NAMI NH (she/her): Melissa asked, is it safer to buy from a dispensary.

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Scott Gagnon: I don’t feel

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Scott Gagnon: comfortable saying yes or no to that question again. I hate to say the devils doubles in the te details. I think that the the issue again is with the lack of research on both.

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Scott Gagnon: And again, when I say research, I’m really talking about like clinical research.

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Scott Gagnon: There’s just a lack of

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Scott Gagnon: that, both on the in the over-the-counter space and the State, and what’s being sold sold in

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Scott Gagnon: state regular market, I would hesitate to say safer. It’s potentially, you know, potentially, there’s more information available. But again, it’s going to depend on state by state. I don’t know enough about New Hampshire’s

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Scott Gagnon: policies that’s weigh in on, and that is someone

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Scott Gagnon: on the call who can speak to that. I would I would defer to them. But

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Scott Gagnon: yeah, it’s hard for me to say it’s safer. But, but that same token, I’m also not gonna say

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Scott Gagnon: I can’t say it’s more dangerous to use one versus the other. It’s

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Scott Gagnon: you know. I should say also be I mean, in a State dispensary there can be more THC because

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Scott Gagnon: products through state regulated dispensaries are are gonna be plant whole drive from the plant. So, you know, the FDA epidia, Alex said. It is pure. THC, it’s not plant material. The CBD is being extracted and derived from cannabis, and you’re talking about pure CBD and that medication.

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Scott Gagnon: whereas products in a dispensary are coming are processed plant material. So, naturally it is going to have a mix of CBD

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Scott Gagnon: and THCs. Now, some products are intentionally

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Scott Gagnon: created to have high CBD content and low THC content, and vice versa. So, that’s another important

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Scott Gagnon: distinction with the the state products is

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Scott Gagnon: just by that nature. They’re, they’re more likely to have higher. THC content. Then there’s other risks associated with that. Which we didn’t even really talk about

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Scott Gagnon: today. And then, you know that’s what we could do a whole hour on this there’s in. There’s individual physiology really with THC. And probably with CBD as well. So, the effects that THC has on one individual will be very different

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Scott Gagnon: and another individual. So some, so you could have 2 different people use the same product from the same dispensary.

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Scott Gagnon: at least on the THC side of things we, we expect there could be very different reactions to that.

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Scott Gagnon: We don’t know enough on CBD to say, that’s the case. But likely, it is likely, like there’s some of the risk. The adverse effects that we talked about earlier may be more pronounced in one versus, versus another.

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Scott Gagnon: So, so again, on either side of the coin. I’m, I’m, I’m, I’m using a lot of words to say. I’m not comfortable, saying it’s safer or more dangerous than than over the counter.

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Michael Holt: And, Scott, I did just bring Michael Holt, hey, folks, my name is Michael Holt on the administrator of the therapeutic Cannabis Program in Hampshire. That program is organized in the Department of Health and Human Services Division of Public Health Services. I’ve been working with program, for since it’s inception

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Michael Holt: I can give you my 2 cents in the Time, in the time that we have left, it shouldn’t take long. In New Hampshire, CBD is regulated by DHS. In 2 areas. The first area is food protection, and the second area is where I regulate with the Therapeutic Cannabis Program. With regard to food protection, New Hampshire adopts the Federal food code, and CDB is not an approved food additive.

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Michael Holt: So, in New Hampshire, CBD is not allowed in food products, and we do enforce that in jurisdictions that the State has enforcement authority over, but because there are many self inspecting towns and cities outside the State’s jurisdiction. Enforcement in name may not be consistent across the entire state. But in areas where we regulate food and food products, we do not allow CBD in those food products. But, as a Scott has said, you know it. It is the

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Michael Holt: FDA’s purview to regulate supplements, dietary supplements health supplements and whatnot. And, and CBD, you know, mysteriously remains outside those classifications as well. So, the second area that DSH regulates is in Therapeutic Cannabis

Program. We’ve got about 14,000 patients. You have to residents enrolled in that program.

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Michael Holt: Right now. there are 3

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Michael Holt: what we call alternative treatment centers or ATCs. That’s the name that New Hampshire providers give to the, the can’t Therapeutic Cannabis Dispensaries. So ATCS, we regulate those entities strictly, and

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Michael Holt: all 3 of the ATCS that are licensed here in New Hampshire do provide and offer CBD products to patients and obviously only register patients can access those dispensaries.

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Michael Holt: but all of them provide CBD products, all of the Cannabis. That is, that is sold in New Hampshire. From those dispensaries is produced in the in New Hampshire. Those 3 companies are vertically integrated, which means that they cultivate manufacture and dispense on their own they’re allowed to sell amongst each other. But they can’t, you know, get external CBD from

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Michael Holt: industrial hemp. None of the ATCS grow hemp. All of the CBD products are created from the

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Michael Holt: cannabis plants. And they are extracting the CBD from the plants to make products. They do offer strains of cannabis or flour that are available that have higher levels of CBD and other cannabinoids, and lower levels of THC, as product offerings and they have many, many rate what we call ratio products, where, so say, you buy a

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Michael Holt: a fruit chew or a tincture that has a ratio of 2 to one THC to CBD, or vice versa. But the point that I wanted to make, and what I wanted to jump in on it’s not a question of saying yes, it is safe or no, it is not safe.

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Michael Holt: But I wanted to offer that. All of the products, you know sold at the New Hampshire Dispensaries are under strict testing requirements. For potency contaminants, and strict labeling requirements. So, the issues that you get for over the counter CBD products, where you don’t know what is in them. You don’t know. You know the the levels. If there’s TCH in, in them where you don’t know

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Michael Holt: what the contaminants are, or you don’t know if you can trust the manufacturer. Those issues are not issues that we see here in New Hampshire, because we closely regulate those products here for contact. So, if you have more questions about this webinar, contact me. But if you have some.

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Scott Gagnon: What do you need? Do you think we can help you? Could you reach Scott? Scott, me Erin or Sarah for for that? So, I just want to thank everyone, and I think, Michael, for talking about the program. I definitely don’t have a lot familiar with this. I’m really glad you chimed in with that important information.

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Michelle Wagner, NAMI NH (she/her): Well, thank you all for joining us today.

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Michelle Wagner, NAMI NH (she/her): Just a reminder, a recording of to day’s discussion will be posted on the education page of OnwardNH.Org. You will receive an email in the next couple of days which will include links for the website along with the evaluation.

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Michelle Wagner, NAMI NH (she/her): Once you’ve completed the survey, you’ll automatically receive a certificate of attendance for questions or comments. Please

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Michelle Wagner, NAMI NH (she/her): reach out to me at MWagner@NAMINH.org, and we look forward to seeing you on October 26th, when we talk about helping someone who doesn’t want help. The IEA process until then. Thank you. Scott, Gagnon and Mike for hopping in Karen Prevay. Take good care all bye, bye.

CBD: What You Need to Know in the Era of Commercial Cannabis

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