Veterinarian Discussion of Cannabis Within the Veterinarian-Client-Patient Relationship

1) California Veterinarians- On September 27, 2018, Governor Edmund G. Brown Jr. signed into law Assembly Bill 2215 (Kalra, Chapter 819, Statutes of 2018). AB 2215 became effective January 1, 2019. This bill amends section 4883 of, and adds a section 4884 to, the BPC relating to veterinarians. The bill prohibits VMB from disciplining, or denying, revoking, or suspending the license of a licensed veterinarian or licensed veterinary professional solely for discussing the use of cannabis on an animal for medicinal purposes, absent negligence or incompetence.

2) Industrial Hemp: Under federal and state law, hemp is not a controlled substance regulated under the Uniform Controlled Substance Acts and is not regulated under the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA). Rather, industrial hemp is regulated by the federal Department of Agriculture and the California Department of Food and Agriculture.

3) Documentation of discussions should include the indication and safety of the use of cannabis.

4) Conflicts of Interest: A veterinarian registered veterinary technician (RVT), or veterinary assistant controlled substance permit (VACSP) holder may be disciplined for the offer, delivery, receipt, or acceptance of any rebate, refund, commission, preference, patronage dividend, discount, or other consideration as compensation or the inducement for referring patients, clients, or customers to a cannabis licensee. The cannabis licensee is any company that has the license to do business within the cannabis industry.

5) The Board is authorized to discipline a veterinarian who accepts, solicits, or offers any form of remuneration from or to a cannabis licensee if the veterinarian or his or her immediate family has a financial interest with a cannabis licensee.

Reference: https://vmb.ca.gov/forms_pubs/cannabis_discussion.pdf

The Hype and Hope of Veterinary Cannabis

Is there research supporting that use or underlying any of the claims made for the scores of cannabis and cannabinoid-based products marketed for pets? Does a practitioner who recommends such a product for a patient risk discipline from the state licensing board, the Food and Drug Administration, or the Drug Enforcement Administration? These were just some of the thorny issues covered during the first-ever AVMA Cannabis Symposium, held Aug. 20-22 during the AVMA Virtual Convention 2020.

1. "We certainly recognize the potential opportunities that cannabis-derived compounds may offer and acknowledge the significant interest in these possibilities,” said symposium speaker Randall Gnatt, a senior regulatory counsel in the Office of Surveillance and Compliance in the FDA’s Center for Veterinary Medicine.

2. California is the only state to specifically address veterinarians’ ability to engage with clients, indicating that veterinarians can discuss the use of cannabis for medical purposes with clients without being disciplined by the veterinary medical board solely for having that conversation. By that same statute, veterinarians are prohibited from prescribing, dispensing, or administering any cannabis or cannabis-based products.

3. “We don’t know about coadministration with other medicines or risks to vulnerable animal populations. This doesn’t mean that we know CBD is categorically unsafe under all circumstances, but given the gaps in our current knowledge and the known risks that have been identified, we’re not at a point where we can conclude that CBD products are safe for use.”

4. In 2019, the AAVSB surveyed state veterinary licensing boards about whether it is legal for a veterinarian to discuss cannabis with a client. Jim Penrod, executive director of the American Association of Veterinary State Boards, said the association recently contacted those boards to determine whether they were still comfortable with the answers they gave in the 2019 survey, and several changed their answers. Responses varied... Six states said veterinarians could lose their license if they even talk about cannabis; four said veterinarians need to adhere to federal law; seven said state boards can’t provide legal advice; seven said they have no formal opinion on the matter; two said veterinarians could talk about cannabis but only if the client starts the conversation; 18 responded that veterinarians could discuss cannabis but could not prescribe or dispense it; and four said veterinarians could discuss the topic.

5. Several speakers support the need for regulation and transparency. Dr. Hazzah, founder of the Veterinary Cannabis Society, cited a 2015 study that evaluated 75 edible cannabis products available in various California cities and found that just 7% of the products were accurately labeled for the cannabinoid content. In a follow-up session, Jack Henion, PhD, professor emeritus of toxicology at Cornell University, also conveyed results of a similar study where 12 of 13 animal products had greater THC levels than acceptable limits. “It is important that clients do their due diligence and ask for a certificate of analysis,” said Dr. Hazzah.

Reference: https://www.avma.org/javma-news/2020-10-01/hype-and-hope-veterinary-cannabis

The Current State of Cannabis Research in Veterinary Medicine

1. All medical cannabis is derived from Cannabis sativa L. Legally speaking, cannabis plants that naturally produce greater than 0.3% tetrahydrocannabinol (THC) are considered to be “marijuana” and are federally illegal.

2. Medicinal hemp plants contain relatively large amounts of CBD, which, while legal, is regulated by the U.S. Food and Drug Administration (FDA).

3. As with any other nutritional supplement, the FDA is watchful to ensure products do not make “drug claims” or are otherwise suggesting their product is a pharmaceutical. This landscape is responsible for the unusual terms sometimes seen on products, such as “phytocannabinoid rich (PCR) oil,” “hemp extract,” and “full extract cannabis oil (FECO).”

4. One constant in botanical medicine is that medicinal plants rarely, if ever, contain only one biologically active compound. Cannabis plants produce a wide range of phytochemicals including phytocannabinoids and terpenes. Phytocannabinoids are plant-based compounds that act on endocannabinoid receptors throughout the body.

5. To demonstrate safety, the CSU study administered oral CBD to dogs at 10 mg/kg/day or 20 mg/kg/day for 6 weeks and found it to be well tolerated in the study population. More than one-third (36%) of animals in the study showed elevations of serum ALP (alkaline phosphatase level) while all other blood parameters remained normal. The elevation in ALP could indicate CBD has the potential to interfere with the metabolism of other hepatically metabolized pharmaceuticals.

Bonus: The first data for veterinary-specific use of CBD for seizures were evaluated and published in 2019. Seizure frequency of dogs was evaluated with and without the use of cannabidiol in conjunction with other drugs. The study showed a statistically significant 89% reduction in seizure frequency in dogs receiving CBD at 2.5 mg/kg q12h compared to a 43% reduction in the control group. Both study groups were concurrently receiving conventional anti-epileptic drug therapy.No severe adverse effects were noted in the study, and blood levels of anti-epileptic drugs in participants were not affected by the addition of CBD.

Reference: https://todaysveterinarypractice.com/the-current-state-of-cannabis-research-in-veterinary-medicine/