A committee representing Health Canada released a review on the safety and efficacy of CBD. Comprised of nine volunteers, the committee was established in 2019 with four objectives regarding cannabis. Pharmacies in Canada may sell over the counter CBD packaged in a box. But don’t expect Canadian gas stations to sell CBD anytime soon.
Canadian cannabis regulations
Canada legalized non-medical cannabis in 2018, but the country established a medical system as early as 2001. Cannabis sold for medical or adult purposes in Canada is generally regulated under Good Production Practices rather than the Food and Drugs Act. The only exceptions are a small handful of prescription cannabis medicines backed by years of clinical trial data.
Bringing CBD under the Food and Drugs Act allows patients to self-medicate and purchase CBD from general stores. No cannabis retail license would be required to sell CBD. And patients will not need a prescription under the new recommendations. Of course, CBD products should remain unaffected in heavily taxed cannabis stores.
Science for the stakeholders
Health Canada does not have to bring any recommendation into law. Although, the review sustains scientific evidence to allow for the re-establishment of regulatory structures. The committee established ten recommendations, including considerations for pets.
Recently, peer-reviewed literature documenting cannabis has proliferated. The committee acknowledged over 1500 sources of information, focusing predominantly on double-blinded trials, observational studies, and thorough meta-analyses.
Stakeholders might not be pleased with the committee’s considerations, according to the review. “We recognize that while these recommendations may not meet the perceived needs of all stakeholders, we feel that our recommendations strike a balance between safety and accessibility (which are not mutually exclusive of each other).” After all, Health Canada’s 2019 consultations heard opinions from stakeholders in the cannabis health industries and Canadians.
Labels and limits
The cannabinoid profile in non-prescription CBD products must be 98% cannabidiol. And the product must not contain more than 1% THC. The restrictions allegedly prevent intoxication even with a maximum recommended daily intake of 200 milligrams.
Only pharmacies will sell non-prescription CBD if Health Canada adopts the sixth recommendation, which intends to encourage physician accessibility. Unsurprisingly, the committee recommended an extensive list of warnings and instructions for CBD products offered without a prescription. To accommodate the length of these warnings, an insert can be placed in a box containing the CBD product.
Labels on over the counter CBD products should also give clear instructions on adverse event reporting, according to the committee’s recommendations. The insert should also clearly display cannabinoid content, source, method of extraction, and any residual solvents.
CBD Doses, the unknowns, and short-term use
With the evidence available (1), the volunteers failed to assess a specific dose. Instead, the review recommended a 200-milligram maximum daily intake for healthy adults. And only short-term use for up to 30 days was recommended by the committee. Unknowns regarding absorption, chemovar, formulation, and a plethora of factors prevented more specific dose recommendations.
The volunteers greatly worried about the liver and drug interactions. But grapefruits, maca root, and bioflavonoids found in many foods can disrupt similar processes as CBD. And food concentrates are not discussed with the same level of concern.
With that said, herbal CBD products and grapefruits do disrupt the function of certain drugs. And critical drugs affected by CBD and grapefruit might be vital for a particular individual’s heart function (for example.)
Over the counter CBD for Pregnant women, children, pets, LGBQT2+
FAAH, an enzyme inhibited by CBD, plays a significant role in varying hormones. Therefore, CBD will uniquely affect men and women. But the committee clearly noted that their recommendations cannot cover “people who identify as LGBQT2+.” This is purportedly due to a lack of information surrounding gender differences.
Due to a lack of evidence, the committee could not recommend CBD for children or pregnant women without a prescription. Of course, individuals with underlying medical conditions should consult their doctor or physician. And the review cautioned people attempting to medicate pets with CBD. Although, a body of evidence does support the use of CBD for dogs experiencing pain as long as there is a veterinarian diagnosis of osteoarthritis.
MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19. doi:10.1016/j.ejim.2018.01.004