The important role of pharmacists and medicinal cannabis

The role of pharmacists is as important as prescribers. Pharmacists discuss the risks of a drug with patients and help to minimize drug harm. They also provide information about safety, effectiveness and side effects.

As a pharmacist Salma Boudhan dispenses cannabis flos, and oil extracts (with CBD and THC) for named patients throughout the Netherlands. She dispenses high quality whole cannabis oil, including CBD oil Bedrolite®, for sublingual use since 2015. A typical patient arriving at her pharmacy are those suffering from cancer pain, nausea and vomiting, neuropathic pain or epilepsy.

What is the safest cannabis oil and CBD oil dose?

“In accordance with their doctor’s prescription, we suggest that patients start low and go slow. As a starting dose for oil (e.g. Bedrolite®), we recommend to use two drops (0,05ml) under the tongue, three times a day and increase the dose until the desired effect is achieved. The maximum dosage is ten drops (0,25ml), three times a day.

The ‘steady state’ concentration of THC/CBD and the active metabolite is reached after one or two weeks. This time span should be taken into account for the assessment of the medicines effectiveness for the patient.”

What is your dosing advice on vaporization?

“We recommend patients inhale one or two times a day until the desired effect is achieved or until (psychotropic) side effects occur. This means they have had too much. Per inhalation, we recommend patients wait at least five minutes between the inhalations.

Patients should take into account that inhaling cannabis results in a higher uptake than when using other administration routes. Patients have to dose carefully when changing to a different variety, especially if they have previously used cannabis with a lower content of THC/CBD.

The ‘steady state’ concentration of THC/CBD and the active metabolite is reached after one to two weeks. Like oral dosing, this time span should be taken into account for the assessment of the medicines effectiveness for the patient.”

Does cannabis interact with other medicines?

“We know that cannabis is metabolised by CYP450 enzymes. When taken together with other medicines metabolised by the same enzymes, there may be the potential for drug-drug interactions. We discuss with patients about the risk of using such medicines concurrently, or recommend alternative medications.”

What are the actual and potential complications with medicinal cannabis?

“The biggest risk is getting high and triggering psychoses (especially with psychiatric patients) or worsening current depression. There are risks in prescribing in the elderly, and the potential long-term effects on children are still unknown.”

What are the key risks of patients who have other conditions, and are using cannabis as a therapeutic product?

“The only known contra-indications include schizophrenia, arrhythmia and other heart conditions. We work closely with prescribing doctors and also provide adequate instructions to patients about the benefits and risk of their medicines.”