Mary Leigh Meyer: Howdy everybody! Welcome to another episode of sounds like health. My name is Mary Leigh Meyer.
Sam Craft: And I’m her cohost, Sam Craft.
Jayne Reuben: Thank you!
Mary Leigh Meyer: Tell us a little bit about who you are and what you do over with dentistry.
Jayne Reuben: Yes, so I always tell people that I’m a pharmacologist, which means I do drugs in a good way. I am an instructional associate professor in the College of Dentistry and the Department of Biomedical Sciences, and I’m also director of Instructional Effectiveness here at the College of Dentistry.
Sam Craft: That is a way bigger title than I would’ve remembered.
Mary Leigh Meyer: Awesome. So, we are going to talk about something we’ve been hearing quite a bit about and I don’t know if I know as much…
Sam Craft: I for sure don’t.
Mary Leigh Meyer: … about it as I should.
Sam Craft: I’m really interested to talk to her about this today.
Mary Leigh Meyer: But CBD oil, I feel like it’s a pretty trendy word I’m seeing around. I just don’t know much about it.
Jayne Reuben: So yeah, so CBD oil or CBD, which is Cannabidiol is actually a component of marijuana. So, there are a lot of different components of marijuana as we think of it. The one that most people are familiar with is the component THC, which is the component that gives you the psychotropic effects that we associate with marijuana. So, CBD is another component, but it does not have those same psychotropic effects.
Mary Leigh Meyer: Okay. So THC is what people typically think of when they think marijuana?
Jayne Reuben: Yes. So they think that it’s… THC stands for delta-9-tetrahydrocannabinol, or the name is THC, and that’s what most people think about because they think about it as a particular substance of abuse.
Mary Leigh Meyer: And so, what makes CBD oil different?
Jayne Reuben: So, first of all, CBD oil is a different structure when you look at the chemistry, and it doesn’t have the same effects. It doesn’t get you high, as THC containing compounds would, and it doesn’t seem to work through the same mechanisms as THC when we look at its effects on the body, and specifically on the nervous system.
Sam Craft: So, the difference… and again, I’m just a little ignorant to the subject, so please pardon the questions that I’m going to have for you today.
Mary Leigh Meyer: That’s why we’re here, to ask questions!
Sam Craft: When you talk about the good side of marijuana, meaning the THC or the CBD oils, is that correct in saying that? I mean, what’s the medical benefit of CBD oil?
Jayne Reuben: So, why people are using CBD oil, there are a couple of reasons why people are using it. Some people believe that it does give them some pain relief. There’s data that actually supports that CBD has anti-inflammatory properties and there are some experiments that have been done that have actually shown that on the skin. So, it may have potential pain relief in the use of arthritis. But what I will say is right now we do not have sufficient human data to support a lot of the indications, or the reasons why people take CBD.
Mary Leigh Meyer: Okay, it doesn’t give them necessarily the stereotypical high, but they take CBD oil, do you think, to try and achieve those… you know, really for their arthritis, or is there another reason that people are talking about it, using it?
Jayne Reuben: So, a lot of people talk about it. It has been used in the past, for many years, to treat mild anxiety. And again, this is what we call an over-the-counter supplement use. There really is only one prescription drug that contains CBD that has been approved by the FDA, and it’s actually used specifically to treat a severe form of epilepsy. So, that’s really the only drug, at least to date, that’s been approved by the FDA, and it has a very specific use. But people are using CBD, one, because it doesn’t have those psychotropic effects it, it may have some anti-inflammatory… Well, we know it does have anti-inflammatory properties, it may decrease anxiety. And one, when you go back to talk about the anti-inflammatory properties, there are a lot of an anti-inflammatory disorders that people can have where they think it might be useful. But again, we do not have sufficient human studies yet.
Mary Leigh Meyer: Okay. So, what does anti-inflammatory mean for the everyday person?
Jayne Reuben: Okay, I guess the easiest way to tell you, to show you over the radio is, if you actually took your finger nail and scraped against your hand and you scraped hard enough, you’d actually see a kind of redness appear. And so, when we have an inflammation or inflammatory response, that’s actually a normal response to either an infection or an injury to ourselves. And so, this is part of the body’s innate immune system that is ready to go and to keep us well. So, before you can form antibodies that take a little bit longer to form, your innate immune system is the system that’s ready to keep you healthy and help prevent you to have infections.
Mary Leigh Meyer: Okay. So it doesn’t necessarily relieve pain, per se, but more the inflammation. I’m thinking of the over-the-counter pain medicine, that’s an anti-inflammatory, it’s not quite that, it’s a little bit different?
Jayne Reuben: Okay. No. Actually, when we look at the concept of inflammation, there are actually four parts of inflammation, and pain is one of them. And so, there’s heat… a classic inflammatory response will include redness, swelling, heat and pain. Okay? And if it continues and is not checked, you can start to see a loss of function, or destruction to either cells or tissue, or loss of function in that particular organ. So inflammation, when we talk about the classic response, actually includes pain.
And so, a lot of the anti-inflammatory medicines that we use are specifically targeting inflammatory pain. So, pain that’s due to an inflammatory process. And so, when we compare things like acetaminophen to ibuprofen or aspirin… That’s why we call aspirin and ibuprofen, they’re in a class called the N-S-A-I-D or NSAIDs, and then we have acetaminophen, which is not in that class because acetaminophen can treat pain, it can treat fever, but it does not treat inflammation. And, it works in a different way, and that explains why it doesn’t treat inflammation like ibuprofen or aspirin.
Mary Leigh Meyer: Okay. So, does CBD oil have any other different properties?
Jayne Reuben: So, the anti-inflammatory property is also related to what we think is its antioxidant property. And so, what we know is that some of our inflammatory disorders, and even some of the damage that occurs to our tissues, can occur due to the increased amount of production of reactive oxygen species. And these are just molecules that are very reactive, and they basically can bind to different components of our cells and then cause cell damage. And, when we have a lot of these reactive oxygen species produced, it overwhelms the innate system that we have that is supposed to help clear them.
They are normally produced in our metabolism, so every day we’re producing these, but it’s the amount that is formed that is really important. And so, I think the classic example is when we look at skin damage from tanning or sun exposure, one of the things that people think about that you hear a lot about reactive oxygen species in anti-aging creams. And again, the issue is, are we causing damage to our cells? Are we causing dysfunction to the systems that help repair our body?
Mary Leigh Meyer: Okay. So, is there any research connecting CBD oil to those antioxidant properties and the cell rejuvenation?
Jayne Reuben: Yes…
Mary Leigh Meyer: Is that the right word for it?
Jayne Reuben: Well, I’ll say cellular repair.
Mary Leigh Meyer: Cellular repair.
Jayne Reuben: And so, there is some data, but again, there’s so much limited… A lot of it is animal data, or what we call in-vitro data where you’re working in a Petri dish with cells. And so, there is not a lot of human data yet that would lead the FDA to approve some of these components as prescription drugs. And so, what I would like to also say is that when you compare prescription drugs to what we call supplements or dietary nutrients, a lot of these supplements, dietary supplements or herbal remedies, they don’t experience the same kind of stringent review that the FDA would give a drug that’s designed to be a prescription drug. And so, any drug that’s going to be a prescription drug has to show two main characteristics.
They have to prove that the drug is effective and the manufacturer also has to prove that the drug is safe. Okay? So, when you talk about any kind of supplements, so all of these things that you buy over-the-counter or you buy at some of these popup shops, those formulations of whatever it is, and it includes CBD oil, will not have that review. So, you don’t know how much of the ingredient that you’re interested in is actually going to be in that particular oil that you get.
Sam Craft: So, just asking you about maybe like what are the benefits and drawbacks of using CBD oil from an oral health perspective? Since you’re in dentistry up there, so I know that that’s a big part of your work.
Jayne Reuben: So, I would say first of all in general, CBD I would say is probably one of the safer supplements that you can find. But one of the concerns we’re always worried about is with the potential to actually interact with prescription drugs. Okay? So, depending on what other medications someone might be on that can also impact oral health, then CBD, the component itself, can actually interact with those drugs and change the levels of those medications, where the problem might not even be CBD directly, but it’s the CBD effect on another compound. So, as far as oral health, there are a couple of websites that you can look at to find out more about its particular indication. There’s some people who think that because of its anti-inflammatory properties, it could potentially be prescribed either as a complimentary medication for gingivitis… It does help, as we say, for people who may, like me, experience dental anxiety. So, it can be helpful for that possibly.
Sam Craft: So yeah, just a quick side note, dental anxiety. Can you explain that to me?
Jayne Reuben: Those are individuals who have anxiety about going to the dentist. And I hope you don’t make me lose my job because of…
Sam Craft: No, no, no. I think that’s everybody on earth. Nobody knew what that was called until just now.
Jayne Reuben: I think the dentists knew, no one else knew. But there is a caution, so again, this is something with the CBD oil, it’s something that you always have to have caution with because you don’t have right now a government agency that’s regulating it, like the FDA. And so, here’s the other thing to remember is that when we think about marijuana, even though it’s becoming legal in several states, when we look at marijuana on a federal level, it’s still what we call a Schedule 1 drug by the DEA, which means technically it has no approved medical use.
And so, that’s something to keep in mind. I think I was reading the other day about maybe a law that may have passed in Massachusetts that now is going to make it a little more difficult and challenging for people to even get access to CBD oil. Now, here in Texas we’re starting to see a lot of, as I said, these little popup shops. They really are popup shops because they’ll pop up and then if there starts to be some problems, they’ll disappear. We’ve seen that with…
Mary Leigh Meyer: Yeah, I thought I heard something about a coffee shop in Houston that was a CBD oil coffee shop, or something along those lines. I was surprised at it.
Jayne Reuben: I haven’t seen anything like that here yet in Dallas, but I think maybe this weekend when I’m driving around I’ll probably look around to see if I can see anything.
Mary Leigh Meyer: What are some things everyday patients should consider before taking CBD oil?
Jayne Reuben: Okay, so these are the same things I would think about taking any kind of supplement, is first and foremost you want to discuss it with your physician or your primary care provider, whoever that may be. I would also encourage everyone to educate themselves. Whenever anything new comes out, and this is another new kind of fad, everyone runs to take it, but I think fewer people actually take the time to really read up about the new supplement or fad that’s in practice. And so, I will always encourage my family members and friends who ask me information about medications is to one, I’m a source, but there are a lot of online sources that you have available to you.
I mean, the National Institutes of Health has wonderful information for a lay public, a lay audience just like they have information for health care providers. They have these wonderful websites that will give you as much information almost as you could ever want to find on almost any particular health topic that they study. And then we also have this national center that is devoted to complimentary alternative and integrative health. And, on that website you can actually see a list of things like herbs and supplements, and also there are plenty of links there to information about cannabis in general, and CBD and CBD oil formulations in particular.
Sam Craft: So, we’ve talked about the CBD oil and its drawbacks and benefits and all this stuff. We haven’t really talked about how people are actually taking this oil, is it absorbed in the skin, is it taken orally? How does that work?
Jayne Reuben: Some people do ingest it, and they usually will ingest it if they’re doing that, they’re trying to ingest it usually for a variety of reasons, but it can also be effective for nausea. The cannabinoids have been used for very long periods of time for the treatment of nausea and vomiting. For the CBD oil specifically, most people are ingesting it or putting it on the skin. We do not recommend, you should not be vaping it or inhaling it because the oil formulation can certainly disrupt your breathing function and potentially could lead to an oil or lipid pneumonia that people could suffer from. So, you should not be inhaling the CBD oil.
Mary Leigh Meyer: That’s crazy. But CBD oil isn’t legal, is that correct? So is it safe to say people shouldn’t be doing anything with it?
Jayne Reuben: So, it’s not the issue of the legality, it’s the issue of, is this something that’s going to give you a benefit? Why are you taking it? The issue of the legality, I think it’s probably gonna be in flux, right now it is legal for you to have access to it unless…
Mary Leigh Meyer: To use CBD oil?
Jayne Reuben: To use CBD oil. So, I think the states do have laws about it with varying degrees of restriction. But I think right now the federal government still considered it to be pretty much in the same class with marijuana. I think I read some article, the FDA did pass some sort of regulatory requirements to actually allow researchers to conduct CBD research trials. So, you can see that there’s an interest in it, particularly because of its anti-inflammatory properties. Again, it’s already been approved as a prescription drug for treatment of epilepsy. I know that some people use it to treat some of the inflammation and pain associated with multiple sclerosis. And again, this is what we call complimentary medicine or alternative medicine. So again, complimentary medicine is what you use with traditional medicine. So, you might use it alongside with your prescription drugs. Alternative medicine is what you do when you do instead of using traditional, what we call traditional medicine, or what might have been prescribed for you. So, those are different approaches, and so people are using it both as a complimentary compound and as an alternative compound, I feel.
Mary Leigh Meyer: Yeah, that so interesting. I know you referenced it as a supplement earlier and I think that’s something that a lot of our listeners might not quite understand, is that sometimes these supplements can interact with other prescribed medications. Pretty much, your healthcare providers need to know what supplements you’re taking, if you’re doing anything extra. So, what are some types of things that a CBD oil can interfere with?
Jayne Reuben: Okay, so again, when we think about what CBD… how it’s related to marijuana, marijuana itself is what we call a CNS depressant, in that it decreases the activity of our central nervous system. Basically it can decrease activity in the brain. Now, usually the amount of CBD that you get in these oil formulations should not be enough to actually depress you so that you go into a coma. However, they can make you mildly drowsy, depending on how concentrated the CBD is, that particular formulation.
And again, because they’re not regulated like prescription drugs are, which means that when you take a prescription medication that’s a pill, we know almost exactly how much drug is in that pill, as opposed to CBD oil formulations. If you get it from one person, one company, or another store, they might have different concentrations or you can actually get it from the same supplier, but because it’s not regulated and you don’t know who’s testing it, then you can actually get the compound from the same supplier but it’ll have different concentrations of CBD. So, that’s why you always have to be careful when you’re taking these supplements…
Mary Leigh Meyer: That’s so true.
Jayne Reuben: And so, because a formulation of CBD has been approved for the treatment of epilepsy, so then, potentially we already know CBD can interact with some of the drugs that we use to treat epilepsy and modify their levels, and potentially increase its levels. Some of the antifungal drugs that we use, we know can increase the levels of other medications. And so, if you’re taking an antifungal drug like ketoconazole, it has the potential to increase the levels of other medications and supplements that you’re already taking. So, there is the potential for those types of what we call pharmacokinetic interactions. And pharmacokinetic just means what the body does to the drug and how it processes the drug, how it eliminates the drug from your body.
There are also people who are taking Warfarin, which is a blood thinner, need to be very careful with anything that they take. So, one thing we know is that you have interactions with prescription drugs with other prescription drugs. You can have interactions with prescription drugs and supplements, and you can also have interactions with prescription drugs and even some of the foods that you eat. And Warfarin is one of what I would call a problem drug, in the sense that it has a lot of drug interactions. You also have to watch what you eat many times when you’re taking that particular medication. So again, it really just depends on what you’re taking, as to whether you have an interaction, but that also means it’s very important for you to be well-educated about anything that you ingest or put on your body. And to be very honest with your health care providers about what you are taking.
Sam Craft: With CBD, is there the potential to help reduce the reliance on opioids for people that are, I say involved in opioids, I’m not sure what the correct term is nowadays.
Jayne Reuben: So, we call it opioid use disorder. So, with the opioid crisis, there’s obviously been a lot of discussions on a local, state and national level. I actually just came back from the opioid education workshop that was held in Washington DC area. It was a workshop that gathered stakeholders, particularly those who are educators, medical educators and dental educators, to discuss how are we going to talk about opioids in our curriculum, what can we do to better educate our healthcare students? And again, the issue with the opioid crisis is what it’s led to, and we actually heard some of the healthcare providers say this at the workshop, is that people may be very hesitant, clinicians may be hesitant about prescribing opioids even when they are warranted.
Now, what I will tell you is that the ADA actually already has some stated guidelines about opioid prescribing. And with a lot of the procedures that occur in dentistry, for the most part, you’ll see opioids prescribed for an acute condition, which is a shorter-term condition, as opposed to a chronic, which is a long-term condition. And so the general guidelines are, let’s try other analgesic medications, or analgesic, meaning pain-relieving medications, before we try opioids. And again, the reason for this is that for some individuals it may only take a few days, five to seven days, where they can start to develop a dependence.
And so, there are a lot of steps that led up to the crisis that we’re experiencing. And it’s very important for us to actually educate our health care providers because there are instances when patients will need opioids, when the pain is severe enough that they will need them, and they are very effective. Again, it’s a balance to understand, one, only prescribed the number of pills that the patient will actually need as opposed to overprescribing opioids, which has been done in the past and sadly does continue to happen today.
Mary Leigh Meyer: You know what though, Dr. Reuben? It makes my heart so happy that everyone over at the College of Dentistry is informed about all of the opioid issues and the opioid crisis. It makes me feel… you know, we have this huge problem, but we all definitely see what’s being done about it. Now I think were about to wrap up. We’re running kind of low on time. Is there anything else you think our listeners should know about CBD oil?
Jayne Reuben: I probably would just say make sure you know… What do you know about the supplier? If you’re going to use it, what do you know about the supplier? How is it tested? Is the product pure? What are the sources where the supplier is going to get the either the hemp, the plant-based sources that the supplier is using? And again, the thing is, is that when people use supplements, sometimes they’re actually prescription drugs within the supplements. And again, because it’s not regulated, you actually may not know what’s in that supplement that you’re taking. And this goes for CBD oil or any other supplement. And so, make sure you pay attention to how you feel before, when you take a supplement, and make sure you’re honest with the health care provider and do your best to live a happy, healthy life.
Mary Leigh Meyer: And I bet even just run it by your health care provider before you take CBD oil, especially with all those specific drug interactions…you just really never know.
Jayne Reuben: Yes. And because of the issues with the formulations you may not even have sufficient amounts, but in case you do have sufficient amounts of CBD that could interact, it’s always best to just be very honest with your health care providers about all the medications that you’re taking that are over-the-counter, any kind of vitamins that you’re taking, any supplements or herbs. That includes teas, because a lot of people drink herbal teas. Make sure you’re honest with all the things and disclose all the other alternative approaches that you’re using to treat your problems.
Mary Leigh Meyer: Good to know. I’m definitely an avid tea drinker over here. So, Dr. Reuben, I think that’s all the time we have. Thank you so much for coming on the show! Both Sam and I learned a lot.
Sam Craft: Yeah.
Jayne Reuben: Thank you for having me.
Mary Leigh Meyer: And thank you all for listening. This has been another episode of Sounds Like Health!