Can Veterinarians Legally Prescribe Cannabis?

On a recent Sunday morning I was hiking with my wife and pups near my home town of Buena Vista, CO.  The ring of my cell phone rudely interrupted the peace and quiet.  Before I could complete my greeting, the frantic gentleman interrupted me exclaiming “my dog just ate all my cannabis edibles , what do I do?”

Welcome to Colorado, land of “420”,”Indica”,”Trainwreck”, “Gorilla Glue,” “Double Fudge CBD Cookies”, and “Mountain High Suckers.”

Nationwide, marijuana related pet poisonings are reported to be on the rise. Marijuana exposure happens when pets inhale second hand smoke, ingest “edibles” (cannabis candies and foods) or the owner’s stash in any form.   

Cannabis poisoning in it’s most severe form can cause seizures, coma and death in your pet. Less severe symptoms include dilated pupils, depression or hyperactivity and vomiting.  Also seen are excessive vocalizing, dribbling urine, falling asleep while standing and disorientation.

Clinical signs can develop within minutes to several hours after inhaling or ingesting  the product.

The gentleman cited in the opening paragraph had left his cannabis edibles on the counter.  While he was taking a shower, the dog “counter-surfed” and ate three remaining double fudge cookies and the packaging material.  This presents a potential triple pronged medical situation as the cannabis, the chocolate and the packaging material are all problematic.  There is no specific antidote for cannabis toxicity.  Treatment involves induction of vomiting to empty the stomach.  Activated charcoal can also be administered to help prevent absorption. Hospitalization, supportive care and monitoring of vital signs follows.

Because marijuana toxicity can resemble other types of toxicity such as antifreeze poisoning, it is very important for the owner to give complete and accurate medical history.  While some people may worry about being stigmatized by their veterinarian, rest assured that they are not there to judge you.  They are also not obligated to report the incident to the authorities.  Be up front with your veterinarian about what and how much product your pet was exposed to.    This will ensure a proper treatment plan and increase the chance for a successful outcome.  It will also lessen the financial burden on you as your vet will not have to perform extraneous and expensive tests trying to determine the cause for your pet’s symptoms.

Medical Uses of Cannabis in Humans

An often cited and accepted use of marijuana is in the treatment of chronic pain from whatever cause, be it arthritis, back pain or cancer.  It is also effective in the treatment of nausea induced by chemotherapy.  Anecdotal reports suggests it may be effective in treatment of multiple sclerosis, epilepsy, IBD, fibromyalagia,  PTSD,  sleep apnea, dementia, glaucoma and even cancer.  In fact the internet is replete with effusive claims regarding the positive benefits of cannabis.

Because many states now allow the use of medical cannabis in humans, people come to their veterinarian and ask if the same option is available for their pet.

CVMA Position on Cannabis and Cannabis-Derived Products in Companion Animals

The scientific data on the medical and therapeutic benefits of marijuana and its derivatives in animals is limited and anecdotal at best.  The Colorado Veterinary Medical Association (CVMA) recognizes that the general public and practicing veterinarians have an interest in garnering more information about the potential benefits and side-effects of marijuana in companion animals.  Veterinarians in the best interest of their patients have an obligation to become informed about this issue and pass their knowledge onto their clients.  A recent seminar on marijuana issues at the 2017 CVMA conference was well attended by veterinarians.

Veterinarians recognize that companion animal owners are researching and asking about the use of cannabis derived products for their animals.  They are also giving such products to their pets because they are frustrated by the lack of results obtained by conventional therapies.

By federal statute marijuana is classified by the DEA as a Schedule 1 Controlled Substance. It is ILLEGAL for veterinarians in ANY state to PPRESCRIBE marijuana and any of its derivatives including cannabidiol (CBD).  Even in states like Colorado where medical marijuana laws allow doctors to recommend the substance, this legality does NOT extend to veterinarians.  No FDA approved marijuana or hemp products for use in animals exist. Recommending unapproved substances puts veterinarians in legal jeopardy.

Still there is a groundswell desire by the public to use these products for themselves and/or their pets.  Due to the legal quandary that vets could find themselves in providing helpful guidance and education is the best course to take.  Any discussion should only happen under a valid veterinarian-client-patient relationship where proper documentation of the conversation can occur.  Here are some key points regarding marijuana:

• cannabis contains over 500 active compounds.
• cannabinoids are the most important compounds.
• tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two main cannabinoids of medical interest.
• THC causes a “high” while CBD does not.
• humans, dogs, cats and all mammals have an intrinsic endocannabinoid system composed of two receptors CB1 & CB2.
• innate cannabinoids as well as THC & CBD interact with these receptors in the nervous system to exert their effect.
• dog brains have higher concentrations of CB1 receptors.  Incoordination will be more pronounced in this species.
• no scientifically proven medical uses exist for THC or CBD in pets.
• positive effects of marijuana in dogs and cats are anecdotal at best.  Pre-clinical rodent studies suggest potential therapeutic benefits.
• pets that have been given marijuana derived products should be closely watched.
• highly concentrated THC products (30% THC) are available from dispensaries and pose the biggest risk for animals that consume them.
• while marijuana and hemp are both Cannabis sativa, they are treated differently by the DEA based on quantity of THC.
• marijuana is the female plant while hemp is the male plant.
• marijuana is high in THC while hemp is not.
• hemp is excluded from the DEA definition of marijuana.
• the DEA recognizes industrial hemp research and its products (ointments, textiles, clothing, etc) as legal in some states.  This protection does not necessarily extend to CBD products derived from hemp.
• many CBD products (i.e. CBD oils) are readily available.  Many are derived from hemp sources grown in Europe and are marketed as nutritional supplements.  They are said to contain beneficial cannabidiols and terpenes with no THC.
• the medical benefits of pure CBD supplements may be less than those obtained from the whole plant.  The “entourage effect” is the name given to the sum total of medical benefits derived from using the whole plant.
• there are no industry standards for purity, concentration, shelf life and labeling of CBD products.  Thus there is no assurance of safety or effectiveness of these products.  You are on your own.

The Future for Cannabis in People and Pets

Consumers will continue to press for legal access to marijuana derived products for themselves and their pets.  As of January 2018, 30 states  have laws broadly legalizing marijuana in some form (medical vs recreational vs both).  Some medical marijuana laws are broader than others.  Again these laws apply to medical doctors, not veterinarians.

With increased availability of product will come increased numbers of pets admitted to veterinary hospitals for emergency treatment.

Attempts to reclassify marijuana from a Schedule 1 to a Schedule 2 drug to facilitate research have failed.

Early in 2018, the DOJ rescinded previously approved policies of the prior administration.  This shifts federal policy from a hands-off to a hands-on approach. It is now easier for prosecutors to enforce federal marijuana laws in those states that had  previously approved it.  How this will effect the industry remains uncertain at this time.

Your best option at this time is to protect your pets from potential harm by making wise and informed decisions.  Your veterinarian is your best source of information.

References:

• https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
• https://www.sciencedirect.com/science/article/pii/S0006322316000457
• https://www.marijuanadoctors.com/blog/marijuana-recommendation-vs-marijuana-prescription/
• https://www.cnn.com/2016/10/21/health/colorado-marijuana-potency-above-national-average/index.html
• https://www.veterinarycannabis.org/uploads/4/3/5/9/43599201/cvma_position_statement_2017-01.pdf
• https://www.leafscience.com/2017/08/28/marijuana-edibles-a-beginners-guide//www.sinsemillagardensco.com/about-us.html
• https://www.leafly.com/news/cannabis-101/sativa-indica-and-hybrid-whats-the-difference-between-cannabis-ty
• https://norml.org/states
• https://www.marijuanadoctors.com/medical-marijuana/
• https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881
• https://www.avma.org/KB/Resources/Reference/Pages/Cannabis-Use-Pets.aspx
• Seminar Notes 2017 CVMA Convention: Medical Cannabis for Veterinarians-Risks & Benefits by Robert J. Silver DVM, MS, CVA