Best practices for selling CBD and incorporating it into your practice for patients
Nearly a third of all people use CBD products and tend to prefer non-traditional therapies that are becoming more mainstream such as chiropractic. When considering selling CBD, as you see patients you have a great way to introduce them to CBD therapy and guide them to results that will reduce their pain and bring them back to health as soon as possible.
CBD origins and why quality matters
Cannabidiol is a single component of the cannabis plant widely known to have pain-relieving and other health benefits. It is one of over 80 cannabinoids that help reduce anxiety and inflammation.
The chemicals within the cannabis plants, particularly CBD, stimulate the endocannabinoid system, endogenous lipid-based retrograde neurotransmitters binding to cannabinoid receptors, expressed throughout the central (CB1) and peripheral nervous system (CB2). CBD doesn’t appear to bind to these receptors but seems to work by preventing the breakdown of the natural endocannabinoids anandamide (AEA) and 2-arachidonoylglyerol (2-AG).
The cannabis plant contains over 400 cannabinoids, terpenes, flavonoids, lipids, and the most famous cannabinoid: delta-9-tetrahydrocannabinol (THC). Most cannabinoids do not produce as strong or effective an interaction with the endocannabinoid system as CBD, and CBD has no hallucinogenic effect.
The other potent chemical within the cannabis plant is THC, which is the hallucinogenic component and still illegal. Fortunately, strains of the cannabis plant that are commercially and legally farmed for CBD contain low levels of to zero THC.
CBD and contaminants
That doesn’t mean all CBD products are pure and free of contamination. Under selected studies, various CBD products were tested for the concentration of CBD and other cannabinoids, including THC. Many products did not contain the CBD listed, with some barely containing 5% of the stated value.
Additionally, when legally selling CBD products, the product must contain less than 0.3% THC. Over half contained levels of THC much higher than this, some going above 10%.
If you are considering using CBD products, or you already are, be sure to obtain the quality control data that is legally required to be available with all products to guarantee the levels of CBD and THC within your product. There could be dangerous drug interactions for many of your patients, as CBD and THC interact with medications for pain, cancer, arthritis, seizures and blood pressure.
CBD is metabolized in the liver by the cytochrome P450 enzymes, specifically the CYP3A4 enzyme. Nearly 60% of clinically-prescribed drugs, including methotrexate, are metabolized by CYP3A4. Metabolism of the drugs could be slowed, possibly leading to a dangerous buildup, particularly in methotrexate used for cancer and rheumatoid arthritis, blood pressure medications and blood thinners.
Despite the potential side effects, many people turn to CBD to reduce the side effects and number of medications they take. Many people who use CBD find a significant reduction in the need for prescription medications for pain, anxiety and other health issues.
You should be aware of the side effects of CBD. Although few and very mild, CBD can affect some people negatively. The most common side effect tends to be drowsiness or decreased alertness. CBD can change your patient’s appetite, for better or worse. Others experience faster-than-normal digestion that can result in diarrhea. Finally, CBD can result in anxiety, mood swings and erratic behavior in some people.
For any of these side effects, you should monitor your patients closely and document their feelings, digestion and any physical side effect to adjust the dosage or cease use altogether.
Selling CBD and why patients want it
Any number of reasons exist why people use CBD. The top reasons include:
- Depression and anxiety
- Sleep problems
- Cancer treatment symptom relief
- Muscle spasms associated with MS, Parkinson’s
- High blood pressure
- Substance abuse
Of course, there are plenty of false claims out there, including curative solutions for: weight loss, arthritis, diabetes, kidney disease, liver disease, asthma and breathing disorders (smoking cannabis may help, but causes other health problems), and with autoimmune issues.
But let’s not forget potentially the biggest downside of CBD — it’s a palliative therapy in most cases. It may not stop the problem from progressing; instead, it unfortunately may only mask the symptoms. Pain, arthritis, anxiety and other issues often have deeper, systemic origins that CBD does not treat.
Still, given a choice between prescription medication or over-the-counter pain relievers and CBD, many choose CBD.
Selling CBD in the practice
An estimated 33% of the population already uses CBD, with that number expected to double over the next five years. Some research estimates over half of the population will be using CBD to help control health issues within the next 10 years.
As chiropractors, many balance between what is considered allopathic medicine and that considered alternative medicine. Offering CBD can help increase your patients’ trust and compliance, while helping to deliver increased results. Many patients prefer to speak to chiropractors and other more holistic-based practitioners about CBD versus their regular medical or traditional doctor, and many trust chiropractors will provide natural and safe solutions over prescription medications.
Fortunately, that puts you in a situation of being seen as an authority and the products you offer and use as higher-quality and worth the price. By using and selling CBD in your practice and educating your patients on safe use, you can help establish your authority and have a potential income stream.
However, you must be very careful so you’re not perceived as prescribing CBD or recommending CBD over prescription medications. This is considered illegal in most areas and against most chiropractic association guidelines.
Teaching patients how to use CBD
Finding the proper CBD product with the easiest delivery and quality necessary to achieve results can be challenging. Poor-quality products may do nothing for your clients.
Most well-established, reputable companies provide CBD oil as their primary delivery method. Most have documented bioavailability at 20-30% and should indicate that in their materials. Nano-particulate-based oil preparations tend to have a high bioavailability. Established professionals trust CBD oil over other methods and applications.
Capsules and edibles have a wide bioavailability range from 5-20%. And when it comes to edibles, the amount of CBD available can vary within the batch from 0-30%. Edibles include gummies, chewables, food-based snacks (brownies, cookies) and liquid drinks.
Topical application for massage therapy and relaxation can be an integral part of your therapy for your patients. Most CBD topical applications have a 1% bioavailability because of poor transmission to the bloodstream. However, the skin and muscle concentration at the application site is much higher (>50%) and can provide tangible results.
There are multiple other delivery forms, including vapes, sublinguals, injectables and patches. However, these are not recommended, as dosing can vary considerably.
Manufacturers should label how much CBD is present within a product. You should work with your patients to understand a proper dose. A common unit of measurement is a 10-milliliter bottle of oil containing 1,000 mg of CBD. At the recommended starting dosage of 5 mg, you would have 200 doses within the bottle. At 0.5 ml per dose, your client would take one drop to achieve proper dosing (one drop = 0.5 ml).
Properly labeled and tested CBD products will contain the correct amount of CBD and often include cheat sheets for how much to use.
Most medical documentation shows most people tolerate 20 to 1,500 mg of CBD per day well. However, this depends on a person’s body weight, illness or condition, individual body chemistry, and previous use. Currently, there is no recommended amount of CBD set for health conditions. The exception is the prescription Epidiolex, used for two specific types of seizures. However, there are some common suggestions found in literature:
Anxiety — 300-600 mg/day
Central neuropathic and cancer-related pain — A maximum of 30 mg/day
Arthritis and pain — A maximum of 30 mg/day or 250 mg applied topically
IBS and gut inflammation — 5 mg twice daily
The most important thing about CBD dosing is that it follows the biphasic effect. A certain optimal dosing will react well within the body. If the dosage is too low, the results will not be felt. However, if the dose is too high, the CBD interferes with itself and reduces the effectiveness and relief a person feels.
A person will normally feel the effects of CBD within 5-7 days of taking the dose, as long as daily consistency is maintained.
Incorporating CBD into your practice effectively
Providing CBD products for sale within your practice can offer you additional revenue and authority. Choosing the better grade and higher-quality CBD products positions you as someone people can trust.
Fortunately, many quality CBD companies offer training and provide services to help set up a practice, providing educational and marketing materials to sell the product.
Additionally, you can start using and selling CBD within your practice through massage therapy to relax muscles. The proper application of massage therapy combined with CBD can help loosen muscles and tendons before an adjustment and help increase the effectiveness and results your patients feel.
The use of CBD within your practice takes a little bit of effort to get established but can provide additional revenue and health benefits to your patients. A quality company will help you set up and make sales. The pain relief your patients can get from CBD is worth the time and effort you put into it.
ANTHONY CRIFASE, DC, CNS, DACBN, is double board-certified in clinical nutrition and maintains an active virtual functional medicine and chiropractic practice. With experience in multiple different industries and as a seasoned chiropractor who understands the ins and outs of functional medicine, chiropractic and practice management, he is on a mission to help other practitioners maximize their time, revenue and systems. Learn more at drcrifase.com.