CBD & Why The Jury Is Still Out!

by Dr. Bill Blank, M.D.
Published in Midwest Flyer – February/March 2020 issue

Is CBD (Cannabidiol) the latest fad or is it a medication with the potential to help people with certain conditions? CBD has certainly been getting a lot of publicity recently. While driving around, signs promoting it are frequently seen. Every time I open my email, I seem to have four or five ads promoting its benefits.

CBD is a chemical compound found in the marijuana (cannabis) and hemp plants. It is not psychoactive like the THC (tetrahydrocannabinol) in marijuana. CBD can be taken by mouth, under the tongue, applied to the skin, or smoked or vaped. Hemp-derived CBD products containing less than 0.3% THC are legal at the federal level. CBD derived from marijuana is not.

CBD is being promoted to relieve pain, inflammation, insomnia, anxiety, cancer, type 1 diabetes, acne and seizures. Very little scientific research has been done, so far, on the subject. The contents of CBD products are not regulated. Therefore quality, concentration, and purity may vary. Prescription medications have guidelines for minimum and maximum safe doses. So far, this has not been done for CBD. Prescription medications have a comprehensive list of side effects.  So far, I have found that possible side effects of CBD include nausea, fatigue and irritability.

There is only one FDA-approved CBD-based medication, Epidiolex, used to treat two rare, serious types of childhood epilepsy. Fortunately, it seems to be helpful with these two devastating diseases. My research seems to show that it can be helpful in the control of chronic pain and inflammation, as well as insomnia and anxiety. I don’t know if it is more effective than currently available medications or where it fits in on the spectrum of treatments. As far as I can tell, not much is known about drug interactions, which may increase or decrease the effectiveness of other medications being taken concurrently. I hope that it will turn out to be helpful in treating some of the previously discussed conditions, such as chronic pain and anxiety. These conditions can be debilitating and more effective treatments would be welcomed.

How does the FAA look at CBD? I talk at several Aviation Medical Examiner (AME) seminars every year. I try to listen carefully. Not much has been said.  I suspect they hope the problem will go away. My opinion is that since there is an FDA-approved CBD-based medication, the FAA regards it as a medication. The FAA does not approve drugs until they are FDA approved and have been on the market for, at least, one year without significant side effects.

Epidiolex is not on the FAA-approved medication list. I doubt that it will be. There are no FAA-approved anti-seizure medications.

Most AMEs, I think, would feel obligated to defer any applicant listing CBD as one of his medications. If an applicant were to say that he is taking CBD for pain control, the question becomes the cause of the pain. Is the underlying condition disqualifying?

AMEs do not test applicants for drugs. If you happen to use a CBD product with more than the permitted level of THC, your AME will not know it. If you are a pilot under parts 135 or 121 and test positive for THC, that is going to cause problems. At a minimum, you will have to undergo a substance abuse evaluation and may face revocation of your medical certificate.

CBD does seem to have the potential to be helpful to certain people. However, the current fanfare seems excessive. I can’t believe it is the undiscovered wonder drug. The jury is still out.

Happy and healthy flying!

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985.

Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII) and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season and held a Statement of Aerobatic Competency (SAC) since 1987.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.

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