Editor's Note

The CBD Opportunity

CBD could help a lot of HME customers, but some things must happen before HMEs dive in.

• By David Kopf
• Jan 01, 2019

It sounds trite to say, but many of your patients are in pain — real, honest-to-goodness pain. If they’re coming into your HME business for a knee brace, there’s a good chance they’re in pain. If they’re coming in for orthopedic footwear, they’re likely feeling some pain. If they’re coming in for a TENS unit, you know they’re in pain. In fact, for some providers, pain management represents a healthy percentage of their revenues.

So many of the conditions that HME clients must manage include some segment of pain. Frankly to not provide non-drug solutions for pain management seems like not only waste of a business opportunity, but almost a failure to live up to the patient relationship. People should have access to a spectrum of non-prescription pain management options, and HME providers are in an excellent position to offer those options.

Should CBD be part of that spectrum? I think it should be, but some things need to happen before it becomes a legitimate opportunity.

Let’s start with a definition. For those unfamiliar with CBD, it is one of two compounds called cannabinoids produced by the cannabis plant. The first cannabinoid most everyone has heard of is THC, the psychoactive component in recreational marijuana. CBD, also known as cannabidiol, is the cannabinoid often used in managing chronic pain, insomnia and anxiety.

CBD oils, lotions and pills are being sold online and at brick-and-mortar retail locations in states where it is legal to do so. CBD products are sold in varying dosages that might or might not contain very small percentages of THC, as well.

I can speak from personal experience on the efficacy of CBD: I bought some CBD oil over the Internet that completely managed chronic shoulder pain that has caused me many sleepless nights for more than a decade. My only other option were serious prescription medciations I did not want to take. It’s not surprising to me that many CBD advocates argue that, as a non-addictive painkiller, the drug could help address the opioid epidemic.

In terms of market size, CBD use has grown so widespread according to market researchers the Brightfield Group, the global CBD market could expand to $22 billion by 2022. Suffice it to say that’s not a niche — it’s practically an economy unto itself. And it’s a market need that providers should consider serving given that many of their customers likely suffer some form of chronic pain.

There’s just one hitch: CBD still sits in a legal grey area. The Department of Justice and the Drug Enforcement Agency consider any part of cannabis — and that includes CBD — a narcotic, but they have not enforced any laws when it comes to what is called “industrial hemp” products that include less than 0.3 percent THC, which covers most CBD products. As a result, many farmers and others further down the CBD economy have been reticent to participate in the business — until now.

Enter the 2018 Farm Bill. As this issue was going to press, both the House and the Senate bill, which includes legislative language removing industrial hemp production from the Controlled Substances Act. As I type this the bill has gone to President Trump’s desk, where he is anticipated to sign it into law. This will further protect both hemp farmers and CBD sellers, which is a major reassurance.

That said, the Farm Bill is half the equation. CBD also needs real scientific research. Right now, me telling you that CBD completely handled my chronic shoulder pain is an unfounded claim. Well, that goes for all CBD claims. CBD needs to see some real research into its efficacy as well as its use. For instance, CBD can influence the liver’s cytochrome P450 enzyme system, which helps metabolize various compounds — including a whole host of drugs such as statins, steroids and antidepressants. Without research into these interactions, the medical community, providers and users are flying blind.

CBD needs FDA-approved research that cements its medical and pharmaceutical legitimacy and makes it a product that customers will trust. Providers offering CBD should push CBD manufacturers to fund that research so they can confidently back it with their brands.

This article originally appeared in the Jan/Feb 2019 issue of HME Business.