Cannabidiol (CBD), a non-psychoactive compound of cannabis, is growing profits at a prolific pace among retailers across the country. The natural product purports a bevy of therapeutic benefits without the requirement of a prescription or the risk of addiction. And consumers are all in.
This year, the CBD market reached $500 million, according to Statistica. An optimistic estimate by the Brightfield Group, a cannabis industry analyst, places the market at $22 billion by 2022âpresuming legalization of hemp from a pending farm bill.
A more conservative estimate predicts the market to reach nearly $2 billion, still an enormous number considering it was just over $100 million in 2014.
Right now the market is populated by shops of every sortâhead shops, nutrition stores, local grocers, dispensaries, farmersâ markets, online stores. None of those retailers carry the clout of a Doctor of Pharmacy. Pharmacies are perfectly positioned to dominate sales of this novel natural product that comes with so many question marks.
âPharmacies have a distinct advantage over other retail or online sites selling CBD,â said Danny Bannister, co-owner of Natural Native, a supplier of CBD products. âPeople have learned to trust in their pharmacist. They expect him or her to have vetted and researched the products they carry and recommend.â
This is true for Jesica Mills, whoâs been selling CBD at her community pharmacy for just over a year. âPeople want to get it from a pharmacy and from a pharmacist,â said Mills, PharmD, MBA, RPh, CNHP, owner of Owensboro Family Pharmacy in Kentucky. âBecause everyone takes some sort of prescription medicine, they want to know what the side effects are going to be, how to take it, how to dose it.â
Even more, independents have the CBD pharmacy market cornered for the time being. National chains are unlikely to take the plunge until the legality is crystal clear at the federal and state level and theyâre able to sell the products nationally.
Current CBD revenue reports from independent pharmacies are off the charts, even for those whoâve just begun selling the products. Mike Bellesine, owner of TrueCare Pharmacy in El Dorado, Kansas, collected $10,000 in six days selling the plant product. He anticipates $10K-$15K per month at a minimum. Millsâs pharmacy makes $15K per month in sales. Natural Native and Ananda Professional, two major CBD suppliers, have had clients earn up to $30K in a single month.
âThe most compelling reason for getting on board with CBD comes from pharmacy owners who have been in the business a long time,â said Chuck Schneider, chief revenue officer of Ananda Professional. âThese owners state they have never seen a better front-end profit generator for independent pharmacies than CBD.â
These products come with a 40â50 percent margin on average, all cash. And unlike the cents-to-dollars profit your pharmacy makes on most OTC products like acetaminophen, CBD brings hefty profit with products ranging from $50 to $300, Bellesine said.
More than that, many of the patients purchasing CBD are high-needs patients managing chronic conditions such as cancer and autoimmune disease. Offering CBD can attract those patients to your pharmacy, potentially earning their prescriptions as well.
After a marketing push in the first few weeks of selling CBD, Bellesine earned around 70 prescription transfers in a matter of days. And heâs been rolling out the products slowly to ensure heâs doing it right.
âPharmacies have a distinct advantage over other retail or online sites selling CBD. People have learned to trust in their pharmacist.â
Although CBD draws in high-needs patients, the people buying CBD come from every corner and with every condition, even from those youâd least expect. âThere are people who have Medicaid, who have issues with one or two dollars on their copays, and they will spend 70 dollars on CBD oil without blinking an eye,â Mills said.
More and more, patients are looking to get away from traditional medication and get into natural remedies like CBD. âThereâs such an increase of people wanting natural products over prescriptions now,â said Mills, who also has a doctorate in natural medicine. âWeâre able to counsel on natural products, and thatâs attracted quite a few new natural-minded patients. Itâs opened the door for a whole different set of clients to come in, and leads to more fulfillment as a pharmacist.â
Bellesine, whoâs owned TrueCare Pharmacy for 36 years, has never seen more promise from a product. âIf your state allows it, I recommend getting this product on your shelf,â he said. âIt is a high-dollar, high-margin product and it really works.â
Schneider believes independent pharmacies could easily and drastically boost profits even if they want to move slowly. âWith so many people that it can apply to, thereâs no reason why they shouldnât easily be able to start a patient a day on CBD,â he said. âIf they start a patient a day, that pharmacy will improve their profitability by $60,000 per year.â
What is CBD?
CBD is a natural constituent of the cannabis plant, typically hemp. CBD sold commercially canât contain more than .3 percent THC (tetrahydrocannabinol), the chemical responsible for the psychoactive effects induced by marijuana. Manufacturers distill CBD into an isolate or as the primary active ingredient among other cannabinoids. Itâs formulated into several variations including oil, ointments, balms, water, edibles, and more.
There are more than 100 cannabinoids in cannabis. CBD and THC are the most prevalent. All the cannabinoids are said to contribute health benefits. Using them all together, referred to as âfull spectrum,â creates whatâs called an entourage effect, compounding the therapeutic effectiveness.
CBD doesnât come with the same risks as its sibling cannabinoid THC. According to the World Health Organization, âIn humans, CBD exhibits no effects indicative of any abuse or dependence potential. To date, there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.â
Health benefits of CBD
The science behind CBDâs therapeutic benefits revolves around the endocannabinoid system. This system in humans regulates all sorts of homeostatic activities, said Dr. Alex Capano, DNP, CRNP, FNP-BC, medical director for Ananda Professional and faculty at The Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University.
The system contains receptors for cannabinoids throughout the body, including the brain, digestive system, and lymphatic system. Our bodies already naturally produce two cannabinoids, but âwe can harness the potential of the endocannabinoid system through these plant-derived cannabinoids,â Capano said.
The reason CBDâs therapeutic properties remain controversial is a lack of conclusive clinical evidence. CBD is still in its early stages of study, although research is increasing rapidly. Many of the common health claims come from animal or preclinical studies, some of which have shown CBDâs promise to reduce pain and inflammation.
The strongest evidence, according to a comprehensive review of cannabinoid studies from the National Academies of Sciences, Engineering, and Medicine, shows that cannabinoids can be effective in improving two conditions: patient-reported multiple sclerosis spasticity symptoms and short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.
The demand for CBD is driven mainly by anecdotal evidence. But the word-of-mouth success stories are plentiful. âAlthough I was skeptical at first about its benefits and possibly the psychological perception of our patients relating us to hemp sales, we kept hearing story after story of how our patients are able to reduce their pain meds, how much better they are sleeping, and how much less stress and anxiety they are feeling,â Bellesine said. âWhen you have patients on fixed income coming back and sometimes paying over $100 per bottle for CBD, you know itâs working.â
In a survey from the Brightfield Group and HelloMD, a digital healthcare platform for the cannabis industry, 82 percent of users claimed CBD was a âvery effectiveâ treatment. In another survey by Consumer Reports, 90 percent of people who took CBD claimed it helped treat their medical condition.
Many patients are even tapering off prescription and OTC pain medicine once they start taking CBD. In the HelloMD survey, nearly half of the CBD users said they had stopped using traditional medications after starting on CBD. One of Bellesineâs patients with crushing lumbar discs was able to cut his Percocet dose in half. One of Millsâs patients was able to switch from Oxycontin 30mg daily to Oxycodone 5mg daily. Another had been taking Clonazepam 2mg four times a day and has completely discontinued the medication.
âIâve realized that pharmacists are dispensing pills to people that really donât want to take any of them,â Mills said. âEvery single person that Iâve talked to doesnât want to take any pills. Patients are wanting to stop taking their narcotic medicines like Xanax and Percocet, actively looking for something healthier for them.â
Most Common Conditions Treated by CBD
Pain
Anxiety
Depression
Sleep disorders
Chronic headaches
Legality of CBD
With the passing of the Hemp Farming Act of 2018, hemp-derived CBD is effectively legal federally. The bill removed hemp from the controlled substances list and legalized cultivation of the crop nationally. Hemp products are now considered agricultural commodities, and regulatory authority falls to the USDA and state departments of agriculture.
Although hemp-derived CBD can legally be sold, it canât come with any health claims, no matter how minor.
At TrueCare Pharmacy, Bellesine said heâs very careful not to promise patients anything. Instead, he simply offers testimony from his patients whoâve experienced benefits. âWhen I talk to people, I say, âThis is just what other people are telling us. They are coming back and telling us the same things.ââ
The bottom line for your pharmacy: Purchase only from suppliers whoâve obtained CBD from hemp cultivated in accordance to the 2014 Farm Bill; make sure your state allows it; and donât make any health claims.
Purchasing CBD products
With little-to-no regulation, CBD products are easily susceptible to fraud. Without proper vetting, your pharmacy could end up with products that donât contain CBD at all, contain less CBD than claimed, contain too much THC, or contain contaminants, among other risks.
âSo much of this is really the wild west,â Schneider said. âYou can buy a product, and seven out of ten times whatâs in the bottle doesnât match whatâs on the label.â
A 2017 study published in JAMA found that 69 percent of CBD products purchased online were mislabeled, containing more or less ingredients than claimed. Twenty percent had THC levels high enough to potentially result in intoxication or impairment. Over the last three years, the FDA has sent more than 40 warning letters to CBD sellers whoâve falsified the content in their products.
Bannister and Schneider both said to make sure your supplier can provide a certificate of analysis for each batch of products to verify its purity and its THC level. Bannister suggested going a step further by tracing the products to the original farm. Schneider emphasized the importance of seeing the supplierâs license with the state agriculture department or university operating under a pilot program.
Another important factor to consider is the amount of resources and education the supplier can provide. âEverything starts with education,â Schneider said. âMost pharmacists never studied the endocannabinoid system and are not familiar with how CBD works in the body. A reputable company will provide training for the pharmacy owner and staff.â
Some suppliers offer an initial training session on the endocannabinoid system and the fundamentals of CBD. Thatâs how Mills gained the majority of her knowledge initially, mostly from Ananda Professional. âWhen youâre first getting started, a lot of your information will come from the company youâre buying from,â Mills said.
Top 5 CBD Formulations
1. Sublingual: tinctures, drops, sprays
2. Capsules
3. Liquids
4. Edibles
5. Topicals
CBD education
CBD is a novel product with little clinical evidence, lots of anecdotal proclamations, stigma associated with marijuana, and confusing legality that make many consumers hesitant. The majority of CBD users learn about it from friends, family, and the internet.
Your pharmacy may be patientsâ only reputable source on CBD information, and youâre likely their most reputable source. The best way to know how to counsel patients on CBD is to learn the science for yourself, said Mills. âTake a look at the reason why it works, because once you understand why it works then you understand why it works for so many different things.â
Some sellers and suppliers claim that because CBD is a natural product, it wonât interact with any other drugs. Pharmacist Bellesine knows better. âIt does have a lot of interactions,â he said. âJust as you would with any drug, you want to learn CBDâs interactions and be able to counsel patients on the product. Thatâs where the pharmacy really shines because we understand the drugs, we understand the possible side effects, we understand how theyâre taken out of the body. The head shop down the street doesnât have a clue.â
Bellesine began by researching the only FDA-approved drug containing CBD, Epidiolex. That provided some insight on possible interactions, as well as the possible side effects. âIf youâre going to be a good pharmacist, you better understand your drugs or nutraceuticals that youâre going to be dispensing,â he said.
âPharmacy owners state they have never seen a better front-end profit generator for independent pharmacies than CBD.â
Deciding dosing is tricky because CBD isnât a well-researched or tested product. âWe donât have evidence where we can give you definite dosing guidelines for specific conditions,â said Dr. Capano. âBut we do know the safety profile of these CBD hemp oils is fantastic. â
Most suppliers will provide dosing recommendations. Capano suggests starting with 10mgâ15mg and titrating up slowly every three days until finding the right dose for the patient.
Lastly, your pharmacy should inform every patient about CBDâs effect on drug tests. This has been a significant issue for Mills in the year sheâs been offering CBD. Even though legal CBD products contain no more than .3 percent THC, that can be enough to show up on a drug test, Mills said.
âIdentifying those people and asking if theyâre drug tested was one of the things we had to learn the hard way. We had a few people who were not able to get a job because of the CBD oil,â Mills said. âWe always tell people, if you canât risk it, THC-free is the way to go.â
However, Capano said even THC-free products wonât always put patients in the clear. âThey can cause a false positive with the most commonly used immunoassay tests, because they have low specificity and can confuse CBD for THC,â she said. âA hair or serum test will confirm a true negative in these cases, but a false positive is certainly possible.â
Forecasting the futureÂ
Weâre in the budding stages of the CBD rush. With so many variables lurking legally and scientifically, no one can predict how long the market will stay this hot. If the 2018 Farm Bill is passed, there will likely be an influx of suppliers, driving prices, and therefore profits, down. Once national pharmacies and retailers get involved, competition will be steep.
In addition, new scientific research could contradict many of the current claims and consumers may begin to abandon CBD altogether. On the other hand, studies could corroborate the therapeutic benefits or discover even more. The market could continue to cruise and even expand.
Either way, pharmacies should always keep their advantage over other retailers. âWe have the edge of being the experts in drugs,â Bellesine said. âKnowledge along with your good pharmacist reputation will draw patients to you.â
For the moment, the bandwagon is barreling forward. Will your pharmacy hop on? âThe time is perfect for independent pharmacies to get involved with CBD and do so before the chain pharmacies and mass merchandisers,â Schneider said. âThere is no better retail location for patients to turn to than an independent pharmacy.â
FAQs
Here are some answers to consumersâ most frequently asked CBD questions
Will CBD get me high?
CBD containing less than .3% THC (tetrahydrocannabinol) doesnât cause psychoactive effects.
Will CBD make me fail a drug test?
If any amount of THC is present in the CBD product, THC could potentially show up on a drug test. Even products with zero THC are no guarantee, as some tests confuse CBD for THC.
How much CBD should I take?
There is no standard dosing, but CBD has been shown to have a strong safety profile. A common recommendation is to begin at 10mg and double the dose every three days until finding the right dosage.
Will CBD cause drug interactions?
CBD does interact with other drugs. Pharmacists should review patientsâ medication profiles before they start taking CBD.
Are there side effects to CBD?
More research is needed to conclusively determine CBDâs side effects. The FDA-approved cannabidiol oral solution EpidiolexÂź (100mg) can cause liver problems as well as the following common side effects: sleepiness, decreased appetite, diarrhea, increase in liver enzymes, feeling very tired and weak, rash, sleep problems, and infections.
Whatâs the difference between CBD isolate and full-spectrum CBD?
CBD isolate contains only cannabidiol. Full-spectrum CBD contains additional cannabinoids that work in tandem with cannabidiol and may provide additional benefits.
From the Magazine
This article was published in our quarterly print magazine, which covers relevant topics in greater depth featuring leading experts in the industry. Subscribe to receive the quarterly print issue in your mailbox. All registered independent pharmacies in the U.S. are eligible to receive a free subscription.
Read more articles from the December issue:
- How to protect your patients from online pharmacy scams
- One simple solution to making more money from your front-end
- The latest independent pharmacy trends from 2018 NCPA Digest
- How to boost front-end revenue by engaging all five senses
- The guide to getting a loan from the experts who lend them out
- How one independent pharmacy thrives through nonprofit partnerships
- New USP guidelines on water purity for reconstitution
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