CBD for burnout in healthcare?

reference

Crippa Jas, Zuardi AW, Guimarães FS, et al. Effectiveness and safety of cannabidiol plus standard supply compared to standard care solely to treat emotional exhaustion and burnout for health care employees at the forefront during the covid 19 pandemic: a randomized clinical study. Jama network open . 2021; 4 (8): E2120603.

Study goal

The aim of this study was to examine the security and effectiveness of cannabidiol (CBD) therapy in reducing emotional exhaustion and burnout symptoms in medical specialist personnel at the forefront that works with covid 19 patients.

draft

Open, randomized, controlled study in a single hospital in Sao Paulo, Brazil

participant

This study randomized 118 medical specialists at the forefront of the Covid 19 pandemic (n = 59 in every arm, 66.9 % women, average age 33.6 years) in a single hospital.

The healthcare staff included doctors, nurses and physiotherapists who work directly with COVID-19 patients. The providers were all healthy and between 24 and 60 years old.

The exclusion criteria included providers of medication with potential CBD interaction (not all medication revenues have been excluded), prehistory of side effects on CBD or other phytocannabinoids, covid-19 high-risk corporation (e.g. diabetes) and pregnancy.

Intervention

The control arm received standard support therapy ("motivation and instruction videos for physical exercises with low stress and weekly consultations with psychiatrists who offer psychological support"). The intervention low received a supportive standard therapy plus 150 mg cannabidiol (99.6 % purity; Purmed Global) in MCT oil twice a day for 28 days.

study parameters evaluated

The primary endpoint was evaluated with the subscala emotional exhaustion of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Secondary endpoints of fear, depression and post-traumatic stress disorder (PTSD) were used with the GAD-7 (7-point scale for generalized anxiety disorders), PHQ-9 (9-point questionnaire for patient health) and the PTSD checklist (from the DSM-5) or laboratory analyzes and unwanted side effects evaluated.

primary result measurements

The primary result was the effectiveness and safety of a CBD supplement in addition to the standard treatment compared to standard treatment solely in the case of symptoms of emotional exhaustion and burnout after 28 days.

important knowledge

• 300 mg daily CBD plus standard support therapy was superior to the standard support therapy to relieve emotional exhaustion ( p = 0.08), fear ( p <0.001) and depression ( p <0.001).
• The CBD arm also reduced the "burnout syndrome" (ICD-10 criteria) among the participants ( p = 0.08).
• The CBD arm significantly reduced the fear (significant reduction in participants with GAD-7 values> 9) after 4 weeks ( p <0.001).
• The CBD arm reduced significant depression (reduction of participants with PHQ-9 score> 9 points) after 4 weeks ( p <0.001).
• The CBD arm experienced similar side effects to the control group.
• The undesirable events of both groups were mostly mild and temporary.
• The 5 potentially worrying undesirable events (see effects on practice) disappeared with the discontinuation of Cbd.
• Although unwanted events are rare at 300 mg CBD, providers should regularly monitor liver enzymes in first therapy, similar to the first application of niacin.

practice implications

COVID-19 pandemic has exhausted the company emotionally, physically and financially. Health workers have experienced excessive stress and emotional overload at the forefront.

The study checked here suggests that CBD is a practical and relatively safe option to relieve emotional overload and burnout for healthcare employees. In addition, CBD showed an antianxiolytic and antidepressant benefit for these stressed health service providers.

Many potential mechanisms of action could explain the observed advantages. First of all, CBD is an exogenous phytocannabinoid that modulates the endogenous cannabinoids anandamide (AEA), Palmitoylethanolamide (PEA) and Oleoylethanolamide (OEA). Endogenous cannabinoids are signal molecules derived from fat, which are involved in reward, appetite, metabolism, mood, memory, circadian rhythms and neuroprotection.

This study complements previous studies by suggesting the advantages of CBD as neuroendocrine immune modulators and as potential allies in avoiding burnout and emotional exhaustion for medical staff.

In addition to the modulation of our endocannabinoids, CBD serotonin supports as 5-hydroxytophane-1a (5HT1A) receptor agonist, acts as a partial agonist on dopamine-D2 receptors and stimulates the anti-inflammatory receptors adenosine A2, Glycin and G protein-coupled receptor 55 (GPR55). ^{4-8 In animal experiments, CBD shows a reimbursement of noradrenaline, dopamine, serotonin, gamma amino acid (GABA) and Anandamide. 9.10}

The dosage of 300 mg CBD isolate used in this study is a considerable dose and ahms many of the earlier advantages in human pilot tests for mood and affect. In contrast to other phytocannabinoids that can cause intoxicating (e.g. THC) or sedative effects (e.g. terpenes such as Myrcen in full spectrum), a productivity -increasing molecule can be hemp). ¹¹

The only serious undesirable events in this study concerned 5 participants in the CBD intervention arm. Remarkably, all of them were temporarily and dissolved after stopping CBD. Four of the participants showed temporary liver enzyme increases (> 3 times higher than the upper normal limit) and one suffered from severe pharmaceutical coodern. In general, CBD has an excellent security profile. 12

The increased liver enzymes can be found on unique phase I problems of the liver metabolism among the participants, interactions between CBD and medication (10 participants in the study did not receive open recipes), an immune response to CBD or the carrier oil used (MCT is often obtained from coconut) or an undetected substance in the intervention (CBD purity was 99.6 %).

When using CBD in hundreds of patients in clinical practice, I have not yet seen any increased liver enzymes with CBD isolate in doses of 30 to 300 mg. However, our patients are under holistic naturopathic care, with many obstacles to healing and eating and lifestyle support.

The 2 patients we saw with light beehive reactions were related to a coconut allergy (MCT oil carrier) and a beeswax allergy in a topical CBD balm.

Nonetheless, based on "Do No Harm", my approach is to titrate the initial dose of 30–60 mg cannabidiol until the clinical benefit is achieved (up to 300 mg) and to monitor the liver enzymes regularly (at least once within the first month of application). .

CBD personally helped me with the stress and overwhelming pandemic. I use 150-300 mg daily, depending on the overwhelming of the day. This study complements previous studies by stating the advantages of CBD as a neuroendocrine immune modulator and as potential allies in avoiding burnout and emotional exhaustion for medical staff.

disclosure of conflicts of interest

The author of this review has positions at companies that manufacture or sell CBD products, including Blue Sky CBD, Apex Energetics and Roots and Branches Integrative Health Care.