CBD for healthcare burnout?

Relation

Crippa JAS, Zuardi AW, Guimarães FS, et al. Efficacy and safety of cannabidiol plus standard care compared to standard care alone for the treatment of emotional exhaustion and burnout in frontline healthcare workers during the COVID-19 pandemic: a randomized clinical trial.JAMA network opened. 2021;4(8):e2120603.

Study objective

The aim of this study was to examine the safety and effectiveness of cannabidiol (CBD) therapy in reducing emotional exhaustion and burnout symptoms in frontline healthcare professionals working with Covid-19 patients.

Draft

Open-label, randomized, controlled trial in a single hospital in Sao Paulo, Brazil

Participant

This study randomized 118 healthcare workers on the front lines of the Covid-19 pandemic (n = 59 in each arm, 66.9% women, mean age 33.6 years) to a single hospital between June 12, 2020 and November 12, 2020.

Healthcare workers included doctors, nurses and physical therapists working directly with Covid-19 patients. The providers were all healthy and between 24 and 60 years old.

Exclusion criteria included providers of medications with potential CBD interactions (not all medications were excluded), history of adverse reactions to CBD or other phytocannabinoids, Covid-19 high-risk group (e.g. diabetes), and pregnancy.

intervention

The control arm received standard supportive therapy (“motivational and instructional videos on low-impact exercise and weekly consultations with psychiatrists who offered psychological support”). The intervention arm received standard supportive care plus 150 mg cannabidiol (99.6% purity; PurMed Global) in MCT oil twice daily for 28 days.

Study parameters assessed

The primary outcome was assessed with the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Secondary endpoints of anxiety, depression and post-traumatic stress disorder (PTSD) were assessed using the GAD-7 (7-item Generalized Anxiety Disorder Scale), PHQ-9 (9-item Patient Health Questionnaire) and the PTSD Checklist (from the DSM-5) respectively. Laboratory analyzes and adverse events were assessed with regard to treatment safety evaluated.

Primary outcome measures

The primary outcome was the effectiveness and safety of CBD supplementation in addition to standard treatment compared to standard treatment alone on symptoms of emotional exhaustion and burnout at 28 days.

Key insights

• 300 mg täglich CBD plus Standard-Unterstützungstherapie war der Standard-Unterstützungstherapie allein überlegen, um emotionale Erschöpfung zu lindern (P=0,08), Angst (P<0,001) und Depressionen (P<0,001).
• Der CBD-Arm verringerte auch das „Burnout-Syndrom“ (ICD-10-Kriterien) bei den Teilnehmern (P=0,08).
• Der CBD-Arm reduzierte die Angst signifikant (signifikante Reduktion bei Teilnehmern mit GAD-7-Werten >9) nach 4 Wochen (P<0,001).
• Der CBD-Arm reduzierte signifikant Depressionen (Reduktion der Teilnehmer mit PHQ-9-Score >9 Punkte) nach 4 Wochen (P<0,001).
• Der CBD-Arm erlebte ähnliche Nebenwirkungen wie die Kontrollgruppe.
• Die unerwünschten Ereignisse beider Gruppen waren überwiegend mild und vorübergehend.
• Die 5 potenziell besorgniserregenden unerwünschten Ereignisse (siehe Auswirkungen auf die Praxis) verschwanden mit dem Absetzen von CBD.
• Obwohl unerwünschte Ereignisse bei 300 mg CBD selten sind, sollten Anbieter die Leberenzyme bei der Ersttherapie regelmäßig überwachen, ähnlich wie bei der Erstanwendung von Niacin.

Practice implications

The Covid-19 pandemic has left society emotionally, physically and financially drained. Frontline healthcare workers have experienced excessive stress and emotional overload.¹

The study reviewed here suggests that CBD is a viable and relatively safe option for alleviating emotional overload and burnout in healthcare workers. Additionally, CBD demonstrated anti-anxiolytic and antidepressant benefits for these stressed healthcare providers.

Many potential mechanisms of action could explain the observed benefits. First of all, CBD is an exogenous phytocannabinoid that modulates the endogenous cannabinoids anandamide (AEA), palmitoylethanolamide (PEA), and oleoylethanolamide (OEA). Endogenous cannabinoids are fat-derived signaling molecules involved in reward, appetite, metabolism, mood, memory, circadian rhythms and neuroprotection.^2.3

This study complements previous studies by suggesting the benefits of CBD as a neuroendocrine immunomodulator and a potential ally in preventing burnout and emotional exhaustion for healthcare workers.

In addition to modulating our endocannabinoids, CBD supports serotonin as a 5-hydroxytryptophan-1A (5HT1A) receptor agonist, acts as a partial agonist at dopamine D2 receptors, and stimulates the anti-inflammatory receptors adenosine A2, glycine, and G protein – coupled receptor 55 (GPR55).^4-8In animal studies, CBD shows an inhibition of reuptake of norepinephrine, dopamine, serotonin, gamma-aminobutyric acid (GABA) and anandamide.^9.10

The dosage of 300 mg of CBD isolate used in this study is a significant dose and mimics many of the previous benefits in human pilot studies on mood and affect.¹⁰The mechanisms of action of CBD isolate mimic similarities to a “runner’s high,” suggesting that CBD isolate may be a productivity-enhancing molecule, unlike other phytocannabinoids that can produce intoxicating (e.g. THC) or sedative effects (e.g. terpenes such as full-spectrum myrcene). hemp).¹¹

The only serious adverse events in this study affected 5 participants in the CBD intervention arm. Notably, all of these were temporary and resolved upon discontinuation of CBD. Four of the participants had transient liver enzyme elevations (>3-fold higher than the upper limit of normal) and one suffered from severe pharmacoderma. In general, CBD has an excellent safety profile.¹²

The elevated liver enzymes may be due to unique Phase I problems of liver metabolism in the participants, interactions between CBD and medications (10 participants in the study received undisclosed prescriptions), an immune reaction to CBD or the carrier oil used (MCT is often derived from coconut), or an unidentified substance in the intervention (CBD purity was 99.6%).

Using CBD on hundreds of patients in clinical practice, I have yet to see elevated liver enzymes with CBD isolate at dosages of 30 to 300 mg. However, our patients are under holistic naturopathic care, with many barriers to healing removed and nutritional and lifestyle supports in place.

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

Nonetheless, my approach, following Do No Harm, is to titrate the starting dose of 30-60 mg of cannabidiol until clinical benefit is achieved (up to 300 mg) and monitor liver enzymes regularly (at least once within the first month of use). .

CBD has personally helped me through the stress and overwhelmingness of the pandemic. I use 150-300 mg daily depending on how overwhelmed I am for the day. This study complements previous studies by suggesting the benefits of CBD as a neuroendocrine immunomodulator and a potential ally in preventing burnout and emotional exhaustion for healthcare workers.

Disclosure of Conflicts of Interest

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