CBD in Schools

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Elizabeth Cross, RN, MSN, PPCNP-BC

October

2022

Topics to be covered...

What is CBD oil?

Uses?

Is it legal?

Side Effects?

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What about

TASB?

Questions ?

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What’s the difference?

Hemp

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• Legal! (Farm Bill 2018)

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• Less than 0.3% by weight of THC

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• Named based on THC content

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• Unregulated by government

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• Unknown other ingredients

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• Largely untested/inconsistent

CBD/Low THC

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• Legal in Texas under Compassionate Use

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• Allows up to 1% by weight of THC

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• Derived from Cannabis plants

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• Heavily regulated by the DPS

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• Third party tested (each and every batch)

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• Testing results are made public

Marijuana

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• Illegal!

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• THC content varies but average is around 15%-20%

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• Unregulated

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• Usually don’t know the source

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• Could contain other ingredients/heavy metals

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• Not tested

CBD ≠ CBD ≠ CBD

What is CBD oil?

The marijuana plant contains ~500 naturally occurring chemicals

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There are OVER 120 different phytocannabinoids in the marijuana plant.

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The two most well known are CBD and THC.

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• CBD: anti-anxiety, anti-epileptic, sleep inducing, anti-inflammatory
• THC: anti-nausea, appetite stimulant, improvement of pain

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• At HIGH doses of THC: euphoria, paranoia, sleep cycle interruption, vomiting

These phytocannabinoids are extracted from the plant and mixed with MCT oil or Safflower oil, they can also be turned into gummies, and lozenges.

Do these prescription CBD products contain THC in Texas?

Yes!

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In Texas the CBD medical program is discussed in terms of ratios

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All of these ratios keep to the allowable

1% THC (or under) by weight of the product.

Gummies:

Lozenges and Gummies - Can have higher THC content due to weight.

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PROS: Taste better, Reliable dosing, No spilling, Gummies CAN be cut

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? Faster onset and longer duration?

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CONS: Occasionally in hot conditions they will get stuck together

Tinctures:

Tinctures are currently the most common form. They are dosed by a syringe. For best results they should be given under the tongue and allowed to “soak in” for 1-2 minutes before swallowing.

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CONS: Easily spilled, Small doses make measurements difficult, Oil coats the syringe

Lozenges:

Lozenges and Gummies- Can have higher THC content due to weight.

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PROS: Taste Better, Reliable dosing, No spilling, Stay in the mouth for good absorption,

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CONS: Lozenges can not be cut/chewed, Can stick together easily and do no break cleanly

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Is it Legal?

YES!

Texas is one of 47 states to have a law allowing cannabis consumption.

HOWEVER….It is still a crime to possess marijuana (over 0.3% THC by weight) not prescribed by a registered doctor for an approved condition in the state of Texas.

Texas’ CBD Legal History

Senate Bill 339

HB 3703

HB 1535

Texas Compassionate Use Act is signed into legislation.

Limited THC to 0.5% by weight

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Governor Abbott signs Expansion of CUP to include multiple new conditions, indications and rules.

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*This was when Autism was added!

Texas House again expands CUP to allow access for all cancers, patients suffering from PTSD, and increases the allowable THC to 1% by weight

June 2015

June

2019

June

2021

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• Texas DPS provide a streamlined portal for prescribing medical cannabis

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• There are currently 2 medical dispensaries in Texas ( but 3 licenses)

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• Program is regulated by Texas Department of Public Safety

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• The CUP allows qualified physicians to prescribe cannabis for medical use to patients with approved medical conditions.

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• Must be a qualifying physicians who is board certified in a relevant medical specialty approved by American Board of Medical Specialties.

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Texas Compassionate Use Program

(CUP)

Who are the two dispensaries?

Names: Texas Original, Compassionate Cultivation, TOCC

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Names: Goodblend, Surterra, Coral Reefer

What conditions are covered under CUP?

• All forms of epilepsy and other seizure disorders
• Autism and other spectrum disorders
• Multiple Sclerosis (MS)
• Spasticity
• Amyotrophic Lateral Sclerosis (ALS)
• All Cancer ( September 1, 2021)
• Alzheimer’s Disease and other dementias
• Parkinson’s Disease
• Post-Traumatic Stress Disorder (PTSD) (September 1, 2021)
• Huntington’s Disease
• Chronic Traumatic Encephalopathy (CTE)
• Over 100 other incurable neurodegenerative diseases

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What do we use it for?

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SYMPTOM REDUCTION!

• Seizure reduction
• Increased attention
• Improved speech
• Improved sleep
• Developmental gains in milestones
• Calming effect

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• Decreased anxiety
• Decreased disruptive behaviors
• Decreased agitation
• Improved cognition
• Improved appetite
• Happier overall disposition

Most Common Side Effects

Severe Side Effects

• Somnolence
• GI upset
• Diarrhea (can alleviate constipation)
• Insomnia
• Aggression
• Increased LFT’s (dose-dependent/ in addition to other meds)

• True change in mental state
• Constant vomiting

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• Can Employees possess CBD at work?

Only if they are covered under Compassionate Use Act, are prescribed Epidiolex or using a product with less than 0.3% by weight.

What does TASB say? (Jan 2022)

• Can Students take RX CBD at School?

A school district may NOT adopt or enforce any rule that prohibits a patient’s access to low-THC cannabis pursuant to the Act, which enables authorized physicians to prescribe low-THC, high-CBD cannabis to patients suffering from certain conditions or using a product with less than 0.3% by weight.

Students with a condition such as autism, MS, or a seizure disorder are

entitled to legally use CBD products under the Texas Compassionate Use Act.

Student’s IEP or Section 504 plan should address when the CBD is needed and who will administer it to the student.

2019 - Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Co-morbidities

2018- Cannabidiol Based Medical Cannabis in Children with Autism- a Retrospective Feasibility Study

2019- Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy

2019 -Ethical Implications for Providers Regarding Cannabis Use in Children With Autism Spectrum Disorders

2019 - Cannabidiol as a suggested candidate for treatment of autism spectrum disorder

2019 - The effect of cannabidiol (CBD) on low-frequency activity and functional connectivity in the brain of adults with and without autism spectrum disorder (ASD)

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Autism and CBD

• Marinol (dronabinol/ Synthetically derived but naturally occurring Delta 9 THC ) approved 1985
• Cesamet ( nabilone / Synthetically derived NOT naturally occurring THC) approved 2006
• Syndros (dronabinol/ Synthetically derived but naturally occurring Delta 9 THC ) approved 2016
• Epidiolex (cannabidiol/ naturally derived from the plant ) approved June 2018

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Are their similar FDA approved medications?

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Questions ?????

Best interest of the children!

Doctors

CBD

Education, Research!

Schools

How can we eliminate the barriers?

Thanks

Feel free to reach out!

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liz.cross@gmail.com

512-705-9723

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