Cannabidiol Oil

Cannabidiol (CBD)

Introduction to CBD

 Cannabidiol (CBD), the second most abundant cannabinoid in marijuana, has medicinal properties differing from THC and, most importantly, it does not provide the euphoria, or “high” that is associated with THC. Currently, cannabidiol products are legal in the U.S. including Louisiana but only if derived from industrial hemp seeds and stalks but not flowers or leaves, not synthetic, and they must be 100% free of THC. 

 

Links to other Pertinent Educational Pages:

Links to ALL Marijuana Educational Pages

 

Cannabidiol (CBD):

 

Key to Links:

  • Grey text – handout
  • Red text – another page on this website
  • Blue text – Journal publication

 

This Page:

 

 

Cannabidiol (CBD) – Introduction

CBD is legal, not considered a drug of abuse and not regulated. This has caused the development of a market of CBD-based products for medical purpose, such as CBD oil, tinctures and vapors that has rapidly expanded in a no man’s land of scientific ignorance relative to specific therapeutic benefits and applicable doses. The lack of regulation of CBD products does not allow for oversight of the quality of CBD products, their purity or the presence of chemical or microbiological contaminants that is fundamental for predicting its therapeutic effectiveness and safety. It is therefore important for the consumer/patient to inform themselves prior to embarking on self-treatment with CBD.

 

The clinical benefits obtained from marijuana (cannabis) are derived from many constituents found in the plant, including more than 100 pharmacologically active compounds. The two best understood and most common are the cannabinoids THC (delta-9 tetrahydrocannabinol) and CBD (cannabidiol), which together are responsible for the majority of the medical benefits associated with cannabis use. Other cannabinoids also contribute to some of the effects associated with use of marijuana, See: Cannabinoids.

 

THC (∆-9 tetrahydrocannabinol)

THC has analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-emetic properties, but also mind-altering effects (euphoria). It has 20 times the anti- inflammatory power of aspirin and twice that of hydrocortisone. THC and its active metabolite, 11-Hydroxy-THC, are responsible for the “high” associated with use of marijuana.

For more information, See: THC – Introduction (coming soon)

 

CBD (Cannabidiol)

CBD has anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory effects but does not produce mind-altering effects like euphoria. CBD is a neuroprotective antioxidant more potent than Vitemin C (ascorbate) or Vitamin E (tocopherol). CBD is also thought to support sleep and reduce nausea, particularly related to chemotherapy. CBD, in combination with THC, modulates some of the side effects of THC, including reducing THC-induced anxiety and euphoria.

For more information regarding the clinical use of CBD: Cannabidiol (CBD) – Clinical Use

 

Other Cannabis-based Compounds

In addition to the cannabinoids, another major family of compounds is the terpenes (and related terpenoids) which are responsible for the distinct aromas associated with cannabis. The terpenes may also contribute to therapeutic benefits although less is known about the terpenes compared to THC and CBD. Besides the cannabinoids and terpenes, there at least fifteen different classes of compounds, including nitrogenous compounds, amino acids, hydrocarbons, carbohydrates, and fatty acids, all of which may contribute to the pharmacological and toxicological properties of cannabis. There is very limited scientific information available on the pharmacology and toxicology of the constituents found in cannabis.

Marijuana (Cannabis) vs. Cannabis-based Commercial Products

This underscores the importance of pharmaceutical medical marijuana in which pharmacologic agents are manufactured with specific doses and ratios which allow for safer titration of dosing to achieve desired clinical benefits. It also underscores the fact that the use of CBD only as an isolated constituent of marijuana will not reproduce the effects of marijuana while it may nevertheless offer its own specific therapeutic benefits.

 

 

 

CBD – Legal Status

The conflict between federal and state laws on the medical use of cannabis products, the lack of consistency among state laws, and the availability of artisanal cannabis and CBD products in dispensaries and online has caused significant confusion for researchers, practitioners, and patients and their caregivers, particularly with regard to CBD products.

 

Federal Law

The DEA’s most recent denial of two marijuana rescheduling petitions means that marijuana and its constituent cannabinoids, including CBD from any source, including hemp, will currently remain in Schedule I and therefore, based on federal law, CBD is illegal in all states regardless of source. This conclusion is based on a recent legal review article published in 2017 and considered accurate through August, 2016, However, while the DEA maintains that CBD is definitely still illegal, in November 2017, a spokesperson for the agency stated that while those who violate federal drug laws could run the “risk of arrest and prosecution,”  the DEA is not going after individuals who have benefited from CBD oil.

 

Louisiana Law

Currently, CBD (cannabidiol) products are legal in Louisiana but only if  free of THC (See: House Bill 225 – 2017). Practically speaking, it appears that if the THC content is less than 0.3%, it is considered “THC-free.”

See:  Marijuana -Legislative Update for Louisiana

Cannabidiol – Products

Cannabidiol – Prescription CBD Products

Currently, there is only one prescription CBD-only medication (Epidiolex) available and one medication (Sativex) that contains both THC and CBD. They are available by prescription but are very expensive and insurance is likely to pay for them only for FDA-approved conditions.

See: FDA-Approved Prescription Cannabis-Based Medications

 

 

Cannabidiol – Over-the-Counter (OTC) CBD Products

There are three basic types of over-the-counter (OTC) CBD products:  Isolate, Broad Spectrum and Full Spectrum. They differ in  the presence of other cannabis-based constituents than CBD.

See: Cannabidiol (CBD) – Dosing, Products and Formulations

 

 

Entourage Effects

The pharmacologic effects of cannabis depend on the combined effects of all the pharmacologically active constituents present. The interplay of the different constituents that determine the therapeutic benefits is known as the “Entourage Effect,” in which it is the combined effects of all the constituents that determine the ultimate therapeutic effects. There is a wide range of differences in both the number, amounts and ratios of different constituents in cannabis strains leading to a wide range of therapeutic benefits.

 

Different mechanisms of synergy have been proposed to explain the Entourage Effect: (i) multi-target effects; (ii) pharmacokinetic effects such as improved solubility or bioavailability; (iii) agent interactions; and (iv) modulation of adverse events.

 

Entourage Effect – THC and CBD

The strength and ratio of the two major cannabinoids, THC and CBD, play a dominate role in the clinical effects of cannabis. A synergy exists between these two components in which their combination produces effects that are uniquely determined by the amount and ratios of these two constituents. At low concentrations CBD antagonizes some effects of THC, regulating THC-related adverse effects like rapid heart rate, anxiety, sedation and hunger.

 

In one early study, CBD proved to be a critical factor in the ability of Sativex (nabiximols oromucosal extract consisting of a 1:1 ratio combination of THC and CBD) in successfully treating intractable cancer pain patients unresponsive to opioids (30% reduction in pain from baseline). In this study a high-THC extract devoid of CBD failed to distinguish from placebo. This may represent true synergy of the THC–CBD combination.

 

CBD products lack the potential benefit of the Entourage Effect contributed by the THC, and may be less effective than when combined with THC.

 

Entourage Effect – CBD & Other Cannabinoids and Terpenes

In addition to THC and CBD, other cannabinoids and terpenes are believed to impact the clinic effects of cannabis and contribute to the entourage effect. For this reason, the Broad Spectrum and Full Spectrum CBD products offer potentially greater clinical benefits compared with the CBD Isolates. While the theory is sound, there is little research evaluating specific constituent combinations or doses nor specific therapeutic benefits. Much of the research does not clearly identify the content of cannabinoids and terpenes present in the marijuana studied. As the industry grows and research begins to catch up, it may be possible to select specific Broad Spectrum and Full Spectrum products to match specific desired therapeutic benefits.

 

In the meantime, one can explore what is known about the therapeutic effects of specific cannabinoids and terpenes and look for CBD products which could likely target desired therapeutic benefits. Careful attention to Certificates of Analysis can guide one to better product choices.

See: Cannabinoids and Terpenes – An Overview

Entourage Effect – CBD & β-Caryophyllene (BCP)

There is evidence that combining  CBD and the terpene, β-Caryophyllene, may have a synergistic benefit with respect to pain and inflammation.

See: β-Caryophyllene

 

 

Entourage Effect – CBD & Palmitoylethnolamide (PEA)

Palmitoylethnolamide (PEA) is a potent nutraceutical that is naturally produced in many plant and animal food sources, as well as in cells and tissues of mammals.  PEA has important neuroprotective, anti-inflammatory and analgesic actions both in the central and the peripheral nervous system. There are multiple mechanisms of action of PEA responsible for its therapeutic benefits, some that involve the endocannabinoid system (ECS) which is the basis of its proposed synergistic action with CBD, THC and other cannabinoids.

 

PEA produces indirect receptor-mediated effects within the ECS. PEA inhibits FAAH, the enzyme that breaks down endogenous (natural) cannabinoids (or endocannabinoids) such as anandamide (AEA), and plant cannabinoids (phytocannabinoids) like CBD and THC, that directly or indirectly activate CB2 and CB1 receptors. Likewise, PEA can indirectly activate the transient receptor potential vanilloid receptor type 1 (TRPV1) channels, which are also targets for the endocannabinoids. In addition, PEA is also able to increase AEA- or 2-AG-induced TRPV1 activation and desensitization . More recently, it has also been demonstrated that PEA can activate TRPV1 channels or increase the expression of CB2 receptors via PPAR-α receptors.

 

 

Quality Control – A Cautionary Note on Purchasing CBD Products

Because there are no regulatory agencies that oversee CBD manufacturing processes or product quality and because there are no universal standards for laboratory testing protocols, there are many products on the market, especially on the internet, that are not as advertised and many are not THC-free ( See: News Item March 2018). One study found that 70% of CBD products sold on the internet did not contain what their labels indicated (See: Label Accuracy by Cannabidiol Extract Type). It is best to buy from reputable businesses and gas stations are probably not to be recommended.

 

Look for products with labels clearly showing the quantity and concentration, a manufacturing date, and a batch number (for quality control). Choose products without corn syrup, trans-fats, GMOs, artificial additives, thinning agents or preservatives. Look to see if they have been lab tested for product consistency and verified as being free of mold, bacteria, pesticides, solvent residues, and other contaminants. Avoid CBD products extracted with toxic solvents like BHO, propane, hexane or other hydrocarbons. Instead, select products utilizing safer extraction methods such as supercritical CO2 or food-grade ethanol.

 

It is recommended that one obtain a “Certificate of Analysis” from an independent laboratory prior to purchasing a CBD product. A reputable dealer should be able to provide such a certificate on demand. The purpose of obtaining this certificate is to both provide an accurate breakdown of the compounds present in the product including cannabinoids and terpenes, but also to confirm the absence of toxic compounds introduced during the manufacturing process such as heavy metals, solvents and pesticides.

 

 

 

Dosing of CBD

Specific dosing of CBD needs to be guided individually, taking into account desired therapeutic benefits related to specific symptoms and disease processes as well as the potential for drug-drug interactions with other prescribed medications. Dosing should be guided by a physician knowledgeable about cannabis and cannabis-based products.

See: CBD Dosing

 

 

Safety

CBD has been determined to be safe, with no fatal overdoses on record and is generally well tolerated with minimal or mild side effects. CBD does not affect motor function or memory and does not appear to have the potential for physical dependence (e.g. withdrawal and tolerance), nor is it associated with abuse or addiction. The side effects of CBD are mild and include low blood pressure, dry mouth, light-headedness, sedation and drowsiness.

 

 

 

CBD Formulations

Thirty percent of top marketed drugs in the USA and 70% of all new drug candidates are lipophilic and exhibit poor water solubility. With theee physicochemical properties, the oral bioavailability of these compounds is very limited and extremely erratic. Different lipid-based formulations have been explored in the past few decades to improve the oral delivery of such compounds. In recent years, the most popular approach is their incorporation into self-emulsifying drug delivery systems (SEDDS), with particular emphasis on self-nano-emulsifying drug delivery systems (SNEDDS).

See: CBD Dosing, Products and Formulations

 

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

These lay-person websites appear to be good resources for exploring medical marijuana:

  1. www.GreenCamp.com
  2. www.Healer.com
  3. www.MedicalJane.com
  4. www.ProjectCBD.org

 

 

References:

Epidiolex (cannabidiol)

  1. FDA approves CBD drug – Epidiolex – The Washington Post

Marinol (dronabinol)

  1. Marinol – dronabinol

  

Cannabidiol (CBD)- Overviews

  1. CANNABIDIOL (CBD) Pre-Review Report WHO 2017
  2. Cannabidiol – State of the art and new challenges for therapeutic applications. – 2017 PubMed – NCBI
  3. Molecular Targets of Cannabidiol in Neurological Disorders – 2015
  4. Clinicians’ Guide to Cannabidiol and Hemp Oils – 2019

 

CBD – Anxiety

  1. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain – Clinical Implications – 2016
  2. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  3. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. – PubMed – NCBI
  4. Review of the neurological benefits of phytocannabinoids – 2018
  5. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders – 2017
  6. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. – PubMed – NCBI
  7. Evidences for the Anti-panic Actions of Cannabidiol – 2017
  8. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug – 2012
  9. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients – 2011
  10. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. – PubMed – NCBI 2007

 

CBD – Interaction with THC

  1. Cannabidiol: a promising drug for neurodegenerative disorders? – PubMed – NCBI
  2. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2015
  3. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  4. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  5. Clinical and Preclinical Evidence for Functional Interactions of Cannabidiol and Δ9-Tetrahydrocannabinol. 2018 – PubMed – NCBI
  6. Does Cannabis Composition Matter? Differential Effects of Delta-9-tetrahydrocannabinol and Cannabidiol on Human Cognition – 2017

 

 

CBD – Metabolites

  1. Human Metabolites of Cannabidiol – A Review on Their Formation, Biological Activity, and Relevance in Therapy – 2016

 

CBD – Drug-Metabolic Interactions

  1. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  2. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014 
  3. Characterization of P-glycoprotein Inhibition by Major Cannabinoids from Marijuana – 2006

 

CBD – Formulations

  1. Self-nano-emulsifying drug delivery systems an update of the biopharmaceutical aspects – PubMed – 2016
  2. The effect of Pro NanoLipospheres (PNL) formulation containing natural absorption enhancers on the oral bioavailability of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) – PubMed – 2017

 

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendations – Canadian Family Physician – 2014

 

CBD – Pain

  1. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. – PubMed – NCBI 2007
  2. Molecular Targets of Cannabidiol in Neurological Disorders – 2015
  3. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  4. Cannabidiol enhances morphine antinociception, diminishes NMDA-mediated seizures and reduces stroke damage via the sigma 1 receptor – 2018
  5. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. – PubMed – NCBI – 2018
  6. Cannabidiol for Pain Treatment – Focus on Pharmacology and Mechanism of Action – 2020
  7. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities – 2020

 

Medical Marijuana – Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post
  15. Opioid transport by ATP-binding cassette transporters at the blood-brain barrier: implications for neuropsychopharmacology. – PubMed – NCBI – 2011
  16. Opioids and the Blood-Brain Barrier – A Dynamic Interaction with Consequences on Drug Disposition in Brain – 2017
  17. The pharmacokinetics and the pharmacodynamics of cannabinoids. – PubMed – NCBI – 2018
  18. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI – 2016
  19. Pharmacogenetics of Cannabinoids – 2017 Enhanced Brain Disposition and Effects of Δ9-Tetrahydrocannabinol in P-Glycoprotein and Breast Cancer Resistance Protein Knockout Mice. 2012
  20. Pharmacogenomics of methadone maintenance treatment. – PubMed – NCBI
  21. Relationship between ABCB1 polymorphisms and serum methadone concentration in patients undergoing methadone maintenance therapy (MMT). – PubMed – NCBI- 2016
  22. Impact of ABCB1 and CYP2B6 Genetic Polymorphisms on Methadone Metabolism, Dose and Treatment Response in Patients with Opioid Addiction – A Systematic Review and Meta-Analysis – 2014
  23. ABCB1 haplotype and OPRM1 118A > G genotype interaction in methadone maintenance treatment pharmacogenetics – 2012
  24. The opioid epidemic – a central role for the blood brain barrier in opioid analgesia and abuse – 2017
  25. Morphine and the blood-brain barrier – diffusion, uptake, or efflux? – 2017
  26. Cyclosporine-inhibitable Blood-Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics – 2013
  27. Methadone Treatment for Pain States – 2005
  28. Cyclosporine-inhibitable Cerebral Drug Transport Does not Influence Clinical Methadone Pharmacodynamics – 2014
  29. Targeting blood–brain barrier changes during inflammatory pain – an opportunity for optimizing CNS drug delivery – 2011
  30. Targeting Transporters – Promoting Blood-Brain Barrier Repair in Response to Oxidative Stress Injury – 2015
  31. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. – PubMed – NCBI 2007

 

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Liposomal and Nanoformulations

  1. Phyto-liposomes as nanoshuttles for water-insoluble silybin–phospholipid complex
  2. Getting into the brain – liposome-based strategies for effective drug delivery across the blood–brain barrier – 2016

 

Medical Marijuana – Product Evaluation

  1. Labeling Accuracy of Cannabidiol Extracts Sold Online – 2017
  2. Public Health Focus > Warning Letters and Test Results for Cannabidiol-Related Products – 2017
  3. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  4. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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