THE PROGNOSIS

Looking for some CBD oil this Cyber Monday? It won’t be hard to find. It’s the first holiday shopping season since Congress legalized hemp, and products derived from its oil are being sold all over the place.

The oil — which is said to relieve a host of ailments — has exploded onto the health and wellness scene in the last few years. Sales of CBD have nearly quadrupled since 2015 and they’re projected to hit $1.8 billion by 2022. 

The product got a particularly large boost from the farm funding bill Congress passed at the end of 2018, which officially classified hemp as an agricultural commodity and removed it from the federal controlled substances list.

“Good lord, that really took our business to a whole other echelon,” Brandon Gadles, president of Boston Hempire, a wholesaler and retailer of hemp and CBD products, told me.

Gadles says his company’s sales of CBD products are about seven times more now compared with the start of this year. He expects they’ll generate $2 million in revenue this year for the company, which sells in about 2,500 stores, mostly in New England.

Boston Hempire was already selling some CBD oil before Congress legalized hemp (previously, the government didn’t habitually enforce federal laws on it). But Gadles feels the measure gave the industry a major boost by making consumers feel more confident in buying the products — especially from small businesses such as his own.

The farm bill “is really what increased production,” Gadles said. “Once that bill started to protect the industry on a federal level, people got more comfortable ordering from small businesses.”

The projections for CBD sales aren’t hard to believe after hitting the mall and surfing the Web for gift deals. I learned that you can buy CBD oil as a deodorant-type stick. Or as lotion. Or as ingestible powder, pills and gummies. You can buy CBD-infused coffee, water and juice. You can buy CBD dog treats and bath bombs.

The place where my husband gets his hair cut was even selling CBD hair serum (he didn’t purchase any).

Just look at the number of Internet searches for CBD oil. Hardly anyone was Googling “CBD oil” five years ago. But there were 6.4 million Google searches for “CBD” in April, and searches increased 160 percent in 2018 compared with 2017, according to a research letter published last spring in the Journal of the American Medical Association.

The oil has gained such an enthusiastic fan base that people are making fun of it on Twitter:

CBD oil is an essential part of marijuana, but it's not the part that produces the “high.” It’s derived directly from hemp, which is a form of the cannabis plant. Until the past year, most hemp sold in the United States came from Canada, where growing industrial hemp has been legal since 1998. 

The popular oil has some clearly documented benefits — and a lot of unknowns. 

It has been shown to be highly effective in treating childhood epilepsy syndromes such as Dravet syndrome and Lennox-Gastaut syndrome, which are so severe they don’t typically respond to anti-seizure medications. Last year, the Food and Drug Administration approved Epidiolex as the first-ever marijuana-derived medicine, which is used to treat these conditions and contains CBD oil.

Preliminary data from small clinical trials have also suggested that applying CBD oil to the skin could be effective for treating chronic pain — such as the pain from inflammation experienced by patients with arthritis — and may also help those with insomnia or anxiety. 

If you believe all the Black Friday and Cyber Monday marketing, the oil can solve numerous other health problems. But take a pause before you buy it for everyone on your gift list.

There’s much scientists don’t know about potential benefits from CBD oil. Because of a lack of research, there are still many questions about which conditions it might be most effective at treating and the optimal dosages. There are also some known, negative side effects, including nausea, fatigue and irritability.

The FDA is taking a cautious approach (too cautious, some argue) to the oil, warning that too little is known about its effects and side effects. Last week, the agency sent warning letters to 15 companies the agency says were violating federal law by marketing the products to treat diseases or for use as dietary supplements.

The agency also released a consumer update about CBD, saying it cannot recognize the ingredient as safe or approve products that contain it under more research is carried out.

“Many unanswered questions and data gaps about CBD toxicity exist, and some of the available data raise serious concerns about potential harm from CBD,” the FDA wrote.

Boston Hemphire wasn’t among those 15 companies. Gadles said the company gets hundreds of emails a day from customers asking whether CBD products will cure their depression or other illnesses, but the company directs its employees to avoid making any such assurance. He said it’s “disheartening” to see other companies making unsubstantiated claims because it could eventually lead to stricter government regulation.

“We make absolutely no claims,” Gadles said. “We don’t guide anyone in any which way.”

AHH, OOF and OUCH

AHH: Health-care has majorly entangled Sen. Elizabeth Warren's (D-Mass.) campaign, as she has retreated from a purist stance on Medicare-for-all to a more centrist position. Influential Medicare-for-all advocates saw Warren’s plan to have a transition phase with an interim public option as a retreat, while moderates said supporting Medicare-for-all with no qualifications would be too risky, our Post colleague Annie Linskey, Jeff Stein and Dan Balz report in this well-sourced play-by-play of how Warren has struggled over how to approach the issue.

The moment Warren proposed a slower transition to Medicare-for-all "highlighted the political turbulence that Warren has experienced in recent weeks as she has attempted to extricate herself from a policy dilemma that has blunted her steady rise to the top ranks of the Democratic nominating contest," write our colleagues, who spoke with more than two dozen advisers, experts and others familiar with the campaigns discussions for this story.

"Recent polling suggests Warren has sustained political damage from her health-care policy," they write. "After climbing to the top of the field by focusing on a message of overhauling Washington and Wall Street, Warren plateaued as her campaign became consumed with health care." After a nationwide high of 27 percent in October’s RealClearPolitics average of polls, Warren fell to nearly 16 percent in late November.

"The irony is that a candidate whose political identity has been built in part on her reputation as a policy wonk — a potential president who boasts of having a plan for nearly every challenge facing everyday Americans — has been tripped up by a policy issue that has dominated politics and defined her party for years," our colleagues write.

OOF: A Tampa-based company, the Lung Health Institute, aggressively marketed stem cell therapies it claimed could treat incurable conditions like COPD. Its clinics have been singled out for particularly intense marketing and unproven claims, our Post colleagues William Wan and Laurie McGinley report.

“Former patients of the Tampa-based Lung Health Institute said they were encouraged to take out bank loans or borrow money from family members. Some withdrew from their retirement accounts and took up church offerings," they write. "Others borrowed against their homes.”

The company has brought in patients using tactics like targeted online ads and high-pressure seminars. Employees were given monthly sales quotas, and former doctors and nurses working for the company detailed how they convinced wavering patients to give in, our colleagues report in this deep dive based on numerous interviews, internal memos, telephone scripts, emails and financial records.

“In two lengthy interviews, the company’s chief operating officer, Ann Sells Miller, defended the company, saying its treatments have helped many patients who have no other options. Miller and other executives dismissed complaints about their marketing strategies and treatments, saying that their critics are often people who don’t understand their stem cell procedures or lawyers looking to make money by filing lawsuits against them,” William and Laurie write.

"The FDA has not approved most stem cell treatments and has said it considers many of them illegal. Miller and other officials at Lung Health Institute said they believe their treatment doesn’t require FDA approval. Nevertheless, the company now plans to apply to the FDA for approval," they report.

OUCH: Authorities allege a group of UPS employees were part of a major drug-shipping operation, importing and trafficking massive amounts of marijuana, cocaine and counterfeit vaping oils.

“The lucrative operation at times involved moving thousands of pounds of marijuana and narcotics each week from narco-traffickers into the United States to destinations across the country, using standard cardboard boxes that were carefully routed through the private mail carrier’s trucking and delivery systems, authorities said,” our Post colleague Arelis R. Hernández reports. “Four UPS employees have been charged with drug trafficking in state court, and court records show that at least 11 people — including two UPS supervisors and drivers — have been arrested in the past two weeks on a slew of state charges stemming from the decade-long investigation by a task force of local, state and federal law enforcement.”

The alleged ringleader was Mario Barcelo, a 20-year employee of the company and a dispatch supervisor. Counter Narcotics Alliance investigators are worried Barcelo’s “method to obscure the origin and destination of drug shipments, a tactic they worry could be replicated by other UPS employees and other drug-trafficking organizations.”

“Their sales pitch was that because of who Barcelo was at UPS, he could make sure your package will make it out without anyone finding it,” said Tucson Police Sgt. William Kaderly. “He had face time with traffickers.”

REPRODUCTIVE WARS

— Abortion access across the country is more vulnerable than it’s been for years, with states passing 58 abortion restrictions over a six-month period in 2019, the New York Times’s Elizabeth Dias and Lisa Lerer report.

“For abortion opponents, this moment of ascendancy was years in the making. Set back on their heels when President Barack Obama took office, they started methodically working from the ground up. They focused on delivering state legislatures and gerrymandered districts into Republican control. They passed abortion restrictions in red states and pushed for conservative judges to protect them,” they write. “And then unexpectedly, and serendipitously, Mr. Trump won the White House. Ending legal abortion appeared within their reach.”

Divisions within the abortion rights movement have also contributed to the struggle for its activists, Elizabeth and Lisa write.

“National leaders became overly reliant on the protections granted by a Democratic presidency under Mr. Obama and a relatively balanced Supreme Court, critics say, leading to overconfidence that their goals were not seriously threatened,” they add. “Their expectation that Mr. Trump would lose led them to forgo battles they now wish they had fought harder, like Judge Merrick B. Garland’s failed nomination to the bench.”

MEDICAL MISSIVES

— Justice Ruth Bader Ginsburg was recently hospitalized for chills and a fever. In August, she announced she’d completed radiation therapy after a malignancy was found on her pancreas. Months before that, cancerous nodules were removed from her left lung. The recent spate of hospitalizations has raised questions about a potential election year Supreme Court vacancy, the Hill’s Alexander Bolton reports.

“Liberal activists are already calling on President Trump to keep any possible Supreme Court vacancy open until after the 2020 election, but Senate Majority Leader Mitch McConnell (R-Ky.) has indicated he would fill a court vacancy next year, even though he blocked former President Obama’s nominee for most of 2016 after the death of Justice Antonin Scalia,” he writes.

If there is another vacancy during Trump's tenure, conservative activists are expecting a fierce battle, Alexander writes, especially as it could shift the court on the issue of abortion and the landmark 1973 Roe v. Wade ruling.

— And here are a few more good reads:

STATE SCAN

No single agency keeps tabs on the number of deaths at psychiatric facilities in California, or elsewhere in the nation. The Times submitted more than 100 public record requests to obtain the information.
Los Angeles Times

AGENCY ALERT

“You can’t take proper care of patients if you don’t document."
Politico

INDUSTRY RX

Health
Patients are more likely to resort to out-of-network providers. Insurance firms also reimburse behavioral health providers at lower rates.
Jenny Gold

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a business meeting to consider nominations, including Stephen Hahn to lead the Food and Drug Administration on Tuesday.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on flu season preparedness and response on Wednesday.
  • The Senate Armed Services Subcommittee on Personnel holds a hearing examine testimony about servicemember, family, and veteran suicides and prevention strategies on Wednesday.

SUGAR RUSH