CBD May Alleviate Burnout, Exhaustion in Health Care Professionals

Health care professionals working with patients during the COVID-19 pandemic reported reduced burnout and emotional exhaustion following treatment with CBD therapy, according to findings published in JAMA Network Open.¹

Despite the potential efficacy of this treatment, consideration before taking CBD is still warranted due to the potential undesired adverse events (AEs) associated with the therapy, the study authors wrote.

The BONSAI study (NCT04504877) assessed a total of 118 health care professionals. Participants were randomly designated to receive either CBD at 300 mg (150 mg twice daily) for 28 days in addition to standard care, or standard care alone.

The 61 participants who received CBD reported significant decreases in emotional exhaustion on days 14 (4.14 points; 95% CI, 1.47-6.80), 21 (4.34 points; 95% CI, 0.94-7.73), and 28 (4.01 points; 95% CI, 0.43-7.59).

“Burnout among health care workers is an important issue for health care systems, with a direct impact on quality of care,” the study authors wrote. “No pharmacological treatment is currently available for the prevention or treatment of burnout symptoms and emotional exhaustion among frontline health care professionals working with patients with COVID-19, even though several studies have reported that depression, anxiety, insomnia, and PTSD symptoms are more common in this population. Therefore, the results of the present study could have a relevant impact on the mental health of health care staff worldwide.”

The primary outcomes in the trial were emotional exhaustion and burnout symptoms, which were evaluated using an emotional exhaustion subscale on a Brazilian version of the Maslach Burnout Inventory–Human Services Survey for Medical Personnel.

Secondary outcomes included anxiety, depression, and PTSD symptoms and were evaluated through the Brazilian versions of the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire, the 9-item Patient Health Questionnaire, and the PTSD Checklist from the Diagnostic and Statistical Manual of Mental Disorders. Mood and burnout were also assessed through the Clinical global Impression scale and the daily Ecological Momentary Assessment.

In addition, researchers took blood samples at baseline, as well as on days 7, 14, 21, and 28 to measure proinflammatory cytokine levels, CBD plasma levels, and other general laboratory measurements.

The standard-of-care treatment that both cohorts received included motivational and instructional videos on low-impact physical exercise as well as weekly consultations with psychiatrists who provided psychological support. Other measures to foster a supportive working environment included personal protective equipment, work schedule modification, ongoing testing, and the hiring of new personal.

Notable AEs (occurring in greater than 10% of participants) included somnolence, fatigue, increased appetite, diarrhea, weight gain, and lethargy. These symptoms were consistent across both treatment groups, except for increased appetite, which was higher in the control arm compared with the treatment arm (14 vs 5 participants, respectively).

Five of those 61 participants also experienced serious AEs and discontinued CBD treatment. Notably, all 5 experienced a full recovery. AEs included 4 cases of elevated liver enzymes (1 critical and 3 mild cases) and 1 severe case of pharmacodermia. In addition, 1 participant in the experimental arm also reported mild pharmacodermia. No participants with elevated liver enzymes experienced an increase greater than 2-fold normal levels of total serum bilirubin.

“Cannabidiol may act as an effective agent for the reduction of burnout symptoms among a population with important mental health needs worldwide,” the study authors concluded. “However, it is necessary to balance the benefits with potential adverse and undesired effects when making decisions regarding the use of this compound.”

Trial limitations include the lack of a double-blind placebo-controlled design, as well as short follow-up periods, small sample size, and single-intervention dose. Future research should seek to obtain more broadly applicable results by incorporating a double-blind placebo-controlled clinical trial approach, longer follow-up periods, multiple dosage interventions, and a multicenter design.

Reference

Crippa JAS, Zuardi AW, Guimarães FS, et al. Efficacy and safety of cannabidiol plus standard care vs standard care alone for the treatment of emotional exhaustion and burnout among frontline health care workers during the COVID-19 pandemic: a randomized clinical trial. JAMA Netw Open. 2021;4(8):e2120603. doi:10.1001/jamanetworkopen.2021.20603