OCT 2018

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�e ABCs of CBDfor Insurance Agents

HOW RETAIL AGENTS CANGROW THEIR BUSINESSWITH CANNABIDIOL (CBD)

WHITE PAPER

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The ABCs of CBD for Insurance Agents: How Retail Agents Can Grow Their Business with Cannabidiol (CBD)

Within the rapidly expanding cannabis market, a new category of products is experiencing an exciting increase in popularity: Cannabidiol or CBD compounds. A recent report by Hemp Business Journal predicted the CBD market would grow globally from $202 million in 2017 to $2.1 billion by 2020.1

CBD is one of the many compounds found in the cannabis plant. Unlike marijuana, CBD oil, a popular extraction from cannabis, has many therapeutic uses. This paper will explore the history of medical marijuana and CBD oil, how people use CBD oil, some of its health benefits, some precautions and how agents can enter this rapidly emerging market.

Insurance agents with little or no experience in “nutraceuticals” such as CBD oil can benefit from learning about its tremendous potential to relieve pain and lessen symptoms of various illnesses like diabetes and Alzheimer’s. More importantly, the manufacturers, retailers, cultivators and all the industries supporting CBD production and sale will require insurance.

It seems likely that if your agents have not considered writing for this growing market, they soon will.

Knowing about medical marijuana—its uses, benefits, side effects, safety concerns, drug interactions and legality—will help you better serve clients in this emerging market.

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History of CBDTwenty-nine states plus the District of Columbia legalized medical marijuana while nine states and the District of Columbia legalized recreational marijuana.It is likely that more states will follow these leaders, especially since the financial returns have proved to be so compelling. In addition, the FDA approved Epidiolex, a brand of CBD or medical marijuana, on June 25, 2018. While the approval is for two seizure syndromes—Lennox-Gastaut and Dravet—in patients two years of age or older, it is the first federally approved use of medical marijuana in the United States.2

What is Marijuana?Manufacturers make marijuana by cutting and drying cannabis sativa or the hemp plant, which contains delta-9-tetrahydrocannabinol (THC). THC causes the symptoms of euphoria typically associated with cannabis use. Cannabis also contains, according to various sources, anywhere from 66 to 120 cannabinoids (medical marijuana substances). Most cannabinoids do not produce the “high” effect of THC.3

The FDA has approved another cannabis-derived drug, Marinol, a synthetic form of marijuana. Cancer patients use Marinol to treat nausea and appetite loss. Yet another cannabis product, called K2 or Spice, is an illegal synthetic marijuana that has been linked to a number of “serious side effects, including seizure, psychosis and even death,” according to CBS News.4

Studies show marijuana itself may be harmful. Smoking marijuana recreationally may increase the possibility of developing certain conditions, such as gum disease, acute memory loss, testicular cancer and psychosis in young adults. In addition, regular, longtime users may become dependent or even addicted. To be certain that these risks exist, however, researchers need to conduct further study.

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A Brief History of Medical MarijuanaIn 2700 B.C.E. Chinese doctors made a cannabis tea for gout and malaria.5 Some historians posit that the anointing holy oil described in Exodus and used in Biblical lands around 1450 B.C.E. contained cannabis. In 200 B.C.E., ancient Grecian healers used it for earaches. For physicians in the Middle Ages, it was a medicinal herb, and Queen Victoria used cannabis as an extract in alcohol during the 1840s. The late 1700s in the United States saw marijuana seeds and roots suggested for skin inflammation.6

However, by 1937, 23 states outlawed marijuana, and in 1970, the federal government made it a Schedule I drug. Schedule I drugs are classified as the most dangerous and include heroin. Today, medical marijuana is legal in 29 states, and the FDA has approved one form, Epidiolex, making that form legal in all states.

What are the Various Types of Medical Marijuana?Another name for medical marijuana is cannabinoid, which is a chemical compound. The cannabis plant synthesizes its cannabinoids naturally, but does not on its own produce THC or the cannabinoids. Producers must activate THC and cannabinoids, usually by applying heat.7 Researchers have studied only a few of the known cannabinoids with CBD being the most commonly known. Other well-known cannabinoids, in addition to CBD, include those listed below:8

CBN (Cannibiol) CBC (Cannabichromene) CBG (Cannabigerol) CBGV (Cannabigerivarin) THCV (Tetrahydrocannabivarin)

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CBDV (Cannabidivarin) CBCV (Cannabichromevarin)

CBD may be the most widely used cannabinoid. Many of these cannabinoids provide reported medical benefits. The main benefit of a cannabinoid over marijuana or THC is that the user does not experience a high.

Some marijuana growers have developed CBD strains that have a higher than usual level of cannabidiol. CBD may relieve anxiety, depression, some forms of childhood epilepsy, pain and inflammation. It also may protect an injured brain. Popular brands include Charlotte’s Web, Harlequin and Cannatonic.

Growers produce all other cannabinoids listed above from CBG, which reduces pain and inflammation, acts as an antibacterial and antifungal and protects the brain. CBN is an “accident.” It occurs when growers store THC incorrectly, exposing it to excessive heat or light for a very long time. CBN may fight bacteria, increase appetite and relieve pain, convulsions and agitation. Studies show that CBC has antibacterial and antifungal effects. It may also act as an antidepressant, improve acne and relieve diarrhea.9

Because CBD may be the most widely used cannabinoid, we will discuss it in more detail than the other cannabinoids.

How do Cannabinoids Work in the Human Body? The human body produces its own natural cannabinoids. Thus, humans have inborn cannabinoid receptors: CB1 and CB2. These receptors operate in your central nervous system (CNS) and your peripheral nervous system (PNS). CB1 functions throughout your body, but mainly in your brain and CNS. CB1 influences all the functions of your brain, including coordination, emotion, reasoning and hunger. THC, the version of marijuana that produces a “high,” attaches to CB1 receptors.

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The PNS consists of the nerves and nerve cell clusters, the parts of the nervous system outside the brain and spinal cord. The other type of receptor, CB2, operates in the PNS. Scientists used to think that CBD attaches to CB2, but research shows that CBD does not attach to either CB1 or CB2 receptors. Instead, it causes the body to produce more of its own cannabinoids.10

To sum up, cannabinoids work in our bodies in two ways: 1. THC affects us directly when it attaches to our CB1 receptors, producing the feeling of a “high.” 2. CBD causes our bodies to produce more of their own cannabinoids.

CBD produces some proven medical benefits. In addition, CBD might benefit other conditions, but that conclusion needs more research.11

We will begin an in-depth discussion of CBD by looking at the product that the FDA recently approved, Epidiolex.

What is Epidiolex?The British company GW Pharmaceuticals developed Epidiolex and ran its three-year drug trials from September 2013 through September 2016. GW Pharmaceuticals describes Epidiolex as a “pure CBD” plant extract, a thick, sticky liquid packaged in droppers.12

The FDA approved the drug in patients two years of age or older on June 25, 2018, for two syndromes: Lennox-Gastaut and Dravet. However, according to FDA chief Scott Gottlieb, “This is an important medical advance. . . . But it’s also important to note that this is not an approval of marijuana or all of its components. This is the approval of one specific CBD medication for a specific use.”13

Epidiolex is 98 percent CBD and two percent other cannabinoids. Patient studies show a high rate of success. Studies show that Epidiolex reduces seizures in children by 84 percent, and 11 percent of those children studied no longer suffered seizures. Seizures in 42 percent of those children reduced by 80 percent,

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and seizures for the rest of the children in the study reduced 25 percent to 60 percent. Other studies report similar good results. “CBD offers parents and children alike unprecedented hope,” according to Medical Marijuana, an online resource for medical marijuana information.

However, the side effects of Epidiolex can be very serious. They include liver problems, appetite loss, vomiting, fever, fatigue, jaundice and various forms of psychological distress. These types of side effects would of course be of concern to product liability carriers.

How do People Use CBD?Most CBD comes as oil, so manufacturers will frequently call their product “CBD oils.” People use these oils in many forms and concentrations.

Form Description Concentrations/DosesTinctures A mixture of cannabis and alcohol,

vegetable glycerine, or even vinegar that is usually mixed into a drink, a meal or taken straight

From 20 – 80 mg to 100 – 1000 mg

Edibles Easy to take, difficult to accurately dose

Varies

Patches Easy to take, difficult to accurately dose

Varies

Gums, Lozenges, Mints

Easy to take, difficult to accurately dose

Varies

Oral Sprays Quickest technique 1 – 3 mg, 2 - 3 sprays orally

Topicals (Balms, Salves)

Use for pain, inflammation and topical skin issues. Apply as any other body care product.

Dosage varies

Vape Juice CBD enters blood stream almost immediately. Research the ingredients to avoid dangerous vape juices and be aware of unregulated sellers.

Accurate dosing difficult

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Form Description Concentrations/DosesConcentrates Many delivery and application

techniques, all very effective Dosage varies

Capsules Easy technique for daily use 10 -25 mg dailyBeverages Easy technique for daily use VariesBHO “Honey oil”; concentrated form of

CBD; used when daily high doses are required; use vaping technique

From about 55% - more than 80%

RSO Concentrated form of CBD; used when daily high doses are required; used in syringes when treating cancer

From about 55% - more than 80%

What are the Proven Benefits of CBD?Listed below and then discussed are some CBD benefits. Research and scientific studies have proven these benefits.

Relieves pain As early as 2900 B.C.E., humans began using marijuana to relieve pain.

Only recently have scientists found that CBD is one of the key reasons marijuana reduces pain. Additionally, they discovered that CBD reduces pain because it impedes the neurons that conduct pain. The Journal of Experimental Medicine published a 2012 study showing that the use of CBD led to major inhibition of both chronic inflammation and pain in rats without causing the rats to develop a tolerance to CBD. This suggests that CBD may be useful in reducing chronic pain and inflammation in people.

In 2007, Canada performed an analysis of multiple studies regarding the results of spraying a combination of CBD and THC on the inside of the cheek. The results show this to be an effective method of treating the kind of nerve pain suffered by people who have multiple sclerosis. This kind of pain is not only one of the most intense types of chronic pain, but also incapacitates 50–70 percent of MS patients.14

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Reduces anxiety and depression The World Health Organization says that depression is the leading cause of disability worldwide and that the various anxiety conditions place sixth.15

Studies, including one from 2011, show that CBD reduces social anxiety disorder caused by being required to give a public presentation or speech. Researchers think CBD also reduces the following disorders: obsessive-compulsive, post-traumatic stress, general anxiety and panic. Since an estimated one in five of today’s college students report anxiety and depression, CBD oils may be a holistic remedy Gen Z and Millennials will

turn to for treatment of these disorders.16

Fights cancer CBD fights cancer directly, reduces the symptoms of cancer and relieves the side effects of cancer treatment.

In the cancer fight, the Journal of Pharmacology and Experimental Therapeutics published a study in 2006 showing, for the first time, that “CBD potently and selectively inhibited the growth of different breast tumor cell lines and exhibited significantly less potency in non-cancer cells.”17

Oncologists treat leukemia with CBD, and research shows that CBD can slow both lung and colon cancer.

The British Journal of Clinical Pharmacology published evidence that CBD not only substantially helped to check the spread of cancer but also inhibited cancer cell growth while stimulating the death of those cells.18

People have used marijuana to relieve nausea and vomiting for centuries. CBD lessened nausea, vomiting and pain in the treatment of both cancer symptoms and the side effects of traditional cancer treatments.

Treats seisures As previously stated, Epidiolex is FDA-approved for the treatment of two seizure syndromes, Lennox-Gastaut and Dravet, in patients two years of

age or older.

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Reduces the rate of diabetes A study of 4,657 adults published in the American Journal of Medicine in 2013 established that the 579 participants that were currently using marijuana tested with a 16 percent lower fasting insulin level.19 The lower

the fasting insulin level, the less likely one is to develop diabetes.

Clinical Hemorheology and Microcirculation published research in 2016 that indicates CBD may decrease pancreas inflammation, which occurs when the immune system attacks pancreatic cells. Because pancreas inflammation causes Type 1 diabetes, known formerly as juvenile diabetes, this research could lead to a CBD-based treatment for Type 1 diabetes.

Increases heart health According to several recent studies, CBD may successfully treat high blood pressure, which can lead to strokes and heart attacks. In one example of such a study, researchers gave one dose of 600 mg CBD oil to 10 healthy men and a placebo to 10 other healthy men. The CBD oil lowered the resting blood pressure of the group who received it. Additionally, the men in the study took a series of stress tests that usually result in increased blood pressure. The group who received the CBD dose had a lower blood pressure increase after the tests than the group who received the placebo.

The British Journal of Clinical Pharmacology published a study in 2013 using animal models. It shows that CBD protects blood vessels from damage caused by too-high blood sugar levels, by inflammation or by Type 2 diabetes.

What are the Possible Benefits of CBD?Marijuana growers, researchers and scientists continue to study CBD in relation to a myriad of health disorders. Listed below are only a few that CBD may positively affect:

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Neurological disorders other than seizures

Huntington’s disease Parkinson’s disease

Quitting smoking and withdrawing from drugs

Kidney disease Prion/Mad Cow disease

Acne Liver disease PTSDAlzheimer’s disease Migraine RheumatismADD and ADHD Multiple Sclerosis (MS) GlaucomaAIDS Obesity InsomniaAnorexia OCD LupusArthritis Osteoporosis/Bone

HealthNightmares

Back pain

What are the Side Effects of CBD?Of interest to product liability insurers are studies related to CBD side effects. Some studies show that adults tolerate a wide range of doses with few and insignificant side effects, even in high doses. Adults most often reported tiredness with diarrhea and changes in appetite or weight less often reported.

CBD oil can produce a number of possible side effects; below are some of them:

Fatigue Hypotension Psychosis DrowsinessDry mouth Impaired motor functions Nausea DiarrheaLightheadedness Anxiety/Depression Vomiting Change in appetite

Studies show that these side effects do not affect most people, especially when they use the CBD oil in moderate amounts. None of the current literature reviewed for this white paper refers to these side effects as extremely dangerous or at risk of being fatal.

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What are the Safety Concerns regarding CBD? In the past 15 years, researchers and scientists have conducted more than 20,000 studies on cannabis, hemp and cannabinoids. The results entirely validate the beneficial possibilities and feasibility of CBD oil. Nevertheless, reasons exist to be careful before using CBD. Even the highest quality CBD may cause adverse reactions in some people.

CBD oil can cause drowsiness, fatigue, dizziness and impaired motor functions, especially in high doses. Therefore, when taking high doses of CBD oil, manufacturers may warn against driving or using heavy machinery.

If reducing or controlling weight is an issue, users should be aware that CBD could cause an increase in appetite.

One very dangerous risk when using CBD oil is improperly produced or low-quality oil.20 This danger can increase when purchasing CBD oil online. Of course, this danger would be a concern to product liability underwriters. Underwriters with experience in this market will have questions about the production processes of CBD vendors they may insure.

Researchers have not studied the use of CBD oil during pregnancy and most experts recommend against its use. While CBD oil may be beneficial in treating pregnancy-related issues, a physician’s input in such cases is critical.

Can CBD Interact with Other Drugs?While a few studies have looked at other drug interactions with CBD, one published in the summer of 2017 reports a “favorable safety profile” of CBD when people use it while taking prescription medication.21 Several years ago, the U.S.

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Department of Health said that “serious adverse [side] effects are rare with [the use of] cannabis or its constituents.”22

Some studies show that CBD does interact with medications. For instance, CBD oil lowers blood pressure. If taking medication for high blood pressure, those suffering from hypertension should avoid CBD oil. Using CBD could lower blood pressure to dangerous levels.

CBD can interact with some sedatives, including Xanax and Valium. Research is ongoing regarding the interaction of high doses of CBD with epilepsy medications.

CBD interacts with cancer-treatment drugs. With three of these drugs, Etoposide (VePesid, Eposin, Etopophos), Methotrexate and Paclitaxel (Taxol), the interaction can be severe.

For patients taking antidepressants, two drugs known to have a strong interaction with CBD are Buspirone and Clomipramine. A physician’s input in these instances is critical.

CBD interacts with medications that treat heart and circulatory conditions. CBD interaction information sheets may discuss this in more detail. Types of cardiovascular medications that contain such warnings include statins, a class of lipid-lowering medication and beta-blockers.

Here is a list of other medications known to interact with CBD:

Lovastatin (Mevacor)

Ketoconazole (Nizoral) and Itraconazole (Sporanox)

Troglitazone and Methylprednisolone

Fexofenadine (Allegra) and Terfenadine (Seldane)

Viagra (Sildenafil)

Simvastatin (Zocor)

Artemether (Artenam, Paluther) and Halofantrine

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How do Federal and State Laws Affect Using CBD?Although regulations regarding possession and use differ, as of September 2018, medical marijuana is legal in: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Mexico, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and West Virginia.23 Most states require a prescription.

Other of the states have no broad laws covering medical marijuana, although some of these have laws specific to certain diseases. Some states, Virginia for example, allow people to use marijuana if they have a doctor’s prescription. However, federal law does not allow doctors to prescribe marijuana, so any such prescription is illegal. Doctors can recommend but not prescribe marijuana in written form.

To use CBD oil, some states require doctors to write prescriptions that call for specific CBD levels. However, these prescriptions also are not legal under federal law. Another example is Missouri, which allows a person with epilepsy to use a specific CBD composition if three other treatment options have failed to treat their epilepsy. Alabama and Mississippi allow people with severe epilepsy to use medical marijuana. Louisiana residents can use medical marijuana in any form except they may not smoke it.

You can find a list of the states that have laws applying to CBD oil here. This list is accurate as of May 8, 2018.

The Controlled Substances Act (CSA) contains the federal regulations for marijuana, current as of May 8, 2018. You can read about federal regulations here. The CSA sees no difference between medical and recreational marijuana. Federal law supersedes state law. However, as recently as May 2018, the Drug Enforcement Administration released a directive stating that “Products and materials that are made from the cannabis plant and which fall outside the CSA

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definition of marijuana (such as sterilized seeds, oil or cake made from the seeds, and mature stalks) are not controlled under the CSA.”24

This site discusses medical marijuana state laws current for May 8, 2018, for each state.

ConclusionMedical marijuana and CBD oils are emerging as one of the nation’s fastest growing industries. The wellness industry, of which CBD is rapidly becoming a bestseller, is here to stay.

As insurers continue to respond to changes in society by developing new insurance products, the market for alternative medicines will require innovation and product development by insurers.

For producers who get ahead of the curve of coming growth, these coverage lines can help retail agents grow their businesses. Choosing a wholesaler who has been in the nutraceuticals space can help you grow your sales with CBD and other nutraceutical products.

Rely on NutraRiskNutraRisk is a wholesale insurance broker and program manager offering insurance coverage for the nutraceutical and dietary supplement industry. A division of Worldwide Facilities, LLC, NutraRisk offers innovative insurance solutions for the emerging cannabis nutraceutical industry. Headquartered in Los Angeles, CA, NutraRisks’ insurance specialists bring more than 70 years of combined experience in the insurance industry. NutraRisk provides coveragein all states where Cannabis and CBD oils are legally manufactured and distributed.

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Take advantage of our expertise in placing Cannabidiol (CBD) risks today—contact Morgan Moore in our Los Angeles office at (213) 236-4566 or mmoore@wwfi.com to schedule a conversation.

Medical Disclaimer: The material offered in this white paper is for informational purposes only. It provides consumer education for retail insurance agents and does not constitute medical advice. Always seek your physician’s guidance before undertaking any new medical care regime, including the use of CBD oils.

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Notes1 “Forecast Indicates CBD Global Market Projected to Experience Continued Significant Growth,” Cision PR Newswire. April 3, 2018.2 “FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy,” U.S. Food & Drug Administration. June 25, 2018.3 Nick Jikomes, “List of Major Cannabinoids in Cannabis and Their Effects,” Leafly.4 Rachel Rettner, “Why synthetic marijuana like K2 or Spice can cause “really bizarre” symptoms,” CBS News. February 3, 2017.5 Shanna Freeman, “History of Medical Cannabis Use,” How Stuff Works. December 7, 2011.6 Lecia Bushak, “A Brief History Of Medical Cannabis: From Ancient Anesthesia To The Modern Dispensary,” The Grapevine. January 21, 2016.7 Nick Jikomes, “List of Major Cannabinoids in Cannabis and Their Effects,” Leafly.8 Ibid.9 “What Are Cannabinoids?” Leaf Science. October 25,2017.10 “How Does CBD Affect the Endocannabinoid System?” CBD Oil Review.11 Jon Johnson, “Everything you need to know about CBD oil,” Medical News Today. July 27, 2018.12 “Epidiolex Approval History,” Drugs.com.13 Meagan Morris, “What is Epidiolex? Cannabis-based drug was just approved by the FDA,” Metro. June 25, 2018.14 Erica Jacques, “An Overview of Neuropathic Pain,” Verywell Health. September 18, 2018.15 Jillian Kubala, “7 Benefits and Uses of CBD Oil (Plus Side Effects),” Health Line. February 26, 2018.16 David Rosenberg, “1 in 5 college students have anxiety or depression. Here’s why,” The Conversation. February 9, 2018.17 Paola Massi, “Cannabidiol as potential anticancer drug,” NCBI. April 17, 2012.18 Ibid19 Elizabeth Penner, “The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults,” The American Journal of Medicine. July 2013.

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20 “The Secret to Choosing High-quality CBD Oil in Today’s Unregulated Market,” High Times. . April 2, 2018.21 Kerstin Iffland, “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies,” NCBI. June 1, 2017.22 Ibid23 “State Marijuana Laws in 2018 Map,” Governing the States and Localities. February 18, 2018.24 Jude Clemente, “DEA Internal Directive Regarding the Presence of Cannabinoids in Products and Materials Made from the Cannabis Plant,” Drug Enforcement Administration. May 22, 2018.

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reference use only and does not constitute the rendering of legal, financial, or other professional

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