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Jennifer Burch, PharmD
Sejjal Patel, PharmD
Jhuvon Francis, PharmD 


2609 North Duke Street, #103
Durham, NC 27704
Telephone: (919) 220-5121
Fax: (919) 220-6307


6224 Fayetteville Rd, #104
Durham, NC 27713
Telephone: (919) 484-7600

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Medicine: For Some, a Toxic Threat

“My response to the word ‘toxin,’” observes Pharmacist Jennifer Burch of Central Compounding Center in Durham, “is probably quite different from the typical reaction—which is to picture poisons or pollution. But I have to look at it differently, because I know that for many of the patients we serve, the medicines we dispense might themselves be toxic.

Dr. Burch is experiencing good results with clients in the use of CBD oil to address a variety of symptoms.

“We’re all individual,” she explains, “and what’s toxic to me may not be toxic to you or anyone else. Medicines are not neutral; they all have risks as well as benefits. Each of us is a unique organism, and how we respond to medicine—or food or allergens or other toxins, for that matter—is affected by our body’s chemistry, genetics, age, health, and so on.

“That said, the rigorous testing required for FDA approval of prescription medications ensures that—for a majority of patients—a medicine's benefits will outweigh its known risks. And for most patients, the risk of adverse reactions is fairly low.

“However, my perspective as a pharmacist—especially as a compounding pharmacist—is different from that of the FDA. I need to be thinking not about most patients, but the individual patient for whom a medicine may be a poison.”

Health&Healing: What medicines are likely to be toxic?

DR. BURCH: “Toxic” is a very individual issue, so a given patient’s allergies or sensitivities will come into play. But a general area of concern is what’s called “polypharmacy.” This is when a patient takes many prescription medicines, perhaps along with multiple supplements, resulting in problematic interactions. It could simply result in one medicine reducing the effectiveness of another; but some interactions have very serious health consequences. And when someone takes 10, 20 or more different medications (not uncommon!), the potential for problems high.

So, we try to work with patients with multiple prescriptions to ensure there are no problem interactions, and often help them reduce the number of medications they take.

H&H: What else are you looking for?

DR. BURCH: There are three different patient groups who are at serious risk of having a toxic reaction to medication, and who get our special attention: those with celiac disease; those with Alpha-gal allergy; and those sensitive to dyes. In each case, commercial prescription medications can be extremely problematic, and compounding offers a safe, “non-toxic” alternative.

Remember that, in addition to the active ingredients in any medication, other “inactive” or “inert” components—including fillers and dyes—are used to make the medicine more palatable or help with absorption. But often these “inert” ingredients cannot be tolerated.

Celiac disease is particularly challenging. This is a serious autoimmune disease involving an intolerance to a gluten protein found in many of grains including wheat, barley, rye, and some oats. Many “inactive” ingredients used in medicines—including starches, sugar derivatives, and caramel coloring—can contain gluten. And even the tiniest amount can affect a celiac patient.

Alpha-gal patients are another category requiring special consideration. In their case, a tick bite has triggered an allergic reaction to a sugar called galactose alpha galactose (‘alpha-gal’). Mammal-based products contain this simple sugar, and it can lead to reactions as serious as anaphylaxis.

Consequently, there’s a whole list of things these patients can’t tolerate. For example, they can’t take gelatin products—including gelatin-based capsules—or tolerate ingredients such as glycerin or magnesium stearate. Using vegetable-based capsules is just one of the ways we adjust medicines for these patients.

H&H: You mentioned sensitivity to dyes.

DR. BURCH: Dyes are a major problem, because people don’t often know they have a sensitivity until they get a bad reaction. A classic example of this is a recent patient who had been taking medicine for ADHD. Another pharmacy had switched her to a different brand, and suddenly the medicine made her ADHD not better, but much worse!

We researched the ingredients in the new medicine and found that the capsule used FD&C red number three—an ingredient known to make some people hyperactive. The dye in the capsule increased her ADHD! We found another brand that uses iron oxide as the colorant, and after only one day, she reported that she was “back to myself!”

Colors are often used in preparing medications, to distinguish one from another, but for the people allergic to dyes, it’s a big problem. You’ll see a lot of white and clear capsules at our pharmacy for that very reason.

H&H: What other “toxic” issues do you encounter?

DR. BURCH: A lot of what we do is detective work. If someone has an adverse reaction to a medication, our goal is to determine the source and find an effective alternative. We want to get them the medicine they need without the ingredients they can’t tolerate.

For that reason, we’re cautious about introducing a lot of new medicines at one time. Instead, we’ll suggest starting one and introduce the next one a week later. That way, if a reaction occurs, we can more easily pinpoint the problem drug or ingredient and bypass it with a compounded formulation.

Cannabidiol (CBD)—Not Just for Pain

While prescription medications are a primary focus of her practice, Dr. Burch also has considerable interest in non-pharmaceutical options for treating medical conditions, and has become a dedicated student of the properties and uses for cannabidiol (CBD).

Since its approval in 2014 for over-the-counter sale in North Carolina, CBD has been widely used as an alternative, non-pharmaceutical treatment for pain and other conditions.

“The body’s endocannabinoid system plays a number of stabilizing roles, with hundreds of receptors throughout the body,” explains Dr. Burch. “And while researchers continue to learn more about this system, they do know it plays a role in regulating sleep, mood, appetite, memory, even fertility. When there’s a deficiency in the body’s endocannabinoid system,” she says, “CBD can help to boost that.”

Dr. Burch emphasizes that “CBD is not medical marijuana. Cannabidiol is one of 104 chemical compounds found in cannabis; THC—the psychoactive ingredient that makes one high—is not part of CBD.”

Many Uses of CBD

Many people are familiar with CBD use as an option for pain management, says Dr. Burch, but may not appreciate how broadly it can be used. “It is effective for all kinds of pain: musculoskeletal, neuropathic, even vaginal pain; it’s a proven treatment for epilepsy; and one of my patients even found that the right dose of CBD calmed her restless leg syndrome.”

CBD also helps with a range of mood disorders, including anxiety, panic, and PTSD, notes Dr. Burch. “And I have found it particularly useful for patients who are on medications for anxiety. Many use prescription benzodiazepines, such as Xanax, which can be effective. But taking those medicines all the time or long-term is a concern, because long-term benzodiazepine use can increase the risk of dementia.

“So, we’ve found that the right dosage of CBD can help such patients lower their usage of other medications or even to help them get off other anxiety medications entirely.”

Keys to Success:
The Right Product and the Right Dosage

While CBD doesn’t require a prescription, its effectiveness does depend on guidance and education. “We have learned the importance of careful, individualized dosing,” says Dr. Burch. “And we work closely with our patients to find the ‘sweet spot’ that produces the desired result. More is not necessarily better with CBD,” she emphasizes. “We start everyone on a lower dose and teach them how to titrate until they get the appropriate effect.”

Just as important as the dosage, she adds, is the quality of the product. “The hemp plant—which is the source of CBD—is much like a sponge. So, you don’t want to use CBD from hemp planted in toxic soil. We carefully vet all products to ensure they have the appropriate level of CBD and are not contaminated with pesticides, herbicides, or heavy metals.”