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Psychiatry Practice Research Review

Released: September 29, 2021

Efficacy and Safety of Cannabidiol Plus Standard of Care vs Standard of Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial

Crippa JAS, et al. JAMA Netw Open. 2021;4:e2120603.

Background
Frontline healthcare professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. This study investigated the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline healthcare professionals working with patients with COVID-19.

Methods
This prospective, open-label, single-site, randomized clinical trial conducted in Brazil used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline healthcare professionals (physicians, nurses, and physical therapists) working with patients with COVID-19. Participants were enrolled between June 12 and November 12, 2020. In total, 214 healthcare professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection to CBD 300 mg (150 mg twice daily) plus standard of care or standard of care alone for 28 days.

The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel.

Results
In total, 120 participants were randomized to receive either CBD 300 mg plus standard of care (treatment arm; n = 61) or standard of care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age: 33.6 years) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory statistically significantly decreased at Day 14, Day 21, and Day 28. However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with a critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery.

Conclusions
In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among healthcare professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse events. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings.

Clinical Commentary
The deadly and persistent nature of the COVID-19 pandemic together with relatively high rate of infection and mortality among healthcare professionals and the rise of new variants and heavy workload have contributed to symptoms of anxiety, depression, and emotional exhaustion among healthcare professionals on frontlines resulting in a shrinking healthcare workforce.

This study represents the first randomized trial testing CBD for the treatment of COVID-19–related emotional exhaustion and burnout in healthcare professionals. Its strengths include having a control group and assessment of burnout using rating measures (Maslach Burnout Inventory-Human Services Survey for Medical Personnel). This study also used other standard assessment instruments like General Anxiety Disorder-7, Patient Health Questionnaire-9, and a PTSD checklist, which make the findings more relevant. CBD plasma levels were also assessed. The limitations include the lack of a double-blind, placebo-controlled design and the short duration of the trial.

Clinical Insights

  • CBD works to reduce burnout symptoms when combined with low-impact physical exercise and counseling in a supportive work environment.
  • No correlation of response with plasma levels were noted in this study. No effects were found on plasma levels of cytokines.
  • CBD does have adverse events that were noted such as elevated liver enzymes and pharmacodermia (an allergic reaction affecting the skin).
  • Effects on cognition were not assessed.

Summary
In the clinical realm, emotional burnout happens and is real, although healthcare professionals may deny it. Counseling and psychotropic medications, although effective for burnout, can take time to take effect, and CBD may be helpful and more rapid acting. CBD is available freely in many locations, but adverse events and drug interactions can occur. It is essential to make individualized decisions with available information to balance the risk of adverse events with the urgent need to treat burnout symptoms amongst healthcare professionals.

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