The only thing growing as quickly as the CBD market is the confusion surrounding its efficacy, safe usage guidelines, and regulations. That’s why this issue of Lift Up your Life features a CBD School segment.
Chock full of useful information presented in a digestible form, we hope that our CBD School segment contributes toward building a base of educated consumers.
This month’s CBD School segment contributor is the Arthritis Foundation, a leading organization providing support and funding research to improve the lives of individuals with arthritis.
Welcome back to school. -Editor
The Arthritis Foundation has been studying the growing popularity and availability of CBD-based products. Industry reports show people with arthritis are interested consumers and among the top buyers, and pain is the leading reason for purchase.
The Foundation’s survey of 2,600 people with arthritis shows significant use and awareness of CBD or cannabidiol. Earlier surveys have shown repeatedly that pain is the most burdensome arthritis symptom.
Experts at the Foundation produced this FAQ (frequently asked question) guide to help educate their membership and consumers interested in CBD.
What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.
Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement, and/or anxiety reduction.
Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point, very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis.
Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).
Are CBD products legal? CBD products derived from hemp are no longer considered Schedule 1 drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.
Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose, and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:
What type of product should I consider? CBD-based products can be taken orally, applied to the skin, or inhaled. There are pros and cons to each.
TINCTURE/SPRAY (UnderTongue). CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds.. The effects may be felt within 15 to 45 minutes. (Editor’s Note: Product taste varies based upon brand.)
ORALLY (By Mouth). CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract.
Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals, and other factors.
CAPSULES. (By Mouth). Capsules can work for daily use after a safe, effective capsule dose has been established.
TOPICAL (On the Skin). Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin, or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.
VAPE/INHALER (Inhaled). CBD can be inhaled via a vaporizing, or vape pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.
How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:
What to look for when shopping? There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are the strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals, and solvents.
Editor’s Note: See Patients Tell Us About CBD Use to see the full survey results.
The Arthritis Foundation’s CBD Guidance Report was produced with the support and contributions of the following researchers:
Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan who focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.
Daniel Clauw, MD, a professor of anesthesiology, rheumatology, and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. He leads research on arthritis pain and fibromyalgia as well as the effects of cannabis, particularly CBD, in pain.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, where she conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.