For the tens of millions of Americans with arthritis, the pain, stiffness and other symptoms from the chronic disease can be stubborn.
There are various treatments for alleviating the symptoms of arthritis, but no cure. Options can include steroid injections into affected joints and even joint replacement surgery for some with advanced osteoarthritis, where cartilage in the hips, knees or other joints has worn away. For those with another common form of arthritis, the autoimmune disorder rheumatoid arthritis, antirheumatic drugs may also be used to slow the progression of the disease that also causes severe joint pain.
But for many, conventional therapies aren’t enough to relieve the discomfort. So in addition to alternative treatments like acupuncture, some people with arthritis turn to cannabidiol, or CBD, an active ingredient derived from the cannabis plant. This is the same plant from which THC (tetrahydrocannabinol), the psychoactive ingredient in marijuana that produces a high, is extracted.
The chemical compound CBD is frequently taken orally in oil, gel tablet or even gummy form, and it can also be applied topically in lotions and creams. Although CBD can contain up to 0.3% THC, it’s not been found to be habit-forming or able to give a person the same high. (By comparison, according to the National Institute on Drug Abuse, average THC levels in marijuana have risen in recent decades and are around 10%.)
Does CBD Work?
In short, that depends on whom you ask.
At the moment, experts say there’s a lack of high-quality, controlled human studies to determine whether CBD can effectively relieve arthritis pain and inflammation. There’s no shortage of anecdotal reports that CBD helps at least decrease discomfort. Similarly, there are plenty of reports that CBD proved to be a dud for others.
“We only have mostly animal studies — especially with pain — and the enthusiasm for CBD has obviously gotten ahead of the actual hardcore scientific data. So we’re in this little bit of a gray twilight zone,” explains Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital, a board member for Doctors for Cannabis Regulation. The group is pushing for legalization with fairly strict regulation of cannabis.
Legal restrictions have greatly limited researchers’ access to cannabis — including medical marijuana and CBD. And that impedes research on the possible usefulness of cannabis to treat chronic conditions like arthritis.
Grinspoon says some of his patients have had success with using CBD to treat arthritis pain. Others have seen no results and thought it was a waste of money. “So I’ve had mixed results,” he says. But he and some other experts who recommend CBD to patients say mixed results are better than no success at all, especially when many people with arthritis are desperate to find any relief and are looking for alternative low-risk options.
Similarly, Dr. Leslie Mendoza Temple, medical director of the Integrative Medicine Program at NorthShore University HealthSystem in Illinois, has found some of her patients seemed to benefit from taking CBD, while others didn’t. For the most part, patients who reported positive results noted that “it takes the edge off” or that they felt more relaxed — like, for example, that their muscles felt relaxed and they didn’t have as much pain, Temple notes.
“If they’re bone-on-bone with their arthritis or their RA (rheumatoid arthritis) pain is flaring up like crazy, I don’t find that CBD hemp oil is good enough,” she says. “But it can be tried, and it can take the edge off — maybe.” Experts reiterate that until there are randomized, controlled trials testing CBD against a placebo and against other treatments for arthritis, its effectiveness is simply not clear.
“There are many, many anecdotal reports of fantastic responses to these drugs,” says Dr. James Pauly, a professor of pharmaceutical sciences at the University of Kentucky College of Pharmacy. But right now, Pauly — who says he’s not against patients trying CBD for pain — and other experts stress there just isn’t sufficient data to support the unbridled hype and marketing around CBD.
Is It Safe?
Nevertheless, even with a paucity of data available, some clinicians recommend trying CBD for arthritis pain. A primary reason some doctors still recommend it is because it’s generally considered safe.
Last year, the Food and Drug Administration approved the drug Epidiolex — CBD that’s taken orally — for treatment of certain rare, serious forms of epilepsy. This is the first drug “compromised of an active ingredient derived from marijuana” that’s been approved by the FDA, the agency pointed out in a press release. Safety studies done in the run up to approval provide some insights on the risks associated with CBD, which experts say tend to be modest.
The most common side effects that occurred with Epidiolex were sleepiness and sedation, decreased appetite, diarrhea, rash, insomnia and poor quality sleep, according to the FDA.
“As is true for all drugs that treat epilepsy, the most serious risks include thoughts about suicide, attempts to commit suicide, feelings of agitation, new or worsening depression, aggression and panic attacks,” the agency notes. “Epidiolex also caused liver injury, generally mild, but raising the possibility of rare, but more severe injury. More severe liver injury can cause nausea, vomiting, abdominal pain, fatigue, anorexia, jaundice and/or dark urine.”
But experts say generally the most notable effect some experience from taking CBD tends to be drowsiness. In fact, some people take CBD before bed for that reason. However, that needs to be considered if one is planning to take CBD and drive, especially as it can contain up to 0.3% THC, doctors caution.
With any drug or supplement it’s important to let your doctor what you’re taking to make sure they don’t interact poorly with other medications
Is It Legal?
The evolving way in which CBD is being regulated complicates the legal picture.
The 2018 Farm Bill supported legalizing the growing of hemp, the low-THC variety of the cannabis plant from which most CBD is derived. But, just as with marijuana, the Drug Enforcement Agency still categorizes cannabis-derived CBD as a Schedule 1 substance: drugs that are considered to have no currently accepted medical use and a high potential for abuse and for which access is highly restricted.
Yet experts point out CBD doesn’t have a potential for abuse, and the FDA’s own recent approval of Epidiolex indicates it has a medical use as well. The complicated and contradictory legal tangle is further demonstrated by the fact that the DEA lists Epidiolex as a Schedule V substance, the least restrictive category under the Controlled Substances Act — even though it’s CBD.
On a state level, laws vary on using marijuana for medical or recreational purposes — and state laws allowing marijuana use clash with federal statutes forbidding it. While the sale and purchase of CBD isn’t tightly regulated, experts say it’s important to check on any possible restrictions where you live.
You could also possibly fail a drug test if you’re taking CBD with THC in it. Experts say while it’s definitely no certainty you will fail a drug test if you’re taking CBD, that scenario has landed some employees who work for companies with strict drug policies in hot water. “So if you’re drug-tested and they care about marijuana — a lot of places don’t, but if they do care about marijuana — you have to be very careful about using CBD,” Grinspoon says. “You might want to talk about it with your boss.”
How Should I Buy CBD?
Despite the legal fuzziness surrounding CBD, sales are booming, and you can buy it just about anywhere these days. All the more reason to be smart about where and how to buy CBD.
“It’s not regulated,” Grinspoon says. “So you need to make sure you get it from a reputable source.”
Past research has found that CBD labels frequently misrepresent what’s in their products. “When the government did some random testing, some had no CBD, some had wildly different levels of CBD than they advertised, and some had much more THC than it was supposed to have,” he points out. So make sure to confirm any CBD product you’re considering buying has been independently tested to ensure it’s safety and that ingredients and dosing (like milligrams of CBD, and THC content) match what’s on the label. ConsumerLabs.com, which requires a subscription, independently tests and reviews supplements, including CBD products, and verifies what’s in the products. It’s key to have that kind of independent confirmation, Temple says.
If you’re considering purchasing CBD from a brick-and-mortar location, Temple recommends going somewhere you might buy other health products or supplements — like a pharmacy. There, of course, you can also ask a pharmacist questions about any over-the-counter medication or supplement. On the contrary, Temple says she worries especially about CBD being sold so casually at places like gas stations — where of course a person has no recourse if they’re looking for that kind of expert opinion. “Are you going to complain to the gas station clerk if you have a side effect?”
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