Use of Cannabidiol (CBD) for Arthritis

Safety, Effectiveness, and Legalities

Cannabidiol (CBD), a component of the marijuana and hemp plants, has been touted for its ability to cure everything from chronic pain to migraine headaches and arthritis. With the legalities loosening up about the use of natural products such as CBD oil, it’s become a popular topic in the health care and natural healing arena. But can CBD oil really help people with arthritis? Is it safe? Is it legal? What do the experts say?

What Is Cannabidiol (CBD)?

Cannabidiol (CBD) is just one of hundreds of different substances that can be found in the Cannabis sativa plant. Most CBD products are free of the chemical that causes a person to get high—called the psychotropic effect—but it depends on how the manufacturer processes it. The name of this psychotropic inducing chemical is tetrahydrocannabinol (THC).

Is It Legal?

There is quite a bit of controversy over the legalities of CBD. The laws are quite complex, and CBD can be derived from different varieties, strains, and sources (including hemp and marijuana). Another controversy comes into play because there are federal laws governing the legal use of cannabis, and in addition, each state has its own laws. A breakdown of individual state laws is available on Procon.org.

Generally, CBD may or may not be legal to buy or to sell, depending on several factors. For example, If the CBD product comes from hemp plants, and it contains less than 0.3% THC, it’s legal, federally; but if it comes from a marijuana plant, it’s considered a federally illegal schedule 1 drug. According to the Arthritis Foundation, The U.S. Drug Enforcement Administration (DEA) says that it is the THC that makes marijuana illegal in a number of different states. As a result, the answer to ‘Is CBD oil legal?’ isn’t quite so clear.”

What Is Osteoarthritis?

Osteoarthritis (OA) is a type of arthritis that impacts nearly 630 million people worldwide. This number reflects 15% of the world’s population. 

Osteoarthritis is a joint disease that involves many different symptoms, these include:

  • Intermittent inflammation
  • Peripheral neuropathy (pain caused by damage to the peripheral [outside of the central nervous system] nerves)
  • Degeneration of joints

According to the Hospital for Specialty Surgery Osteoarthritis Center of Excellence Research, “The need for new and ever more effective osteoarthritis treatments will continue to expand as populations age.” One such possible new and more effective treatment option could be CBD (cannabidiol).

Properties of CBD Oil That May Relieve Arthritis

Cannabis has very strong healing properties that could potentially alleviate some of the symptoms of osteoarthritis, these properties include:

  • Analgesic (pain-relieving) properties
  • Anti-inflammatory effects

CBD is also thought to have other properties that could help with arthritis-related symptoms, including:

  • Possible anti-insomnia effects
  • Possible anti-anxiety effects

Research

In a 2017 study published in the journal Pain, the effectiveness of CBD for osteoarthritic pain and joint neuropathy was evaluated in rats. The study authors concluded that CBD decreased joint inflammation and served to protect the nerves. Thus, CBD was found to help symptoms of pain and neuropathy in the animal study subjects. Note, because there is a lack of human studies on natural products such as CBD oil, much of the scientific data has been compiled from the results of animal studies. These studies are not nearly as reliable as human studies, but they do point to the possible benefits of various products.

According to a 2018 compilation review of other studies, “There is a growing body of evidence to suggest that cannabinoids are beneficial for a range of clinical conditions, including pain, inflammation, epilepsy, sleep disorders, the symptoms of multiple sclerosis, anorexia, schizophrenia, and other conditions.”

In a 2019 review by Harvard Health Publishing, CBD studies reportedly discovered mechanisms by which CBD inhibits two of the most difficult symptoms to treat, chronic pain and neuropathic pain. According to the Harvard Health report, “On the skin could help lower pain and inflammation due to arthritis.” But the report goes on to explain that more human studies are needed to back up the claims about pain control while establishing safe parameters about dosing.

Guidelines From the Arthritis Foundation

According to the Arthritis Foundation, “We are intrigued by the potential of CBD to help people find pain relief and are on record urging the FDA to expedite the study and regulation of these products. While currently there is limited scientific evidence about CBD’s ability to help ease arthritis symptoms, and no universal quality standards or regulations exist, we have listened to our constituents and consulted with leading experts to develop general recommendations for adults who are interested in trying CBD.”

The Arthritis Foundation’s general recommendations include: 

  • Although no “rigorous” studies exist regarding the effectiveness of CBD for arthritis symptoms, CBD may help with symptoms such as pain, insomnia, and anxiety.
  • When taken in moderate doses, no potential drug interactions or safety issues have been identified.
  • Never replace CBD for prescription medications for arthritis.
  • Always consult with your health care provider before taking CBD.
  • Although there are no ironclad clinical research data guidelines to suggest a safe dose of CBD, experts recommend starting with a low dose and then gradually increasing the dose in small increments weekly (if relief is not obtained).
  • Learn how to select a product from a reputable seller, one that has been tested for purity, potency, and safety.

Preparation and Dosage

Preparation

Products that contain CBD are available in several forms,.There are advantages and disadvantages of each type of preparation.

Oral products such as capsules or liquids (taken by mouth), disadvantages of pills or capsules include slow absorption and tricky dosing because of delayed onset, as well as unknown side effects of the digestive tract. Advantages of liquid products are that they can be quickly absorbed into the bloodstream by holding the liquid under the tongue (sublingually) for one to two minutes; this may increase the time that the medication will begin to work (sometimes as fast as 15 minutes).

Experts do not recommend chewable CBD products such as gummies, or other edible products, because the dosing is unreliable. If these products are purchased, consumers should be aware of the attraction of gummy products as well as other edibles (like cookies) for children and keep these products locked up or out of the reach of children.

Topical products (applied directly to the skin) lotions and balms can be applied to painful joints, directly over the skin, but there is not enough clinical research data to support whether topical CBD does, in fact, reach the joint below the skin. In addition, topical products may contain other ingredients, such as camphor or capsaicin (making it difficult to assess the results of the CBD component of the products).

Products for inhalation (vapor oils available via vaping devices) are said to carry unknown risks and chemical byproducts, particularly for individuals with inflammatory arthritis because these chemicals could increase inflammation. Therefore, the Arthritis Foundation does not recommend vaping CBD products.

Dosage

Much like with other natural and herbal supplements, there are no established guidelines on the therapeutic dose of CBD. But the Arthritis Foundation recommends the following guidelines for adults:

  • Be aware that the liquid form of CBD oil is not 100% CBD, but rather is comprised of CBD in a carrier oil. Therefore, it’s very important to read the label closely to find out just how much (in milligrams) of the CBD oil is contained in each milliliter, teaspoon, or other liquid dosage parameter.
  • It is recommended to take just a few milligrams of CBD liquid two times each day under the tongue (sublingually). If the desired effects are not obtained, slowly increase the dose by a few milligrams in one week. If needed, continue to increase the dose in small increments, just a few milligrams, (each week) over several weeks. Once pain relief is obtained, stay at that dose to maintain a stable CBD blood level.
  • The Arthritis Foundation also suggests that after several weeks, if CBD isn’t working for pain relief, (if medical marijuana is legal in your state) talking to your health care provider about taking the CBD along with a very low dose of THC containing product.

If taking CBD along with THC, note that even small amounts of THC can cause cognitive, motor or balance issues and get a person high. Avoid driving or being out in public when trying THC containing products, particularly when taking the products for the first time.

Possible Side Effects and Contraindications

According to Harvard Health, “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.”

Possible Side Effects

Side effects of CBD may include:

  • Nausea
  • Fatigue
  • Irritability

Contraindications

A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person, or in which two medications should not be taken together (this may include over the counter drugs, prescription drugs and natural supplements (such as CBD).

Contraindications (medications in which CBD should not be taken with) include:

  • Anticoagulants (blood thinners such as coumadin and more, as CBD can increase the level of the blood thinner in the blood)
  • Corticosteroids (such as prednisone)
  • Certain antidepressants, including Elavil (amitriptyline), Celexa (citalopram), Prozac (fluoxetine), Remeron (mirtazapine), Paxil (paroxetine), Zoloft (sertraline)
  • Certain medications for nerve pain or fibromyalgia, including Neurontin (gabapentin) and Lyrica (pregabalin).
  • Xeljanz (tofacitinib)
  • Aleve (naproxen)
  • Celebrex (celecoxib)
  • Ultram (tramadol)

CBD can increase the levels of other specific medications in the blood. Anyone taking any type of medications or other supplements, should not take CBD without first consulting with their prescribing health care provider.

The U.S. Food and Drug Administration (FDA) strongly recommends that anyone who is pregnant or breastfeeding should not use cannabidiol (CBD) or tetrahydrocannabinol (THC). The agency cites animal studies that show CBD affects the reproductive system development of male fetuses, and products may be contaminated with THC, which has further effects on fetal and newborn brain development.

If you experience any unwanted side effects or symptoms after taking CBD, discontinue use and consult with your health care provider.

What to Look For

Although the Food and Drug Administration (FDA) regulates prescription and over-the-counter medications, CBD is considered a natural/herbal supplement, so there are no regulations governing the quality, purity, or safety of CBD products that are sold in stores or online. Therefore, the burden of ensuring getting a pure product that is appropriately labeled with the active ingredients and dosage is on the consumer. 

Be aware that because CBD products are mostly unregulated in the U.S., there have been many products found by independent testing measures to be mislabeled (mostly the strength of the CBD product, which has been found to be significantly stronger than what the labels says). Also, products have been found to contain more THC than the label reports, as well as having pesticides, metals and solvent contamination.

To ensure a safe, pure product with the correct labeling, look for:

  • Products made in the U.S. with domestically grown ingredients (versus those imported from other countries such as Mexico).
  • Products made by companies that follow manufacturing practices established by the FDA (although this is not mandatory for CBD products)
  • Products that test batch from independent labs such as the American Herbal Pharmacopoeia (AHP), U.S. Pharmacopeia (USP) or the Association of Official Agricultural Chemists (AOAC), NSF International, or ConsumerLab.com. These organizations evaluate and report on a product’s level of safety, purity and potency.

A Word From Verywell

Without enough quality clinical studies on CBD and its effect on arthritis, some health care providers may hesitate to recommend CBD, because they may not know who would benefit most and what dose or form of CBD is right for each patient. Safe dosages vary depending on overall health, age and more. Without reliable studies, consumers may need to make the decision, when it comes to taking natural products such as CBD. Expert sources like the Arthritis Foundation can help provide general guidelines, but your primary health care provider should always be consulted before a decision is made to take CBD products for arthritis (or any other condition). 

Keep in mind that CBD products can be expensive, and they are not for everyone. Before trying CBD products, always consult with your health care provider about what has provided symptom relief and what has not worked in the past. Also, be sure to consult with a professional when you are taking other prescription medications to ensure that CBD is not contraindicated. 

It may be helpful to keep a record of dosage, symptom relief and any side effects from taking CBD products, to report your progress to your health care provider at regular visits. This will help enable your health care provider in assisting you in getting the best results, without wasting money on products that are not working for you.

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Article Sources
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