Arthritis Foundation Releases Guidelines For Patients Who Want To Use CBD To Manage Pain

Doctors are noticing patients who suffer from arthritis are asking by name for CBD, a cannabis extract, to help manage pain. 

CBD products have become more widely available, but there's still confusion about where to buy it, how to take it and if it's even legal — which it is. That's why The Arthritis Foundation recently developed guidelines to help patients navigate the world of CBD. 

For starters, CBD, short for cannabidiol, is a component of the cannabis plant that preliminary clinical studies have shown to help with pain. It is a different part of the plant than THC, which is the psychoactive component of marijuana, says Dr. Daniel Clauw, a rheumatologist at the University of Michigan who helped develop the Arthritis Foundation guidelines.

“It appears as though CBD is fairly safe, and it might be effective in certain types of pain,” he says. “The biggest concern about CBD is knowing your source of CBD and making sure that you’re not in some way consuming CBD that is in some way contaminated, either with THC or with any number of other chemicals depending on how it’s been manufactured and processed.”

Clauw says patients ask him “all the time” about CBD and not just for pain. 

“Out on the Internet people are purporting that CBD is effective for almost everything, so a lot of patients are coming in asking their providers,” he says. ‘Most providers haven’t been educated or trained in the appropriate medicinal use of cannabinoids and especially CBD. So a lot of people, unfortunately, are out there flying blind.”

While CBD is legal, it exists in a gray zone, Clauw says. Much like vaping products, people should be very careful about where they get their CBD since there is almost no regulation of it.  

“These products can be very dangerous, especially if they’re in some way sort of adulterated or contaminated. We still need to know more about just pure THC and pure CBD,” he says. “But when you start then having products that are contaminated with all sorts of different things, it’s sort of the Wild West out there, unfortunately.”

Below Clauw shares some tips for how to use CBD safely to treat pain: 

What is the difference between CBD and THC? 

“THC is the psychoactive component of cannabis or marijuana whereas CBD is a different cannabinoid that’s in marijuana that is not psychoactive, and in fact, it even protects against the high you get from THC. So if people are trying CBD for pain, we know that CBD is quite safe. When you add THC to that, the safety changes because that is the psychoactive component of cannabis. Then you have a risk of dependence and addiction and a number of other things. So I think it’s important for people to understand that when they’re going the sort of cannabis route, CBD is something quite different than something that might contain THC.”

What is the best way to take CBD? 

“The best way to take CBD is probably some type of oral administration either a pill or a gummy bear or a tincture. It’s not a good idea to vape or in any way take CBD via any kind of sort of inhaled or respiratory route. We see some of the problems that are occurring now with vaping that almost certainly is from contaminants in the vape products, but be that as it may, it’s just an inherently more dangerous route of administration.”

Why shouldn't someone inhale CBD or use it in a topical form?

“It’s going into your lungs, and it’s not necessary for appropriate medicinal use. If you take CBD orally, it will start working within a half hour or an hour. There’s no reason you would need to get that really rapid onset of action that inhaling a drug would give. 

“The other thing we should talk about here are topicals or lotions. CBD, unless it’s prepared with something else in it that helps it penetrate through the skin, does not penetrate through the skin very well at all. So people are probably wasting a fair amount of money with topicals that don’t have anything else in it besides CBD because again, pure CBD or THC or any form of the cannabinoid they’re very lipid-soluble, fat-soluble, and thus just putting a cannabinoid on the skin, very little of it is going to be absorbed. So both the topical route of administration, which is quite popular, and the inhaled route of administration are probably suboptimal compared to just somehow taking it orally.”

What should you be looking for in a quality CBD product? 

“Well, first of all, look for something that’s been tested and labeled by some sort of regulatory body. More and more states as they either decriminalize or pass legal marijuana laws are putting mandatory testing programs in place. This is really essential because this is really, I think, the biggest problem or biggest danger right now with CBD is that people don’t know what they’re getting. They don’t know if it’s pure. People have to be particularly careful if they have any type of employment where they’re getting, for example, random urine drug screens because a very small amount of THC that is allowed in your CBD could be enough to flip a urine drug screen to be positive for an individual. So people that are, for example, getting urine drug tests have to be even more vigilant about where they get their CBD from.”

Ashley Locke produced and edited this interview for broadcast with Tinku Ray. Samantha Raphelson adapted it for the web.

This article was originally published on WBUR.org.

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