Arthritis Foundation Releases First Guidance for CBD Use in Patients with Joint Pain

Cannabidiol (CBD) is a plant-based compound that has grown in popularity over the past several years, especially among individuals seeking relief from chronic pain. However, there is a lack of scientific data regarding the safety and efficacy of CBD-based products, as well as uncertainty about their legality, which has led to confusion among patients and healthcare providers. To provide some clarity on these issues, the Arthritis Foundation has released the first guidance for adults with arthritis who are considering trying, or who are already using, CBD to alleviate pain associated with their disease.

“While CBD is controversial and its effectiveness inconclusive, people with arthritis aren’t waiting to try it to treat their pain,” Cindy McDaniel, MBA, Senior Vice President, Consumer Health and Impact, Arthritis Foundation, Atlanta, GA, said in a press release. “To help gain a deeper understanding about how people with arthritis feel about using CBD, we conducted a national survey in July. Our survey results confirmed the need to push for more regulation and provide useful CBD guidance.”

Of the 2600 people who responded to the survey, 79% reported that they are either currently using CBD, have used it in the past, or are considering using it as an alternative treatment to help manage their arthritis pain.

Based on these findings, the Arthritis Foundation partnered with 3 experts; Kevin Boehnke, PhD, Research Investigator, Department of Anesthesiology and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor; Daniel Clauw, MD, Professor, Anesthesiology, Rheumatology, and Psychiatry, and Director, Chronic Pain and Fatigue Research Center, University of Michigan; and Mary Ann Fitzcharles, MD, Associate Professor, Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada, to develop recommendations. Together, they reached a consensus on the following points:

  • CBD may help patients with arthritis alleviate their pain, anxiety, and insomnia; however, it is important to remember that no rigorous clinical trials have been conducted among this population to confirm the efficacy of these products
  • Although no major safety issues have been discovered regarding the use of moderate doses of CBD, potential drug interactions have been identified
  • CBD should never be used in place of disease-modifying antirheumatic drugs that may prevent permanent joint damage in inflammatory types of arthritis
  • Patients should discuss the use of CBD with their physicians beforehand, and should schedule follow-up visits every 3 months, as they would with the start of any new treatment
  • Patients using CBD should start with a low dose and only increase the amount as needed on a weekly basis
  • CBD should only be purchased from reputable companies that test each batch for purity, potency, and safety, using an independent laboratory and providing a certificate of analysis.

Regarding the legal status of CBD, the Arthritis Foundation stated that although products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, they are still in the “gray zone” until federal and state laws can be clarified, and patients should check with their specific state laws before purchasing and using them.

The Arthritis Foundation also sent a formal comment to the US Food and Drug Administration (FDA) in July 2019, asking the agency to expedite the testing and regulation of CBD-based products to promote their safe use in patients who experience pain associated with arthritis.

“As the largest organization representing the voice and needs of people with arthritis, the Arthritis Foundation has always welcomed new treatment options because no single drug, supplement or therapy works for everyone,” the statement read. “We believe patients should be empowered to find safe management strategies that are appropriate for them. The more options available, the likelier it is that more people will benefit. 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.”

Until formal clinical guidelines are developed, patients and healthcare providers can use the Arthritis Foundation’s guidance to help answer some of their questions.

“Millions of people in the US are likely trying to use cannabinoids to treat pain, and many are doing this in ways that might cause more harm than good, especially when they use high doses of THC,” noted Dr Clauw in the press release. “It’s important that the Arthritis Foundation has taken a stand on CBD. Right now, it appears to be fairly safe and might help certain types of pain. It’s far better to give this guidance, even if preliminary, because otherwise people will have no guidance whatsoever.”

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