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November 2019

Arthritis Foundation Issues First Ever Guidance for CBD Use

Interest in using CBD for chronic pain continues to grow. The Arthritis Foundation, a patient advocacy group, has developed the first ever recommendations to help counsel adult patients on the use of CBD for arthritis. What are the takeaways?

The new recommendations explain that, while preclinical research shows that CBD might improve some arthritis symptoms, including pain and anxiety, there aren’t any quality studies in humans to confirm it helps. Although safety issues don’t seem to be a major concern, more research is needed to confirm that this is true. And there are several potential drug interactions to keep an eye on.

The Arthritis Foundation states that if arthritis patients want to try CBD, make sure they understand that it should never replace prescribed drugs for rheumatoid arthritis progression. When it comes to choosing a dosage form, the recommendations suggest starting with low-dose oral or sublingual forms – vape and topical products should be avoided. Also discourage using edibles because dosing isn’t consistent. Start with a few milligrams under the tongue twice daily and increase dosing from there. Patients should keep a diary to track its effects and meet with their provider every three months. Also, tell patients to discontinue CBD if no benefit is seen after a few weeks.

Unfortunately, these new guidelines can’t help one major issue the CBD industry is facing as a whole: product quality. CBD is currently in a legal gray area, which makes finding quality products for medical use difficult. The guidelines recommend using only CBD products with a certificate of analysis from an independent lab, but this is difficult to do given the general lack of regulation in this industry. A clinician would have a hard time verifying the standardized testing methods of an independent lab, never mind a consumer. And unfortunately, it still doesn’t guarantee that a product contains what’s listed on the label or that it’s free of contaminants like THC. There are also growing concerns that taking CBD can lead to false positives on drug tests for THC. And finally, patients should know that CBD is not approved by the FDA for use in dietary supplements. In fact, the FDA and FTC have recently been cracking down on companies manufacturing and/or advertising CBD for therapeutic or medical uses. Because the FDA has not approved most CBD products for medical use, other than one prescription drug (Epidolex), there is very limited available information about these marketed CBD products, including their composition and potential adverse effects. Make sure patients are aware of these concerns before trying any CBD products. If they still wish to give it a try, tell patients to look for products made in the US by manufacturers that follow GMP, and to avoid any products that make health claims.

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