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Arthritis Foundation issues first CBD guidance for adults with arthritis
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Although cannabidiol — better known as CBD — may help patients with arthritis alleviate their pain, insomnia and anxiety, there have been no rigorous clinical studies to confirm these effects, and the product should never be used to replace DMARDs that prevent permanent joint damage, according to guidance from the Arthritis Foundation.
“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 of consumer health and impact for the Arthritis Foundation, 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.”
According to the Arthritis Foundation, 79% of the 2,600 people who responded to the survey reported they are either currently using CBD, have used it in the past or are considering using it as an alternative therapy to help manage arthritis pain.
To development guidance for the use of CBD among adults with arthritis, the foundation partnered with three experts — Daniel Clauw, MD, of the University of Michigan and director of the Chronic Pain and Fatigue Research Center; Mary Ann Fitzcharles, MD, of McGill University; and Kevin Boehnke, PhD, of the University of Michigan and a researcher at the Chronic Pain and Fatigue Research Center.
“Millions of people in the U.S. 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,” Clauw said in the release.
“It’s important that the Arthritis Foundation has taken a stand on CBD,” he added. “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.”
According to the Arthritis Foundation, there are currently no established clinical guidelines for CBD use. However, the three experts who worked with the Arthritis Foundation were able to agree on the following points:
- Although CBD may help patients with arthritis alleviate their pain, anxiety and insomnia, it is important to keep in mind the lack of rigorous clinical studies among this population;
- Although no major safety issues have been uncovered regarding moderate doses of CBD, potential drug interactions have been found;
- CBD should never be used in place a DMARD that can prevent permanent joint damage in arthritis;
- Patients should discuss CBD before using it, and schedule follow-up visits every 3 months, similar to 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; and
- 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.
Alongside these recommendations, the Arthritis Foundation released a statement noting the organization is “intrigued by the potential of CBD” to provide pain relief for patients.
“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,” the statement continued. “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 these general recommendations for adults who are interested in CBD.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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This position statement is a timely update on a topic that occurs nearly every day in rheumatology clinics. The emergence of the various forms of cannabidiol (CBD) now available to consumers has happened with amazing rapidity. Unfortunately, there is a dearth of data, and while this statement from the Arthritis Foundation acknowledges that point, the “guidelines” give credence to responses on the subject from surveys and testimonies from patients.
Conceding that there are virtually no standards for the production of and safety of CBD, the Foundation advises consumers to procure the product from a “reputable company” — whatever that is.
A few prudent precautions are provided in the statement. There is no good (or even mediocre) evidence that CBD helps arthritis of any type; patients are urged to discuss CBD with their doctors; and CBD should not be used to replace any DMARD. Not mentioned in this statement, however, are two important points clinicians should keep in mind: CBD can be quite costly, and its use could result in a positive urine drug screen for THC, since there can be small amounts of THC in many of these CBD products. Such an occurrence could jeopardize a patient’s employment.
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