what dose cbd oil for arthritis

How To Use CBD for Arthritis

Arthritis is a condition marked by inflammation of the joints. The main symptoms of arthritis are joint pain, redness, tenderness, swelling, and stiffness. Many people also have significant stiffness in the joints and reduced mobility of that joint—this is usually referred to as a decreased range of motion.

Origins of Arthritis

350 million people around the world suffer from arthritis, including osteoarthritis, rheumatoid arthritis, and psoriatic arthritis.

    • Osteoarthritis (OA) is due to wear and tear from use and overuse of joints. It affects the cartilage on the ends of the bones of the joints, causing the joints to “grind” against each end. OA increases as we age and is more common in women and can also be associated with obesity, joint pain, and overuse.
    • Rheumatoid arthritis (RA) is an autoimmune disorder—the immune system gets “confused” and begins to attack the lining of the joint capsule- the synovial membrane which then becomes inflamed, swollen, and painful. Rheumatoid arthritis is more common in women. . It can affect any joint either on just one side or both sides of the body.
    • Other forms of arthritis —there are over 100—include gout, juvenile arthritis, reactive arthritis, infectious arthritis, and ankylosing spondylitis.
    • The long-term effects of arthritis are degeneration and destruction of the joints.

    While many conventional medications that treat arthritis pain are available, they are not always effective and some carry significant adverse side effects.

    Many arthritis sufferers are choosing to use medical cannabis for its anti-inflammatory properties, pain management, and minimal side effects. CBD is derived from hemp—a cousin of cannabis—and has been shown to have potential benefits for arthritis pain.

    Potential Benefits of Using CBD for Arthritis Pain Relief

    • Chronic pain management
    • Reduced need for opiates
    • Reduced need for NSAIDs
    • Reduced side effects from conventional arthritis treatments
    • Improved mobility
    • Better sleep

    Side Effects of Using CBD for Arthritis

    How Does CBD Work for Arthritis?

    CBD is considered an effective anti-inflammatory agent—and inflammation is at the root of arthritic pain. CBD oil appears to decrease inflammation in the body and at the affected joint so that a person with arthritis symptoms will have less chronic pain, and overall reduce pain in the body.

    Other important cannabinoids with anti-inflammatory properties include THC, cannabichromene (CBC), tetrahydrocannabinolic acid (THCA), cannabigerol (CBG), cannabidiolic acid (CBDA), cannabidivarin (CBGV), and cannabigerolic acid (CBGA).

    How Should I Use CBD for Chronic Pain from Arthritis?

    Always speak with a doctor before using CBD products, especially if you already take other medications.

    CBD can cause drug interactions. It may increase or decrease the blood levels of different drugs—it is best to talk to your doctor and pharmacist about your specific risks for interactions. This may be especially important if you are taking any of the following medications 7 :

    • Antidepressants
    • Anti-psychotics
    • Macrolide antibiotics such as erythromycin or clarithromycin
    • Anticoagulants or blood thinners
    • Statins
    • Some heart medications including calcium channel blockers (eg. Amlodipine, diltiazem, felodipine, verapamil)

    Because of the connection between joint inflammation, arthritis and chronic pain , using CBD products may reduce the arthritic pain and discomfort.

    Most delivery methods all work well for relief from arthritis but for smaller areas, topical may often be best. Other delivery methods can include vaping, tinctures, edibles, and capsules.

    The fastest relief can come from vaping, using tinctures, and applying topicals to treat local pain. You should be aware, however, that while vaping can produce the fastest results, there are still a number of health conditions with vaping. While vape products from reputable companies appear to be safe, there is much we don’t know about the effects of long-term or short-term vaping on the lungs.

    CBD and THC (medical or recreational marijuana) may work synergistically together for relieving chronic pain conditions. The ratios of CBD to THC most commonly used for pain relief vary from 2:1 (CBD to THC) to 1:2 (CBD: THC). Keep in mind that if you use larger doses of CBD, maintaining those ratios may not be legal in your state. Both cannabinoids are anti-inflammatory.

    If you dislike the psychoactive effects of THC, you can stick to just CBD, or mostly CBD oil during the day and add in some THC products at night.

    Always start with a low dose of CBD oil and increase it in small, even increments until you reach the desired relief you are seeking.

    What are Terpenes?

    When CBD is extracted from the hemp plant, another very large class of plant substances—the terpenes—are extracted as well. Terpenes are currently a “hot research” topic because many have beneficial medicinal properties that may work alongside CBD in what is known as the “entourage effect”.

    Are Terpenes Helpful for Arthritis?

    The following terpenes are good to look for because they work synergistically with CBD to provide relief from inflammation 8 .

    • β-caryophyllene (beta-caryophyllene)
    • α-Pinene (alpha-pinene)
    • Myrcene
    • Linalool
    • Limonene

    What Does the Research Say About CBD for Arthritis?

    • CBD, cannabinoids, and compounds in cannabis decrease inflammation by blocking the formation of pro-inflammatory cytokines. Cytokines are a general term for substances that act as intracellular messengers and are made in response to an infection, injury, or triggered by an improperly working immune system (as in an autoimmune disease) 9 , 10 .
    • Pre-clinical studies—ie. animal studies—have shown that CBD can act through a variety of mechanisms to reduce the inflammatory response thereby reducing pain 11 , 12 , 13 .
    • There have been no studies done in humans to date—but watch this space!
    • THC has been shown to be 20 times more anti-inflammatory than aspirin and 2 times more anti-inflammatory than hydrocortisone 14 .

    Recently, the Arthritis Foundation produced a set of guidelines for the use of CBD in arthritis. In these Arthritis Foundation guidelines, it was stated:

    “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 these general recommendations for adults who are interested in trying CBD15.”

    Arthritis Foundation Releases First CBD Guidance for Adults With Arthritis

    The Arthritis Foundation, in partnership with top experts in arthritis pain and CBD, offers patients a practical, first-of-its-kind resource with answers to their most common questions.

    News provided by

    Sep 24, 2019, 07:40 ET

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    ATLANTA , Sept. 24, 2019 /PRNewswire/ — As the leading organization for people with arthritis, the Arthritis Foundation has just released the first CBD guidance for adults with arthritis. CBD, or cannabidiol, a plant-based compound, has become popular among people with arthritis seeking to ease chronic joint pain. With no federal oversight of CBD products, a lack of scientific evidence for safety or effectiveness, and even uncertainty about its legality, there has been vast confusion for patients with arthritis and health care providers too.

    "While CBD is controversial and its effectiveness inconclusive, people with arthritis aren’t waiting to try it to treat their pain," said Cindy McDaniel , Arthritis Foundation senior vice president of consumer health and impact. "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 2,600 people who responded to the survey*, 79% are currently using CBD, have used it in the past or are considering using it as an alternative therapy to help manage their arthritis pain.

    To develop the CBD guidance for adults with arthritis, the Arthritis Foundation partnered with leading CBD and arthritis pain experts – Daniel Clauw , MD, Mary Ann Fitzcharles , MD, and Kevin Boehnke , PhD – to develop practical guidance that addresses top questions.

    "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," said Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. (CBD is one of the more than 100 cannabinoids, or active compounds, in cannabis. THC, another compound, is the chemical in marijuana that gets users high. CBD is not intoxicating.)

    "It’s important that the Arthritis Foundation has taken a stand on CBD," Dr. Clauw said. "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."

    The Arthritis Foundation also sent a formal comment to the U.S. Food and Drug Administration (FDA) in July urging the agency to expedite the study and regulation of CBD products to help make them a safe option for the 54 million people with arthritis.

    The official statement from the Arthritis Foundation reads:

    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. 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. 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 trying CBD.

    "Listening to people with arthritis – using data (surveys and Live Yes! INSIGHTS), patient listening sessions and testimonies – drives our work, from science to programming to setting our advocacy agenda," said the Arthritis Foundation’s McDaniel.

    The Arthritis Foundation continues to ask people with arthritis to raise their voice and share their day-to-day experiences via Live Yes! INSIGHTS, so the organization can continue to break down barriers to care, accelerate research and tailor local and national programs that fit the needs of people with arthritis.

    "The Arthritis Foundation values the patient voice," said Stacy Courtnay, rheumatoid arthritis patient and a member of the Arthritis Foundation Patient Leadership Council. "Some doctors aren’t open to discussing CBD with patients, and it’s fantastic and encouraging that the Arthritis Foundation is helping people with arthritis gain access to whatever treatments might help them."

    While there are no established clinical guidelines for CBD use, the medical experts who worked in partnership with the Arthritis Foundation agree on the following points:

    • CBD may help with arthritis-related symptoms, such as pain, insomnia and anxiety, but there have been no rigorous clinical studies in people with arthritis to confirm this.
    • While no major safety issues have been found with CBD when taken in moderate doses, potential drug interactions have been identified.
    • CBD should never be used to replace disease-modifying drugs that help prevent permanent joint damage in inflammatory types of arthritis.
    • CBD use should be discussed with your doctor in advance, with follow-up evaluations every three months or so, as would be done for any new treatment.
    • There are no established clinical guidelines to inform usage. Experts recommend starting with a low dose, and if relief is inadequate, increase in small increments weekly.
    • Buy from a reputable company that has each batch tested for purity, potency and safety by an independent laboratory and provides a certificate of analysis.

    Beyond providing CBD guidance for people with arthritis, the Arthritis Foundation has a track record for bringing important issues that people with arthritis face into the public dialogue, including authoring the Osteoarthritis (OA) Voice of the Patient Report that presented treatment options most important to patients with OA and helped influence the FDA’s updated osteoarthritis research and treatment guidance and legislation calling for transparency at the pharmacy counter.

    To impact the future of arthritis, visit Live Yes! INSIGHTS.

    **Our gratitude to the following experts for their partnership and guidance:

    Kevin Boehnke , PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan , focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.

    Daniel Clauw , MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.

    Mary Ann Fitzcharles , MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec , conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.

    About the Arthritis Foundation:
    The Arthritis Foundation is the Champion of Yes. Leading the fight for the arthritis community, the Foundation helps conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. The Arthritis Foundation’s goal is to chart a winning course, guiding families in developing personalized plans for living a full life – and making each day another stride towards a cure. The Foundation also publishes Arthritis Today, the award-winning magazine that reaches 4 million readers.

    What Every Person With Arthritis Needs to Know About Cannabis

    “I actually don't remember what it was like not to be in pain,” says Bridget Seritt, who has dealt with chronic illness since she was a small girl. “I have both types of arthritis—rheumatoid and osteoarthritis. I have Sjogren's syndrome. I have lupus, and I have Ehlers-Danlos syndrome, which is a genetic collagen disorder that affects all of my joints, ligaments, and tendons.”

    When she lived in Georgia, her treatment centered on methotrexate, a drug used to slow down the progression of rheumatoid arthritis.

    Unfortunately, Seritt experienced all three of the drug’s most common side effects—nausea, stomach upset, and fatigue—and, for a time, she used black-market cannabis to alleviate those symptoms. (Georgia didn’t have a medical-marijuana program at the time.) Seritt moved to Colorado in 2013, still taking “a handful of opiates and a whole bunch of prescription medications,” and quickly realized that, as a chronic-pain patient requiring high doses, the growing war on opioids might affect her options for relief sooner rather than later.

    It didn’t take long: Her new pharmacy wasn’t always able to fill her full oxymorphone prescription on time. “I was consistently running out,” she says, which led to muscle spasms. Since cannabis was legal in Colorado, “I decided to see if it would help with pain and withdrawal. I smoked a couple of joints, but it didn’t do anything except help my insomnia.” That was good enough, and eventually she replaced smoking pot with making her own cannabis butter and topicals.

    It wasn’t until about three months later that Seritt noticed another change: “I could walk better. I could be active for longer periods of time, and I didn't need as long to recover.” Between 2014 and 2015, she went from being able to walk just 200 feet to hiking several miles. She credits medical cannabis.

    Which States Allow Medical Marijuana for Arthritis?

    If Seritt still lived in Georgia, she wouldn’t have achieved this level of relief without breaking the law. Currently, the state allows only cannabis oil with less than 5% THC—the chemical that causes most of pot’s psychoactive effects. In Colorado, however, some form of medical marijuana has been legal since 2000, and patients aren’t limited to low-THC oils. Instead, patients like Seritt have access to a seemingly endless variety of cannabis products with a wide range of potency, along with professional staff equipped to answer medical questions. Colorado also allows home cultivation of up to six plants per patient, so they can grow the specific strains they need to get results.

    Though medical marijuana programs exist in 33 states and Washington, D.C., cannabis is still illegal in the eyes of the federal government. As a Schedule I drug according to the Controlled Substances Act (CSA), it’s considered a dangerous substance with "no currently accepted medical use." That means that doctors and patients complying with state laws still operate as federal outlaws, risking fines, arrest, even prison time.

    Several bills in congress aim to erase cannabis from the CSA. Among them, Oregon Sen. Ron Wyden’s cleverly-titled S.420 Marijuana Revenue and Regulation Act; Hawaii Rep. Tulsi Gabbard’s March reintroduction of the Ending Federal Marijuana Prohibition Act; New Jersey Sen. Cory Booker’s Marijuana Justice Act; and New York Sen. Charles Schumer’s Marijuana Freedom and Opportunity Act. Passing any of these bills would allow millions of Americans with arthritis to legally benefit from the plant’s therapeutic properties.

    How Does Medical Marijuana Relieve Arthritis Pain?

    Traditional arthritis treatments are rife with potentially dangerous side effects. Cases in point: Tylenol and non-steroidal anti-inflammatory drugs, or NSAIDs, can exacerbate liver and bleeding issues. Excessive doses of Tylenol can cause liver toxicity and high dose anti-inflammatory drugs, such as NSAIDs, can cause gastrointestinal bleeding and kidney problems. Disease-modifying anti-rheumatic drugs (DMARDs) and biologics can interfere with the immune system's ability to fight infection. And, if those categories don’t work, patients are left with opioids, which can become habit-forming.

    “If you put the opioids head-to-head with cannabis for mild to moderate pain, what we find is that they're about equal,” says Jordan Tishler, M.D., a Boston cannabis physician at Inhale MD, Harvard instructor of medicine, and president of the Association of Cannabis Specialists. “In that situation, cannabis may be equally effective, but it's a lot safer.”

    Scientific evidence confirming Dr. Tishler’s experience continues to grow, showing cannabis to be “remarkably helpful as a pain medication, interacting with receptors in multiple locations throughout the body,” he says. It also impacts pain processing in the spinal cord and brain. Preclinical data suggest that cannabinoids have particular therapeutic potential for rheumatic diseases like rheumatoid arthritis and osteoarthritis (plus systemic sclerosis and fibromyalgia, too).

    Here’s how it works: Cannabis contains dozens of cannabinoids, chemicals that interact with our body’s own endocannabinoid system, which regulates inflammation and pain. THC is the most well-known (it’s what gets you high) and CBD is another. “The THC in cannabis is the primary pain reliever, so what I do as a doctor is find the smallest dose of the THC or cannabis that will do the job with the minimum side effects,” Dr. Tishler says. The most common side effect, unsurprisingly, is getting stoned. “All pain medications have side effects and cannabis is no different,” he says.

    Like any other clinician, Dr. Tishler helps arthritis patients manage side effects through dosing, timing, and route of delivery. For example, for chronic pain, he might recommend an edible with 5 mg THC twice a day for long-lasting coverage, and a vaporizer for acute relief on an as-needed basis.

    “One cannabinoid called THC-A—which is different from THC—is a better anti-inflammatory than THC or CBD,” he says. “When I treat somebody with an autoimmune disease like rheumatoid arthritis, I often try to add THC-A to the THC so that we're covering the underlying inflammation as well as deriving pain control.” Dr. Tishler supplements THC-A through an extract; Seritt gets her dose of THC-A and THC from a paste made from fresh plants that she grows herself.

    Watch Our Interview with Dr. Tishler.

    Why Do Medical Marijuana Programs Matter?

    When it comes to CBD for arthritis, Dr. Tishler is unconvinced that the extract is particularly useful for pain at the available doses. (The most compelling research so far has been in rodents, not humans.)

    “There's also the issue of how harmful hemp-derived CBD oils may be. Not because of the CBD, but because of whatever else might be in that bottle,” says Dr. Tishler, who cites traces of everything from pesticides and heavy metals to fentanyl, an anesthetic pharmaceutical.

    The 2018 Farm Bill loosened regulations on hemp-derived CBD by removing hemp products from the list of Schedule 1 drugs. There’s only one CBD drug that’s been approved by the U.S. Food and Drug Administration (FDA) — Epidiolex for severe epilepsy — and the FDA doesn’t regulate supplements, so scams are rampant. Recent research from Penn Medicine revealed that 70% of CBD products available online mislabeled their CBD content. These are precisely the types of shenanigans medical marijuana laws are meant to prevent, and why medical programs are important, even for states with legal recreational cannabis.

    “Medical patients are not the same as recreational cannabis users,” says Dr. Tishler. An arthritis patient wants medicine that’s easy to take, precisely dosed, and provides reliable results with the least intoxication. (Not exactly a recreational user’s idea of a party.)

    Having a medical system in place allows physicians to follow up on what patients are purchasing through the registry system. Medical dispensaries and dual-licensed shops are best equipped to answer patient questions about how to dose cannabis or what contraindications there might be.

    “It’s completely inappropriate to have this type of advice coming out of the mouth of a budtender,” says Dr. Tishler.

    There are other advantages to medical-marijuana programs. In states like Colorado, patients pay standard sales tax on cannabis, but not high excise taxes or additional state taxes applied to recreational cannabis sales. Minors with qualifying conditions can also register as medical marijuana patients, which isn’t addressed by the recreational model.

    Advocating for Access

    There are many reasons to keep an eye on upcoming cannabis bills, both federal and in your specific state. Even putting the overarching problem of federal prohibition aside, the state laws are a messy patchwork of contradicting rules. For example, cannabis is straight-up illegal—for any reason—in Idaho, Kansas, Nebraska, and South Dakota. There are 33 states offering medical marijuana, but only seven list arthritis as a qualifying condition (Arkansas, California, Connecticut, Hawaii, Illinois, New Mexico, and New York).

    Some states allow physicians more leeway by letting them determine “other medical conditions” at their discretion. In some states, even CBD oil is a no-go. In Kentucky, only people participating in a clinical trial or an expanded access program are legally allowed to possess it; in Mississippi, only people with a debilitating epileptic-seizure disorder qualify.

    The laws are constantly evolving. If access is important to you, contact your state legislators and congress members and let them know. There are dozens of pending marijuana bills and resolutions on the state and federal level right now. (Check out this list from NORML to see which ones affect you and the arthritis patients in your life. Then refresh your browser and do it again, as cannabis laws can rapidly change.)

    Having a medical-marijuana program in place doesn’t necessarily guarantee unfettered access. Seritt, who makes her own cannabis medicine from homegrown plants, laments the passing of House Bill 1220, which lowered the number of plants one residence could grow from 99 to a dozen, max. Her belief? “If your state program doesn’t allow access to fresh plants or cultivation, you don’t have real medical access.”