CBD Oil: Promising Treatment for Arthritis and Inflammation
by Madeleine Beckman and Lynn Parodneck, M.D.
Cannabidiol (CBD) is a chemical found in cannabis. CBD and tetrahydrocannabinol (THC), the psychoactive component of cannabis, are among many constituents in cannabis plants being studied for potentially therapeutic effects. CBD alone does not cause psychoactivity. CBD derived from cannabis plants remains classified as a Schedule 1 illegal substance by the DEA, but CBD derived from industrial hemp (cannabis sativa plants tested to contain less than 0.3% THC), is now federally legal on a national scale after the passage of the 2018 Hemp Farming Act.  Hemp-derived CBD products can currently be purchased online and over-the-counter (OTC) throughout the country. In contrast, marijuana-derived CBD products can only be purchased by qualifying patients in states with medical marijuana programs (30 states, and the District of Columbia as of this writing) or by consumers in states with adult-use/recreational laws (9 states and the District of Columbia as of this writing). In 2018 the FDA also approved the prescription drug Epidiolex,® an isolated form of CBD, as a treatment for certain forms of epilepsy. 
Ongoing research shows the potential benefit of CBD for reducing arthritis pain and inflammation.  CBD acts on the body’s own endocannabinoid system, a network of receptors in the central nervous system that modulate inflammation, pain, and immune response, among other functions that are still being actively studied. The body produces its own cannabinoids (endocannabinoids), but receptors can also respond to cannabinoids found from cannabis plants (phytocannabinoids).
Animal studies show that CBD relieves arthritis pain and inflammation in dogs. In one study, canines receiving 2 mg/kg of CBD twice daily showed decreased pain from osteoarthritis and increased activity levels.  In another study, cannabinoids were shown to affect the expression of TRPV1-4 channels (aka: capsaicin receptor) with potential therapeutic applications, including reduction of inflammation.  The European Journal of Pain notes that transdermal administration of CBD has long-lasting therapeutic effects of symptomatic arthritis. The study’s data indicate that transdermal CBD is a promising treatment for developing new and improved therapies for arthritis. CBD has also been shown to have a preventative effect on inflammation and arthritis symptoms; a study published in the journal Pain in December 2017 analyzed whether CBD could prevent osteoarthritis pain and joint neuropathy. Based on the study’s findings, researchers affirmed that it did both, because it decreased joint inflammation and served as a protectant to nerve function. 
Other support for CBD oil comes from Daniel Clauw, MD, a pain specialist at the University of Michigan in Ann Arbor, whose clinical experience shows the potential benefits of CBD. Dr. Cluaw recommends OTC CBD oil to some patients in his practice and cites one recent trial showing that CBD alone was effective in the treatment of osteoarthritis of the knee. 
Oil-based preparations of CBD can be administered orally in pills, by mixing into food, by vaporization, or transdermally via topical creams or patches. All legal OTC CBD products contain less than 0.3% THC, and many contain pure CBD. There is no risk of psychoactivity in pure-CBD oils, so they can be safely used during the day and on a long-term basis. CBD oil is generally well-tolerated, with mild side effects reported including dry mouth, drowsiness, and appetite changes.  For patients interested in trying OTC CBD oils, Dr. Clauw recommends starting with a CBD-only product, 5-10mg twice daily, and slowly
increasing to a dose of 50-100mg per day.
A great deal of confusion exists among both consumers and healthcare professionals about the way CBD is sourced, processed, and employed medicinally. Many OTC CBD products contain chemically-isolated CBD from industrial hemp, which is then suspended in a carrier oil (typically coconut oil). Other products are “whole plant” extracts made by heating hemp flowers within the carrier oil to extract the full spectrum of cannabinoids, including small amounts of THC. (To qualify as legal under the Hemp Farming Act, concentrations must not exceed 0.3%). Consumers should be cautious of hemp products that are not tested for pesticides or other contaminants. Some research also suggests that isolated CBD may not be as effective as CBD administered in combination with the other terpenes and flavinoids present in cannabis, many of which have their own demonstrated therapeutic effects.  One theory about the way that cannabis modulates the endocannabinoid system is through the synergy of these various phytocannabinoids, but this remains disputed among researchers, and studies employing pure CBD have also produced positive results for a wide range of ailments. 
Patients with significant pain who live in states where medical marijuana is legalized may wish to seek the care of a certified doctor to obtain cannabis products containing greater concentrations of THC. Finally, there is some risk of CBD interacting with certain prescription medications, particularly those metabolized in the liver, due to the potential of CBD to increase liver enzymes at higher doses. [12 When considering CBD oil as an herbal alternative or adjunct therapy to NSAID’s for the treatment of arthralgias, patients should always speak with a physician before trying new supplements, herbs, or products not fully FDA-approved.
1.Hemp Farming Act of 2018 2.FDA approval of Epidiolex. 2018, Jun. 3.Rheumatology (Oxford). 2006 Jan;45(1):50-2. Epub 2005 Nov 9. 4.Front Vet Sci. “Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs.” 2018 Jul. 5.Acta Physiol (Oxf). “Cannabinoid actions at TRPV channels: effects on TRPV3 and TRPV4 and their potential relevance to gastrointestinal inflammation.” 2012 Feb. 6.European Journal of Pain. “Transdermal cannabidiol reduces inflammation and pain-related behaviors in a rat model of arthritis.” 2015. 7.Pain. 2017 Dec. 8.www.arthritis.org 9.Cannabis and Cannabinoid Research. “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.” 2017 Jun 1. 10.British Journal of Pharmacology. “Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. 2011 Aug. 11.Scientific American. “Some of the Parts: Is the ‘Entourage Effect’ Scientifically Valid?” 2017 Apr. 12.MedicinePlus: Cannabidiol
ABOUT THE AUTHORS
Madeleine Beckman is a writer and editor specializing in medicine & wellness. She teaches Narrative & Reflective Writing at NYU School of Medicine in the Division of Medical Humanities, and Creative Nonfiction with Denver University. Her books are available online. www.MadeleineBeckman.com
Lynn Parodneck, M.D.
Dr. Parodneck studied at Sarah Lawrence College and New York Medical College. Originally trained in obstetrics and gynecology, she made a major career shift to specialize in medical marijuana after the passage of the New York Compassionate Care Act in 2016, and is now a leading medical marijuana clinician in New York. Her website is www.DrLynnParodneck.com.
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