Posted on

Cbd oil for rheumatoid arthritis mayo clinic

‘You must be very careful’: Common questions about CBD health claims for pain and other conditions answered

As consumer interest in CBD grows ahead of the Oct. 17 legalization of cannabis edibles, extracts and topicals, here’s a primer to answer common questions about its health claims for seizures, pain and other conditions.

Social Sharing

Doctors weigh the science behind cannabidiol claims

An oral administration syringe loaded with CBD hemp oil for treating a severely-ill child is shown at a home in Colorado Springs, Colo., in 2014. (Brennan Linsley/The Associated Press)

Cannabidiol, or CBD oil, is promoted for a wide range of medical conditions. Recently, a review for doctors weighed the science behind the claims.

The Clinicians’ Guide to Cannabidiol and Hemp Oils was published earlier this month in the journal Mayo Clinic Proceedings.

CBD is a compound found in the cannabis plant. It is not intoxicating, Health Canada said.

As of October 2018, the sale of dried cannabis, fresh cannabis, cannabis oil, cannabis plants and cannabis seeds are permitted under the the Cannabis Act.

As consumer interest in CBD grows ahead of the Oct. 17 legalization of cannabis edibles, extracts and topicals, here’s a primer to answer common questions about its health claims for seizures, pain and other conditions.

What is CBD approved to treat?

Epidiolex, a purified form of plant-based CBD, is the only CBD-related treatment approved by the U.S. Food and Drug Administration (FDA). It is used to treat severe forms of epilepsy. Epidiolex isn’t listed in Health Canada’s database of medications approved for use in this country.

Health Canada assigns a drug identification number (DIN) to all drug products evaluated and authorized for sale in this country. To qualify, a drug manufacturer needs to provide information including dosing, strength and how it’s taken.

“Currently, there are two cannabis-related drugs that have a DIN and are authorized for sale in Canada,” a spokesperson for Health Canada said in an email.

Nabilone, a synthetic tetrahydrocannabinol, or THC, product is approved to treat nausea. THC is the main psychoactive component in cannabis that gives users a high.

The other drug with a DIN is Sativex, which is manufactured from whole botanical extracts and contains THC and CBD, according to Health Canada. Sativex is added to treatments aimed at relieving spasticity in adults with multiple sclerosis. Spasticity is a muscle-control disorder.

No CBD-specific product has a DIN.

As well, no other “cannabis-related drug (including fresh or dried marijuana or cannabis oil) has been approved to be marketed as a drug for therapeutic use and sale in Canada,” Health Canada said.

What is CBD commonly used for?

There are anecdotal reports from users of CBD helping with certain types of pain, such as nerve-related back pain.

“Chronic pain management continues to challenge patients and physicians alike, and investigation into potential therapies such as CBD and hemp oils is a promising area for the future of clinical pain management for both pain relief as well as addiction management,” Dr. Karen Mauck, an internist at Mayo Clinic, and her co-authors wrote.

Dr. Hance Clarke, director of pain services at Toronto General Hospital who wasn’t involved in the U.S. paper, said he starts by asking patients what symptoms they want to use CBD to treat.

It’s one of the first times in Canadian history where a medication has made it to the population without the science actually leading us there. – Dr. Hance Clarke, director of pain services at Toronto General Hospital

“The evidence has not caught up to the story that’s in the public,” Clarke said. “It’s tricky. It’s one of the first times in Canadian history where a medication has made it to the population without the science actually leading us there.”

The world is looking to Canada for answers on CBD, said Dr. Hance Clarke. (University Health Network)

Physicians need to work with patients to figure out what people are using, the levels in their body and what’s actually helped and what hasn’t.

“The world is looking to Canada over the next five to 10 years,” Clarke said. An evidence-based perspective on cannabis is needed rather than solely industry’s, he said.

Canada’s Arthritis Society said there’s limited clinical evidence so far on the relative benefits and risks of medical cannabis to treat osteoarthritis and rheumatoid arthritis.

CBD now is widely used by people for all kinds of disease, in particular anxiety, panic attack, bipolar disorder, depression. But we don’t know if CBD is really good for these kind of diseases. – Dr. Gabriella Gobbi

In January, research into CBD’s effects on pain and anxiety in lab rats was published in the scientific journal Pain.

“CBD now is widely used by people for all kinds of disease, in particular anxiety, panic attack, bipolar disorder, depression,” said Dr. Gabriella Gobbi, the study’s author and a psychiatrist at McGill University’s faculty of medicine in Montreal. “But we don’t know if CBD is really good for these kinds of diseases.”

Only clinical trials in humans can show if CBD is really effective for an illness, Gobbi said.

In Canada, pharmaceutical companies are sponsoring clinical trials to test CBD products in people.

How do you know what’s in the product?

Depending on what part of the plant is extracted, different components will be present in the oil, the Mayo Clinic authors said. Their list of what clinicians should look for includes:

  • Manufacturing standards certification, such as pesticide or herbicide testing.
  • European Union or Australian organic certification.
  • Lab testing to confirm cannabinoid levels and the absence of heavy metals.

“We see variations from batch to batch where patients are doing well on something, and potentially the next time they seek that same product, potentially they’re not seeing the same effects,” Clarke said.

A research letter published in 2017 in JAMA found nearly 70 per cent of CBD extracts sold online were mislabelled.

“A lot of CBD oil can have very little or contain lots of THC, so you must be very careful,” Gobbi said. “We need more quality control.”

What side-effects have been reported?

In larger studies on CBD treatment for epileptic patients, it was associated with drowsiness, decreased appetite and diarrhea in up to 36 per cent of people, the Mayo Clinic authors said, adding the side-effects were less severe and frequent compared with a conventional anticonvulsant medication.

CBD oil products can have very little of the active ingredient or contain a lot of THC, the main psychoactive component in cannabis that gives users a high. (Tijana Martin/The Canadian Press)

The FDA said its review of a marketing application for Epidiolex suggested potential for liver injury associated with CBD.

“You can’t just self-treat,” Gobbi said.

What about drug interactions?

The main drug interactions doctors and pharmacists look for are drugs, such as morphine, oxycodone, sleeping pills, antidepressants or antipsychotics, that already make you sleepy, confused or impair co-ordination.

“If you’re taking those medications to begin with and you use cannabis, we’d expect that those side effects would get worse,” said Kelly Grindrod of the University of Waterloo’s School of Pharmacy.

Doctors should look for lab testing to confirm cannabinoid levels when looking for products for patients, researchers say. (Guillaume Payen/SOPA Images/LightRocket/Getty)

People should talk to their physician, nurse or pharmacist to discuss potential drug interactions when determining whether to try CBD.

Maddie Brown, a registered practical nurse and cannabis consultant based in Ottawa, helps patients with medical cannabis prescriptions understand how CBD works and obtain it.

“I’m definitely most concerned about blood thinners,” Brown told CBC Radio’s White Coat, Black Art. “CBD can make Coumadin [a blood thinning medication] more potent.”

The general advice is to start low and go slow, especially if taking medications that are known to interact, Grindrod said.

CBD Oil: 9 Science-Backed Benefits

Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

Cannabidiol, or CBD, is a chemical compound found in the cannabis sativa plant. When applied topically or consumed through smoke inhalation or edible consumption, CBD interacts with neuroreceptors in your endocannabinoid system, which sends signals between your cells to help regulate your movement, mood, homeostasis and immune system.

You May Also Be Interested In CBD Oils From Our Featured Partner

Isolate CBD Oil

On Medterra’s Website

500mg,1000mg, 3000mg, 6000mg

True Full Spectrum™ CBD Oil

On Medterra’s Website

750mg,1500mg, 3000mg, 6000mg

Chocolate Mint, Citrus

Ultra Broad Spectrum™ CBD Oil

On Medterra’s Website

Citrus, Strawberry Mint, Unflavored

Immune Boost CBD Oil

On Medterra’s Website

On Medterra’s Website

(Note: Product details and price are accurate as of publication and are subject to change.)

CBD is often extracted from the cannabis sativa plant in oil form and mixed with an inert carrier oil like hemp seed oil for consumption. In fact, of the 60% of U.S. adults who report having used CBD before, 55% of them use CBD oils and tinctures specifically, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.

CBD research is growing, too. Here are nine ways studies suggest CBD oil could benefit your health.

1. Offset Anxiety and Depression

CBD’s ability to calm is perhaps its most popular effect and the reason its use is so widespread. A 2017 study in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test. Some received a placebo while others received either 150 milligrams, 300 milligrams or 600 milligrams of CBD before their speeches. Those who received 300 milligrams of CBD experienced significantly reduced anxiety during the test compared to those who received the placebo. Interestingly, participants who received either 150 or 600 milligrams of CBD experienced more anxiety during the test than the 300 milligrams group.

Meanwhile, at least one study in mice revealed CBD had effects similar to the antidepressant imipramine. Human trials are needed, though, to confirm whether CBD can induce this same antidepressant reaction in our bodies.

2. Treat Select Epilepsy Syndromes

In some instances, CBD can be used to treat epileptic seizures.

In 2018, the Food and Drug Administration (FDA) approved the use of CBD under the brand name Epidiolex to treat seizures resulting from Lennox-Gastaut syndrome and Dravet syndrome—two rare forms of epilepsy—in patients at least 2 years old.

Three well-vetted studies provide the basis of support for the FDA’s decision. In these trials, 516 patients with Lennox-Gastaut syndrome or Dravet syndrome received either Epidiolex or a placebo. Epidiolex, when taken along with other prescribed medications, decreased the frequency of participants’ seizures compared to the placebo.

3. Reduce PTSD Symptoms

In a small 2018 study in the Journal of Alternative and Complementary Medicine, 11 people with post-traumatic stress disorder (PTSD) received CBD along with routine psychiatric care for eight weeks in an outpatient psychiatric clinic. Ten of the 11 experienced a decrease in their PTSD symptoms. CBD was generally well tolerated, the researchers write.

Margaret Rajnic, a doctor of nursing practice experienced in medical cannabis and CBD, emphasizes the importance of using therapy in tandem with any type of cannabis or CBD for PTSD. “There is an amount of therapy that is needed for PTSD,” she says. “But CBD will give you that little bit of decreased anxiety.”

Four other human trials from 2012 to 2016 suggest CBD reduces PTSD symptoms, although some include THC, or tetrahydrocannabinol, the main mind-altering element in cannabis. When THC and CBD work together, they create what’s called an “entourage effect,” complementing each other’s benefits and potency. For example, taking the same dose of THC and CBD together tempers the “high” from THC, while just a little THC paired with more CBD enhances the effects of the CBD.

4. Treat Opioid Addiction

Some studies—both preclinical animal and human clinical trials—suggest CBD could be used to help treat people who are dependent on opioids.

In one such study, researchers administered CBD to people with heroin use disorder. Over the course of a week, CBD significantly reduced heroin users’ cue-induced cravings, withdrawal anxiety, resting heart rate and salivary cortisol levels. No serious adverse effects were found.

Other studies find CBD helpful in reducing various psychiatric and medical symptoms like anxiety, insomnia and pain in patients with substance use disorders, indicating that CBD may be an effective treatment for opioid addiction. However, further studies are necessary.

5. Alleviate ALS Symptoms

Amyotrophic lateral sclerosis (ALS) is a disease that causes nerve cells in the brain and spinal cord to deteriorate, resulting in loss of muscle control that worsens over time. It’s not yet understood exactly why ALS occurs, although it can be hereditary in some cases. There’s no known cure, and there are only two FDA-approved medications to help treat ALS symptoms.

Research suggests people with ALS can benefit from the entourage effect created by the combination of THC and CBD, similar to people with PTSD. In a 2019 study, patients received a combination of THC and CBD in varying doses depending on their needs and preferences. Those with mild, moderate or severe spasticity (muscle tightness and stiffness) due to ALS reported high levels of satisfaction with the treatment, and those with moderate to severe spasticity reported higher satisfaction rates than those with mild spasticity.

6. Relieve Unmanageable Pain

In 2005, Canada approved the use of Sativex, an oromucosal (absorbed in the lining of the mouth) spray with equal proportions of THC and CBD, for the treatment of multiple sclerosis-related central neuropathic pain. In 2007, Canada approved the medicine’s use again for cancer pain that proved unresponsive to other medications.

Meanwhile, continued studies in the U.S. indicate CBD is effective in treating chronic, non-cancer pain. In one 2020 study, researchers administered CBD topically to a group of patients with symptomatic peripheral neuropathy (a result of brain nerve and spinal cord nerve damage) while another group with the same condition received a placebo. Results showed a significant reduction in intense, sharp pains and cold, itchy sensations in those who used the topical CBD compared to those who used the placebo. No participants reported adverse side effects.

When introduced topically, CBD oil doesn’t affect the systemic issue as it might if it were introduced directly into the bloodstream. Instead, topical CBD is more localized and treats pain in a certain area. Since it’s more direct, it may have a more pronounced effect.

7. Ease Diabetic Complications

For starters, tests on human cells found that CBD helps reduce the effects of high glucose levels on other cells in the body, which typically precedes the development of diabetes and various complications. Researchers concluded that with further studies, CBD could have significant benefits when used in patients with diabetes, diabetic complications and plaque buildup in artery walls.

In another small study, 13 patients with type 2 diabetes who weren’t on insulin treatment were given both CBD and a placebo (in lieu of insulin). Researchers found CBD decreased their levels of resistin (which causes resistance to insulin, the protein that regulates sugar levels) and increased their levels of glucose-dependent insulinotropic peptide (a hormone that ensures a sufficient release of insulin from digested food) compared to their baselines before they started the test. These results suggest CBD could be a natural treatment for diabetes by helping the body regulate insulin-related hormone levels.

8. Protect Against Neurological Disease

Preclinical and clinical studies show that CBD has antioxidant and anti-inflammatory properties. Researchers deduce these characteristics can provide significant neuroprotection, or protection against numerous pathological disorders.

Several preclinical studies suggest CBD can produce beneficial effects against Parkinson’s disease, Alzheimer’s disease and multiple sclerosis. Huntington’s disease and cerebral ischemia were also tested, although significant positive results were not recorded. Further clinical studies are needed to confirm CBD’s benefits when used as a treatment for these disorders.

9. Inhibit Arthritis Symptoms

Arthritis involves the deterioration of the tissues in and around your joints. There are several types of arthritis, and symptoms include pain, stiffness and loss of motion. Arthritis treatment usually targets pain relief and improved joint function.

A 2006 study found that Sativex—a CBD-based botanical drug approved in the United Kingdom in 2010—promoted statistically significant improvements in quality of sleep, pain during movement and pain at rest in patients with rheumatoid arthritis when compared to a placebo. It was the first controlled trial of Sativex as a treatment for rheumatoid arthritis, involving 58 patients. CBD was found to have a pain-relieving effect, as well as an ability to suppress disease activity.

In 2018, in a study of more localized treatment, researchers administered a synthetic CBD gel in either 250-milligram or 500-milligram doses daily or a placebo to patients with knee pain due to osteoarthritis. Patients also stopped taking any other anti-inflammatory medications or painkillers, with the exception of acetaminophen, before and during the study period.

The results were interesting, although not entirely conclusive. On one hand, those treated with CBD did not experience much change in pain when compared with placebo patients. On the other hand, there were statistically significant differences between the group receiving the 250-milligram dose and the placebo group when measuring the average weekly improvement of their worst pain levels and their WOMAC (Western Ontario and McMaster Universities Arthritis Index) physical function rating. Additionally, men seemed to benefit from CBD more significantly than women in this test.

Pure, Premium, Powerful CBD

FAB CBD’s products are made from organically grown, lab tested, Colorado hemp. Their range of products include CBD oils, gummies, topical CBD cream, dog treats and more.