By Jennifer Freeman, MD, April 2020
Approximately 54 million adults and 300,000 children in the U.S. have been diagnosed with arthritis or some other type of rheumatic disease causing joint pain according to the Arthritis Foundation (AF).
If you consider all of the individuals who have arthritis but have not yet been diagnosed, the AF suggests that the true count is likely closer to 91.2 million in total. To make matters even worse, that number is expected to grow by 49 percent by the year 2040.
The most precarious and debilitating symptoms suffered by arthritis patients include pain, stiffness, and decreased movement within the joints, all of which can be severe and worsen over time. In addition, there are other symptoms that are just as troublesome, such as anxiety and depression. Not only that, but it can become especially trying when you have to contend with other medical problems that tend to coexist with arthritis, like heart disease, diabetes, and obesity.
Some medications and treatment programs can potentially help ease these negative effects, but many people are searching for a more natural pain relief option. This is where CBD oil comes into play.
What is CBD Oil?
CBD is short for cannabidiol, which MedlinePlus explains is one of more than 80 chemical cannabinoids found in the marijuana plant Cannabis sativa. Thus, cannabis oil, or CBD oil as it is more commonly known, is an oil that is developed using this particular compound.
Although CBD oil is just now becoming fairly mainstream, largely because of the debates surrounding medical marijuana, cannabis actually has a long history of providing relief in many different countries around the world.
CBD’s Long History
In June 2015, National Geographic ran a story about how Siberian burial mounds as far back as 3000 B.C. were found to contain charred cannabis seeds. Cannabis has also been used in Chinese medicine for thousands and thousands of years.
The article went on to explain how American use of cannabis goes back to our country’s founding fathers as well. In fact, George Washington himself grew hemp at his plantation estate and the location of his burial, Mount Vernon.
Because of its somewhat tumultuous history marijuana has had with the law (regarding whether it is illegal or not), research on the positive properties of hemp plants’ derivatives such as cannabidiol oil has been extremely limited.
This has caused many people to question its use for modern day ailments, primarily because they don’t know a lot about how it works.
How Cannabis Oil Works
According to Medical News Today, the body’s endocannabinoid system has two cannabinoid receptors: CB1 and CB2.
A majority of CB1 receptors are located in the brain and are associated with cognitive actions related to coordination, mood, thinking, memory, and appetite. The CB2 receptors, on the other hand, can be found in the immune system. This makes them more responsible for the body’s response to pain and inflammation.
Tetrahydrocannabinol, or THC, attaches to the CB1 receptors, which explains why smoking or otherwise ingesting marijuana affects users on a cognitive level.
However, CBD impacts the CB2 receptors. And it does so indirectly, not by attaching to the CB2 receptor, but by enticing the body to make more of its own cannabinoids. This creates a positive effect on the body’s pain and inflammation responses.
Benefits of CBD Oil
Many studies have been conducted on CBD and found that this compound offers individuals diagnosed with arthritis several potential benefits.
CBD Oil Eases Arthritis Pain
One of the primary CBD oil benefits for arthritis sufferers is its positive effect on pain, and research confirms it.
A study published in the journal Pain in December 2017 analyzed whether CBD could prevent osteoarthritis pain and joint neuropathy. Based on their findings, researchers affirmed that it did both because it decreased joint inflammation and served as a protectant to the nerves.
CBD Oil Relieves Other Chronic Pain Conditions
CBD oil has been found to relieve other chronic pains as well. For instance, research published in Therapeutics and Clinical Risk Management indicates that cannabinoids have been helpful with easing pain for individuals diagnosed with conditions such as multiple sclerosis and cancer.
Other studies have reported positive effects for individuals taking CBD to ease their fibromyalgia pain, many of whom only experienced mild side effects from this chemical compound, such as dry mouth, drowsiness, and dizziness.
CBD Oil and Anxiety
CBD oil has also been linked to a variety of mental health benefits, such as a reduction in anxiety. Research suggests that it is so effective in this regard that it has “considerable potential as a treatment for multiple anxiety disorders.” One study published in The Permanente Journal even found that CBD oil can help reduce anxiety in young children.
CBD Oil for Depression
Several studies have also linked CBD to a reduction of symptoms associated with depression. This is extremely important because as the Arthritis Foundation says that the depression rates of those diagnosed with certain types of arthritis “can be between two- and ten-times greater than the rates of the general population.”
Is CBD Oil Legal?
Although CBD oil has a number of potential benefits, one of the top questions that individuals diagnosed with rheumatoid arthritis have is whether or not it is legal. Answering this question requires some understanding of certain components of the marijuana plant.
The compound in the cannabis plant that is most well-known is THC. This is the chemical responsible for marijuana’s notorious high. However, unlike THC, CBD does not have psychoactive properties. This means that it does not create the same effect that one normally gets when smoking, inhaling, or otherwise ingesting marijuana. Furthermore, the U.S. Drug Enforcement Administration (DEA) says that it is the THC that makes marijuana illegal in a number of different states.
As a result, the answer to “Is CBD oil legal?” isn’t quite so clear.
** Information regarding the legality of CBD inserted into this article by Mary Coupland so you have all the info on this and you can make your own choice is found at the bottom of this article.
Originally, marijuana use and sales became illegal under the Marijuana Tax Act of 1937, with this illegality continuing under the Controlled Substances Act. Yet, since then, several states have taken the steps to legalize this drug, even if just for use as medical cannabis.
For instance, some states allow the consumption of marijuana and its extracts only for medical reasons, which makes a medical marijuana card necessary for its use. Some states have approved this drug and its components for recreational use as well.
To make matters more complex, on December 14, 2016, the DEA issued a Final Rule that created a new code number (7350) designed to cover “any material, compound, mixture, or preparation” surrounding the marijuana plant.
Upon clarification of this new code, the DEA indicated that CBD extracts that contains even small amounts of other cannabinoids would still fall under the old code, making them illegal under federal rule. However, CBD extracts that contain no other cannabinoids would fall under the new code, where they could potentially be legal to use.
Plus, some CBD oils are derived from hemp, the fiber of the cannabis plant. Though the 2014 Farm Bill declared certain hemp cultivation practices legal, muddying the legal waters even more, the president signed the new Farm Bill into law in December 2018, effectively legalizing hemp under federal law.
What does all of this mean in real-life terms?
In short, to determine whether a CBD oil or any other CBD product is legal or illegal depends on a multitude of factors. Your geographical location, local laws, and whether there are any other cannabinoids in the extract must all be taken into consideration before arriving at a final answer.
Is CBD Oil Safe?
The second most common question people have when it comes to CBD oil for pain management or its anti-inflammatory properties is whether or not it is safe to use for arthritis symptoms.
Patients are always concerned with additional potential and side effects (as they should be). According to some top health experts and agencies, the answer is yes. It is safe to use.
For instance, Medscape shares that while cannabinoid medicine is still in its early stages, “unlike marijuana and THC, the risks associated with CBD are extremely low, with not a single case report of CBD overdose in the literature. The National Institute on Drug Abuse agrees and states that “CBD appears to be a safe drug with no addictive effects.”
In the future, it is likely that the Food and Drug Administration (FDA) will also begin to regulate CBD products, providing an additional safety net, as this agency indicates that “increasing public interest” in this substance increases the importance of establishing regulatory procedures.
Potential Risks of CBD Oil
Many health experts have deemed CBD safe to use, but like with any substance, there does appear to be a few potential risks when it comes to using this extract.
Medication/Drug Interactions
MedlinePlus indicates that CBD can sometimes interact with certain prescription medications, primarily those that are “changed and broken down by the liver.”
These include, but are not limited to common medications such as:
ondansetron (Zofran)
clozapine (Clozaril, FazaClo)
progesterone (Endometrin, Prometrium)
testosterone
disulfiram (Antabuse)
ketamine (Ketalar)
phenobarbital (Luminal)
omeprazole (Prilosec)
lansoprazole (Prevacid)
diazepam (Valium)
carisoprodol (Soma)
ibuprofen (Motrin)
celecoxib (Celebrex)
amitriptyline (Elavil)
warfarin (Coumadin)
codeine
paroxetine (Paxil)
tramadol (Ultram)
venlafaxine (Effexor)
alprazolam (Xanax)
fexofenadine (Allegra)
benzodiazepines
morphine
MedlinePlus further states that there are other “drugs” that can potentially interact with CBD as well, including caffeine and nicotine. However, research has not necessarily supported these claims.
For instance, a 2015 study published in the journal Pharmacology Biochemistry and Behavior found that, in the right dose, caffeine can actually potentially help prevent CBD effects on memory.
Another piece of research, this one published in the Addictive Behaviors journal, found that CBD “significantly reduced” (as much as 40 percent) the number of cigarettes smoked by individuals who wanted to quit.
CBD and Drowsiness
Another potential risk of CBD is that it can cause drowsiness. Therefore, if you’re taking supplements or medications to help you sleep, CBD could enhance these effects even more. It’s important to keep this in mind if you’re performing activities that require maximum alertness, such as driving or operating heavy machinery.
CBD Dosing Considerations
If you’d like to use CBD oil to help ease your arthritis pain, you may be wondering how much to administer or apply. However, when talking about proper CBD dosing, it’s important to first understand bioavailability.
CBD Bioavailability
Bioavailability is defined as the “amount of a substance that becomes available (reaches the target organ or system circulation) to an organism’s body for bioactivity when introduced through ingestion, inhalation, injection, or skin contact.” In short, it is how much of the substance your body can effectively use based on the type and route taken.
In the case of CBD oil specifically, Medscape shares that while intranasal administration of CBD has a bioavailability of 34 to 46 percent and CBD vaporization has 40 percent bioavailability, “oral CBD is thought to be as low as 6 percent, owing to significant first pass-metabolism.”
First-Pass Metabolism and CBD
An article published in the journal Nurse Prescribing explains that first-pass metabolism occurs in the gut or the liver and is when some of the drug is destroyed before it is able to be circulated around the body. Thus, based on the research above, taking CBD oil in pill form may mean that your body only receives as little as 6 percent of the CBD.
Another option is to take CBD oil topically, either alone or as part of a lotion or cream. Research published in the European Journal of Pain studied the effectiveness of this approach and found that “topical CBD application has therapeutic potential for relief of arthritis pain-related behaviors and inflammation without evident side-effects.”
Proper CBD Dosing
Because CBD is so new, Medscape recommends that users “start low, go slow.” This enables you to see how well your body responds without giving it more than the necessary amount.
Plus, there are no government regulations regarding the manufacture and sale of CBD, so you never know if you’re getting the amount actually listed on the label. This makes erring on the side of caution even more important.
CBD Oil Options
Consumer Health Digest (CHD) researched products on the web and, according to this guide, the three most important terms to know before purchasing your CBD oil are CBD volume, hemp oil volume, and CBD concentration. The second and third are the most critical, according to CHD, because they indicate the oil’s potency.
It’s also important to realize that there are different product options with regard to CBD oils. They are:
CBD oil, which is the “more potent version and delivery system of CBD”
CBD oil topical solutions, enabling the user to use it on a more targeted area
CBD oil tinctures, which are alcohol-based cannabis extracts that can be ingested orally, and the most popular CBD oil choice
CBD dietary supplements, or capsules containing CBD oil in in a powdered form
The one you choose will depend largely on the location and severity of your pain. If you want to target a specific area, an oil or oil topical may be the best. However, if the pain is all over, then a tincture or dietary supplement may provide the most relief.
Also, if you’re new to using CBD oil, we recommend you start with 10 milligrams per day to establish a safe, effective amount for you. Most of our RA colleagues end up getting relief when they take 20mg of full spectrum lab grade CBD tincture under the tongue twice per day. It’s important to hold it there for at least 60 seconds. Others with more severe pain go as high as 80mg twice or more per day to get full relief.
Where to Buy Lab Grade CBD Oil and Topical CBD Cream?
There has been an explosion of new CBD products hitting the market in the past year. We’re seeing reports of many of them having far less CBD than they report or even including no CBD at all. Worse some have even failed testing for pesticides and dangerous bacteria. The FDA seems to be ramping up enforcement to tackle this problem.
Article Submitted by:
Amber Stewart
PR Coordinator
Rheumatoid Arthritis Support Network (RASN)
A 501(c)(3) non-profit organization
Information regarding the legality of CBD provided by:
Annette Atkinson, Herablist
Orenda CBD
360-850-5809
Listen to the Compass & Clock Info-Tainment Podcast I did with Annette Atkinson on May 27th: What are the Alternative Healthcare Benefits of CBD? And reducing the stigma when shopping for this holistic product.
Additional info regarding the legality of CBD inserted at the bottom of this article by Mary Coupland
Can THC or CBD products be sold as dietary supplements?
A. No. Based on available evidence, FDA has concluded that THC and CBD products are excluded from the dietary supplement definition under section 201(ff)(3)(B) of the FD&C Act [21 U.S.C. § 321(ff)(3)(B)]. Under that provision, if a substance (such as THC or CBD) is an active ingredient in a drug product that has been approved under section 505 of the FD&C Act [21 U.S.C. § 355], or has been authorized for investigation as a new drug for which substantial clinical investigations have been instituted and for which the existence of such investigations has been made public, then products containing that substance are excluded from the definition of a dietary supplement. FDA considers a substance to be "authorized for investigation as a new drug" if it is the subject of an Investigational New Drug application (IND) that has gone into effect. Under FDA’s regulations (21 CFR 312.2), unless a clinical investigation meets the limited criteria in that regulation, an IND is required for all clinical investigations of products that are subject to section 505 of the FD&C Act.
There is an exception to section 201(ff)(3)(B) if the substance was "marketed as" a dietary supplement or as a conventional food before the drug was approved or before the new drug investigations were authorized, as applicable. However, based on available evidence, FDA has concluded that this is not the case for THC or CBD.
FDA is not aware of any evidence that would call into question its current conclusions that THC and CBD products are excluded from the dietary supplement definition under section 201(ff)(3)(B) of the FD&C Act. Interested parties may present the agency with any evidence that they think has bearing on this issue. Our continuing review of information that has been submitted thus far has not caused us to change our conclusions.
When a substance is excluded from the dietary supplement definition under section 201(ff)(3)(B) of the FD&C Act, the exclusion applies unless FDA, in the agency’s discretion, has issued a regulation, after notice and comment, finding that the article would be lawful under the FD&C Act. To date, no such regulation has been issued for any substance.
Ingredients that are derived from parts of the cannabis plant that do not contain THC or CBD might fall outside the scope of this exclusion, and therefore might be able to be marketed as dietary supplements. However, all products marketed as dietary supplements must comply with all applicable laws and regulations governing dietary supplement products. For example, manufacturers and distributors who wish to market dietary supplements that contain "new dietary ingredients" (i.e., dietary ingredients that were not marketed in the United States in a dietary supplement before October 15, 1994) generally must notify FDA about these ingredients (see section 413(d) of the FD&C Act [21 U.S.C. § 350b(d)]). Generally, the notification must include information demonstrating that a dietary supplement containing the new dietary ingredient will reasonably be expected to be safe under the conditions of use recommended or suggested in the labeling. A dietary supplement is adulterated if it contains a new dietary ingredient for which there is inadequate information to provide reasonable assurance that the ingredient does not present a significant or unreasonable risk of illness or injury (see section 402(f)(1)(B) of the FD&C Act [21 U.S.C. 342(f)(1)(B)]).
Numerous other legal requirements apply to dietary supplement products, including requirements relating to Current Good Manufacturing Practices (CGMPs) and labeling. Information about these requirements, and about FDA requirements across all product areas, can be found on FDA’s website.
10. Is it legal, in interstate commerce, to sell a food (including any animal food or feed) to which THC or CBD has been added?
A. No. Under section 301(ll) of the FD&C Act [21 U.S.C. § 331(ll)], it is prohibited to introduce or deliver for introduction into interstate commerce any food (including any animal food or feed) to which has been added a substance which is an active ingredient in a drug product that has been approved under section 505 of the FD&C Act [21 U.S.C. § 355], or a drug for which substantial clinical investigations have been instituted and for which the existence of such investigations has been made public. There are exceptions, including when the drug was marketed in food before the drug was approved or before the substantial clinical investigations involving the drug had been instituted or, in the case of animal feed, that the drug is a new animal drug approved for use in feed and used according to the approved labeling. However, based on available evidence, FDA has concluded that none of these is the case for THC or CBD. FDA has therefore concluded that it is a prohibited act to introduce or deliver for introduction into interstate commerce any food (including any animal food or feed) to which THC or CBD has been added. FDA is not aware of any evidence that would call into question these conclusions. Interested parties may present the agency with any evidence that they think has bearing on this issue. Our continuing review of information that has been submitted thus far has not caused us to change our conclusions.
When this statutory prohibition applies to a substance, it prohibits the introduction into interstate commerce of any food to which the substance has been added unless FDA, in the agency’s discretion, has issued a regulation approving the use of the substance in the food (section 301(ll)(2) of the FD&C Act [21 U.S.C. § 331(ll)(2)]). To date, no such regulation has been issued for any substance.
Ingredients that are derived from parts of the cannabis plant that do not contain THC or CBD might fall outside the scope of 301(ll), and therefore might be able to be added to food. For example, as discussed in Question #12, certain hemp seed ingredients can be legally marketed in human food. However, all food ingredients must comply with all applicable laws and regulations. For example, by statute, any substance intentionally added to food is a food additive, and therefore subject to premarket review and approval by FDA, unless the substance is generally recognized as safe (GRAS) by qualified experts under the conditions of its intended use, or the use of the substance is otherwise excepted from the definition of a food additive (sections 201(s) and 409 of the FD&C Act [21 U.S.C. §§ 321(s) and 348]). Aside from the three hemp seed ingredients mentioned in Question #12, no other cannabis or cannabis-derived ingredients have been the subject of a food additive petition, an evaluated GRAS notification, or have otherwise been approved for use in food by FDA. Food companies that wish to use cannabis or cannabis-derived ingredients in their foods are subject to the relevant laws and regulations that govern all food products, including those that relate to the food additive and GRAS processes.