This September, AARP marked a milestone in medical marijuana acceptance with the announcement that it “does not want older Americans to navigate this brave new world of cannabis alone.” Now the Arthritis Foundation, the largest advocacy group in the United States for people with arthritis, is helping its constituents figure out how to use CBD, with the “CBD Guidance for Adults with Arthritis” recently published on its website.
Clinical research on the efficacy and safety of cannabinoid-based medicines is still far from adequate to satisfy the mainstream medical establishment. And yet, with millions of people using these medicines, consumer advocacy organizations like AARP and the Arthritis Foundation are finding they must balance the conservative stance of most medical authorities with the real-life needs of their constituents. And as the AARP September Bulletin noted, “the tipping point has been reached.”
Like AARP, the Arthritis Foundation is stepping up to fill the information gap for older adults by outlining the risks and benefits of cannabinoid-based medicine, rationally and responsibly, for those desperately in need of this guidance.
Intrigued by the Potential
The Arthritis Foundation’s official position regarding CBD, which prefaces the guidance on usage, states that:
“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.”
I spoke with Cindy McDaniel, Senior VP of Consumer Health and Impact at the Arthritis Foundation, about the decision to come forth with guidelines for using CBD to treat arthritis, and how the needs of older adults factored into that decision.
Abbie Rosner (AR): This past July, the Arthritis Foundation conducted a survey among its constituents about CBD use. Tell me about that survey. How many responders were over 50?
Cindy McDaniel (CM): The survey had approximately 2600 responses. Of about 2400 responders who provided a year of birth, 69% were people over 50.
AR: What were your key take-aways from the survey?
CM: First of all, the biggest take-away was the number of people who are either using or looking into using CBD, which was 79%, which is a very high number. And when we asked what they used it for, treating pain was number one, along with anxiety and sleep. Most reported that it did something for them…
But the survey told us enough about what we already knew, that there’s a real interest here. People are using this (CBD) whether they have real firm guidance or not, so we felt an obligation as an organization to step up and provide as much guidance as we could, working with some of the experts who are doing research on CBD in the field.
AR: Were the survey results instrumental in the Arthritis Foundation’s decision to create the CBD guidelines? Were other factors involved?
CM: Yes, the survey results certainly were. But the other thing was this. We listen to patients and pay attention to what they are asking about, whether through our social channels or other places, and we’ve been hearing this question about CBD all year. Interestingly, we were also starting to hear it a lot from the doctors we work with, who were asking for guidance on how to answer their patients’ questions about CBD. So it was kind of a combination that caused us to say, if someone’s going to do it, it has to be us.
AR: You are walking a very fine line here – you’re not endorsing the use of CBD, and you’re also not dismissing it. But even without endorsing it, just placing CBD on the public agenda is a significant step. How do you feel about that?
CM: One of the experts we worked with actually said to us, if we don’t provide guidance, people are going to have no guidance at all. They’re going to do this anyway, so it should be in a way that doesn’t harm them. The guidelines very intentionally don’t say “use this.” What they say is, “if you are going to try it, here’s how to do it safely.” …. In the world of arthritis and chronic pain, there are certainly no cures. There aren’t even great treatments for chronic pain. So we try very hard to give as many options as we think may be useful.
AR: The guidelines give a general overview of CBD to educate readers about its forms of administration, safety, legality, etc. And ultimately you send readers to their physicians to confirm if they are a good candidate for using CBD. But you must be aware that most physicians are not informed about the safety and risks of CBD. Do you think that’s still a problem?
CM: I do think that there is still a gap in knowledge… What we can hope a doctor will do is monitor the patient’s progress and check about their other drugs, because a number of the drugs that could have contraindications with CBD are used to treat arthritis… If the patient was seeing pain relief, whether it’s the drug or the CBD, the patient and doctor might work together to adjust dosages and optimize the pain relief.
AR: The guidelines also mention the possibility of using products with THC in legal states. Was that an issue for the Foundation to address?
CM: It was a rather bold move. When we started down this path, the first question was, do we focus just on CBD or do we take on the full gamut of medical marijuana? And we decided to stay with CBD as our initial foray, partly because it is more widely legal, and also because the FDA has taken on CBD as a solo topic this year…. Interestingly, the experts we consulted were saying that there is probably more data on THC in medical marijuana, and perhaps if someone is really in dire need of pain relief and the CBD alone isn’t working, the recommendation from our experts was to perhaps try mixing in a very low dose of THC…. We need to be cautionary about the legality of THC and also the need to keep the dosage low. But we did make the decision to keep the THC option in.”
AR: Are these guidelines going to appear in the Arthritis Today magazine, which has some 4 million subscribers?
CM: Yes, we’re doing an article on CBD for an upcoming issue. It will be from a consumer perspective but absolutely following these guidelines. We’re also putting together a consumer-oriented handout that will be available to physicians who may want them to give to their patients. Our main affiliations are with the rheumatology community, which is a very small sub-section of the physicians who see people with arthritis. So if other physicians see this as a resource they could use, that would be phenomenal.
* The leading experts are Kevin Boehnke, PhD, Daniel Clauw, MD, and Mary Ann Fitzcharles, MD.