Dear Nurse Susan,
I recently bought a CBD sublingual tincture for my arthritis pain and inflammation. I have used most of the bottle but have not noticed any benefits. Is this expected? Does that mean that CBD doesn’t work for me?
Skeptical

Dear Skeptical,
Great question! People often ask me about cannabidiol (CBD) and if it really works. CBD is a cannabinoid found in cannabis and has many therapeutic effects, without the intoxicating effects of delta-9 tetrahydrocannabinol (THC). In addition to pain and inflammation from arthritis, CBD is frequently used for conditions that are difficult to treat, such as Crohn’s disease, PTSD, anxiety and Multiple Sclerosis. CBD interacts with 65 targets and receptors in the body. CBD does not bind to the CB1 receptor, but it reduces the intoxicating effects of THC, while boosting THC’s pain killing and anti-inflammatory properties. Due to its lack of intoxication, it is ideal for use by the elderly, children, and those who need to be clear-headed. If you prefer to consume CBD using infused beverages, remember that plastic absorbs CBD so you may end up with more CBD in the plastic than the beverage!
Let’s start with a short video of what some doctors have to say about CBD:

I want to address your question in a couple of different ways:
First, what did you buy? There are more and more CBD products flooding the market every day. Unfortunately, some manufacturers are less scrupulous than others and are making low-quality products. Some products have been tested independently and have little to no CBD in them! According to a recent report by the Journal of the American Medical Association (JAMA), discrepancies between federal and state cannabis laws have resulted in inadequate regulation and oversight, leading to inaccurate labeling of some products. You can read about it here: https://arstechnica.com/science/2017/11/study-nearly-70-of-online-cbd-marijuana-extracts-tested-were-mislabeled/
The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD they claimed to contain. It is important to note that these products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products: https://www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm
It is important to only use cannabis products that have been lab tested for purity, potency, safety, and consistency. The most comprehensive testing measures the levels of cannabinoids (THC, CBD, etc.), terpenes (myrcene, pinene, etc.), residual solvents (ETOH, butane, etc.), pesticides and microbial content (mold, bacteria, etc.).
So, how do you get lab results? Go to the manufacturer’s website and see if they post their lab results. For example, go to www.wvapes.com and under Products, click on Strain Results and you can review lab reports on each of their products. If a manufacturer does independent lab testing they are happy to show the lab reports because it is instant credibility. If a manufacturer cannot provide lab reports, don’t use their products. Ask your dispensary which testing laboratory they use and look into that laboratory. If your dispensary cannot provide lab results on the products it sells, maybe it’s time to find a new dispensary.
Second, what dose did you use? If a 30ml bottle lasted 6 months, you probably weren’t getting an optimal dose. Just as with many traditional pharmaceuticals, every individual must find the dose that is best for them, because dosing is the most important factor in a successful cannabis experience. That is one of the services I provide to medical patients who want to use the appropriate cannabinoids and need help finding their optimal dose. The general rule for dosing is to start low and go slow. That means slowly increase the daily dose until you get the results you are looking for. If you aren’t feeling as well as you did with a lower dose, go back to the lower dose and make a note of how many milligrams of CBD, THC etc. work best for you.
Finally, cannabis is not a miracle drug and does not work for everyone. Don’t expect cannabis to cancel out your less-than-optimal lifestyle choices. To obtain the optimal effects of CBD for arthritis, combine cannabis/CBD therapeutics with healthy choices such as
• minimal consumption of sugar
• no tobacco
• minimal caffeine
• limited consumption simple carbohydrates like bread, pasta and rice
• eat lots of vegetables and berries
• use healthy fats like avocado, coconut, olive oil etc.
• avoidance of night-shade vegetables (peppers, eggplant, tomatoes etc.)
• minimal alcohol consumption
• plenty of good-quality sleep and exercise
Skeptical, don’t give up! Make the effort to find the best products and dose for your optimal cannabis experience. The exploration of all the different products and methods of consumption can be educational and fun!

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