Cautious Hope for Cannabidiol (CBD) in Rheumatology Care

Cannabidiol (CBD), a major metabolite of Cannabis sativa, is popularized as a medicinal product, with potential for analgesic, antiinflammatory, and antioxidant effects. CBD may hold promise as a treatment in rheumatic diseases, but evidence to date remains preclinical. Preclinical effects on pain and inflammation is encouraging, but clinical study is lacking, with only a single study in knee osteoarthritis reporting a promising effect on symptoms. CBD products are freely available over the counter and marketed as food supplements or wellness products. The World Health Organization has identified pure CBD as safe and without abuse potential, but products are not subject to drug regulatory standards, leading to inconsistency in manufacturing practices and quality of products. Not only have molecular concentrations of CBD been identified as inaccurate, but concerns exist regarding contaminants, including heavy metals, pesticides, microbes, and mycotoxins, as well as added tetrahydrocannabinol. Drug-drug interactions pose a potential risk due to metabolism via the cytochrome P450 enzyme pathway. Patients wishing to use CBD should obtain a product with certification of Good Manufacturing Practices, initiate treatment with a nighttime low dose, and have defined outcome goals within a reasonable time frame. Treatments should not be managed by nonmedical dispensary personnel. The hope that CBD may be a useful therapy must be substantiated by sound scientific study.