Arthritis Foundation Endorses Snake Oil?

NBC reported on new guidelines about CBD released by the Arthritis Foundation. Given that CBD is sold everywhere from gas stations to flea markets, information from a supposedly reputable organization should be welcome. 

The Arthritis Foundation started off reasonably enough, saying CBD may help, but there aren’t rigorous controlled studies to confirm this notion. That should have been enough for a prudent organization to discourage use. However, the Arthritis Foundation went on to give a how-to guide on using cannabinoids for arthritis. They ignored the Food and Drug Administration’s position on CBD: “Selling unapproved products with unsubstantiated therapeutic claims is not only a violation of the law, but also can put patients at risk, as these products have not been proven to be safe or effective.”

The transcript of the Arthritis Foundation report is below, but – inspired by a Congressional Committee Chairman’s recent performance – let me first tell you what the transcript essentially says. 

“There is no evidence that CBD does anything for arthritis pain, but if you like taking over-priced, unregulated junk, we will help. Find a fancy looking bottle that says CBD. Cross your fingers that it actually contains the concentration of CBD that the label claims. Pray to the Gods it is not contaminated with pesticides, lead, synthetic cannabinoids or high levels of THC like many of these potions. Put the tiniest homeopathic amount of the concoction under your tongue. If the placebo effect isn’t strong enough, take more so you might feel something. If the power of suggestion still doesn’t work, add THC to the mix. Now you will catch a buzz, so try it while in a safe administration zone because you could fall and break that arthritic hip that you’re trying to help in the first place. And if you get paranoid or feel a psychotic reaction coming on, sleep it off and hope you wake up in one piece.”

Here is the actual transcript which isn’t much different than my synopsis except that it contains no links to actual data:

“How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:

When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.

Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.

If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.”

Dear Arthritis Foundation, if you want to do something useful for arthritis sufferers, use some of your $86,761,758 in total revenue to sponsor double blind, randomized controlled trials. Until then, stop giving false hope by encouraging patients to drink a magic elixir at $80 an ounce. 

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  12 comments for “Arthritis Foundation Endorses Snake Oil?

  1. Christine L. Miller, Ph.D.
    October 1, 2019 at 12:26 pm

    Dr. Kamer makes excellent points at a time when medical societies are not doing a great job of educating the public on this complex issue. Many will have approved cannabinoid position papers, warning of health risks and discussing the risk/benefit balance for specific indications, but their points are buried in their websites. By in large, they have failed to broadcast their knowledge for the benefit of public health. Here you have the Arthritis Foundation (which is not a medical society, I should point out) virtually endorsing the rampant use of CBD, without an adequate discussion of the risks or the limited benefits, and Dr. Kamer has called them on it. We have to look no farther than the vaping crisis to see how the stewards of our public health have failed this country.

  2. Michael J. McKenzie, MD
    September 29, 2019 at 11:42 am

    Because of the Farm Bill, Industrial hemp that is <0.3% THC by dry weight is LEGAL. The CBD oil derived from this industrial hemp is LEGAL. One caveat, however, You need the WHOLE FAMILY of cannabinoids (THC, CBD, etc), terpenes, and flavonoids working TOGETHER in order to have the proper "entourage effect". I liken it to the Jackson family.

    -Michael Jackson is like THC

    -Janet Jackson is like CBD

    -Tito, Jermaine, Marlon, Jacky, and Randy are the terpenes and flavonoids
    You need the whole family in order to make proper music.

    -Whats being passed off as CBD is Garage Tribute/Cover Band Janet Jackson and not the Jimmy Jam/Terry Lewis-produced Rhythm Nation 1814 Janet Jackson.

    -Latoya Jackson is like the pesticides that often accompany cannabis that noone wants to deal with

    -Rebbie Jackson is like THCV. Noone hardly ever hears of it. Known for one thing (potential for weight loss) and hardly ever makes an appearance. Just Like Rebbie was known for that one song "Centipede" in 1984 (which was the JAM by the way)

    Whole Plant/Whole Family is always best brotha 😉

    As a physician who has also been involved with cannabinoids medicine since 2015, I don't have much use for isolated CBD that ppl seem to by hyping up nowadays.

    Remember, medical cannabis can represent ANY combination/ratio of cannabinoids, terpenes, and flavonoids. The elderly have become the fastest growing demographic using cannabinoids, mainly because of PAIN and INSOMNIA. They actually want to REDUCE their use of Benzos and Narcotics. And that is what I have seen. An overall REDUCTION in the consumption of Benzos and Opiates. I don't need a "double-blind FDA study" to tell me what I see in my practice on a regular basis.

    YES the right combo of cannabinoids/terpenes/flavonoids CAN reduce arthritis pain by its actions on the CB1 (located in the CNS) and CB2 (located in the periphery) receptors. Certain combos can be effective for one person and not be effective for someone else. Some ppl do well with a 1:1 ratio of THC:CBD. Others need a different ratio to achieve efficacy. How I would dose a naive patient who never tried cannabis in their life is WAYYY different than someone who is a chronic daily user like Willie Nelson. So it is not a one-size-fits-all therapeutic option.

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    • Lori Robinson
      September 30, 2019 at 10:09 am

      Dr McKenzie- you know there is no scientific evidence of cannabinoids producing an “entourage effect”. Why not level with the public that all these pot products, besides destroying our youth, are not being tested adequately tested for presence of mold, pesticides, fungicides, heavy metals… Did you miss U.S. Surgeon General Jerome Adams 8/29/19 Public Health Advisory: Marijuana Use and the Developing Brain (the harms)? He was flanked by key representatives from the Dept of Health and Human Services, SAMHSA… Did you miss Surgeon General Adams declaration at another conference recently “there is no such thing as medical marijuana”?
      https://www.youtube.com/watch?v=YeVs7aTh9vw
      Do you not recall the Hippocratic Oath you took when you became a physician ? Shame on you.

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      • Michael J. Mckenzie, MD
        September 30, 2019 at 7:01 pm

        I do not have the life energy or desire to get into a back and forth pissing match with ignorant prohibitionists. However, I will say this…

        If you would have read the research that has been going on in Israel since the 1990s, there is a basis for the term “entourage effect” WHOLE plant extract that contains cannabinoids (both major and minor), terpenes, and flavonoids showed far superior results than the use of isolated cannabinoids alone. Neurologist Dr. Ethan Russo who has been studying and researching cannabinoid medicine for many years penned this paper:

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/

        You should read it and the many other papers like it which talk about the Entourage Effect as it relates to cannabinoids effects. Still so much to research/discover.

        Or better yet, you should have come to Pasadena, California last week when they held the Cannmed 2019 conference. You would have had the perfect opportunity to ask Dr. Raphael Mechoulam (Who isolated THC in 1964 and has been researching it ever since then) or Dr. David Mieri DIRECTLY to their face if the “entourage effect” is real or not. Those cats are straight-up academic OG’s…You would have been laughed out of the room.

        https://cannmedevents.com

        Do you know anything about Florida’s program?? Clearly not. The vertically-licensed dispensing organizations in FL all test their products for mold, pesticides, etc. It is not as “wild-wild-west-ey” as Colorado or California who have made their share of missteps. I am NOT saying we have a perfect program, but we are always seeking ways to improve and not reproduce the mistakes made by other states.

        We see the results in practices every day. Remember, in FL, patients are mandated to have a followup with a certified physician every 7 months. We have a patient database of over 200,000 patients treated with cannabinoids UNDER PHYSICIAN SUPERVISION since the passage of Amendment 2. Patients of ALL ages are doing generally BETTER. One immediate thing we noticed in FL is an overall REDUCTION of opiate and Benzo use. That is a POSITIVE thing. If a patient with Crohns Disease can stay in remission with THC:CBD 1:1 capsules and not have flareups and not have to resort to the biologic agents which have a zillion side effect, that is a GOOD thing.

        I am aware of the hippocratic oath very well. Our directive is to DO NO HARM. Please show me evidence where these 200,000+ Florida patients are being harmed. We are actually preventing the harm done by OPIATES and BENZOS. Cancer patients do quite well. The local Cancer institutes (whether it be Memorial or Moffett REGULARLY refer their cancer patients to folks like me or one of the certified docs for this OFF-LABEL treatment adjunct/option.

        The only thing we are upsetting is the prohibitionist narrative of organizations like yours “Mom Strong” who along with your buddies in SAM and the Rehab-Industrial-Complex fight against any relaxation of the illogical cannabis laws because it is bad for y’alls bottom line. NOBODY wants to see youth abusing cannabis , but here’s the piece…If you want to prevent youth abuse of cannabis, how about ensuring and increasing ACCESS to mental health services for kids. I don’t care how good of a PPO you think you have, that does not ensure ACCESS to a psychiatrist, because we all know COVERAGE does not equate to ACCESS. A child who abuses cannabis to the point of bad grades, bad relationship with family, withdrawal from friends, etc is trying to TREAT something. Could be early depression, bipolar disorder, PTSD, which kids can develop. With no access to mental health care, these kids self-treat, and it is with the WRONG thing. Black market/street cannabis can exacerbate their problem. Betcha dollars to doughnuts that access to a board-certified child psychiatrist and addressing their mental health issues EARLY ON and GOOD ol’ fashioned EDUCATION will PREVENT the majority of youth abuse.

        Where is Mom Strong on the fight to increase mental health ACCESS in the different communities and early screenings for depression when kids get their school physicals??

        We already have a problem with all these kids on the molecular cousin of CRYSTAL METH (Adderall, etc) which Pediatricians & Psychiatrists dole out like chiclets and these kids barter/sell their ADHD meds in the school…Where is “Mom Strong” on this issue?? One can actually DIE from amphetamine abuse.

        As to our beloved US Surgeon General Jerome Adams. I respect the man and the office, but to be honest and frank, the man is grossly IGNORANT. He seems to be only interested in listening to one side, and that is the folks at SAM, the Rehab industry, and the Pharm industry. He has NEVER approached any of the experienced cannabis clinicians , nor ever visited a clinic, nor ever visited a dispensary, nor ever spoke to any of the cannabis researchers in Israel, Spain, etc. We offered him a chance to attend Cannmed in California and speak to the experienced clinicians and researchers themselves…Surprise, surprise, he never took us up on our offer. When one is so BIASED towards one side, and have a vested interest in maintaining a status quo, I am not going to hold my breath waiting for them to reach out and try to learn something new.

        Docs like Dr. Barry Gordon at the Compassionate Cannabis Clinic in Venice, FL (http://www.venicecare.com)
        have an OPEN DOOR POLICY to ANY and ALL Physicians, Local/State/National Politicians, Hospital Administrators, and yes even the skeptics/prohibitionist crowd are welcomed too!!. Visit a medical dispensary on Florida. Visit Dr. Gordon’s clinic. He don’t bite 😉

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        • Kenneth Finn, MD
          October 1, 2019 at 11:54 am

          Yet more than 80% of vaping-related deaths are related to marijuana related products, some purchased in regulated markets like California, and likely under a physicians supervision, who may be in jeopardy of losing his license if that is the case because they will be sued. Yes….do no harm and please practice evidence-based medicine.
          Nobody can or will argue that a natural, FDA-approved and purified, cannabinoid, proven to work is a bad thing, even if its a blend of natural molecules.
          Yes….marijuana products are killing people, California has an 18% fail rate of its products, Oregon has had the capacity to test 3% of its stores and cannot ensure public safety. Yes. Do no harm

  3. Kenneth Finn, MD
    September 29, 2019 at 10:46 am

    Arthritis Associations recommendation is reckless and pushes the envelope of malpractice, making recommendations on a substance that has not been proven and likely contaminated and not purified. With the new vaping lung illness, there are reports of CBD being part of the equation. AA needs to redact their statement and support FDA drug development to protect our patients.

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    • Michael J. McKenzie, MD
      September 29, 2019 at 12:38 pm

      What would have been better for the Arthritis Foundation to do is this…

      1-Reach out/Consult with an actual experienced cannabinoid clinician in a legal state (We’re not that hard to find) before publishing their piece.

      2-A disclaimer at the outset that Cannabis is an OFF-LABEL treatment option and can represent ANY ratio/combination of cannabinoids, terpenes, and flavonoids administered via different delivery methods, the purpose of which is to produce a therapeutic effect.

      3-Point out the 2 main fundamental characteristics of cannabis that differentiate it from the standard FDA-approved isolated compounds that make up our pharmacopeia…
      A-Heterogeneity
      B-Pleiotropy

      Its heterogeneity and pleiotropy precludes us from treating it as the single compound therapeutic agent(s) that we all have been trained on.

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      • Kenneth Finn, MD
        September 29, 2019 at 3:04 pm

        No. They need FDA to support the development of cannabinoids which are safe and proven effective. Even the Epidiolex website which is the ONLY purified CBD on the planet cautions patients regarding liver toxicity, renal effects, suicidal behavior, and pregnancy issues. The AA did nothing to warn consumers of these risks. I also found your Jackson family analogy ridiculous as well. Can you cal the patient who got Ill on CBD vapes they got a little too much Janet??! Let the actual science direct public policy and protect consumers.

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    • Sir Lance-a-lot
      September 29, 2019 at 8:20 pm

      “Arthritis Associations recommendation is reckless and pushes the envelope of malpractice…”

      Not really. The Arthritis Association is not a physician and has no obligation to meet any standard of care, so it cannot, by definition, commit malpractice.

      All they’re doing is what every “non-profit” organization does:
      Create hype to pump up the memberships and pump up the donations.

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      • Kenneth Finn, MD
        September 29, 2019 at 9:42 pm

        I agree with what “non-profits” do, however their recommendation needed to come with the approval of their board, where several physicians sit

  4. Thomas David Guastavino
    September 29, 2019 at 10:07 am

    Raise the THC high enough and you will not care about your arthritis-or anything else for that matter.

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    • Kurt
      October 2, 2019 at 4:45 pm

      JB is making it all legal in Illinois come January 1st. Perhaps he thinks we’ll all get so stoned we won’t care when he starts taxing the h$ll out of all Illinoisans.

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