Products containing CBD are often marketed for pain relief, but there’s no solid evidence that they actually do anything. In fact, the FDA recently issued warning letters to two companies that explicitly make CBD products intended to provide pain relief.
What is CBD again?
It is Cannabidiol, which comes from cannabis. It’s not the part of the plant that gets you high, and the 2018 Farm Bill opened a loophole that sorta-kinda-maybe-technically allows it to be sold even where cannabis is otherwise illegal. As the CBD market subsequently boomed, the compound has been added to everything from lotions to lattes, with implied promises of relaxation, pain relief, and generally curing of whatever ails you.
Does CBD do anything for pain?
It’s really hard to say. The way it’s marketed, you would think pain relief is a well-understood use of CBD. There are versions of the product that you can swallow or inhale, but there are also tons of salves and lotions that aim to make you feel better when you rub it on whatever body part hurts. But the truth is, nobody knows if it works.
A few months back, I wanted to write about CBD products that are marketed to athletes for “recovery” and for muscle pain. I got samples of CBD gels and roll-ons from different companies and tried them out. I interviewed the CEO of a CBD company and a supplement expert who was skeptical of the claims. I read a bunch of studies. In the end I had nothing to report but a big ol’ shrug. I couldn’t feel the topicals working, and I couldn’t come up with any solid evidence that CBD relieves pain or promotes recovery—outside of a potential placebo effect. On the other hand, I couldn’t find any solid evidence that it doesn’t.
There is research on CBD, but the setups of the studies are only distantly related to the scenarios in which people use over-the-counter CBD products. Sometimes the studies will administer a massive dose of CBD that’s out of the average person’s budget for regular use, or they’ll test CBD/THC combination products—and even then, the results aren’t necessarily clear. The studies are also often looking at patients with cancer or specific medical conditions, rather than people who want to treat everyday aches and pains. This 2020 review paper on CBD for chronic pain sums up the state of the science:
While these [CBD + THC] products have shown some promising results as a treatment for chronic pain, the efficacy of CBD must be questioned since the product contains THC as well as CBD. Furthermore, the safety profile of current CBD products, specifically non-pharmaceuticals, should be questioned due to their false advertising and variable quantities of CBD in the product. Therefore, careful selection of a CBD product should be made by physicians and patients to ensure patients are taking a high- quality product. Despite these concerns, CBD is a promising area for the treatment of chronic pain, and further studies need to be performed to evaluate the role of CBD in chronic pain management.
Does the FDA have anything helpful to say about this?
One medication made from CBD, called Epidiolex, is an FDA-approved drug for treating a certain type of epilepsy. Otherwise, CBD falls into a very bizarre legal grey area.
CBD is not approved as an over-the-counter drug, so consumer products that use it for pain relief are considered to be selling unapproved drugs. But because the FDA knows that CBD is a drug, companies can’t get away with including it in their “inactive ingredients” or calling it a supplement and putting one of those “this statement has not been evaluated by the FDA…” disclaimers on it.
Rather than crack down on every CBD-containing product out there, the FDA sends warning letters to the specific companies that it thinks are doing the most harm. This month’s letters include one to a company that sells “Elixicure” “pain relief” CBD products, and another to a company that markets a variety of unproven products as if they were drugs, including silver-containing products in addition to CBD. Both companies also failed factory inspections.
But what if I like my CBD lotion?
If you use a CBD product and you think it’s working, I certainly won’t tell you to stop. But the FDA may come for the manufacturer eventually.
In the meantime, it might be helpful to think about the inconclusive science: If CBD were a strongly effective drug, it would be a lot easier for studies to find results. So if it does work, the effect is probably small. It may be worth thinking about what else you do to relieve pain. Does a hot bath help your sore muscles, for example? Or might you enjoy a non-CBD liniment just as much as a pricey CBD-containing one? It may be worth experimenting, just to broaden your options.