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Cannabidiol, commonly called CBD, is a substance that comes from the plant Cannabis sativa. Another common chemical that comes from this plant is delta-9-tetrahydrocannabinol, or THC, which is commonly known for its intoxicating effects that make people ‘high,'

Cannabis has been used for many years for medical purposes, and many people use cannabis products such as CBD for musculoskeletal pain. This article answers some frequently asked questions about the use of CBD to help inform your treatment decisions.

Many people use CBD products as an alternative to oral medications to relieve musculoskeletal pain.

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Q: How are CBD products thought to work?

 A: The exact mechanism by which CBD works is not entirely known — meaning doctors and scientists have not yet determined how or why CBD may help relieve pain.

There are 2 types of receptors in the body that detect cannabis products. The type II receptors are located throughout the body and are thought to be activated (turned on) when CBD comes into contact with them. By turning on these receptors, the body’s inflammatory chemicals do not function properly in that area, which in theory prevents inflammation and decreases pain.

Q: What forms of CBD are available?

 A: CBD for medical use is available mostly in three forms: cream, gel, or oil.

• The cream and gel may be rubbed onto the area to be treated.
• The oil may be put into a drink or on food, rubbed onto a treatment area, or put directly under the tongue.

CBD oil may be put into a drink or on food. 

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These CBD products are available over the counter and do not require a prescription. There is currently no CBD product approved by the Food and Drug Administration (FDA) for pain.

Q: What does scientific evidence say about the effectiveness of CBD products? Do CBD products really help with pain?

A: Because relatively few high-quality studies have been done, current evidence is inconclusive regarding how effective CBD products are in treating pain.

Studies have been published looking at CBD for  various types of arthritis; muscle soreness; recovery; acute pain; and chronic pain. For the most part, these studies have shown no difference between CBD and placebo when it comes to improving pain.

Q: Are CBD products safe to use? What are potential risks?

A: CBD is not addictive and is considered safe in low doses. CBD may cause some side effects, including:

• Anemia
• Diarrhea
• Drowsiness
• Dry mouth
• Infection
• Irritability
• Liver problems
• Nausea
• Problems with sleep

CBD may also change how medications work with your body. Some medications (prescription and over-the-counter) may increase in concentration (strength) due to CBD, which can cause an increase in the effects (and side effects) of those medicines. Your doctor may need to adjust your prescriptions due to the effects of CBD.

One other concern is quality control. CBD is currently not regulated like other medical products; as a result, there are risks of quality control issues related to potential mishandling or contamination. Given the lower-regulation environment of CBD, it is difficult to ensure consistent quality. If issues arise that compromise quality and safety, this could potentially lead to people having adverse (bad) reactions or outcomes.

Q: With so many CBD choices, how do I know I am using a quality product?

A: It can be challenging to find a quality CBD product.

• Because there are currently no quality standards for CBD products, labels are often not accurate. Several studies have shown that some labels do not show the amount of CBD in the product, and many products are labeled incorrectly. In fact, most CBD products do not contain the amount of CBD listed on the label, and some contain no CBD at all.
• Some CBD products also contain THC and have been found to have enough THC to cause intoxication or impairment, even though there is not supposed to be any THC in these products.
• The amount of CBD is often different from one container to another, even from the same brand. This makes it difficult to determine how much CBD you are actually taking.

Given these challenges, you should be cautious when considering your potential responses to CBD products. First-time users should consider minimizing their dose until they know how they respond to specific products.

Q: Will CBD make me 'high'?

A: CBD itself is not intoxicating; therefore, it will not make you 'high.' However, you should do your best to ensure that the product you use contains only CBD. If it contains THC, it may make you intoxicated or alter your mental status.

Although cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) both come from the plant Cannabis sativa, only THC has an intoxicating effect that can make people ‘high.'

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Q: Is using CBD the same as using marijuana?

A: CBD is different from marijuana:

• CBD is a single compound from the cannabis plant. 
• Marijuana is a type of cannabis plant that may contain several chemicals, including both CBD (which does not make you intoxicated or alter your mental status) and THC (which may make you intoxicated or alter your mental status).

Q: Is CBD legal to use?

A: According to the FDA, it is currently illegal for CBD to be marketed by adding it to a food (which is then sold to consumers) or labeling it as a dietary supplement.

On a federal level, CBD products must contain no more than 0.3% THC (based on dry weight) to be legal. Although there are many CBD products that are, indeed, legal in all 50 states, the intended use of the product and how it is labeled are what determine if it is legal to be sold. The criteria may vary depending on state and local regulations as well, so it is recommended that you check the local laws in your area.

Q: Can athletes use CBD?

A: The World Anti-Doping Agency and the U.S. Anti-Doping Agency removed CBD from their lists of prohibited substances in 2018. However, various sports leagues and governing bodies have their own rules and regulations when it comes to use of CBD.

Keep in mind that THC may be found in CBD products. So, if you use a CBD product, you may unknowingly expose yourself to THC and fail a drug test. The same risk applies to non-athletes who work for companies that require drug testing; if you are concerned about failing a drug test at work, make sure your CBD products do not contain THC.