Some Older Adults Are Taking CBD Oil for Joint Pain — But Does it Work?

Side effects, drug interactions and regulatory issues

In a January 2023 statement, the U.S. Food and Drug Administration announced “a new regulatory pathway for CBD is needed” — one that balances people’s desire for access to CBD products with the regulatory oversight needed to manage risks.

Those risks, especially with long-term use at high doses, include the potential for harm to the liver and interactions with certain medications, such as blood thinners. CBD also has been found to interact with antidepressants, opioids, and anti-epileptic drugs, as well as acetaminophen and alcohol.

That said, “when you look at the side effect profile compared to Tylenol [acetaminophen] or ibuprofen, it’s remarkably safe,” says Kevin Boehnke, a research assistant professor in the University of Michigan's Chronic Pain and Fatigue Research Center in the Department of Anesthesiology. “There are thousands of people a year who have organ damage from some of those conventional drugs, and there’s just not that level of toxicity with CBD.”

The FDA said it was “prepared to work with Congress” on that new regulatory pathway. In the meantime, the only FDA-approved prescription CBD medicine is for treating rare seizure disorders.

The fact that CBD falls into multiple regulatory categories, and that there are no clear industry or regulatory rules for manufacturing, testing, or labeling requirements, makes therapeutic claims about CBD’s effectiveness suspect.

Some of Vandrey’s research explains why. He took part in a 2017 study, published in the Journal of the American Medical Association, which found the concentration of CBD in products to vary immensely — from zero milligrams to more than 600 milligrams per milliliter of liquid. One-quarter of the 84 samples tested contained less CBD than labeled. THC, or tetrahydrocannabinol, the major psychoactive compound in marijuana, was detected in 18 of them.

Barbara St. Marie, an associate professor at The University of Iowa College of Nursing, has examined research on CBD use by older adults for acute and chronic pain. She points to a 2022 analysis of over-the-counter CBD products available in the United Kingdom that showed equally problematic results, in which only 38 percent of products were within 10 percent of advertised CBD levels.  

CBD doses can reach levels high enough to cause potential negative side effects such as dry mouth, drowsiness or cognitive impairment in some people.  

“We really have to do something about making sure people know what they're purchasing,” St. Marie says, “because they don't right now.”

Before starting CBD, talk to your doctor 

Given the gaps in research and issues with labeling, it’s best to seek advice about CBD from a doctor or other credentialed clinician, Vandrey says. If you do decide to try CBD, know that sometimes people deem CBD oil to be life-changing, only to find that it offers no help when bought from a different company or when buying a different CBD product from the same company.

That goes back to the lack of standardized manufacturing methods to guarantee quality control, Vandrey says.

As far as how CBD oil is used, Boehnke lists numerous ways: People can take it by putting a few drops under the tongue with a tincture, or it can be ingested through gummies and other edibles. You can also rub it directly on to the source of the pain with a topical product.

Boehnke advises against vaping or smoking CBD oil because it isn’t good for the lungs, and unregulated CBD vape products may contain harmful contaminants.

As with any new medication, be open and honest with your physician or other health provider about your intentions and actions. Some medical professionals are savvy about CBD in general. Others not so much, especially when it comes to CBD use by older adults for acute and chronic pain.

St. Marie suggests bringing your list of current medications — both prescribed and over-the-counter — to your appointment to talk about potential drug-to-drug interactions with CBD.

Also consider asking these questions: How much do you know about CBD oil? What dose should I start with? When should I follow up about a potential adjustment?

And know that even though you may get answers based on the latest research, there still are more questions than answers at this point about CBD and pain.

“It’s a space where everybody is learning and growing together,” Boehnke says.

Vandrey adds, “I really believe there is immense therapeutic potential for this type of product. But for any formulation and health condition you need to research multiple doses to find the therapeutic sweet spot.”