Before you buy CBDs to treat pain or other conditions related to limb loss, here are five things to know.

Consumer Reports estimates that more than 60 million Americans have tried cannabidiols, or CBDs. A non-psychotropic cousin of marijuana, CBDs are alleged to provide relief from pain, insomnia, anxiety, seizures, and a host of other maladies. These purported health benefits have brought CBDs swiftly into the cultural mainstream. You can chew on CBD gummy bears, stir CBD drops into your herbal tea, rub CBD cream directly onto a wound or aching joint, or light a CBD candle while you’re soaking in the bath. CBD products are on the shelves at Walmart and online at Amazon. Which is to say, they’re everywhere.

CBDs or medical marijuana may help control amputee pain

Aficionados swear by CBDs, including uber-influencers and celebrities such as Kim Kardashian West, Morgan Freeman, Tom Hanks, Jennifer Aniston and John Legend. USA Triathlon, the sport’s official governing body, has an exclusive partnership with Pure Spectrum CBD to supply Team USA competitors with cannabidiols through 2023. A lot of amputees use CBDs too, seeking relief from various aches and pains (including those not directly related to limb loss).

That’s a lot of buy-in for a substance that may or may not actually work. CBD skeptics point out that there is scant scientific evidence to support the claims about most of CBDs’ supposed benefits, with one exception—cannabidiols do minimize the harms of Dravet syndrome, a very rare form of childhood epilepsy. But the case for CBDs’ ability to control pain is purely anecdotal—lotta suggestive stories out there, but no verifiable, reproducible, statistically significant data.

Our informal, totally unscientific survey of amputees turned up CBDisciples and CBDeniers alike, in roughly equal measure. As for the prosthetists we spoke to, they fell decidedly into the “Why not?” camp. “There’s no proof that any of it works,” says Christopher Jones, CPO, of Rebound Prosthetics. “But my feeling is that if you feel better after taking a placebo, keep taking the placebo.”

A lot of amputees do feel better after taking CBDs. While we can’t promise they’ll work for you, we can help you make an informed decision about which CBD products to try. Because they’re mostly unregulated and widely peddled online, CBDs have tremendous variation in quality and character. Selective shopping is essential. If you’re inclined to give CBDs a shot, here are five things to know before you dive in.

1. THC < 0.3

Most commercially marketed CBD products are derived from hemp. They don’t get you high because they only contains trace amounts of tetrahydrocannabinol (THC), the psychoactive component in marijuana. However, you can also find cannabis-derived CBD products that have much higher THC content and are legally classified the same way as medical marijuana. As long as the product you’re buying is derived from hemp (rather than cannabis) and contains less than 0.3 percent THC, it’s not a controlled substance and you can’t be prosecuted for illegal drug possession (although you might run afoul of an FDA regulation or two). You also don’t need a doctor’s prescription to buy CBDs.

2. Find your place on the spectrum.

A “full-spectrum” CBD product is derived from the entire hemp plant—seeds, stalks, and stems. In addition to cannabidiol, full-spectrum CBDs contain natural compounds such as terpenes, flavonoids, and CBG/CBCs, all of which broaden and deepen CBDs’ effects. You’ll also hear the terms “broad-spectrum” or “whole-plant” CBDs, which are also processed from multiple parts of the hemp plant but don’t have the same chemical profile. You could think of full-spectrum CBDs as akin to fresh-squeezed orange juice—they’re the most “natural” way to consume—while broad-spectrum and whole-plant have been undergone varying degrees of filtering and refining.

CBDs or medical marijuana may help control amputee pain

Then there’s CBD isolate, or pure CBD, which has gone through extensive refining to strip away the broader palette of compounds contained in full-spectrum varieties. Their effects are less pronounced than full-spectrum CBDs, but they’re also cheaper and the least likely to trigger a positive result on a drug test. To be clear, full-spectrum CBDs won’t trigger a positive result either, as long as they’re hemp-derived products with a THC concentration below 0.3 percent. But the Journal of the American Medical Association (JAMA) found that a high percentage of CBD products were mislabeled with respect to THC content. If failing a drug test is a deal-breaker for you, CBD isolates are your safest bet.

3. Work with your prosthetist.

We haven’t come across any prosthetists who actively promote CBD use (although if any are out there, please contact us so we can hear your side of the story). However, nobody we spoke with discourages CBD use either, and all of our correspondents have patients who have tried CBDs.

If you’re going to experiment, you should definitely let your prosthetist know. In addition to helping them provide you with the best possible care, collaboration and transparency allow your practitioner to learn from your experience and apply those lessons to other patients. For example, Christopher Jones of Rebound Prosthetics now advises users of CBD lotions and creams to apply the substance at night, just before going to bed. “We’ve found that when people put it on during the day and then put a liner over it,” he explains, “the lotion mixes with sweat and leads to clogged pores.” Whether your prosthetist tends toward support or skepticism of CBDs, keep them in the loop.

4. Go organic.

Hemp is a highly absorbent plant that draws elements in from the surrounding environment through its roots, stalks, and leaves. That makes it highly susceptible to influences from chemical-based fertilizers, pesticides, or other inputs—and those impurities, in turn, will diminish the quality of CBDs derived from those plants. The label to look for is “100 percent USDA certified organic.” CBDs manufactured from organic hemp are generally more expensive, but they’re healthier and more potent.

5. Check the test results.

Because CBD products aren’t closely regulated by any federal agency, manufacturers can make all sorts of unverified claims about the quality, potency, and composition of their products. To distinguish themselves from fly-by-night purveyors, high-quality manufacturers voluntarily submit their wares to third-party analysis by an independent testing lab. These independent analyses can confirm whether or not the product you’re buying is, in fact, a full-spectrum CBD; whether or not it’s organically pure; and whether its THC content falls below 0.3 percent.

Third-party analyses should be published on the manufacturer’s website or readily available on request, with the name and location of the independent testing lab clearly denoted. If you can’t easily find transparent testing data for a given product, that’s probably a sign somebody is trying to hide something.

6. You get what you pay for.

We promised five tips, so here’s a bonus that sums them all up: Good CBDs don’t come cheap. Organic growing, independent testing, and careful refining all cost money, and those expenses get reflected in the price tag. If you’re paying less than $0.10 a milligram for a CBD oil, don’t be surprised if the health benefits are underwhelming. If you’re paying $0.20/mg or more, you’re getting into premium-product territory. Even at that price point, we can’t guarantee good results. But at least you’ll know you’re consuming a legitimate product that’s been manufactured with scientific integrity, and not some watered-down snake oil that’s engineered to rip you off.