In this column I offer language for massage therapists who are reluctant to use CBD-infused products.

Pressure to use these products may come from the marketplace, employers, and colleagues, but here, I will focus on what to say with clients. I offer language for talking with clients who request or even implore therapists to apply CBD- infused products to their skin.

All massage therapists may face this situation, but in oncology massage therapy, it can be particularly pressing and complicated. In a health crisis such as cancer, and even post-treatment, clients present with heightened symptoms, including pain, anxiety and stress, and massage therapists may be tempted to respond with as many tools as possible to help ease their way. If topical CBD application might help, why not?

There is a lot to this Question

The question of whether to use CBD in massage lotion is fraught with confusion and tension. There are strong opinions in the debate, and a number of elements at play:

•        Changing and conflicting legislation on cannabis

•        The state of research on topical CBD

•        Possible therapist exposure to CBD through their hands

•        Consumer demand, markets, and profits

•        Potential professional, ethical, or jurisdictional constraints on CBD use

•        Profits for CBD vendors and “CBD upcharging” by massage therapists

•        How CBD compares to other topical pain relief products

•        Lack of oversight of product potency, purity, and safety

Any one of these topics could dominate a discussion. Space limits a discussion here. Instead, I focus here on how to tell clients kindly and plainly

why you do not use CBD oil in oncology massage therapy. You are welcome to use any of the language with your clients.

Client: Do you use CBD oil?

Therapist: I don’t. I use [xyz] lotion.

I like it because it’s hypoallergenic and clients tell me it is kind to their skin.

Client: Why don’t you use CBD oil when you massage?

Therapist: Good question! For one thing, I’m concerned about the exposure. An individual applying it to their skin is different from a massage therapist using it with clients. My hands are in my lotion all day.

Client: How could exposure be a problem? It seems like it would be good to have it on your hands. Your hands work hard. And couldn’t you just wear gloves?

Therapist: You would think so, but we don’t know for sure that sustained exposure would be helpful for me. Unfortunately, we don’t have much data about the safety or effectiveness of CBD-infused lotions. And I do use gloves for certain situations, but not for the purpose of applying CBD- infused products.

Client: But I have a safe product I use, from a trusted source. It’s helped my cancer pain. Can you use it on my lower back?

Therapist: I hear you. I understand why you would want to include it in your massage.

There is an important distinction between an individual choosing to self- apply a product, and a licensed massage therapist applying it for you. It is not for me to tell you what to put or not put on your body—that is for you and your doctor to work out. But in my role here, I have a duty to keep it simple in what I apply to my clients’ skin.

Client: It seems like all of the resistance to CBD is an overreaction. It’s just a plant, after all.

Therapist: That may be. There is all sorts of hype in all directions, right?

We’re all sifting through the hype to find the truths in there. I know there are reports of CBD oil being effective in certain cases, but also concerns about how it might interact with medication and other factors. There is a rush of interest.

There’s also a rush of information, and we’re all figuring it out right now. You’re navigating all this as a consumer, and I’m sorting it out as a massage therapist.

Where I land is that all products are not the same, and my training does not include how to evaluate these kinds of additives for safety, purity or potency. So far, because there is little testing or oversight of CBD oil products, I haven’t used them.

Client: How come other massage therapists use it, and you don’t?

Therapist: I cannot answer for other therapists or establishments, but you ask a good question. I would definitely ask them how they’ve overcome some of the concerns about CBD oil, and how they know what is actually in the product, aside from what the vendor tells them.

A recent study at U. Penn. determined that nearly 70% of products they tested were mislabeled.1

I imagine the purity, potency, labeling, safety, and effectiveness issues will be worked out in the coming years. In the meantime, for my clients’ health and my own, I need to stick to well-established lotions that have been around for a while.

Language, Not Lecturing

Throughout these conversations, it is important to maintain a steady, caring connection with the client. It is a charged topic, so it can be challenging. A client is discussing a health decision, during a health crisis, and asking you to participate in it.

No matter what your feelings are about CBD-infused products, you can maintain a non-judgmental presence with your client. Using neutral language helps. Remember to breathe, nod, and make eye contact. Simply share the limits of your role and your expertise. Stop short of accepting advice from a client about how to run your practice (as in, you should wear gloves, or you should use a certain oil for your own health, or you should do it for everyone else’s health), but do so in a firm and friendly way. You can stay connected with a client by acknowledging that different people make different choices, and encourage your client to make this particular choice with their doctor if they haven’t already. (Unknown CBD-drug interactions make this one particularly important.)

But help your client draw a clear distinction: Between choices made at home and choices carried out in the massage therapy session.

WHAT CAN YOU DO?

Then return the conversation to what you can do. You provide massage therapy aimed at stress-relief during a stressful time. You can help with pain and anxiety. You target a whole range of cancer- related symptoms and side effects.

All by itself, with no additives, oncology massage therapy has the potential to do just that.