Abstract

Use of cannabidiol (CBD) has markedly increased in the past 5 years, concurrent with marketing claims that over-the-counter CBD can be used to treat almost any health condition. However, the reasons why individuals use CBD remain unclear. To assess whether individuals are using CBD for diagnosable conditions that have evidence-based therapies. This case series assessed claimed treatment applications reported by CBD users in public testimonials shared on the Reddit forum r/CBD. The r/CBD forum was selected because it includes a large, naturally occurring sample of 104 917 registered individuals who publicly discuss their experiences using CBD. All r/CBD posts were obtained from January 1, 2014, through August 31, 2019. A random sample of posts was drawn (n = 3000) and filtered to include posts in which self-identified CBD users testified why they take CBD (n = 376). Self-reported use of CBD for medicinal purposes. Cannabidiol testimonials were divided into 11 subcategories corresponding with the condition's medical subspecialty and 2 subcategories corresponding with wellness benefits. Posts were allowed to receive more than 1 label. Of the 376 posts labeled as testimonials, 90.0% (95% CI, 86.8%-92.8%) of testimonials claimed that CBD treated the individual's diagnosable conditions. Psychiatric conditions (eg, autism or depression) were the most frequently cited subcategory, mentioned in 63.9% (95% CI, 59.0%-69.1%) of testimonials, followed by orthopedic (26.4%; 95% CI, 21.8%-31.1%), sleep (14.6%; 95% CI, 11.3%-18.5%), and neurological (6.9%; 95% CI, 4.4%-9.6%) conditions. Testimonials also claimed that CBD treated gastroenterological conditions (3.9%; 95% CI, 1.9%-6.1%), as well as addiction, cardiological, dermatological, ophthalmological, oral health, and sexual health conditions (<2.0% each). By contrast, just 29.5% (95% CI, 24.8%-34.2%) of testimonies claimed any wellness benefit, with most citing mental wellness (eg, "quieting my mind") (29.5% [95% CI, 24.2%-34.4%]); 1.4% (95% CI, 0.3%-2.8%) claimed a physical wellness benefit (eg, "exercise performance"). The findings of this case series suggest a need for regulation of factors associated with CBD being used to treat diagnosable conditions, engagement of health care professionals with patients on their potential CBD use, and implementation of public health campaigns that encourage the public to seek treatment advice from health care professionals regarding evidence-based therapies.

Highlights

  • Since 2014, the popularity of products containing the cannabis-derived chemical compound cannabidiol (CBD) has exponentially increased in all 50 US states.[1]

  • Just 29.5% of testimonies claimed any wellness benefit, with most citing mental wellness (29.5% [95% CI, 24.2%-34.4%]); 1.4% claimed a physical wellness benefit. The findings of this case series suggest a need for regulation of factors associated with CBD being used to treat diagnosable conditions, engagement of health care professionals with patients on their potential CBD use, and implementation of public health campaigns that encourage the public to seek treatment advice from health care professionals regarding evidence-based therapies

  • Using the random sample of Reddit Cannabidiol Forum (r/CBD) posts, we estimated that 12.1% of all r/CBD posts were authored by individuals who provided testimonials of their use of CBD

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Summary

Introduction

Since 2014, the popularity of products containing the cannabis-derived chemical compound cannabidiol (CBD) has exponentially increased in all 50 US states.[1]. Because of CBD marketing claims, the FDA has expressed concern by stating that “unsubstantiated therapeutic claims [are] a violation of the law [and] can put patients at risk.”[3] the regulatory response of the FDA has been slow, with only a few warning letters issued[6] and no other major actions taken. The FDA commissioner stated the agency would take stronger and wider-ranging actions if patients with diagnosable conditions were using CBD as a substitute or adjunct for approved therapies.[7] Delayed regulatory action may in part result from the lack of available data documenting the reasons why consumers are using CBD-containing products

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