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A Cross-Sectional Study of Cannabidiol Users 1 The Center for Medical Cannabis Education, Del Mar, California. 2 Helfgott Research Institute, National University of Natural Medicine (NUNM), 68% of CBD users find it effective, but 22% say they don't trust it. Get your CBD statistics straight before you try this natural remedy.

A Cross-Sectional Study of Cannabidiol Users

1 The Center for Medical Cannabis Education, Del Mar, California.

2 Helfgott Research Institute, National University of Natural Medicine (NUNM), Portland, Oregon.

Joy A. Phillips

3 Donald P. Shiley BioScience Center, San Diego State University, San Diego, California.

* Address correspondence to: Jamie Corroon, ND, MPH, The Center for Medical Cannabis Education, 1155 Camino Del Mar, #187, Del Mar, CA 92014, E-mail: [email protected]

This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction: Preclinical and clinical studies suggest that cannabidiol (CBD) found in Cannabis spp. has broad therapeutic value. CBD products can currently be purchased online, over the counter and at Cannabis-specific dispensaries throughout most of the country, despite the fact that CBD is generally deemed a Schedule I controlled substance by the U.S. Drug Enforcement Administration and renounced as a dietary supplement ingredient by the U.S. Food and Drug Administration. Consumer demand for CBD is high and growing, but few studies have examined the reasons for increasing CBD use.

Materials and Methods: A self-selected convenience sample (n = 2409) was recruited via an online survey designed to characterize whom, how, and why individuals are currently using CBD. The anonymous questionnaire was accessed from October 25, 2017 to January 25, 2018. Participants were recruited through social media.

Results: Almost 62% of CBD users reported using CBD to treat a medical condition. The top three medical conditions were pain, anxiety, and depression. Almost 36% of respondents reported that CBD treats their medical condition(s) “very well by itself,” while only 4.3% reported “not very well.” One out of every three users reported a nonserious adverse effect. The odds of using CBD to treat a medical condition were 1.44 (95% confidence interval, 1.16–1.79) times greater among nonregular users of Cannabis than among regular users.

Conclusion: Consumers are using CBD as a specific therapy for multiple diverse medical conditions—particularly pain, anxiety, depression, and sleep disorders. These data provide a compelling rationale for further research to better understand the therapeutic potential of CBD.

Introduction

Cannabidiol (CBD) is one of more than a hundred cannabinoids found in Cannabis sativa L (Cannabis spp. or Cannabis), a plant more well known colloquially as marijuana and hemp. CBD is typically the second most abundant cannabinoid found in Cannabis after tetrahydrocannabinol (THC). 1 CBD was first isolated in 1940 and characterized structurally in 1963. 2,3

CBD is well tolerated in humans and maintains a good safety profile. 4,5 Neither abuse nor dependence has been demonstrated. 5 In preclinical studies, CBD shows potential therapeutic efficacy against a diverse assortment of medical conditions. These include seizure disorders, psychotic symptoms, anxiety, depression, inflammation, cancer, cardiovascular diseases, neurodegeneration, symptoms of multiple sclerosis, and chronic pain, either used alone or when coadministered with THC. 5–20

In October of 2017, a New Drug Application was submitted to the U.S. Food and Drug Administration (FDA) to seek approval of CBD isolated from marijuana for the treatment of two pediatric seizure disorders. Approval was granted in June, 2018, making Epidiolex (cannabidiol) the first plant-derived Cannabis compound approved as a drug by the FDA. Availability of Epidiolex is pending Drug Enforcement Administration (DEA) rescheduling of cannabidiol, which is expected to occur within 90 days. 21–23 Sativex (nabiximols), a combination drug with equal parts CBD and THC extracted from marijuana, is currently approved to treat spasticity due to multiple sclerosis in >30 countries worldwide but is not approved in the United States. 17,21

The worldwide regulatory status of CBD is complex and constantly changing. 5 While CBD is legal in many countries as a component of prescription Sativex (nabiximols), it may be simultaneously illegal as a component of a nonapproved Cannabis extract containing >0.2% (particularly in European countries) or 0.3% THC. In Europe, individual European Union Member States currently determine the legality of CBD within their borders. Most allow prescription CBD products, as do Australia and New Zealand. 5,24 Canada became the second nation in the world to legalize Cannabis for recreational use in June 2018. 25 The World Health Organization’s Expert Committee on Drug Dependence recommended that CBD should not be controlled by Schedule I of the 1961 UN Single Convention on Narcotic Drugs. 5 Their comprehensive report is expected this year.

In the United States, until such time as it is rescheduled, CBD from marijuana is deemed by the DEA to fall within the purview of the “marihuana extract rule” (Rule). A dispute over the scope of the Rule was litigated in federal court. The Court found that the Rule applies to extracts of marijuana but that the industrial hemp provisions of the 2014 Farm Act (i.e., “The 2014 Farm Bill”) preempt the Controlled Substances Act (CSA), which the DEA enforces. 26 Thus, hemp cultivated in compliance with the Farm Bill is not a controlled substance. The Court did not address the issue of CBD directly, however, and left open the issue of the legal status of CBD derived from industrial hemp, from imported “nonpsychoactive hemp” or from parts of the Cannabis sativa plant excluded from the legal definition of marijuana in the Controlled Substances Act of 1970. 27–35 Despite conflicting legal interpretations, and DEA prohibition, hemp-derived CBD products can currently be purchased as dietary supplements both online and over the counter throughout most of the country. To complicate matters further, the FDA does not recognize CBD as a dietary supplement ingredient because of its status as an Investigational New Drug. 36

This regulatory confusion has not deterred consumers from exploring the purported benefits of CBD. Retail sales of hemp-derived CBD products in the United States reached $170 million in 2016, and are projected to grow at a 55% compound annual growth rate over the next 5 years to reach >$1 billion. These estimates do not include marijuana-derived CBD. 37 Although Cannabis users have been extensively studied data characterizing the individual use of CBD are scarce. The goal of this study was to collect survey data to elucidate how, and why, individuals are using CBD.

Methods

Survey

The study protocol was submitted electronically to the Institutional Review Board (IRB) of San Diego State University. Given the voluntary nature of the survey, and the lack of identifying information, the electronic approval process determined that no IRB approval was necessary.

We developed a novel questionnaire to assess broad characteristics of self-described CBD users and underlying reasons for, and methods of, CBD use. The survey consisted of structured questions answered by either yes/no or multiple-choice responses. Questions focused on several key domains: sociodemographics; reasons for use; duration and frequency of use; method of administration; perceived clinical efficacy; and adverse effects. Study data were collected and managed using Qualtrics ® Survey Software, a secure tool allowing participants to directly enter responses anonymously.

Subjects were a self-selected convenience sample who accessed the online survey from October 25, 2017 to January 25, 2018. Recruitment strategies included promotion on survey-specific Web pages on Facebook, LinkedIn, and ResearchGate. CBD product manufacturers and herbal vaporizer manufacturers assisted in recruitment by promoting links to the survey on their Facebook pages and/or via email to their customers. The only inclusion criterion was current or prior use of CBD. Respondents could skip any question(s) they did not wish to answer.

Data analyses

Descriptive statistics including simple proportions were used to describe demographics, usage characteristics, medical conditions, perceived efficacy, side effects, and other CBD use preferences. Data analyses were conducted using SAS University Edition (SAS 9.4; SAS Institute Inc., Cary, NC). Univariate and bivariate comparisons were conducted using PROC FREQ and chi-square tests. Odds ratios (ORs) were used to estimate strength of association using PROC LOGISTIC. Statistical significance was assessed using α=0.05. Figures were produced using DeltaGraph version 4.5 for Mac.

Results

Demographics

A total of 2490 responses were collected. Eighty-one respondents were excluded from the analysis for failure to answer the first question regarding stated use of CBD, leaving 2409 respondents included in the final study population. The sample was balanced in terms of gender (female: 50.87%; male: 47.40%) with most respondents reporting ages between 55 and 74 years (39.97%). Most were either graduates of, or currently enrolled in, college or a postgraduate program (71.22%). The vast majority resided in the United States (91.23%). Respondents from all 50 U.S. states were represented in the survey with the majority residing in California (n=412, 21.90%; Table 1 ). In addition, there were survey respondents from 23 other countries. Regular Cannabis use was reported by 55.17% of respondents.

Table 1.

Sociodemographic and Other Characteristics of Survey Respondents (n=2409)

n (%)
Gender
Male 1013 (47.40)
Female 1087 (50.87)
Decline to state 37 (1.73)
Missing 272
Age (years)
≤24 138 (6.33)
25–34 292 (13.40)
35–44 400 (18.36)
45–54 404 (18.54)
55–64 532 (24.41)
65–74 339 (15.56)
≥75 74 (3.40)
Missing 230
Education
Primary/middle school 22 (1.01)
High school/GED 503 (23.13)
College 1138 (52.32)
Postgraduate 411 (18.90)
Other 101 (4.64)
Missing 234
Geography
United States 1987 (91.23)
Canada/Mexico 103 (4.73)
Other 88 (4.04)
Missing 231
Geography—U.S. states (top 5)
California 412 (21.90)
Texas 93 (4.94)
Oregon 83 (4.41)
Florida 79 (4.20)
Colorado 76 (4.04)
Missing 528
Cannabis use
Regular 1189 (55.17)
Nonregular 966 (44.83)
Missing 254
CBD use
General health and well-being 926 (38.44)
Medical condition 1483 (61.56)
Missing

CBD, cannabidiol; GED, General Educational Development.

Stated use: medical versus general health and well-being

More than 60% (61.56%) reported using CBD to treat a medical condition(s) ( Table 1 ). The odds of using CBD to treat a medical condition were 1.65 (95% confidence interval [CI], 1.39–1.97) times greater among women than among men, higher with age, and roughly equal among residents and nonresidents of the United States (OR, 1.06; 95% CI, 0.9–2.5; Table 2 ). Respondents n=25) and wide CI (OR, 18.72; 95% CI, 4.20–83.39, compared with those between 18 and 24 years of age. Data not included in Table 2 ). This additional analysis was based on the established use of CBD to treat pediatric seizure disorders 6,7,16 and the percentage of respondents in that age category reporting using CBD to treat a medical condition (n=23; 92%).

Table 2.

Odds of Using Cannabidiol for a Medical Condition by Sociodemographic and Other Characteristics (n=2409)

General health and well-being, (n=926) n (%) Medical condition, (n=1483) n (%) OR (95% CI)
Gender ***
Male 454 (44.82) 559 (55.18) 1.00 (reference)
Female 358 (32.93) 729 (67.07) 1.65 (1.39–1.97)
Decline to state 12 (32.43) 25 (67.57) 1.69 (0.84–3.41)
Missing 102 170
Age (years) ***
≤24 72 (52.17) 66 (47.83) 1.00 (reference)
25–34 153 (52.40) 139 (47.60) 0.99 (0.66–1.49)
35–44 170 (42.50) 230 (57.50) 1.48 (1.00–2.18)
45–54 150 (37.13) 254 (62.87) 1.85 (1.30–2.73)
55–64 180 (33.83) 352 (66.17) 2.13 (1.50–3.12)
65–74 98 (28.91) 241 (71.09) 2.68 (1.80–4.04)
≥75 19 (25.68) 55 (74.32) 3.16 (1.70–5.86)
Missing 84 146
Education ***
College 478 (42.00) 660 (58.00) 1.00 (reference)
Primary/middle school 1 (4.55) 21 (95.45) 15.18 (2.04–113.09)
High school/GED 172 (34.19) 331 (65.81) 1.39 (1.12–1.73)
Postgraduate 153 (37.23) 258 (62.77) 1.22 (0.97–1.54)
Other 34 (33.66) 67 (66.34) 1.43 (0.93–2.19)
Missing 88 146
Geography
United States 763 (38.40) 1224 (61.60) 1.00 (reference)
Canada/Mexico/other 76 (39.79) 115 (60.21) 1.06 (0.78–1.44)
Missing 87 144
Cannabis use ***
Regular 509 (42.81) 680 (57.19) 1.00 (reference)
Nonregular 320 (33.13) 646 (66.87) 1.44 (1.16–1.79)
Missing 97 157

CI, confidence interval; OR, odds ratio.

The odds of using CBD to treat a medical condition were 1.44 (95% CI, 1.16–1.79) times greater among nonregular users of Cannabis when compared with regular users.

Medical conditions

There were 1483 respondents who reported using CBD to treat at least one medical condition. A minimum of 3963 medical conditions were reported. This represents an average of more than two and a half (mean: 2.67) different medical conditions per respondent.

In order of frequency, the top three medical conditions reported were chronic pain, arthritis/joint pain, and anxiety ( Fig. 1 ).

Number of medical conditions for which respondents reported using CBD, by medical condition (n=3963). CBD, cannabidiol; COPD, chronic obstructive pulmonary disease; PTSD, post-traumatic stress disorder.

Respondents selected “Other” 362 times. The most common “Other” conditions reported were neuropathy (n=48), autoimmune conditions (n=38), and fibromyalgia (n=37).

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Methods of administration

A total of 4135 methods of administration were reported by 2200 respondents. This represents an average of almost two (mean: 1.88) different methods of administration per respondent. Overall, the most common method reported was the administration of CBD in a sublingual form ( Fig. 2 ). This includes liquids administered as sprays, drops, and tinctures. The least common method was topical use.

Number and percentage of methods of administering CBD (n=4135).

More than half (51.36%) of those reporting a method of administration reported using only one method (n=1130; missing=209; not including “Other,” n=31). On average, respondents who reported using one method of administration were 1.6 times more likely to use CBD for a medical condition than for general health and well-being (medical condition, n=691; general health and well-being, n=439). Medical users reporting one method of administration were 2.4 times more likely to use a topical form, 2.0 times more likely to use an edible form of CBD, and 1.8 times more likely to use CBD in a sublingual or pill or capsule form than general health and well-being users reporting one method.

Learning about CBD, frequency and duration of use

Overall, 75.85% of respondents reported learning about CBD from internet research, family members, or friends. Of the remaining respondents, medical users were more likely to learn about CBD from a Medical Doctor or Naturopathic Doctor and to use it more frequently than those using it for general health and well-being. The odds of using CBD to treat a medical condition were 1.79 (95% CI, 1.46–2.19) times greater among respondents using it more than once per day compared with those using it daily ( Table 3 ). Duration of use was more variable, but the odds of using CBD to treat a medical condition were greater among those using it for

Table 3.

Odds of Using Cannabidiol for a Medical Condition, by Cannabidiol Usage Characteristics (n=2409)

General health and well-being, (n=926) n (%) Medical condition, (n=1483) n (%) OR (95% CI)
Learned about CBD **
Family member/friend 320 (41.24) 456 (58.76) 1.00 (reference)
Internet research 337 (38.04) 549 (61.96) 1.14 (0.94–1.39)
Physician/naturopathic doctor 58 (27.36) 154 (72.64) 1.86 (1.33–2.60)
Other (please specify) 131 (41.32) 186 (58.68) 1.00 (0.76–1.30)
Missing 80 138
Frequency of use ***
Daily 418 (39.70) 635 (60.30) 1.00 (reference)
227 (56.47) 175 (43.53) 0.51 (0.40–0.64)
>Once per day 196 (26.92) 532 (73.08) 1.79 (1.46–2.19)
Missing 85 141
Duration of use (years) *
>5 134 (53.17) 118 (46.83) 1.00 (reference)
2–5 151 (35.61) 273 (64.39) 2.05 (1.50–2.82)
1–2 202 (42.98) 268 (57.02) 1.51 (1.11–2.05)
364 (34.57) 689 (65.43) 2.15 (1.63–2.84)
Missing 75 135

Treatment efficacy

Only respondents who reported using CBD to treat a medical condition were asked about its efficacy (n=1483). Almost 36% (35.80%) of respondents reported that CBD treats their medical condition(s) “very well by itself,” while only 4.30% reported “not very well” ( Table 4 ). Respondents most frequently reported feeling that CBD treated their medical condition(s) “very well by itself” or “moderately well by itself” for the following three conditions: chronic pain, arthritis/joint pain, and anxiety ( Fig. 3 ).

Number of medical conditions for which respondents report CBD treating “Very Well by Itself” or “Moderately Well by Itself,” by medical condition (n=2557).

Table 4.

Number and Percentage of Respondents Using Cannabidiol for a Medical Condition, by Treatment Efficacy and Regular Cannabis Use

How well do you feel CBD treats your medical condition(s)? (n=1483) Regular cannabis use (n=674) n (%) Nonregular cannabis use (n=628) n (%) OR (95% CI)
Not very well 57 (4.30) 18 (31.58) 39 (68.42) 1.00 (reference)
Well in combination with conventional medicine * 404 (30.44) 195 (49.24) 201 (50.76) 2.11 (1.170–3.82)
Moderately well by itself *** 391 (29.46) 221 (57.40) 164 (42.60) 2.92 (1.61–5.29)
Very well by itself 475 (35.80) 240 (51.72) 224 (48.28) 2.32 (1.29–4.18)
Missing ** 156

The odds of regular Cannabis use were two to three times greater among those who reported feeling that CBD treated their medical condition “very well by itself” (OR, 2.32; 95% CI, 1.29–4.18) or “moderately well by itself” (OR, 2.92; 95% CI, 1.61–5.29; see Table 4 ).

Side effects

A minimum of 1314 side effects were reported across 2409 respondents (missing, n=1095). Seven hundred eighty-five (59.74%) of these effects were categorized as adverse ( Table 5 ). On average, this represents at least one reported adverse effect in approximately one out of every three (3.07) users of CBD.

Table 5.

Most Common Adverse Effects Reported by Survey Respondents (n=742)

Adverse effect Medical condition (n=1483) n (%) General health and well-being (n=926) n (%) Total (n=2409) n (%)
Dry mouth 174 (11.73%) 94 (10.15%) 268 (11.12%)
Euphoria 59 (3.98%) 96 (10.37%) 155 (6.43%)
Hunger 80 (5.39%) 73 (7.88%) 153 (6.35%)
Other 46 (3.10%) 11 (1.19%) 57 (2.37%)
Red eyes 34 (2.29%) 32 (3.46%) 66 (2.74%)
Sleepy/groggy 29 (1.96%) 14 (1.51%) 43 (1.78%)
Total adverse effects 422 (28.46%) 320 (34.56%) 742 (30.80%)

The top five most frequently reported adverse effects were dry mouth (n=268, 11.12% of all CBD users), euphoria (n=155, 6.43%), hunger (n=153, 6.35%), red eyes (n=66, 2.74%), and sedation/fatigue (n=43, 1.78%). Just under 30% (28.46%) of medical users reported an adverse effect when compared with 34.56% of general health and well-being users.

Discussion

To our knowledge, this is the first published survey (aside from industry reports) that specifically analyzes CBD users, as opposed to overall Cannabis or medical Cannabis users. The results of this study suggest that CBD is used more frequently as a specific therapy for medical conditions than for general health and well-being. This stands in contrast to the majority of marijuana users, who largely use THC-dominant Cannabis for recreational or nonmedical reasons. 38

The most common medical condition for which CBD was reportedly used was pain. In preclinical studies, CBD-based analgesia is associated with potent immune-modulatory, anti-inflammatory, and antioxidant activity. 39–47 CBD acts as an agonist for a wide variety of cell-surface receptors including adenosine A2A, 5-HT1A, TRPV1, α7nAch, α3 glycine receptors, and the peroxisome proliferator-activated receptor gamma (PPAR-γ) nuclear receptor. These receptors are all associated with anti-inflammatory activity. 48–58 Consistent with the efficacy reported by survey respondents, CBD has been shown to reduce inflammatory cytokines in murine models of inflammatory disease and chronic and acute pain. 59

The endocannabinoid system may also play a role in CBD-mediated analgesia. CBD inhibits enzymes (i.e., fatty acid amide hydrolase and monoacylglycerol lipase) that degrade endocannabinoids. This inhibition is associated with increased endocannabinoid levels, analgesia, and opioid-sparing effects in preclinical models of pain. 60

Anxiety and depression were also commonly reported reasons for CBD use in this survey. CBD has long been proposed to inhibit THC-associated anxiety by antagonizing cannabinoid receptor activation by THC. 61–63 CBD may also reduce anxiety via the serotonin 5-HT1A and/or GABAA receptors. 14,64 These receptor pathways are being explored in hopes of novel therapeutic strategies for phobias, post-traumatic stress disorder, and drug abuse. 65,66

The majority of survey respondents learned about CBD from internet research, family members, or friends. This was the case for both medical and general health and well-being users. Over 74% of respondents reported using CBD daily or more than daily. Sublingual delivery was the most common route of administration in both groups. The frequency of use of sublingual preparations found in this study contradicts a recent industry-funded CBD survey where respondents reported more frequent vaping, smoking, and topical use. 67 This industry survey was collected from customers of an online medical marijuana recommendation service. Presumably, these respondents were seeking marijuana-derived products, so the frequency of inhalation as a method of administration is consistent with marijuana users overall. 68 Our finding may be in part due to the fact that hemp-derived CBD products are largely distributed online and in health-food stores and widely offered as oral preparations.

The percentage of respondents (55.17%) who reported regular Cannabis use is markedly higher than national estimates. In 2015, an estimated 8.3% (∼22.2 million people) of individuals aged 12 years or older had used marijuana in the past month. 69 The reason for the higher rate of Cannabis use among survey respondents is not clear, although one possibility is that Cannabis users would be more likely to have heard of CBD. However, CBD use by a relatively high percentage (44.83%) of nonregular Cannabis users suggests that individuals are not using CBD as a perceived legal route to THC consumption.

Approximately half of all respondents reported using CBD for 5 years. Nonserious adverse effects were relatively common among respondents and higher among those using CBD for general health and well-being, despite the fact that this group reported less frequent use than medical users. While dry mouth, sedation/fatigue, decreased appetite, and diarrhea have previously been reported following CBD use, 6,7 other studies have demonstrated no adverse effects. 10,70–72 This dichotomy may be related to dose, interactions with prescription medications, or both. More broadly, adverse effects may also be related to the method of administration and/or the use of purified, high-dose CBD as opposed to CBD in a whole plant extract. These questions and more reinforce the need for more research on unanticipated consequences of CBD use, particularly the impact of long-term usage. 4,5 Many of the adverse effects reported in this study (i.e., euphoria, hunger, and red eyes) are commonly associated with THC use. 73 These analyses did not attempt to discriminate between hemp-derived CBD and marijuana-derived CBD products, which may have differing chemical constituents (including THC content) and therefore different effects. Further, no discrimination could be made between isolated CBD and CBD used as a constituent of a whole plant extract.

Industry-originated studies have found that users are confused about the source of their CBD and the concentration of CBD and other ingredients. 67–74 It is worth noting that independent research has confirmed that the CBD content in almost 70% of CBD-labeled products available online may be mislabeled. In one study, 43% of products were underlabeled and 26% were overlabeled for actual CBD content. More than 20% contained detectable levels of THC. 75 Since CBD-containing products are largely unregulated there is no obvious way for users to know the quantity of CBD, or other constituents, which may be present in the products they use. Given this uncertainty, it is possible that some of the reported efficacy and the adverse effects may be in part due to the inclusion of other compounds in the CBD preparation, including THC.

Strengths and limitations

This study has several strengths, including the size, geographic representation of the sample, wide age range of the respondents, and a focus on specific usage characteristics. In part, this was the result of utilizing multiple recruitment methodologies.

In terms of limitations, the study population was a self-selected convenience sample, and as such, may not be representative of the general population or the overall population of CBD users. Individuals with favorable opinions of or experiences with CBD or Cannabis are more likely to have responded to the questionnaire than those with negative opinions and experiences. In addition, “regular cannabis use” was not defined in the survey and “marijuana” was not distinguished from “Cannabis.” Since the survey was primarily circulated via the internet, CBD users with limited social media connectivity would be underrepresented. Finally, no mechanism for identifying repeat respondents was incorporated into the survey. Although results were examined manually, it is possible that repeat respondents may have distorted the results (i.e., Ballot stuffing).

Conclusion

The use of CBD among individuals for both specific health conditions and general health and well-being is widespread. The results of this study demonstrate that individuals are learning about CBD from the internet, friends, or family members, rather than from healthcare professionals. CBD is being used as a specific therapy for a number of diverse medical conditions—particularly pain and inflammatory disorders, in addition to anxiety, depression, and sleep disorders. A large percentage of respondents indicate that CBD treats their condition(s) effectively in the absence of conventional medicine and with nonserious adverse effects. These data provide a compelling rationale for further research to better understand the therapeutic potential of CBD in treating chronic pain, anxiety, depression, sleep disorders, and other medical conditions.

Abbreviations Used

CBD cannabidiol
CI confidence interval
COPD chronic obstructive pulmonary disease
FDA Food and Drug Administration
GED General Educational Development
IRB institutional review board
OR odds ratio
PTSD post-traumatic stress disorder
THC tetrahydrocannabinol

Acknowledgments

The authors thank Gina Spidel for help with survey design, proofreading, and assistance with the SDSU Electronic Internal Review Board; Edgar Herrera for setting up the survey Facebook page; Belle Della Cruz for help with survey wording; and Rod Kight, Esq., for assistance in clarifying the regulatory status of CBD in the United States.

Author Disclosure Statement

J.C. is the Medical Director at The Center for Medical Cannabis Education, a for-profit clinical, research and consulting entity.

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CBD statistics 2022

22% of people say they don’t trust CBD, but 68% of CBD users find it effective. Get your CBD stats straight before you try this natural remedy.

There’s no getting around it: CBD is officially everywhere . Its popularity has skyrocketed. What started as a niche alternative health treatment has become a nationwide craze. And it doesn’t just show up as oils and tinctures anymore. There is whole array of curious CBD products, including lattes, makeup, bedsheets, bath bombs, and even dog treats.

But is CBD a wonder drug, or just another health fad? There’s no shortage of opinions out there, but we can discern a lot from CBD statistics. We’ve compiled reliable research and conducted a CBD survey to put the prevalence of CBD use and its potential health benefits into perspective.

What is CBD?

When some people hear “CBD,” their minds immediately jump to marijuana. And while there is a connection, it’s not as close as one might think. Since recreational and medical cannabis is available in several states now, it’s important to note the differences. CBD is primarily a hemp derivative, which is like a cousin to marijuana, but not the same plant.

Let’s take a step back. Both hemp and marijuana fall into the cannabis genus. Cannabis plants contain two naturally-occurring compounds: cannabidiol (CBD) and tetrahydrocannabinol (THC). CBD and THC are both cannabinoids but have different effects on the body. Most prominently, THC has psychoactive effects and CBD doesn’t, which is why CBD doesn’t make you feel high.

Marijuana and hemp each contain both compounds but in different ratios. Hemp has much lower levels of THC and larger amounts of CBD, which is why it’s often used for CBD products. Marijuana, on the other hand, has significantly more THC.

CBD uses

People use CBD for almost everything. Name a medical condition and there’s likely someone out there treating it with CBD or other cannabis products. But when someone claims that CBD cured their migraines or skin rash, take it with a grain of salt. Because the CBD industry is so new, there simply hasn’t been enough research to fully understand its effects yet.

While it shows plenty of promise in treating various conditions, “it is not a one-size-fits-all [remedy] to treat specific conditions or symptoms of those conditions for every individual,” says Manisha Singal, MD, the founder of Aethera Beauty . “Research on the benefits and action of CBD in topical formulations as well as ingestible forms is ongoing. That experimentation is in its preliminary stages and there is a long way to go. The medical potential for CBD and other cannabinoids is undeniable, but medical research takes time and careful analysis.”

That said, it has shown efficacy in treating chronic pain and anxiety (two of its most common uses), as well as insomnia and arthritis. And the only FDA-approved medication that contains cannabidiol so far is Epidiolex , which treats childhood seizures associated with Dravet Syndrome or Lennox-Gastaut Syndrome in patients two years of age and older.

How common is CBD use?

  • 33% of American adults have used CBD once or more. (SingleCare, 2020)
  • 64% of Americans are familiar with CBD and/or CBD products. (Gallup, 2019)
  • An estimated 64 million Americans have tried CBD in the last 24 months. (Consumer Reports, 2019)
  • Of those who use CBD, 22% said it helped them supplement or replace prescription or over-the-counter drugs. (Consumer Reports, 2019)

CBD statistics in America

  • Hemp-derived CBD products are legal in all 50 states, as long as they contain no more than 0.3% THC. (Food and Drug Administration, 2020)
  • In overall cannabis sales, Colorado tops the list, having sold over $1 billion since 2014. (CNN, 2019)
  • The top states for CBD sales in 2019 are California ($730 million), Florida ($291 million), and New York ($215 million). (Statista, 2019)
  • Of the Americans who use CBD, the most common uses are for pain relief (64%), anxiety (49%), and insomnia (42%). (SingleCare, 2020)
  • CBD web searches increased by 125.9% from 2016 to 2017 and 160.4% from 2017 to 2018. ( JAMA Network , 2019)
  • United States hemp farmland increased from 25,713 acres in 2017 to 78,176 acres in 2018. (Food Business News, 2019)

CBD statistics by age

CBD user demographics skew young. Of all age groups, Americans age 18-29 are most likely to use CBD consistently, and its popularity decreases with age. (Gallup, 2019):

  • 20% of people ages 18-29 use CBD
  • 16% of people ages 30-49 use CBD
  • 11% of people ages 50-64 use CBD
  • 8% of people age 65 and older use CBD

And the numbers nearly double for adults who have tried it once or more. According to a 2019 Consumer Reports CBD survey:

  • 40% of people ages 18-29 have tried CBD
  • 32% of people ages 30-44 have tried CBD
  • 23% of people ages 45-59 have tried CBD
  • 15% of people 60 and older have tried CBD

CBD statistics by method

According to our SingleCare survey, nearly half of CBD users prefer oils/tinctures, lotions/balms, and gummies. But there’s a growing market for CBD edibles.

  • 18% are interested in capsules/tablets
  • 18% are interested in topical sprays
  • 17% are interested in CBD-infused food, such as chocolate
  • 13% are interested in vaping products
  • 12% are interested in soap
  • 11% are interested in non-alcoholic, CBD-infused drinks
  • 9% are interested in CBD bath bombs and salts
  • 8% are interested in skincare products
  • 8% are interested in patches
  • 1% are interested in other CBD products

When it comes to where CBD users get their products, a 2019 Consumer Reports study says:

  • 40% purchase CBD from a dispensary
  • 34% purchase CBD from a retail store
  • 27% purchase CBD from an online retailer
  • 12% purchase CBD from another source

CBD and overall health

CBD enthusiasts will tell you that it changed their lives, citing all sorts of positive effects. Skeptics will tell you that it’s all hype and has no actual benefits. The truth falls somewhere in between. Our survey found that 32% of people who’ve used CBD did not find it effective. While there hasn’t been extensive research on its effects, it shows promise as an anti-inflammatory , anti-anxiety treatment, as well as a sleep aid . And this can give us some insight into CBD’s appeal as a new addition to holistic wellness routines.

People tout CBD as a miracle treatment for heart disease, cancer, autoimmune diseases, Alzheimer’s, acne, and much more. Researchers haven’t found substantial evidence that it can effectively treat any of these conditions, but we also know that inflammation and stress can be contributing factors to these conditions. So, there may be some truth to the claims that CBD is beneficial to everyday health. Whether it’s in a morning smoothie, part of a skincare routine, or something else entirely, regular CBD use can potentially be beneficial for some people, although it comes with risks too.

Recreational vs. medical cannabis use

Recreational cannabis use isn’t quite the same as medical use. CBD oil and other products intended for medical use typically come in smaller doses and aren’t full-spectrum CBD (or “whole plant” CBD), which contains THC as well.

“CBD can have varying strengths depending on if it is used in isolation or if used in conjunction with THC for entourage effects,” says Dr. Singal. And some people want these compound effects. However, there are a ton of CBD producers and retailers out there, and not all of them are reliable. Although 47% of the Americans that we surveyed think the government regulates CBD, it does not.

A recent study by Penn Medicine revealed that almost 70% of cannabidiol products sold online are mislabeled. So, products from online retailers that haven’t been properly vetted could contain higher levels of THC or other compounds. Our survey found that 22% of people won’t try CBD because they don’t trust the product or manufacturer.

CBD side effects

Like other medications, CBD can have side effects, too. In one study , one-third of CBD users reported a non-serious side effect, including dry mouth, euphoria, hunger, irritated eyes, and/or fatigue. And according to Michael Hall, MD, the founder of the Hall Longevity Clinic , the spectrum of side effects is even broader.

“CBD contains multiple oil-based terpenes, which can excite the immune system,” says Dr. Hall. “The most common side effects associated with CBD-based products include sleepiness, sedation, and lethargy; elevated liver enzymes; decreased appetite; diarrhea; rash; fatigue, malaise, and weakness; insomnia, and possible interaction with some prescription medications.”

Typically, these effects aren’t dire, but they can be inconvenient and disruptive to a person’s everyday routine.

As far as drug interactions go, there hasn’t been a ton of research and testing, so it’s hard to say. CBD can potentially interfere with tacrolimus , an immunosuppressive medication. Because there are a lot of unknowns, anyone looking to supplement their current medications with CBD should consult a healthcare provider first.

The cost of CBD

America’s CBD market has a near-vertical trajectory. With the legalization of recreational and medical marijuana in numerous states, an increasing number of people are looking into the benefits of cannabis, and CBD sales reflect that interest.

  • The United States CBD market value was just over $4 billion in 2019 and may top $25 billion by 2025. (Brightfield Group, 2019)
  • The cannabis- and hemp-derived CBD market may see a compound annual growth rate (CAGR) of 49% by 2024. (BDSA, 2019)
  • 44% of regular CBD users spend $20-$80 per month on CBD products. 13% spend more than $160 per month. (Brightfield Group, 2019)

CBD law and restrictions

Here’s the big question: is CBD legal or not? The laws around cannabis are frequently changing and vary from state to state. CBD derived from hemp is legal, as long as it meets certain requirements. The Agriculture Improvement Act of 2018 (AKA the 2018 Farm Bill) allowed for the production and marketing of hemp-derived CBD products without federal regulation as long as they contain no more than 0.3% THC. But these products should not be labeled or marketed as medications. The FDA has only approved one CBD-based drug (Epidiolex), so the sale of other CBD products as drugs for the treatment of specific medical conditions is not yet legal.

Additionally, the FDA has not approved products that contain cannabis or cannabis-derived compounds for medical use. In fact, at the federal level, all marijuana is illegal (medical or otherwise). It’s still classified as a Schedule I substance (along with heroin and LSD) by the DEA under the Controlled Substances Act . However, 33 states have legalized it for medical purposes, and 11 of those have approved recreational use for adults 21 and older. Technically, federal law supersedes state law, but the federal government has not chosen to prosecute businesses and/or individuals selling or using cannabis in states where it’s been legalized.

CBD questions and answers

How many people know what CBD is?

In a recent Gallup poll, 64% of U.S. adults said that they were familiar with CBD and/or CBD products. In a 2020 SingleCare survey, we found that one-third of Americans have used CBD.

Why do people use CBD?

People claim that CBD can treat everything from acne to cancer. But the most common uses are for pain, inflammation, anxiety, and insomnia.

What age group uses CBD the most?

CBD use is most common in populations ages 18-34, according to a recent SingleCare survey.

How much money is spent on CBD?

The CBD market exceeded $4 billion in 2019, according to a study by the Brightfield Group, and they expect the industry to top $25 billion by 2025.

How many people have died from ingesting CBD oil?

CBD oil consumption has not been directly linked to any deaths. One of the most popular CBD products is vape cartridges, however, and the FDA has linked vaping to certain lung injuries and death .

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