CBD products are still relatively new to the marketplace and their availability is rapidly growing. However, we still don’t know too much about how and why people would purchase CBD, how they would use CBD, and what consumers understand about CBD, including its legality, benefits, and risks. This is particularly true for young adults.
A research group at the University of North Florida recently conducted an online survey among young adults to have a better understanding of the CBD purchasing habits – awareness and use of cannabidiol products – of young American adults. The majority of the 340 responders were young (from age 18 to 24), single, female, white college students. Here, we present the results of this survey.
Just over half (56%) of the respondents had used a CBD product, with about 64% of these using two or more types of products. Edible products (56%) and tinctures (54%) were the most popular purchases. Cannabidiol containing vaping liquids (for use in e-cigarettes) are becoming increasingly popular (38%), and so are topicals (30%), typically a lotion, cream, or salve used to relieve aches, pain, or skin conditions.
Those that reported having purchased CBD products used CBD for a wide variety of reasons, including stress relief (66%), relaxation (55%), to help with sleep (42%), and for pain relief (41%). However, when stating how they used the products, for example, what dosage they used, only 37% followed the label instructions. In addition, 21% took as much as they needed to “feel something”, and 15% simply estimated the dose or were not sure what dose they took. Some noted that they did not know accurately the amount of CBD or other cannabinoids (especially THC or synthetic cannabinoids) in the product.
Respondents often mentioned that they used CBD for psychological / psychiatric self-medication. These participants also mentioned that they were also taking a range of medicinal products such as antidepressants and anxiety medicines, sleep aids, prescription drugs, and the most common self-medication drug, alcohol. Over 10% of users said they did not believe they could stop using CBD products, which is strange given that there is no evidence that cannabidiol would be addictive.
Watch this 1:34 minute video by USA Today about consumer popularity of CBD
The issue of dosage is complex. The most appropriate dose of CBD depends on the specific condition that patients are seeking treatment for and scientists are far from undertanding it. Therefore, the recommended dosage given on products can only be speculative by the manufacturers, without scientific evidence to support it. The assumption of users, and possibly their actual experience when waiting to “feel something”, is that “more is probably better”. However, evidence from one study suggested too little or too much of cannabidiol can result in no effect on users.
In this survey of awareness and use of CBD products, over half of users experienced at least one “unexpected” side effect from using CBD products. These included dry mouth, fatigue, appetite change and feeling high, which might be expected with cannabis use and suggests active compounds were present. Indeed nearly 30% of respondents in the survey said they used CBD products “instead of marijuana”, while 80% had used marijuana as well in the last month.
While CBD in itself is not illegal, the majority of products on the market are untested and, therefore, potentially unsafe. In addition, some may contain contamination of active psychotropic drugs from the cannabis plant and other unknown manufacturing substances. Moreover, some “CBD products” may not contain any CBD whatsoever. CBD products must have accurate labeling, and manufacturers cannot make unproven claims that CBD can treat diseases or has other benefits, or that it is a food supplement.
Over 75% of participants believed that CBD products were legal to use. One might suspect that there is an element of “self-justification” or uncertainty in this response, however, as about 60% of users and non-users were not sure whether using cannabidiol might actually result in a failed drug test.
Respondents probably sought social acceptability for CBD use by stating that they learned about the product from friends and family members (50%). Additionally, 76% of users reported that their friends and family also used CBD products, and were 4.5 times more likely to be users when this was the case. Notably, only 9% had discussed its use with their healthcare provider, suggesting use was not part of a treatment program.
Interestingly, there was a clear difference in ethnicity: White participants were about here times as likely to use cannabidiol products than Black, Hispanic, of other ethnicities.
The overwhelming consensus amongst all those in the survey (about 95%) was that CBD products are becoming more popular to use. In this context, it is all the more important that healthcare providers and public health planners also understand the levels of use and its implications for the general health of the using population.
CBD products are clearly fulfilling a perceived need and a “gap in the market” for users. However, while the products are unregulated, health care professionals should endorse them with caution, even where they may perceive that CBD has positive benefits. The reason for this caution is that there are too many unknowns regarding the safe dosage and long-term use, for example.
Additionally, while many people in the survey expressed that they used CBD products alongside alcohol and prescription medicines (one third up to ten times per month), there is little known about their potential interactions outside of the laboratory setting. We do know, however, that CBD can interfere with warfarin-based medicines and with enzymes that can cause liver-damage, and so further negative interactions are very likely.
Given that consumers use cannabidiol to mostly self-medicate for pain and mental health conditions, it is vital that health professionals make their patients fully aware of the potential risks and legal status of CBD. As things are now, the legal status may be different in countries other than the US, and marijuana-derived CBD is illegal in some US states.
Wheeler M, Merten JW, Gordon BT, Hamadi H. CBD (Cannabidiol) Product Attitudes, Knowledge, and Use Among Young Adults. Subst Use Misuse. 2020;55(7):1138-1145. doi: 10.1080/10826084.2020.1729201. Epub 2020 Feb 24. PMID: 32093530.