Many people are using cannabidiol (CBD) to treat diagnosable conditions for which evidence-based therapy is available, according to a new report. An analysis of 376 testimonial posts on an online forum found nearly two-thirds of individuals used CBD to treat psychiatric conditions such as autism or depression, while about 30% said they used it for wellness benefits, researchers report in JAMA Network Open. "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," Dr. John W. Ayers of the University of California, San Diego, and colleagues conclude. CBD has seen an exponential rise in popularity in recent years, Dr. Ayers and his team note, "concurrent with marketing claims that over-the-counter CBD can be used to treat almost any health condition, including acne, anxiety, and menstrual problems." But the U.S. Food and Drug Administration (FDA) has approved only one CBD-based medication, Epidiolex, for treating rare seizure disorders in children. While the FDA has warned that making unsubstantiated claims for a product's benefit is illegal and could harm patients, they have not taken major steps toward regulation of CBD products aside from issuing warning letters, according to the authors. The head of the FDA did tell Congress that the agency would act more forcefully if patients were using CBD instead of, or along with, evidence-based therapies. To clarify how patients are using CBD, the authors analyzed posts on a Reddit forum, r/CBD, with more than 100,000 registered members. They randomly sampled 3,000 posts and identified 376 in which people discussed why they use CBD. In 90% of posts, individuals said they used CBD to treat a diagnosable condition. Psychiatric disorders were cited most frequently, by 63.9% of posters, followed by orthopedic (26.4%), sleep (14.6%) and neurological (6.9%) issues. More rarely, people reported using CBD to treat gastrointestinal conditions (3.9%), while fewer than 2% reported using it to treat addiction, cardiological, dermatological, ophthalmological, oral-health, or sexual-health conditions. Mental wellness was cited by 29.5% of CBD users, for example for quieting racing thoughts, while 1.4% mentioned physical wellness, such as increased energy. "Although many potential therapeutic uses of CBD remain to be explored, our findings suggest that the public already perceives CBD as an effective therapeutic for many health conditions in ways that are potentially detrimental to public health," the authors write. "Because CBD is not an FDA-approved treatment for nearly all the conditions cited by users who post to Reddit, CBD users may unnecessarily experience prolonged illnesses that would otherwise be alleviated with proven effective treatments." CBD use is also not risk-free, they add, and products may be adulterated with harmful ingredients. In an invited commentary, Dr. Wilson M. Compton and Dr. Emily B. Einstein of the National Institute on Drug Abuse in Bethesda write, "It is important that consumers understand that CBD should be regarded as a psychoactive chemical with multiple biological effects, and is not just an uncomplicated dietary supplement." Currently, Dr. Compton noted in a phone interview with Reuters Health, the National Institutes of Health is funding studies of CBD for treating addiction and other conditions. "Part of the reason for writing a commentary like this is to encourage the kind of research that can help guide clinical practice," he said. "For clinicians treating patients with a whole variety of health problems, they need to be aware of what patients are using on their own outside of medical care," Dr. Compton said. "CBD fortunately does not appear to have a great number of side effects and complications. That doesn't mean it has none." While patients also need to be aware that CBD products may be mislabeled or adulterated, he added, the real concern is that people are using CBD before trying proven therapies. He and Dr. Einstein conclude: "More research will be the key to understanding possible therapeutic indications of CBD. For now, education is critical to ensure that consumers approach the health claims of CBD-containing products with appropriate skepticism and do not forgo evidence-based care in favor of CBD." Dr. Ayers was not available for an interview by press time. —Anne Harding Source
