potential of cbd oil for humans

CBD statistics 2022

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 .

The Biology and Potential Therapeutic Effects of Cannabidiol

“Cannabidiol: Barriers to Research and Potential Medical Benefits”

Mr. Chairman, Ms. Chairwoman, and Members of the Senate Drug Caucus, thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), to participate in this hearing to share what we know about the biology and the potential therapeutic effects of cannabidiol (CBD), one of the main active chemical compounds found in marijuana. In light of the rapidly evolving interest in the potential use of marijuana and its derivative compounds for medical purposes, it is important to take stock of what we know and do not know about the therapeutic potential of CBD.

Background

To date, 23 states and the District of Columbia have passed laws allowing marijuana to be used for a variety of medical conditions. Fifteen additional states have enacted laws intended to allow access to CBD oil and/or high-CBD strains of marijuana. Interest in the potential therapeutic effects of CBD has been growing rapidly, partially in response to media attention surrounding the use of CBD oil in young children with intractable seizure disorders including Dravet syndrome and Lennox-Gastaut syndrome. While there are promising preliminary data, the scientific literature is currently insufficient to either prove or disprove the efficacy and safety of CBD in patients with epilepsy. i and further clinical evaluation is warranted. In addition to epilepsy, the therapeutic potential of CBD is currently being explored for a number of indications including anxiety disorders, substance use disorders, schizophrenia, cancer, pain, inflammatory diseases and others. My testimony will provide an overview of what the science tells us about the therapeutic potential of CBD and of the ongoing research supported by NIH in this area.

CBD Biology and Therapeutic Rationale

CBD is one of more than 80 active cannabinoid chemicals in the marijuana plant. ii Unlike the main psychoactive cannabinoid in marijuana, tetrahydrocannabinol (THC), CBD does not produce euphoria or intoxication. iii,iv,v Cannabinoids have their effect mainly by interacting with specific receptors on cells in the brain and body: the CB1 receptor, found on neurons and glial cells in various parts of the brain, and the CB2 receptor, found mainly in the body’s immune system. The euphoric effects of THC are caused by its activation of CB1 receptors. CBD has a very low affinity for these receptors (100 fold less than THC) and when it binds it produces little to no effect. There is also growing evidence that CBD acts on other brain signaling systems, and that these actions may be important contributors to its therapeutic effects. ii

Preclinical and Clinical Evidence

Rigorous clinical studies are still needed to evaluate the clinical potential of CBD for specific conditions. i However, pre-clinical research (including both cell culture and animal models) has shown CBD to have a range of effects that may be therapeutically useful, including anti-seizure, antioxidant, neuroprotective, anti-inflammatory, analgesic, anti-tumor, anti-psychotic, and anti-anxiety properties.

Anti-Seizure Effects

A number of studies over the last two decades or more have reported that CBD has anti-seizure activity, reducing the severity of seizures in animal models. vi,vii In addition, there have been a number of case studies and anecdotal reports suggesting that CBD may be effective in treating children with drug-resistant epilepsy. viii,ix,x However, there have only been a few small randomized clinical trials examining the efficacy of CBD as a treatment for epilepsy; the total number of subjects enrolled in these studies was 48. Three of the four studies reported positive results, including decreased frequency of seizures. However, the studies suffered from significant design flaws, including failure to fully quantify baseline seizure frequency, inadequate statistical analysis, and a lack of sufficient detail to adequately evaluate and interpret the findings. viii Therefore, the currently available information is insufficient to draw firm conclusions regarding the efficacy of CBD as a treatment for epilepsy; a recent Cochrane review concluded, there is a need for “a series of properly designed, high quality, and adequately powered trials.” xi

NIDA is currently collaborating with the National Institute on Neurological Disorders and Stroke to evaluate CBD in animal models of epilepsy in order to understand the underlying mechanisms and optimize the conditions under which CBD may treat seizure disorders, and determine whether it works synergistically with other anti-seizure medications. In addition, clinical trials are currently underway by GW Pharmaceuticals, testing the efficacy of Epidiolex, a purified CBD extract, for treatment of pediatric epilepsy.

Neuroprotective and Anti-Inflammatory Effects

CBD has also been shown to have neuroprotective properties in cell cultures as well as in animal models of several neurodegenerative diseases, including Alzheimer’s, xii,xiii,xiv stroke, xv glutamate toxicity, xvi multiple sclerosis (MS), xvii Parkinson’s disease, xviii and neurodegeneration caused by alcohol abuse. xix Nabiximols (trade name Sativex), which contains THC and CBD in roughly equal proportions, has been approved throughout most of Europe and in a number of other countries for the treatment of spasticity associated with MS. It has not been approved in the United States, but clinical trials are ongoing, and two recent studies reported that nabiximols reduced the severity of spasticity in MS patients. xx,xxi There have been limited clinical trials to assess the potential efficacy of CBD for the other indications highlighted; however, a recent small double-blind trial in patients with Parkinson’s disease found the CBD improved quality-of-life scores. xxii

Analgesic Effects

There have been multiple clinical trials demonstrating the efficacy of nabiximols on central and peripheral neuropathic pain, rheumatoid arthritis, and cancer pain. xxiii In addition, nabiximols is currently approved in Canada for the treatment of central neuropathic pain in MS and cancer pain unresponsive to opioid therapy. However, the current evidence suggests that the analgesia is mediated by THC and it is unclear whether CBD contributes to the therapeutic effects. xxiv THC alone has been shown to reduce pain; xxv,xxvi we are unaware of clinical studies that have explored the efficacy of CBD alone on pain. However, the anti-inflammatory properties of CBD (discussed above) could be predicted to play a role in the analgesic effects of nabiximols. Recent research has also suggested that cannabinoids and opioids have different mechanisms for reducing pain and that their effects may be additive, which suggests that combination therapies may be developed that may have reduced risks compared to current opioid therapies. However, this work is very preliminary. xxvii

Anti-Tumor Effects

In addition to the research on the use of cannabinoids in palliative treatments for cancer—reducing pain and nausea and in increasing appetite—there are also several pre-clinical reports showing anti-tumor effects of CBD in cell culture and in animal models. xxviii These studies have found reduced cell viability, increased cancer cell death, decreased tumor growth, and inhibition of metastasis (reviewed in McAllister et al, 2015). xxix These effects may be due to the antioxidant and anti-inflammatory effects of CBD; xxx however these findings have not yet been explored in human patients. There are multiple industry sponsored clinical trials underway to begin to test the efficacy of CBD in human cancer patients.

Anti-Psychotic Effects

Marijuana can produce acute psychotic episodes at high doses, and several studies have linked marijuana use to increased risk for chronic psychosis in individuals with specific genetic risk factors. Research suggests that these effects are mediated by THC, and it has been suggested that CBD may mitigate these effects. xxxi There have been a few small-scale clinical trials in which patients with psychotic symptoms were treated with CBD, including case reports of patients with schizophrenia that reported conflicting results; a small case study in patients with Parkinson’s disease with psychosis, which reported positive results; and one small randomized clinical trial reporting clinical improvement in patients with schizophrenia treated with CBD. xxxii Large randomized clinical trials would be needed to fully evaluate the therapeutic potential of CBD for patients with schizophrenia and other forms of psychosis.

Anti-Anxiety Effects

CBD has shown therapeutic efficacy in a range of animal models of anxiety and stress, reducing both behavioral and physiological (e.g., heart rate) measures of stress and anxiety. xxxiii,xxxiv In addition, CBD has shown efficacy in small human laboratory and clinical trials. CBD reduced anxiety in patients with social anxiety subjected to a stressful public speaking task. xxxv In a laboratory protocol designed to model post-traumatic stress disorders, CBD improved “consolidation of extinction learning”, in other words, forgetting of traumatic memories. xxxvi The anxiety-reducing effects of CBD appear to be mediated by alterations in serotonin receptor 1a signaling, although the precise mechanism remains to be elucidated and more research is needed. xxxvii

Efficacy for Treating Substance Use Disorders

Early preclinical findings also suggest that CBD may have therapeutic value as a treatment of substance use disorders. CBD reduced the rewarding effects of morphine xxxviii and reduced cue-induced heroin seeking xxxix in animal models. A few small clinical trials have examined CBD and/or nabiximols (THC/CBD) for the treatment of substance use disorders; however, the available data are not sufficient to draw conclusions. NIDA is supporting multiple ongoing clinical trials in this area.

Safety of CBD

For reasons discussed previously, despite its molecular similarity to THC, CBD only interacts with cannabinoid receptors weakly at very high doses (100 times that of THC), xl and the alterations in thinking and perception caused by THC are not observed with CBD. iii.iv,v The different pharmacological properties of CBD give it a different safety profile from THC.

A review of 25 studies on the safety and efficacy of CBD did not identify significant side effects across a wide range of dosages, including acute and chronic dose regimens, using various modes of administration. xli CBD is present in nabiximols which, as noted earlier, is approved throughout most of Europe and in other countries. Because of this, there is extensive information available with regard to its metabolism, toxicology, and safety. However, additional safety testing among specific patient populations may be warranted should an application be made to the Food and Drug Administration.

Research Opportunities and Challenges

This is a critical area for new research. While there is preliminary evidence that CBD may have therapeutic value for a number of conditions, we need to be careful to not get ahead of the evidence. Ninety-five percent of drugs that move from promising preclinical findings to clinical research do not make it to market. The recently announced elimination of the PHS review of non-federally funded research protocols involving marijuana is an important first step to enhance conducting research on marijuana and its components such as CBD. Still, it is important to try to understand the reasons for the lack of well-controlled clinical trials of CBD including: the regulatory requirements associated with doing research with Schedule I substances, including a requirement to demonstrate institutional review board approval; and the lack of CBD that has been produced under the guidance of Current Good Manufacturing Processes (cGMP) – required for testing in human clinical trials – available for researchers. Furthermore, the opportunity to gather important information on clinical outcomes through practical (non-randomized) trials for patients using CBD products available in state marijuana dispensaries is complicated by the variable quality and purity of CBD from these sources.

Ongoing CBD Research

The NIH recognizes the need for additional research on the therapeutic effects of CBD and other cannabinoids, and supports ongoing efforts to reduce barriers to research in this area. NIH is currently supporting a number of studies on the therapeutic effects as well as the health risks of cannabinoids. These include studies of the therapeutic value of CBD for:

  • Treatment of substance use disorders (opioids, alcohol, cannabis, methamphetamine)
  • Attenuation of the cognitive deficits caused by THC
  • Neuropathic pain due to spinal cord injury
  • Mitigating the impact of cannabis use on risk for schizophrenia
  • Examination of the potential of CBD as an antiepileptic treatment

It is important to note that NIDA’s mission is focused on drug abuse; studies related to the therapeutic effects of CBD in other areas would be funded by the Institute or Center responsible for that program area. For example, studies related to epilepsy will likely be funded by the National Institute of Neurological Disorders and Stroke or by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, while studies related to schizophrenia will likely be funded by the National Institute on Mental Health.

Conclusion

There is significant preliminary research supporting the potential therapeutic value of CBD, and while it is not yet sufficient to support drug approval, it highlights the need for rigorous clinical research in this area. There are barriers that should be addressed to facilitate more research in this area. We appreciate the opportunity to testify on the potential use of CBD for therapeutic purposes. Thank you again for inviting me here today, and I look forward to any questions you may have.