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Study part II: Perception of health risks and benefits. Answers to the question “How do you rate the health risks and health benefits of products containing CBD (cannabidiol)?” on a scale from 1 = very low to 5 = very high. Base: All respondents (n = 2,000), users (n = 535) and non-users (n = 1,271)
Source publication
Background
Cannabidiol (CBD), a non-intoxicating substance of Cannabis sativa L ., is gaining consumer attention. Yet, legal regulations in the EU are complex and questions of potential health risks remain partly unanswered. In Germany, little is known about people who use CBD products. The aim of this cross-sectional study was to gain insight into...
Citations
... A recent study conducted in Germany reported that approximately 40% of the German population are aware of products containing CBD, while around 11% also use these products [8]. Additionally, this study indicated that consumers are insufficiently informed about products containing CBD, i.e., there is limited awareness of potential health risks and of the insufficient scientific data base for the claimed health benefits. ...
Background: Cannabidiol (CBD) is a cannabinoid present in the hemp plant (Cannabis sativa L.). Non-medicinal CBD oils with typically 5–40% CBD are advertised for various alleged positive health effects. While such foodstuffs containing cannabinoids are covered by the Novel Food Regulation in the European Union (EU), none of these products have yet been authorized. Nevertheless, they continue to be available on the European market. Methods: The Permanent Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) reviewed the currently available data on adverse and potential beneficial effects of CBD in the dose range relevant for foods. Results: Increased liver enzyme activities were observed in healthy volunteers following administration of 4.3 mg CBD/kg bw/day and higher for 3–4 weeks. As lower doses were not tested, a no observed adverse effect level (NOAEL) could not be derived, and the dose of 4.3 mg/kg bw/day was identified as the lowest observed adverse effect level (LOAEL). Based on the CBD content and dose recommendations of CBD products on the market, the SKLM considered several exposure scenarios and concluded that the LOAEL for liver toxicity may be easily reached, e.g., via consumption of 30 drops of an oil containing 20% CBD, or even exceeded. A critical evaluation of the available data on potential beneficial health effects of CBD in the dose range at or below the LOAEL of 4.3 mg/kg bw/day revealed no scientific evidence that would substantiate health claims, e.g., in relation to physical performance, the cardiovascular, immune, and nervous system, anxiety, relaxation, stress, sleep, pain, or menstrual health. Conclusions: The SKLM concluded that consumption of CBD-containing foods/food supplements may not provide substantiated health benefits and may even pose a health risk to consumers.
... Compared to nonusers, prior cannabis users also rated all cannabinoids higher for many non-therapeutic positive effects including enhanced mood, creativity, and social and sexual facilitation, and were less likely to endorse negative effects including the risks for impaired cognition, addiction, and psychosis. CBD users mostly report high perceived positive health and wellness effects (Binkowska et al., 2024;Corroon & Phillips, 2018;Fedorova et al., 2021;Geppert et al., 2023;Goodman et al., 2022;R. Kaufmann et al., 2023;Leas et al., 2020;Moltke & Hindocha, 2021). ...
Objectives:
To examine older adults' cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems.
Methods:
Using the 2022 National Survey on Drug Use and Health (N = 10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50-64 and the 65+ age groups.
Results:
In the 50-64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50-64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use.
Conclusions:
CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use.
Clinical implications:
Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users.
... Indeed, there have been notable increases in the use of CBD for medicinal purposes reported globally (World Health Organization, 2018). Although CBD is not yet established as a pharmacological treatment for psychiatric conditions (Black et al., 2019;World Health Organization, 2018) , a primary motive for non-medical CBD use appears to be its purported anxiolytic and stress-dampening effects (Geppert et al., 2023;Gournay et al., 2024). Among healthy individuals, stress and anxiety represent adaptive responses to challenges that arise during daily living, and it is estimated that on average healthy individuals will elicit a stress response once every 3 days (Stawski et al., 2013). ...
... Among healthy individuals, stress and anxiety represent adaptive responses to challenges that arise during daily living, and it is estimated that on average healthy individuals will elicit a stress response once every 3 days (Stawski et al., 2013). Healthy individuals often engage in efforts to dampen stress-related effects when they occur, and there is growing evidence that CBD is commonly used for relaxation and stress relief among the general population (Geppert et al., 2023;Gournay et al., 2024). ...
Background
Cannabidiol (CBD) impacts brain regions implicated in anxiety reactivity and stress reactivity (e.g., amygdala, anterior cingulate cortex (ACC), anterior insula (AI)); however, placebo-controlled studies are mixed regarding CBD’s anxiolytic effects. We previously reported that CBD expectancy alone can alter subjective, physiological, and endocrine markers of stress/anxiety; however, it is unclear whether these findings reflect altered brain reactivity. This study evaluated whether CBD expectancy independently alters amygdala resting-state functional connectivity (rsFC) with the ACC and AI following acute stress.
Method
Thirty-eight (20 females) healthy adults were randomly assigned to receive accurate or inaccurate information regarding the CBD content of a CBD-free oil administered during a single experimental session. Following a baseline resting state MRI scan, participants administered their assigned oil sublingually, engaged in a stress task (serial subtraction with negative feedback) inside the scanner, and underwent another resting state MRI scan. Amygdala rsFC with the ACC and AI was measured during each scan, and the subjective state was assessed at six time points. Outcomes were analyzed using ANCOVA.
Results
CBD expectancy (vs CBD-free expectancy) was associated with significantly weaker rsFC between the left amygdala and right ACC ( p = 0.042), but did not systematically alter amygdala-AI rsFC ( p-values > 0.05). We also replicated our previously reported CBD expectancy effects on subjective stress/anxiety in the scanner context.
Conclusion
CBD placebo effects may be sufficient to alter neural responses relevant to its purported anxiolytic and stress-relieving properties. Future work is needed to replicate these results and determine whether CBD expectancy and pharmacology interact to alter neural anxiety reactivity and stress reactivity.
... Sales in Europe are predicted to reach EUR 3.47 billion by 2024 [28]. Various surveys from Germany [29], the UK and Ireland [30], the USA [31,32], and Canada [32] have examined the number of users, reasons for use, and public perception of CBD. CBD appears to be most popular in the USA, where 26% of respondents [32] stated that they had used CBD, compared to 11% in Germany [29]. ...
... Various surveys from Germany [29], the UK and Ireland [30], the USA [31,32], and Canada [32] have examined the number of users, reasons for use, and public perception of CBD. CBD appears to be most popular in the USA, where 26% of respondents [32] stated that they had used CBD, compared to 11% in Germany [29]. However, there is also some time between the studies (2022 USA, 2020 Germany), and the number of consumers in Germany may have increased in the meantime. ...
... However, there is also some time between the studies (2022 USA, 2020 Germany), and the number of consumers in Germany may have increased in the meantime. The most prevalent method of oral CBD administration is via oils, tinctures, and edibles [29,31,33], and the Internet, including social media, appears to be a popular source of information [31,34,35]. ...
Cannabidiol (CBD), a non-psychotropic main component of the Cannabis plant, has been approved as a drug in the European Union (EU) under the name “Epidyolex”. However, its approval process as a food ingredient under the Novel Food Regulation was paused by the European Food Safety Authority (EFSA) due to a lack of safety data. Nevertheless, there is a growing, unregulated market in which CBD is advertised with various health claims and dosage instructions. Of particular concern is its toxic effect on the liver and possible reproductive toxicity in humans. Studies suitable for calculating the benchmark dose were identified from the available data. Animal studies yielded a benchmark dose lower confidence limit (BMDL) of 43 mg/kg bw/day, which translates into a safe human dose of approximately 15 mg/day. Only the Lowest-Observed-Adverse-Effect Level (LOAEL) of 4.3 mg/kg bw/day could be identified from the human data. This updated risk assessment confirmed a health-based guidance value (HBGV) of 10 mg/day based on human LOAEL. Despite the existing data gaps, preliminary regulation appears advisable because the current form of the gray CBD market is unacceptable from the standpoint of consumer safety and protection.
... Various surveys from Germany [29], UK and Ireland [30], and the USA [31,32] and Canada [32] have looked at the number of users, reasons for use and public perception of CBD. CBD appears to be most popular in the USA, where 26% of respondents [32] stated that they had used CBD, compared to 11% in Germany [29]. ...
... Various surveys from Germany [29], UK and Ireland [30], and the USA [31,32] and Canada [32] have looked at the number of users, reasons for use and public perception of CBD. CBD appears to be most popular in the USA, where 26% of respondents [32] stated that they had used CBD, compared to 11% in Germany [29]. However, there is also some time in between the studies (2022 USA, 2020 Germany), and the number of consumers in Germany may have increased in the meantime. ...
... However, there is also some time in between the studies (2022 USA, 2020 Germany), and the number of consumers in Germany may have increased in the meantime. The most prevalent method of oral administration of CBD is in the form of oils, tinctures, and edibles [29,31,33], and the internet, including social media, seems to be a popular source of information [31,34,35]. ...
Cannabidiol (CBD), a non-psychotropic main component of the Cannabis plant, is approved as a drug in the European Union (EU) under the name “Epidyolex”. However, the approval process as a food ingredient under the Novel Food Regulation was paused by the European Food Safety Authority (EFSA) due to a lack of safety data. Nevertheless, there is a growing, unregulated market in which CBD is advertised with various health claims and different dosage instructions. Of particular concern is its toxic effect on the liver and possible reproductive toxicity in humans. Studies suitable for calculating a benchmark dose were identified from the available data. Animal studies yielded a Benchmark Dose Lower Confidence Limit (BMDL) of 43 mg/kg bw/day, which translates into a safe human dose of approximately 15 mg/day. Only a Lowest Observed Adverse Effect Level (LOAEL) of 4.3 mg/kg bw/day could be identified from the human data. This updated risk assessment confirmed the Health-based Guidance Value (HBGV) of 10 mg/day based on human LOAEL. Despite existing data gaps, preliminary regulation appears advisable as the current form of the gray CBD market is unacceptable from the standpoint of consumer safety and protection.
... General population surveys I am aware of do not explicitly distinguish medical from recreational use (e.g., Germany: [28]; Austria: [35]; Spain: [34]). As for low-THC/ high-CBD products, the rising popularity has resulted in about 1 in 10 adults in Germany reporting using those products, with a sizeable share (18%) reporting daily consumption [16]. In Austria, the prevalence of high-THC and low-THC/high-CBD products was comparable in 2020 (3-5%: [35]). ...
Cannabis use and treatment demand has risen in the past decade. Previous analyses of treatment demand are limited by methodological constraints or are outdated. Cross-country differences and trends in cannabis treatment demand are described using data from the European Monitoring Centre for Drugs and Drug Addiction. Two novel indicators are employed: firstly, the cannabis-attributable treatment fraction (CATF) is obtained by dividing the number of treatment entrants for cannabis use problems by the number of treatment entrants for any substance use problem, accounting for possible changes in the reporting system. Secondly, comparing the number of treatment entrants for cannabis use problems to the number of people who use cannabis (near) daily yields the treated-user-ratio (TUR), which considers a proxy for treatment need (frequent use). Across 30 countries with available data, the importance of cannabis in European treatment facilities varies greatly (CATF: min = 3%; max = 65%), with lower estimates in Eastern European countries. Across 20 countries with complete data, the CATF has risen from 29.4% in 2013 to 37.1% in 2020. The TUR calculated on 26 countries suggests that about 3 in 100 frequent users have sought treatment for their cannabis use problems. Over time, treatment demand has increased at a slower pace than treatment need in most countries. One in three treatment entrants for substance use problems in Europe are due to cannabis, with large variations between countries. There are indications for a widening treatment gap for cannabis use problems. In countries liberalising cannabis laws, monitoring changes in treatment access and demand is warranted.
... Compared to nonusers, prior cannabis users also rated all cannabinoids higher for many non-therapeutic positive effects including enhanced mood, creativity, and social and sexual facilitation, and were less likely to endorse negative effects including the risks for impaired cognition, addiction, and psychosis. CBD users mostly report high perceived positive health and wellness effects (Binkowska et al., 2024;Corroon & Phillips, 2018;Fedorova et al., 2021;Geppert et al., 2023;Goodman et al., 2022;R. Kaufmann et al., 2023;Leas et al., 2020;Moltke & Hindocha, 2021). ...
This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the
likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years
or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation.
Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression
Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less
likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended
that doctors, social workers, and other health care and social services providers pay special attention to younger old adults
with health problems and functional limitations because they have a greater risk of being depressed.
Introduction
Cannabis and cannabidiol (CBD) may potentially alleviate symptoms and improve the quality of life of people with Parkinson’s disease (PD), although clinical results to date have provided conflicting evidence. In France, cannabis use is illegal outside the current restricted medical cannabis experimental framework which does not include PD as an eligible condition. In contrast, CBD products are legal and are easily available. We aimed to evaluate the acceptability of therapeutic cannabis and CBD use, and to assess cannabinoid-related attitudes among people with PD in France, with a view to assessing the potential inclusion of medical cannabinoids in PD treatment options.
Methods
We conducted a French nationwide online survey among people with PD. Cannabis and CBD acceptability levels were derived from the answers to four questions. Logistic regressions were performed to identify factors associated with these levels. We also collected data on knowledge, information-seeking, and barriers to self-medication.
Results
Of 1136 participants, acceptability levels of medical cannabis and CBD use were 81.7% and 87.4%, respectively. For both substances, acceptability was associated with the presence of anxiety symptoms, greater knowledge about cannabinoids, seeking information on medical cannabis, and considering the risk of cannabis dependence to be low. A fear of dependence was one of the main barriers to using either substance; healthcare providers were rarely mentioned as sources of information on medical cannabis.
Conclusions
Acceptability levels of cannabis and CBD were high. Acceptability was associated with knowledge and perceptions of cannabinoids. Given ongoing misconceptions about the effects and risks associated with CBD, disseminating accurate information could increase its acceptability in people with PD.
Abstracts
Background
Cannabidiol (CBD) use has been increasing for its putative therapeutic potential for various health conditions. Research using a nationally representative sample is needed to examine characteristics of CBD users.
Methods
Data came from the adult sample (N=47,100) of the 2022 U.S. National Survey on Drug Use and Health. We fitted generalized linear models to examine the sociodemographic, health, other substance use, and cannabis risk perception as correlates of CBD-only use and CBD-cannabis co-use, compared to cannabis-only use.
Results
In 2022, 20.6 % and 23.0 % of U.S. adults reported using CBD and cannabis, respectively, in the preceding 12 months, and 63 % of CBD users also used cannabis. CBD use was significantly higher among women (CBD-only vs. cannabis-only use: IRR=1.43, 95 % CI=1.31–1.57), but significantly lower among Black and Hispanic individuals compared to non-Hispanic White individuals (CBD-only vs. cannabis-only use: IRR=0.71, 95 % CI=0.60–0.85 for Black individuals; IRR=0.79, 95 % CI=0.65–0.96 for Hispanic individuals). Older ages, higher SES, chronic medical conditions, mental illness, and high cannabis risk perception were also associated with higher likelihood of CBD-only use versus cannabis-only use. CBD-cannabis co-users were at most risk in terms of chronic illness, mental illness, cannabis use disorder, and other substance use problems.
Conclusions
The high prevalence of self-reported CBD use among those with physical and mental health problems warrants public health warnings about potential side effects and drug interactions. The high CBD-cannabis co-use rate also calls for more research on potential benefits and negative effects of the co-use.
Nineteen cannabinoids, including Δ ⁹ -THC (tetrahydrocannabinol) and CBD (cannabidiol), were quantified in 22 CBD oils, 2 CBG (cannabigerol) oils, and 2 CBN (cannabinol) oils, marketed as food supplements, aroma oils, or cosmetic preparations. Analyses were conducted using high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS). The declared concentrations of CBD (or CBG, CBN) in the oils ranged from 2.5 to 20%. Actual concentrations compared to declared concentrations ranged from 81 to 226%. CBD concentrations of up to 9 mg per drop were found. Δ ⁹ -THC was detected in 20 of 26 samples, with concentrations ranging from 5 to 1576 mg/kg (mean = 536 mg/kg). Considering the highest daily intake suggested by one manufacturer (20 drops) and a body weight of 70 kg, the measured Δ ⁹ -THC concentration in 50% (n = 13) of the products would exceed the acute reference dose (ARfD) of 1 µg/kg body weight (bw) derived for Δ ⁹ -THC by the European Food Safety Authority (EFSA). For 7 samples, only 2 drops of oil would be sufficient to exceed the ARfD of Δ ⁹ -THC.
