Cannabis-derived compounds like cannabidiol, better known as CBD, are often marketed as over-the-counter cure-alls, said to fix pretty much anything that ails you, from acne and chronic pain, to depression and sleep disorders.
Despite the lack of evidence to support any of these claims, new research suggests more and more people are buying into the supplement, even when other substantiated treatments exist.
With few available surveys on CBD use among the American public, researchers turned to the internet for answers.
Analysing hundreds of randomly selected testimonials from Reddit's r/CBD forum between January 2014 and August 2019, the team found many users already perceive CBD as an effective medical treatment for numerous health conditions, despite the scientific backing not always being there.
Others reported using CBD oral capsules and tinctures for joint pain, sleep disorders, and neurological conditions, as well as gut issues, addiction, oral health, and even cardiovascular conditions, like heart palpitations.
"The public appears to believe CBD is medicine," says one of the researchers, Davey Smith, Chief of Infectious Diseases and Global Public Health at the University of California San Diego.
"Who would have predicted that the public might ever think CBD is a cardiology medication?"
CBD holds lots of promise in the medical world, especially as a potential therapy for sleep and chronic pain, but its recent popularity has far outpaced the actual science.
The health benefits of this non-psychoactive compound need to be studied more, but as a paper in 2014 put it: "We must also ask if we are getting ahead of ourselves."
Over the course of the five years researchers studied, posts on r/CBD went from roughly 2,000 posts per year to nearly 12,000 per year, and most of these conversations are about CBD's therapeutic uses.
To date, however, the United States Food and Drug Administration (FDA) has only approved one CBD treatment for two severe forms of epilepsy, and this product requires a prescription.
"The benefits include a couple very rare types of seizures," explains James Adams, Chief Medical Officer at Northwestern Medicine, who was not involved in the current study.
"But the misconception is that it's broadly beneficial. It's not that well researched or understood."
The FDA has apparently seen only limited data on the safety of over-the-counter alternatives. There are some lines of evidence to suggest extended use of CBD is not without its harms, especially concerning the liver and possible interactions with other drugs being taken.
"CBD is probably not that harmful, but we shouldn't expect it to be a medicine," says Adams, who works at Northwestern University.
"It's being promoted for all kinds of purposes for which it's never been studied."
The real risk, researchers say, is that people with treatable conditions will turn to CBD as a valid alternative, something the FDA promised Congress it would be stronger on.
But while the FDA has issued several warnings to CBD companies in the past for the contents of their products and their marketing practices, little other action has been taken.
"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."
Regulations need to become stricter, researchers argue, not only when it comes to marketing but also when it comes to the contents of the product itself.
Because CBD oil and tinctures are sold as supplements, they are not regulated for safety or purity by the FDA, which means we have no idea about dosage.
As a result, some CBD products can contain psychoactive ingredients, like THC, which may make a person feel unexpectedly high. In fact, there are several posts on r/CBD discussing this very problem, with one user admitting they unintentionally failed a drug test because they use CBD for pain management.
Obviously, what's said on Reddit doesn't necessarily reflect the views of the larger public, but because few other surveys and studies exist on this topic, online testimonials are a good place to start.
The sample of the study is small, but the longitudinal research suggests CBD use is on the rise, and in the minds of many consumers, the product has gone from supplement to medicine.
"CBD is this generation's snake oil," argues lead author Eric Leas, who studies public health at UC San Diego, "as millions believing to have discovered a new medical breakthrough are actually taking a product without evidence of a benefit."
The study was published in JAMA Network Open.