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People on a popular Reddit forum about cannabidiol (CBD) overwhelmingly noted that they use the ubiquitous cannabis compound to self-medicate and many use CBD for wellness, according to a new study.

In an examination of nearly 400 testimonials, 90% of the posters said CBD could treat a diagnosable condition, John Ayers, PhD, MA, of the University of California San Diego, and colleagues reported in .

Psychiatric conditions (attention deficit disorder, autism, depression, and others) were cited most often, in 63.9% of the posts, followed by orthopedic problems (26.4%), sleep disorders (14.6%), and neurological (6.9%) and gastroenterological (3.9%) conditions.

"The findings of this case series suggest that the public may already perceive CBD as an effective therapeutic for many health conditions," Ayers and co-authors wrote. "We believe this misperception warrants a multipronged response encompassing regulation, clinical practice, and health education."

Use of the products in place of proper medical care could be detrimental to public health, they argued.

"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," the group wrote. "In addition, CBD use is not devoid of health risks."

The willingness to self-medicate with CBD also concerned authors of an .

"These data highlight a potential patient population that may be substituting CBD for evidence-based care," wrote Wilson Compton, MD, and Emily Einstein, PhD, both of the National Institute on Drug Abuse in Bethesda, Maryland.

"More research will be the key to understanding possible therapeutic indications of CBD," they continued. "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."

Ayers' group searched 104,917 posts in the Reddit forum r/CBD, from January 2014 through August 2019, and found 376 testimonials of CBD users explaining why they took the compound. Posts to the forum increased over time, with 1,973 in 2016 and 13,752 by 2018.

The researchers developed a coding system to divide the selected posts into two categories: testimonials of CBD as a treatment for a diagnosable condition or testimonials for wellness. They then split these CBD testimonials into 11 subcategories matching medical subspecialty, and two subcategories matching wellness benefits. Researchers sometimes applied more than one code to a post, and other posts were eliminated from analysis.

Users claimed CBD benefited their mental wellness in 29.5% of testimonials, and their physical wellness in 1.4%. Other cited benefits included addiction and sexual health, as well as cardiac, dermatologic, ophthalmologic, and oral health conditions (all <2.0% each).

"Clinicians across specialties should inform patients that over-the-counter CBD is not an approved or recommended treatment and offer opportunities for patients to obtain efficacious treatments, as well as explain that CBD use may not be risk free," they added.

"The evidence base is still developing at a pace that is outstripped by the uptake of CBD," Compton and Einstein noted.

Limitations of the study included results that may not be generalizable to the larger population, the researchers said, as well as their inability to document the posters' full treatment regimens beyond CBD. In addition, they wrote that their estimates may be significantly undercounted, as some users described symptoms that could be associated with an unmentioned diagnosis.

Ayers's group also noted that while surveys are typically used to assess why people use a given product, no surveys of CBD among U.S. consumers currently exist, to their knowledge.

"Large groups of CBD users are gathering on social media to openly discuss why they use CBD," they wrote. "By reading these ongoing conversations, researchers can assess why the public uses CBD."

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