CBD Retailers in NC Promote CBD Online to Treat Pain Violating FDA Rules About Medical Claims and Offer Low-CBD/High-Price Products

Lindsay Amann; Elizabeth Kruse; Allison J Lazard; Beth A Reboussin; Kimberly G Wagoner; E Alfonso Romero-Sandoval

doi:10.2147/JPR.S384996

CBD Retailers in NC Promote CBD Online to Treat Pain Violating FDA Rules About Medical Claims and Offer Low-CBD/High-Price Products

J Pain Res. 2022 Dec 7:15:3847-3858. doi: 10.2147/JPR.S384996. eCollection 2022.

Authors

Lindsay Amann¹, Elizabeth Kruse¹, Allison J Lazard^{2

3}, Beth A Reboussin⁴, Kimberly G Wagoner⁵, E Alfonso Romero-Sandoval¹

Affiliations

¹ Department of Anesthesiology, Pain Mechanisms Laboratory; Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
² Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, 27514, USA.
³ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel HIll, NC, 27599, USA.
⁴ Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
⁵ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.

Abstract

Introduction: Cannabidiol (CBD) products are available nearly nationwide in the US and can coexist with medical or recreational programs. North Carolina (NC) is an example of a state with a program dedicated to integrating hemp cultivation and medicinal CBD exclusively, containing a multitude of retailers selling it as a primary product. The Food and Drug Administration (FDA) mandates that non-FDA approved CBD products cannot be marketed using medical or health-related claims and has sent warning letters to retailers violating these terms. We aim to characterize the online content of the NC CBD market by analyzing retailers' websites to determine whether hemp/CBD shops comply with FDA regulations in terms of medical claims and analyze the claimed CBD content and price of products offered online.

Methods: We randomly selected three CBD retailers from the ten most populated cities of NC. We analyzed their website content: product type, medical claims, other disclaimers, price, and CBD content.

Results: We found that edible, oral, inhalable, and topical products are offered in similar proportions. Word analysis of product description revealed that "pain" and "pain relief" were the most common medical claim, followed by inflammation and anxiety. Health claims were mostly related to wellbeing. Other attributes indicate that products are associated with pleasant flavors or sensations (ie, cool, lavender, delicious, honey, menthol), which resembles the strategies used for tobacco advertisement. Most products (61%) claimed to contain less than 1000 mg of CBD. The median price of products ranged from $15-30 per 300 mg. We found a positive correlation between CBD content and price.

Discussion: Our data demonstrate that the NC online CBD market does not comply with FDA regulations, primarily targets patients with pain, inflammation, or anxiety, and offers products with low CBD concentration and high prices. New policies should limit the access and online promotion of non-pharmaceutical grade CBD products.

Keywords: cannabidiol; cannabis market; dispensary; hemp; medical marijuana; misleading claims.

Grants and funding

R01 DA053209/DA/NIDA NIH HHS/United States