Health claims about cannabidiol (CBD) at the point-of-sale in three U.S. states with disparate cannabis policies

Objectives: We assessed point-of-sale advertising for CBD in three states with different cannabis laws (i.e., medical/recreational use; medical only; CBD/low THC) to determine if CBD is marketed in ways that are prohibited by the U.S. Food and Drug Administration (FDA). Under FDA authority, CBD cannot be marketed with misleading advertising, as an unapproved drug, dietary supplement, food product, or FDA-approved/endorsed product. Methods: Between November 2021 and April 2022, two trained data collectors systematically documented point-of-sale advertising in 150 retailers using wearable imaging in Colorado, Maryland, and North Carolina. Advertising was content analyzed to determine the types of cannabinoids, prohibited health claims, and medical conditions it claimed to affect. Results: We documented and content analyzed 1090 CBD-specific advertisements, resulting in 985 prohibited claims, representing all claim types. Among CBD-specific ads, over half (61.8%) contained at least one prohibited claim. CBD was frequently advertised as an unapproved drug (53.6%) and food additive (51.6%). Prohibited therapeutic claims were made for 125 different health conditions, including pain, inflammation, and cancer. Most retailers (80%) displayed at least one prohibited claim. Conclusions: Prohibited advertising for CBD, which may mislead consumers about its risks and benefits, is extensive at the point-of-sale, highlighting the need for enforcement efforts.