CBD, cannabis, or both? Examining use patterns and associated factors among U.S. youth and adults

Cannabis and cannabidiol (CBD) use have grown recently among U.S. adults, yet little is known about their exclusive or combined use at the population level. This study sought to assess the prevalence and contributing factors of distinct use patterns.

Data from the 2023 National Survey of Drug Use and Health study were analyzed for adolescents (12-17,n = 11,572) and adults (18+,n = 45,133). Past-month cannabis and CBD use over the past 30 days, including patterns (non-use, exclusive, and dual-use), were reported and associated factors were examined by multinomial regressions.

In 2023, 15.4% and 9.8% of participants reported past-month cannabis and CBD use, respectively; while 8.9, 3.4%, and 6.4% reported exclusive cannabis use, exclusive CBD use, and dual-use, respectively. Cannabis and CBD use were most common among individuals aged 18-34, while dual use was highest in 18-25-year-olds (10.8%). Exclusive cannabis use peaked in 26-34-year-olds (14.8%), and exclusive CBD use was most prevalent in adults 65+ (5.0%). Youth females (vs. males) and those living above the poverty line (vs. in poverty) were more likely to report exclusive CBD use. Adolescents with fair or poor health (vs. excellent/good) were more likely to report exclusive cannabis (AOR = 3.2,p < 0.001), exclusive CBD (AOR = 3.0,p = 0.002), and dual-use (AOR = 3.0, p < 0.001). Based on adolescent regression results, state medical cannabis legalization was associated with higher exclusive cannabis use(AOR = 1.8,p = 0.01). Based on adult regression results, state medical cannabis legalization was associated with higher exclusive cannabis use (AOR = 1.5, p < 0.001) and dual-use (AOR = 1.5, p < 0.001).

Cannabis and CBD use exhibited distinct usage patterns. As cannabis legalization policies continue to evolve, public health professionals should focus on tailored interventions to mitigate potential side effects associated with complex cannabis use.