Use of cannabidiol products in Canada, United States, Australia, Aotearoa New Zealand, United Kingdom and Germany: products, sources and reasons for use.

BACKGROUND: Cannabidiol (CBD) has attracted scientific, clinical, and public interest due to its perceived therapeutic benefits and favourable safety profile. However, a gap remains in understanding how different CBD-only regulatory frameworks shape consumers interaction with the CBD-only market. The study aimed to compare across jurisdictions: 1) CBD-only product use; 2) use for mental/physical symptom management; 3) socio-demographic correlates; and 4) sources of purchase; and 5) to estimate associations between CBD-only product use and perceived access to medical cannabis in jurisdictions without legal recreational cannabis. METHODS: Data were from the 2024 International Cannabis Policy Study, national cross-sectional surveys among participants aged 16-65 in Canada (CA), United States (US), Australia (AU), Aotearoa New Zealand (NZ), United Kingdom (UK), and Germany (DE) (n=79,644). Weighted estimates of CBD-only product use and behaviours were calculated, and multivariable regression analyses were conducted to examine correlates. FINDINGS: Lifetime, past 12-month and past month CBD-only product use was the highest in the US and lowest in AU and NZ. Sources of purchase varied by jurisdiction but generally reflected legal access pathways. Oils (between US27.1% and NZ46.8%) and/or edibles (between AU19.8% and US34.2%) were the most reported product types. Pain (between UK32.3% and NZ49.3%), anxiety (between DE30.4% and US46.5%), and depression (between UK24.2% and AU31.1%) were the most reported reasons for use. The use of cannabis for medical purposes with a prescription had the strongest association with past 12-month use of CBD-only products (range: UKARR=3.42-NZARR=14.73). In UK, AU, and NZ, close to a third of respondents who had ever used a CBD-only product reported to do so because they could not legally access medical cannabis (UK28.4% and AU/NZ39.6%). CONCLUSION: There is wide cross-jurisdictional variation in CBD-only product use and retail access pathways reflecting distinct regulatory environments, alongside consistent patterns in products, and reasons for use. Variation in the relationship between CBD-only product use and medical cannabis systems, combined with the use of CBD-only products for managing anxiety, depression, and pain, underscores the need for clearer public health messaging, consumer guidance, and stronger evidence to guide policy and practice.