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Is it safe to vape CBD?

Last August, Erin Gilbert's organs began to paralyze. First your lungs, then your kidneys and liver. Medical staff at the hospital in Miami, where she had been airlifted, struggled to keep her alive. Just days earlier, Gilbert, 35, a mother of 3, had used her first CBD vaporizer (cannabidiol), a mango-flavored oil that she says she purchased where she lives in St. Croix, US Virgin Islands. United, according to a lawsuit filed in September.


CBD is a non-psychoactive compound found in cannabis plants, including hemp (hemp) and marijuana, which is often used to relieve anxiety, insomnia, and pain.


It is currently legal in the United States thanks to legislation passed in 2018 that allows farmers to grow hemp and extract its derivatives, such as CBD, as long as the product does not contain more than 0.3% THC (tetrahydrocannabinol). That is the compound in cannabis that can get a person high when taken in large quantities.


Gilbert had been vaping CBD for just 4 days when he developed a fever, shortness of breath, cough, vomiting, and diarrhea and went to a St. Croix emergency room. There she suffered acute respiratory failure and had to be transferred to Miami, according to legal documents in her ongoing lawsuit against several defendants, including the alleged manufacturer of the CBD product, JustCBD. But Gilbert's condition worsened, and when his organs became paralyzed, his blood became toxic. Serious clots formed that restricted blood flow in his legs, which had to be amputated, the lawsuit alleges.


Gilbert's attorneys said that neither they nor their client can comment on the case at this time. Terry Fahn, a spokesperson for JustCBD, told CR that the company does not sell products in the US Virgin Islands and that "they have received numerous reports of counterfeits" and believes that Gilbert's injuries may have resulted from "using a counterfeit product. sold illegally through the black market. "


The risks of vaping have drawn a lot of attention since last August, after the Centers for Disease Control and Prevention (CDC) linked these products to a mysterious outbreak of more than 2,600 lung diseases so serious that people had to be hospitalized and another 60 have died. The CDC says that probably thousands more people have been admitted to emergency rooms with complaints related to vaping.


The CDC traced the origin of many of the hospitalizations to vitamin E acetate, used to dilute the oils used in vaping. The vast majority of illnesses involve products containing nicotine or THC, especially those purchased illicitly, says Brian King, Ph.D., CDC's chief scientific officer. After initially warning consumers to avoid all vaping products, the agency on Jan.17 limited that advice to THC vape pens, especially those obtained from family, friends, online, and illegal dealers. as growing research found "a strong link between these products and lung injury," says king.


But in at least 26 of the cases, people like Gilbert were hospitalized after reporting that they had only vaporized CBD and likely more people went to the emergency room. Additionally, many doctors, scientists, government officials, and even industry representatives remain concerned about vaping, especially CBD, for various reasons.


For one thing, beyond the dangers of vitamin E acetate, little is known about the long-term effect of inhaling various other chemicals often found in vaping oils, says Michelle Peace, Ph.D., Toxicologist and Associate Professor in the Department of Forensic Science at Virginia Commonweath University in Richmond who has studied and analyzed vaporizing oils .


On the other hand, the devices themselves, when heated, can cause a chemical reaction in the vapor, posing a greater risk to the lungs, one reason the American Lung Association (ALA) warns people to stay away from all vaping devices, says Erika Sward, the association's national assistant vice president of advocacy, who has advised people not to vape at all.


Finally, there is little regulatory oversight of CBD in general and in vaping in particular the Food and Drug Administration (FDA), which oversees tobacco products, including vaporizers, has yet to determine how it should regulate CBD vaping products.


The CBD industry has requested more oversight from the FDA, says Jonathan Miller, general counsel for the US Hemp Roundtable, which represents CBD manufacturers and funds the industry's certifying group, called the US Hemp Authority . While the FDA provides some guidance on dietary supplements, foods, and cosmetics, it doesn't offer similar oversight of vaping products, it says. This lack of regulation on vaping prevents the US Hemp Authority from certifying CBD vaping oils, as it does for CBD topicals, tinctures, and edibles.


All of those concerns take on more urgency now as the popularity of CBD continues to grow and vaping remains one of the most popular ways to use it. Overall CBD sales are expected to triple over the next 5 years to $ 1.6 billion, according to Brightfield Group, which tracks the CBD industry. And nearly a third of Americans who tried CBD in the past 24 months - roughly 20 million people - said they vaped the substance according to a January 2019 CR national representative survey of more than 1,000 American adults. Even after the lung injury crisis made headlines, less than a quarter of people who vaped CBD said they changed their habits, according to Brightfield Group.


This is what the experts care the most.


Dangerous solvents


While vitamin E in bootleg vaping products appears to be the primary culprit for most of the reported injuries and deaths, there are other substances, even in legitimate vaping oils, that are also of concern.


Manufacturers sometimes add a solvent to an oil to be inhaled with vape pen, battery-powered devices to heat and vaporize the oil, says Neal Benowitz, MD, a cardiologist and toxicologist at the University of California, San Francisco , who has studied smoking, cannabis, and vaping.


Two common ingredients are propylene glycol and vegetable glycerin, although manufacturers sometimes also use polyethylene glycol and what are known as medium chain triglycerides (MCTs), such as coconut oil.

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The long-term effect on human health of repeated use of these solvents is virtually unknown.&nbsp;Few animal or human studies have been done on the safety of propylene glycol or plant glycerin when inhaled, especially in the long term, according to a&nbsp;2018 National Academy of Sciences, Engineering and Medicine (NASEM) report&nbsp;.


Still, manufacturers use some solvents that the FDA has given a GRAS (&quot;Generally Known As Safe&quot;) designation, says Peace.&nbsp;&quot;But the FDA only considered the chemicals safe to ingest through the digestive tract, and they were not considered safe to inhale into the lungs,&quot; says Peace.


In fact, the FDA does not maintain a list of chemicals that are safe to inhale.&nbsp;&quot;GRAS is a standard that applies to food,&quot; says Stephanie Caccomo, an FDA spokesperson.&nbsp;&quot;The FDA does not have a GRAS standard for tobacco products and / or ingredients.&quot;


That's a problem for CBD manufacturers, says Miller of the United States Hemp Roundtable.&nbsp;Without a list of FDA-approved substances that can be used in vaping, they are alone in determining which chemical combinations work best.&nbsp;&quot;Unscrupulous people take advantage of this gray area of ​​regulation and can present products solely for profit and without concern for public health or safety,&quot; says Miller.

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