Federal researchers are racing to trace thousands of cases of lung damage and dozens of deaths to so-called smokeless consumption of tetrahydrocannabinol or THC, the ingredient that produces the marijuana high. Other federal officials also are warning about cannabidiol or CBD — a derivative of marijuana or its cousin hemp — and its burgeoning and unapproved use in an array of products on the market.
To be sure, because blue-nose attitudes blocked rigorous research on marijuana and other drugs, medical scientists have been scrupulous in declining to make sweeping declarations about grass and its potential benefits or harms.
While weed itself may be just another botanical, neither necessarily evil nor good, the embrace of marijuana and its derivatives, especially as commercial enterprises have refined and promoted these, are posing greater challenges. These are getting big public attention.
The federal Centers for Disease Control and Prevention, for example, has raised big concerns, along with other public health experts and agencies and educators and law enforcement, about the rise of e-cigarettes and vaping — the catalyzing in specialized devices of liquids containing high producing substances, notably walloping doses of nicotine and THC.
When the San Francisco-based firm Juul tapped into social media to promote its devices as a hot youth trend, concern spiked among educators and adults about widespread use by young people of e-cigarettes and flavored liquids, mostly to get a nicotine buzz.
But the outbreak of vaping-related lung injuries and deaths, now numbering almost 2,300 cases of serious harm and roughly four dozen fatalities, has led sleuthing medical scientists to zero in on THC users. As the Washington Post and other media organizations have reported, experts have drilled down on how vaping products, especially of the bootleg kind, diluted or tainted expensive THC in vaping liquids by adding Vitamin E acetate, a cheaper extract. But that substance, when pulled deep into the lungs as a vapor, can savage sensitive tissues — with some experts comparing the extract to inhaling grease.
The quest to find what was injuring and killing vapers has been challenging and urgent, involving at least 100 medical experts, the Washington Post reported:
“Over the past three months, teams of scientists working to solve the mystery developed extensive lab tests and built a new data-collection system on the fly. They even relied on 3-D printers to manufacture custom parts so vaping devices could be fit into CDC’s special smoking machines, enabling them to ‘puff’ on the devices to test the aerosols that are released. In many infectious disease outbreaks, disease detectives have some idea of the likely culprit, or at least a sense of how to approach the investigation. The challenge in this case was that no one had any idea what might be making so many people so sick. Even more daunting, federal and state health officials were dealing with a vast number of possible suspects that included several hundred e-cigarette or vaping devices and thousands, if not more, of e-liquids, many of which contain more than one ingredient. Supply chains for the vaping products also appear to vary state to state.”
While authorities haven’t determined that Vitamin E acetate is the major or sole culprit in the deadly outbreak, they have warned users — young and old — to stop vaping for now, especially to consumer THC. State and local officials have cracked down further on e-cigarettes and vaping, though the Trump Administration has waffled so far on how far the federal response should go, including flavoring or even e-cigarette bans.
A tougher outlook on CBD
The federal Food and Drug Administration, meantime, has its hands full with oversight of CBD, a substance whose uses are proliferating faster than regulators seemingly can react.
The agency’s policy-making CBD was complicated by congressional legislation legalizing and promoting hemp-based products, without specifying or foreclosing cannabidiol. The FDA further complicated its own lot by previously forcing an epilepsy-treating drug that relies on CBD to undergo rigorous testing. The agency approved the drug for public use.
But it has become murky whether all CBD products now are subject to the FDA’s toughest oversight, notably with clinical trials. Or is it a foodstuff or supplement, receiving light or minimal federal regulation.
That has left CBD to boom into what some experts predict will be a market exceeding $1 billion. It already has been touted as a pain reliever (for which there is limited substantiating research), and as a purportedly beneficial additive to not only human food but also to pet products.
The FDA moved to stomp out CBD claims, repeating that the substance and the wide uses it is now undergoing, has not been subject to close study. That should mean to consumers the substance cannot be declared anything more than relatively safe, and it certainly does not mean it can be promoted as healthful or beneficial.
The agency revised its consumer information on the product, now stating:
“The FDA has approved only one CBD product, a prescription drug product to treat two rare, severe forms of epilepsy. It is currently illegal to market CBD by adding it to a food or labeling it as a dietary supplement. The FDA has seen only limited data about CBD safety and these data point to real risks that need to be considered before taking CBD for any reason. Some CBD products are being marketed with unproven medical claims and are of unknown quality.”
The FDA added:
“CBD has the potential to harm you, and harm can happen even before you become aware of it. CBD can cause liver injury. CBD can affect the metabolism of other drugs, causing serious side effects. Use of CBD with alcohol or other Central Nervous System depressants increases the risk of sedation and drowsiness, which can lead to injuries. CBD can cause side effects that you might notice. These side effects should improve when CBD is stopped or when the amount ingested is reduced. Changes in alertness, most commonly experienced as somnolence (drowsiness or sleepiness). Gastrointestinal distress, most commonly experienced as diarrhea and/or decreased appetite. Changes in mood, most commonly experienced as irritability and agitation. There are many important aspects about CBD that we just don’t know, such as: What happens if you take CBD daily for sustained periods of time? What is the effect of CBD on the developing brain (such as children who take CBD)? What are the effects of CBD on the developing fetus or breastfed newborn? How does CBD interact with herbs and botanicals? Does CBD cause male reproductive toxicity in humans, as has been reported in studies of animals?”
To further emphasize its tougher new stance on CBD, the FDA issued warning letters to 15 companies, telling them the agency believes they are selling the substance illegally and giving them a short period in which to defend their products.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs. Marijuana long has been a demonized substance, which still has risen in public popularity — among milennials and baby boomers alike — so that it has been legalized to varying degrees in numerous states. Pot legalization has become an issue in federal 2020 races, too.
But, at the same time, states also have struggled to deal with legalization, particularly as high drivers have caused road wrecks, and officials lack legally reliable mechanisms or devices to determine motorists’ possible marijuana intoxication — as law enforcement long has claimed it could do with alcohol and its abuse. (Please don’t drive while stoned.)
So, let’s be clear: More and rigorous study is needed on marijuana and other drugs used for recreational purposes. The execution of policy may have raced far ahead of what medical science can tell the public about the good or ills of substances like THC or CBD. That should suggest to users not to be swayed by what amounts to little more than medical science woo — excessive claims about products’ benefits or harms.
There are clear indications — including marijuana’s implication in bad trips that send users to emergency rooms for vomiting and nausea and analyses showing associations between grass smoking and cancers — that pot may carry higher risks than fans might acknowledge. Similarly, vaping fans need to look hard at the fundamentals: No serious expert argues that e-cigarette use causes no harm — the damages of vaping may (emphasis may) just be less that smoking combustible tobacco, proven to cause cancers and heart and lung disorders.
Don’t be a dope about vaping, THC, and CBD. Just because folks, maybe even in considerable number, promote their use does not mean you should go all in. What was mom’s question about all the kids jumping off a tall building’s roof and whether that meant you should, too?