Vaping CBD carries unique risks
People like vaping because it’s a smokeless, convenient, and fast-acting way to consume pleasure-inducing chemicals including THC and nicotine. It’s also potentially quite dangerous—and that’s also true when it comes to vaping cannabidiol, the popular cannabis-derived compound known as CBD. In fact, thanks to a regulatory no-man’s-land, a consumer craze, and manufacturers who dilute extract with oils better suited for salad dressings, CBD vapes are uniquely risky.
As of Oct. 10, more than 1,200 cases of a mysterious vaping-related illness, and 26 related deaths had been reported to the US Centers for Disease Control and Prevention (CDC), which is advising consumers to “consider refraining” from vaping altogether. Of the 771 patients the CDC previously reported data on, the majority reported vaping THC and/or nicotine. Only about 17% reported having vaped a CBD product, but there is still good reason for CBD enthusiasts to take note—and even to be especially cautious.
“There’s no regulations.”
“There’s no regulations, there’s no one telling companies what to do,” says Jonathan Miller, general counsel for the trade group US Hemp Roundtable. “I don’t want to say it incentivizes bad behavior but it certainly doesn’t crack down on bad behavior.”
While no single brand, product, or ingredient has been identified as the cause of the 1,000-plus cases of vaping-associated pulmonary injury—first called VAPI and now renamed EVALI—we do know that many of the affected patients were vaping illicit, and therefore unregulated, THC products. Tests showed many of those contained vitamin E acetate, an oil derived from vitamin E—which is considered safe for skincare but not for inhalation.
We can’t reasonably expect dealers of illegal cannabis vapes would test their products for safety or share ingredient lists with customers. The thing is, consumers can’t necessarily expect that sort of testing or transparency from manufacturers of hemp-derived CBD vapes either—even if they’re buying them from vape shops, specialty stores, or websites that don’t appear to be breaking the law. The category is completely unregulated. And reckless players are not limited to labeling their products as THC. In September, the Associated Press tested 30 vape products marketed as CBD from brands that authorities had flagged as suspect, and found that 10 contained dangerous synthetic marijuana and many had little to no CBD at all.
While the US Food and Drug Administration (FDA) has been struggling to research and regulate both CBD and vaping separately, the agency has allowed manufacturers to flood the market with both types of products. In the FDA’s eyes, none of these products are legal, as they have not been evaluated or regulated for their safety. And where these two categories overlap in CBD vapes is a grey area that’s ripe for exploitation at the risk of consumers’ health. According to analysts at Cowen and Company, that grey area was worth an estimated $40 million in sales in 2018.
Meanwhile Miller, along with many others in the cannabis and hemp industries, is eager for lawmakers to create legal frameworks for their products. They point to the reported illnesses from black-market vapes as proof that a legal, regulated cannabis market is a safer one.
A brief legal primer
The difference between cannabis and industrial hemp in the eyes of US law is the content of THC, the intoxicating compound in cannabis: If a plant contains more than 0.3% THC by dry weight, it’s cannabis, and still considered federally illegal despite the many states with legalized recreational and medicinal use. If it’s less 0.3% THC by dry weight, it’s considered hemp, which is being incrementally regulated by government agencies. The 2018 Farm Bill removed industrial hemp from the Controlled Substances Act, essentially declassifying it as a dangerous controlled substance of no medical use, clarifying its status as an agricultural product, and making it legal under federal law under some circumstances.
In May of this year, the FDA held a public hearing where more than 100 stakeholders—patients, manufacturers, and researchers among them—testified about their experiences with CBD. Now, the industry is waiting for a timeline for regulation, which was expected this autumn, but has yet to appear. In the meantime, the FDA considers interstate sale of CBD as a food additive or nutritional supplement (ie., all those candies, canned sodas, and tinctures) to be illegal. But it’s not enforcing the law so long as operators in the estimated $590 million market for hemp-derived CBD adhere to the broader rules for the categories they fall in, whether that’s food, supplements, or cosmetics.
But here’s where it gets complicated, because the FDA hasn’t regulated vaping yet.
“You get kind of a double grey area here,” says Miller. “CBD is considered illegal by the FDA, and vaping is now viewed pretty hostilely by the FDA. It really is a great unknown … Without the FDA engaged formally, it makes it a lot tougher for consumers to figure out what’s a good product and what’s not.”
You might be safer with weed
If you’re in a state where weed is legal, you might be safer smoking (or vaping) it, by going to a licensed dispensary for a high CBD-strain or vape that’s subject to the same regulations that cannabis is. In states like California and Oregon, where cannabis is regulated by state agencies, products with THC are subject to testing for contaminants such as pesticides, heavy metals, solvents, and mold-related toxins. Again, hemp-derived CBD products are currently subject to … nothing.
“It’s the wild, wild west,” says Aaron Riley, the CEO of the Los Angeles-based cannabis testing lab CannaSafe, of the CBD landscape. Riley says that many of the CBD products CannaSafe tests would fail if they were subject to the same exacting standards as products containing THC—but they’re not. “You don’t have to get licensed. You don’t have to do any type of testing at all.”
Which isn’t to say that no one is testing CBD products. As the Hemp Roundtable’s Miller said, “some very well-meaning companies will try to promote the best practices.”
Some of those companies are those that come from the cannabis industry, and therefore have years of experience with extraction and testing.
The northern California-based company Bloom Farms—which has been in the cannabis extracts business since 2014—started selling hemp-derived CBD products online in January, and puts them through the same testing processes as their products with THC, which are under the strict purview of the California Bureau of Cannabis Control. Customers can also download a certificate of analysis from Bloom’s website that provides test results from a third-party lab, but that’s far from standard in the CBD space.
An oily situation
And of course, not all CBD vapes are created equal. Many extracts sold in vape pens and cartridges are diluted with other substances, such as medium-chain-triglyceride, or MCT, oils—fats that are frequently derived from natural sources such as coconut oil. While these are known to be safe to eat—and are often found in CBD tinctures—there’s little if any evidence that it’s safe to vape them, despite some manufacturers touting them as an all-natural ingredient.
“It’s totally horrifying to me,” says Katie Stem, an herbalist who cofounded the Oregon-based cannabis company Peak Extracts in 2014, and has researched plant medicine and chemistry at Oregon Health & Science University. “People should not be cutting [cannabis extracts] with any sort of culinary lipid.” Stem says that with an extraction process using carbon dioxide as a solvent, it’s possible to create a vape-able distillate containing only plant material, without any additives.
Quartz contacted two manufacturers of CBD vape pens that contain MCT oil, and neither has replied to our messages. Bloom Farms’ unflavored CBD vape contains no MCTs or other cutting agents. The company’s flavored CBD vape pens contain trace amounts of MCTs—less than 0.3% according to a company representative—and the company is currently phasing them out.
Neal Benowitz, a professor of medicine at the University of California, San Francisco, who has studied the pharmacology of e-cigarettes, says that CO2 extraction process is “pretty clean,” and the results are well-known.
“People have been vaping them for a long time, and haven’t had a problem,” he says. “That seems to be relatively safe, and that’s a solvent that dissolves them. The question now is, when you start messing with that process, what are you adding to it?”
Benowitz said the effects of vaping MCT oil, however, is an understudied area.
“I’m concerned about it,” he says. “But I don’t have any data.”
Stem speculates the tendency to mix cannabis extract with MCTs might come down to greed or ignorance, and a misunderstanding of the term “cannabis oil,” which is something of a misnomer since CBD and THC extracts are not fatty lipids at all.
“They think, ‘Oh, it’s an oil. I can mix it with another oil and that will thin it and it will make it easier to flow into our vape pen,’ and it’s not harmful because we’re already smoking oil. Well, no. Cannabis extract is not an oil,” says Stem.
Kathryn Melamed, a pulmonologist at University of California, Los Angeles, Medical Center who has seen patients affected by vaping, agrees that smoking oils can be dangerous, and notes that the vaping-related illness bears some resemblance to lipoid pneumonia—a direct reaction to lipids or oils in the lungs.
“While one type of substance—like vitamin E or maybe some other oil—can be ingested and metabolized through the gut, the lung just doesn’t have that ability,” she says. “So then it becomes much more dangerous, and a particle that the lung wants to try to fight and expel. And that’s the inflammatory response that you get.”
Everything We Know About the Health Risks of Vaping CBD
Earlier this year, the United States Army issued a public health warning after medical centers at two bases in North Carolina saw some 60 patients within a few months for health issues that officials linked to their use of CBD vape oils. The symptoms included everything from headaches, nausea, and vomiting to disorientation, agitation, and seizures.
A few months later, North Carolina health officials issued their own warning after local emergency rooms saw some 30 people come in suffering from hallucinations, loss of consciousness, and heart irregularities linked to vaping CBD products. Both notices hinted that officials feared such visits could grow exponentially more common as popular interest in and access to CBD vaping, a legal practice in many states with a host of purported (but still not conclusively proven) health benefits expands.
These reports should be enough to give anyone vaping CBD—or considering it for medicinal or recreational purposes—severe pause. Experts and existing evidence largely agree, though, that CBD itself, even when vaped, is largely safe. But that is only if you can get your hands on unadulterated CBD tinctures to vape. The problem many CBD vapers have faced recently seems to stem mainly from poor regulation over the vaping market in general, and the subsequent unreliable quality of any vape or vape oil.
What are the benefits and side effects of vaping CBD?
CBD is an abbreviation for cannabidiol, one of more than 100 active cannabinoid components found in cannabis. Studies of its myriad potential medical benefits have found that people can tolerate a wide range of doses of it with minimal effects, including weeks on continuously high dosages. Granted, that doesn’t mean there are no side effects. Studies have found that CBD can cause some users to experience irritability, lethargy, reduced appetite or urination, gastrointestinal distress, rashes, breathing issues, or in the worst instances, liver problems or exacerbations of mental health issues.
Knowledge of the way our bodies process CBD also suggests that it interacts with enzymes in the liver in ways that may change the efficacy of a number of other drugs, from blood thinners to anticonvulsants, to antidepressants. This may potentially lead to increased side effects, or even a risk of unintentional overdose on other drugs in the worst cases.
We do not yet know enough to say definitively how common these side effects are, or how many of them are native to CBD usage versus the result of those potential interactions between CBD and other drugs. We also don't know with any reliability how different doses might lead to different side effects or drug-drug interactions, or how drastically these effects may differ from body to body or in conjunction with other conditions. Nor do we have any good data on how CBD might affect children differently than adults, or long-term users over the course of decades.
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However scary all of that may sound, though, general consensus seems to be that these risks are tiny, and if encountered, often easily tackled by changing dosages. Even the Army’s health warning on CBD vaping described pure CBD oil, on its own, as relatively safe.
How safe is it to vape CBD?
In theory, nothing about vaping—which just heats a tincture of a substance at high temperatures to create a vapor to inhale—should change the risk profile of CBD. However, Michelle Peace, a toxicologist and vaping expert at Virginia Commonwealth University, does note that, “when you inhale something as opposed to eating something,” the way many other CBD products are consumed, “you do have to be careful about dosing because inhalation is a much more efficient way to get drugs into the system and be active.”
Cannabis industry companies tend to claim vaping CBD makes the same dose about four times more potent, although Peace notes that there are as of yet no real and conclusive studies on this subject. Regardless, that could clearly lead people prone to CBD side effects or drug-drug interactions to face increased risks of negative effects, which could explain some emergency room visits. This risk is easily addressed by exercising due caution about dosing, as one would (or should) with any other substance.
The nature of vapes, however, could introduce a few new risks to CBD usage, even if the process of vaping doesn’t. Earlier this year, a study on vapes at Johns Hopkins University found that, while heating, some of their coils—the metal bits used to heat tinctures—likely leech notable amounts of heavy metals like chromium and nickel into the vapor users eventually inhale. “What is the long-term impact of inhaling these particulate metals?” Peace says. “We don’t fully understand that yet.”
How safe are CBD oils themselves?
Vape oils are also poorly regulated, which has resulted in frequent reports of items sold as, say, pure nicotine that are actually adulterated with known toxic substances. Some of these substances, like the buttery flavoring agent diacetyl, are perfectly safe to, say, eat, but when heated in a vape and inhaled, can cause serious lung irritation. CBD vape oils are no different: A 2017 study of 10 such products found that seven misrepresented the dosage of CBD found within them and two contained THC, the other well-known cannabinoid in cannabis that often has oppositional effects to CBD. This may speak to mischaracterizations of the source of the CBD in a vape product: isolated and purified CBD extracts or a concoction made of whole plant cannabis that had a high CBD:THC ratio. Some scientists worry that vaporizing as opposed to burning and smoking whole cannabis materials can lead to unique complications, failing to break down a waxy material from the plant’s leaves, which can then build up in a vaper’s lungs and cause irritation. Peace notes that her lab has also studied some CBD products and found worrying items in some of them that were not announced on the box. In the products they evaluated, she says, “rarely have we found that there has been much truth in advertising.”
Health officials seem to consider this rampant, hidden adulteration the greatest risk associated with vaping CBD as opposed to consuming it in any other form. The Army’s health warning called out the risk of adulteration with synthetic cannabinoids and high concentrations of THC in these products in particular as the likely cause of many, if not all, of the CBD vaping illnesses it saw. And that could be a huge problem for vapers: Peace notes that usually her advice would be for people interested in vaping CBD to just be conscious consumers, reading product labels and consulting their doctors about dosing and possible drug-drug interactions. However, no one has a master list of questionable brands, or a good sense of how to spot them. Peace notes that even some seemingly legitimate retailers may be selling bad tinctures.
As such, conscious and cautious consumption is almost impossible. Nor is it possible for users to make a real and rational gauge of risk, given uncertainty about the scale of adulteration in the industry. The only real solution to this risk—common to all forms of vaping—would be greater regulation of the industry. But with no signs of that in the offing, users can only approach vaping of CBD or any other substance with a degree of caution and a knowledge of the risks involved.