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.
This article originally appeared on Tonic.