“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.
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.”
You might be safer with weed
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.
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.
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.
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.
Heating polyethylene glycol may create more of those two harmful chemicals than propylene glycol, vegetable glycerin, or MCTs, according to a 2017 study in the Journal of Alternative and Complementary Medicine. The study authors note that with just a single inhalation from a vape oil containing polyethylene glycol, a person’s intake of formaldehyde would be nearly the same as smoking an entire cigarette.
All those concerns take on added urgency now as the popularity of CBD continues to grow, and vaping remains one of the most popular ways of using it. Sales of CBD overall are expected to nearly triple in the next five years to $1.6 billion, according to the Brightfield Group, which tracks the CBD industry. And nearly a third of Americans who tried CBD in the past 24 months—an estimated 20 million people—said they vaped the substance, according to a January 2019 CR nationally representative survey of more than 1,000 U.S. adults. Even after the lung-injury crisis made headlines, fewer than a quarter of people who vape CBD said they changed their habits, according to the Brightfield Group.
Partly to reduce that risk posed by vaping, in December President Donald Trump signed legislation to raise the federal minimum age to purchase any tobacco product, including nicotine vapes, to 21, up from age 18. But, again, the new age rule does not apply to CBD vape products, which the CDC’s King says varies by state.
The risks of vaping have garnered a lot of attention since last August, after the Centers for Disease Control and Prevention linked the products to a mysterious outbreak of more than 2,600 lung illnesses so serious that people had to be admitted to the hospital. Sixty people have died. The CDC says several thousand more people have probably been admitted to emergency rooms with complaints related to vaping.
How much gets released depends on several factors, says Sward, at the American Lung Association. “Ultimately, what is inhaled into the user’s lungs can depend, based on the device used, its voltage, and even its temperature.”
Gilbert had been vaping CBD for just four days when she developed a fever, shortness of breath, cough, vomiting, and diarrhea, and went to a St. Croix emergency room. There she went into acute respiratory failure and had to be moved to Miami, according to legal documents in her ongoing lawsuit against multiple defendants, including the alleged maker of the CBD product, JustCBD. But Gilbert’s condition worsened, and as her organs shut down, her blood became toxic. Serious clots restricting blood flow formed in her legs, both of which had to be amputated, the suit alleges.
But those new rules would apply only to tobacco vape products, not those that contain CBD.
EVALI is a type of chemical-induced injury that manifests like an illness of the lungs and respiratory tract. Its symptoms seem to begin gradually and can be confused for other respiratory conditions, such as pneumonia.
Suppositories: Rectal suppositories are effective treatments for IBS, hemorrhoids, constipation, and other digestive or urinary issues. Vaginal suppositories can also be used to treat menstrual cramps and endometriosis. You may consider suppositories if you would prefer to avoid the psychoactive effects of THC.
Are Dry Herb Vaporizers Safe?
The CDC recommends that people avoid using vaping products that contain THC, especially those that have been modified or purchased off the street. Vaping products should only be used as intended by the manufacturer.
When you vape weed, the therapeutic compounds in THC aren’t the only things you are inhaling. Vape fluids use a wide range of ingredients to suspend THC or CBD, create a vapor-like aerosol, or add flavor—all of which can irritate the delicate tissues and air sacs in the lungs.
The symptoms include: