CBD’s meteoric rise in popularity has seen the compound move from medical marijuana dispensaries into national chain drugstores and high-end beauty and wellness products. From epilepsy to anxiety to pain, people have found it helpful for what ails them.
A recent case study out of New York is especially surprising and troubling.
Because it’s non-intoxicating, it has served as an introduction to cannabis medicine for people who otherwise might avoid the long-maligned plant.
Studies have found CBD to be generally safe in animals and humans alike. The one lingering worry is how CBD is metabolized in the liver. The liver enzymes that break down the compound are also responsible for metabolizing 60-70% of pharmaceuticals. Some drugs don’t play nice with others, and can cause stress on the liver when taken with high doses of CBD. But these interactions can be easily avoided with medical supervision. Studies that over-emphasize CBD’s liver toxicity have been torn apart for everything from their methods to their analysis.
All of that safety data about CBD makes a recent case study out of New York especially surprising and troubling.
A troubling case
In February, a team of doctors from New York and Florida published a case report about a 56-year-old woman who developed a fatal case of Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS-TEN) two days after starting to use a sublingual CBD oil.
SJS-TEN is a poorly understood condition that involves severe rash on the skin and mucous membranes, and has a mortality rate of 10-50%. About half of SJS-TEN cases are thought to be caused by negative drug interactions. The other half, however, don’t have a clear cause.
The patient was on a number of medications to treat chronic pain, hypertension, and coronary artery disease. The only change she made before the onset of a painful rash that developed into SJS-TEN was the consumption of the CBD oil. When she was admitted to the hospital, her doctors took her off of all of her medications. One month later she died of septic shock, a fatal reaction where blood pressure becomes dangerously low due to stress from systemic infection.
Wasn’t her first use of CBD
Curiously, the patient had used CBD oils previously. All of the medications she was using were ones she’d been using for years—including CBD. The only change was the brand of CBD oil she was using.
She'd used CBD before, but the new brand of product coincided with the adverse reaction.
The authors acknowledge this in the report, going as far as to say “the patient has previously utilized other commercial products without side effects or associated allergic reactions. This suggests involvement of other ingredients in this non-FDA-regulated product as the causative agent.” As of the time of the report, the CBD oil the woman had been taking had not been analyzed for other chemical components.
CBD remains largely unregulated
Despite Congressional decree, the FDA has done almost nothing to create a regulatory plan for hemp and CBD products. Last summer they gathered 4,500 comments on the regulation of cannabis and CBD, but have not come to a conclusion about what action they’ll take.
In January 2020, FDA officials released an extremely conservative and poorly researched statement highlighting the “dangers” of CBD. Recently they quietly announced a second comment period, seeking specific scientific information about liver injury, toxicity, and drug interactions, among other topics.
The FDA must take steps to regulate the cannabis industry, and soon. The existing patchwork of state regulations is not doing enough to protect customers from dangerous contaminants. Despite claims that the industry is regulating itself, studies have shown the limits of self-regulation. CBD products with no CBD in them, or THC instead. Products that contain heavy metals, pesticides, or pharmaceuticals. These sorts of contaminants could be what put the SJS-TEN patient in the hospital.
Buyer beware, do your research
As long as there isn’t a national regulatory policy, people’s lives are being put at risk. In the meantime, it’s up to consumers to do what they can to make sure they’re getting a product that they trust. Here are a few indicators of a brand worth trusting:
- They have lab results available online. These are called certificates of analysis, and they should be conducted by third-party labs. Look for results that include CBD, THC, pesticides, and heavy metals.
- They use cannabis grown in this country using organic-like methods. A lot of hemp is imported from China – where it was grown for fiber production. Cannabis is really good at scavenging compounds from the environment it’s grown in, so you want to make sure that it was grown in clean, healthy soil.
- They’re eager to communicate with you about your concerns. The best brands know how hard it is to find a high-quality product, and should be excited to share how they’ve created one.