Cannabidiol is legal when it contains less than 0.3 percent tetrahydrocannabinol. But no government agency tests products to ensure you won't get high or fail a drug test at work.
All she wanted was an escape from the ceaseless pain and the chance at a good night's sleep.
Walking into the emergency room at Doylestown Hospital, a 70-year-old woman on the list for an organ transplant and diagnosed with the incurable autoimmune disease scleroderma had also tested positive for THC. And, the patient insisted, she'd never smoked a joint once in her entire life.
With high concentrations of tetrahydrocannabinol, marijuana's chief psychoactive compound, discovered in her blood, the patient was removed from the list of those eligible for organ transplant, remembers Dr. Christine Roussel, Doylestown's director of pharmacology.
“It was such a shame because obviously she had about 18 months to live. She was very sick,” Roussel said. “She had gone to some scleroderma support groups and they recommended CBD products, but it was the THC that was helping her sleep.”
CBD, or cannabidiol, is everywhere, and growing faster than the proverbial weed. The Colorado-based BDS Analytics predicts U.S. sales will surge from $1.9 billion in 2018 to $20 billion by 2024, with the majority of CBD products sold in retail stores in next four years.
Under U.S. law, CBD can be legally sold so long as products contain less than 0.3% THC.
The trouble is, no government agency is actually testing the THC levels in these products to ensure you won't get high, become intoxicated while driving, or fail a drug test at work. And, recent research suggests, some products are not sold as advertised.
In May 2018, the science journal Molecules published a study of 14 cannabidiol oils purchased on the internet between December 2017 and January 2018. “Nine out of the 14 samples studied had concentrations that differed notably from the declared amount,” researchers reported. “The obtained results clearly show that 12 out of 14 samples contained THC, which is attention-grabbing because of its potential intoxicating activity,” the study reported.
A second study published last October in the journal Forensic Science International looked at THC blood concentrations after smokers used CBD cigarettes currently legal in Switzerland. The Swiss government allows CBD cigarettes so long as they contain no more that 1% THC. Yet, high THC blood concentrations were reported in CBD cigarette smokers at four hours and 12 hours after smoking, researchers said. “Individuals smoking CBD cigarettes or joints directly prior to or during driving could … risk losing their driver’s license.”
Finally, in the February 2019 edition of the journal Scientific Reports, researchers claimed, “the first known evidence to suggest that applying hemp oil to hair, as cosmetic treatment, may result in the incorporation of tetrahydrocannabinol.” “There may be a risk where laboratories observe detectable hair concentrations of CBD, THC, and CBN in donors who use hemp oil cosmetically,” researchers said.
Mary Jane's little sister
Cannabidiol is drawn from the cannabis sativa plant, more commonly known as marijuana, and makes up 40% of the plant extract, according the U.S. National Library of Medicine. Research suggests it may be a more natural way to treat anxiety and pain, and proponents claim it helps with numerous other conditions as well.
Yet the U.S. National Library of Medicine advises women who are pregnant or may become pregnant not to take CBD, and other health officials advise not to begin taking CBD products without first consulting a doctor, as CBD can have drug interactions, particularly with medications broken down by the liver.
Such warnings come even as other researchers point to potential health benefits from cannabis, including strains containing THC.
The U.S. government classifies pot as an illegal substance, complicating its sale and research into its suspected health benefits.
Yet, on its own website, the National Institute of Drug Abuse, a federal agency, says it's currently using tax money to fund studies of the “potential therapeutic uses of THC and other cannabinoids in treatment of pain, HIV, addiction, and other health conditions” since “research suggests that THC and other cannabinoids, may have potential in the treatment of pain, nausea, epilepsy, obesity, wasting disease, addiction, autoimmune disorders, and other conditions.”
The National Institutes of Health, a division of the U.S. Department of Health and Human Services, states on its website that, compared to cigarettes, smoking marijuana is less likely to cause emphysema or lung cancer. “Animal and human studies have not found that marijuana increases risk for emphysema,” the agency concluded. “While a few small, uncontrolled studies have suggested that heavy, regular marijuana smoking could increase risk for respiratory cancers, well-designed population studies have failed to find an increased risk of lung cancer associated with marijuana use.”
The NIH also states that marijuana is not typically a gateway drug since “the majority of people who use marijuana do not go on to use other, “harder” substances.”
To date, the U.S. Food and Drug Administration has certified just one CBD drug as having any health effects. Containing a “purified form” of cannabidiol, Epidiolex has been federally tested and approved for the treatment of seizures. In an April 12 health advisory, the FDA stressed it has not approved or reviewed any other CBD products. “Unlike drugs approved by FDA, products that have not been subject to FDA review as part of the drug approval process have not been evaluated as to whether they work, what the proper dosage may be if they do work, how they could interact with other drugs, or whether they have dangerous side effects or other safety concerns,” the agency warned.
Since 2015, the agency has also issued more than two dozen warning letters to companies selling CBD products. Among them, a March 28 letter to the Mount Laurel-based Relievus pain management centers alleges the company was selling “CBD Salve,” “CBD Oil” and “CBD for Dogs” in violation of the of the Federal Food, Drug, and Cosmetic Act.
“We started selling CBD products five years ago because the opioid crisis was getting out of control,” said Relievus chief operating officer Ron Saltiel. “We wanted to reduce our patients' use of opioids.”
Following the FDA warning letter letter, Saltiel said his company stopped offering CBD. “We told our patients that we weren’t going to offer it, but we tell them of other places where they can get it,” he said. “It's everywhere.”
Selling like hotcakes
At retailer Deep Six inside the Willow Grove Mall in Montgomery County, you can buy CBD-infused pancake mix. There, you can also buy CBD-infused cat and dog treats, body washes, skin lotions, gummy worms and dozens of other products.
In Yardley, the Prancing Peacock massage, meditation and Reiki and yoga center offers massages in Vital Body CBD Massage Cream, which promises “deep penetration for pain and inflammation.” Owner Liz Conner insists the cream contains no THC.
“The ones that are third-party tested — we know that they're made well, they're made under supervision, and they've been tested by another company,” said Conner. “That was very important to us.”
Most who purchase a CBD massage are “in so much pain, and they're seeking out something as an alternative to medication,” Conner added. “Most people just want to have that therapeutic value. They just want to feel better.”
Nine miles south in Lower Southampton, retailer Hempicated.com markets “Special Sauce Hemp Stiks,” “Strain Sour Space Candy Organic Hemp Flower” and chocolate energy chews with 5 mg of cannabidiol and 100 mg of caffeine. The company says all of its products contain 0.3% THC, or less, and are third-party tested.
Even retailers such as CVS and Walgreens are getting into the game.
CVS is selling creams, sprays, roll-ons, lotions and salves at select stores in California, Colorado, Illinios, Indiana, Kentucky, Maryland and Tennessee, said Joe Goode, senior corporate communications director.
“Anecdotally, we’ve heard from our customers that these products have helped with pain relief for arthritis and other ailments, and we believe consumers will be looking for these products as part of their health offering, said Goode. “We’re entering slowly into this new category, and continue to actively monitor the regulatory landscape for CBD products and will expand product availability as appropriate and in compliance with applicable laws.”
Walgreens sells CBD topical creams, patches and sprays in Colorado, Illinois, Indiana, Kentucky, New Mexico, Oregon, South Carolina, Tennessee and Vermont, said Phil Caruso, a company spokesman. “This product offering is in line with our efforts to provide a wider range of accessible health and wellbeing products,” he said.
On the boardwalk in Sea Isle City, Lucky Leo's Sweet Shop is selling CBD chocolate bon bons in flavors such as “Mango Tango” and “Pineapple Express.”
The Mango Tango strain has “loud peach and citrus flavors,” according to Leafly.com, which describes itself as the “world’s largest cannabis information resource.”
Pineapple Express is a mix of the “Hawaiian” and “Trainwreck” strains made famous by the 2008 marijuana action comedy film of the same name.
‘No recommended dose'
Hardly a cannabis critic, Roussel leads regular training sessions for Pennsylvania doctors and pharmacists interested in prescribing medical marijuana in state-regulated dispensaries selling strains containing THC and solely CBD.
During a recent, four-hour training and certification session held on the Philadelphia campus of the University of Sciences, Roussel and others discussed the many potential benefits from careful cannabis use. At the same time, she described incidents where patients — many of them confused and desperately seeking relief from chronic illness — had ingested incorrect amounts of marijuana-based products.
Among them, a patient in his 80s went to the hospital after experiencing intense bouts of vertigo, Roussel told seminar participants. “He had pancreatic cancer and he was using cannabis for appetite,” she said. “He could not get out of bed. He was so dizzy.”
Another time, Roussel said she was approached by a breast cancer patient taking CBD. “This woman asks me, ‘What's the recommended dose of CBD for breast cancer?' And I told her, ‘There is no recommended dose of CBD for breast cancer.'”