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Vaping CBD carries unique risks
senior lifestyle correspondent
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.”
A regulatory no-man's land and a consumer craze have created a perfect storm of untested oils for vaping.