(CNN)Medical marijuana is now legal in 29 states and the District of Columbia. But the law is not quite as black and white regarding marijuana extracts such as cannabidiol. CBD is one of the active ingredients in cannabis, increasingly thought to offer wide-ranging health benefits, with few side effects and little risk of addiction or abuse.
“More and more evidence is coming out that CBD can be helpful for a variety of conditions, from anxiety to inflammation to seizures and epilepsy,” said Marcel Bonn-Miller, an adjunct assistant professor of psychology in psychiatry at the University of Pennsylvania.
No surprise, dozens of companies are jumping on the proverbial bandwagon, peddling these products to consumers who have high hopes that they will help treat myriad ailments, from chronic pain to PTSD.
Even though medical marijuana is legal in more than half of US states, it remains illegal under federal law. As a result, the Food and Drug Administration does not regulate derivatives of the plant, including CBD extracts.
Bonn-Miller believed that a “systematic evaluation” of the products on the market was needed so consumers would know exactly what they were buying. Today, “It’s the Wild West,” he said.
For a study published today in the Journal of the American Medical Association, Bonn-Miller and his team bought 84 commercially available CBD products on the internet and had them chemically analyzed by an independent lab.
The researchers found that only 31% of the products tested contained the precise amount of CBD advertised on the label (within the acceptable margin of error), while 26% contained less CBD than the label indicated and 43% contained more.
Accuracy of labeling, it turned out, was also associated with product type. About half of the CBD extract oils were labeled inaccurately. Nearly 90% of the vaporization liquids were labeled inaccurately. Tinctures (alcoholic extracts) were roughly equally likely to be over-, under- or accurately labeled.
The quick hit history of medical marijuana
“Was I shocked? No,” Bonn-Miller said. “Was I disappointed? Yeah. It just got me thinking, we need oversight of this industry. … (It’s) one thing on the recreational side, but here we’re talking about something that people are using almost exclusively medicinally. You don’t get high off of CBD.”
That’s what made another finding from the study stand out: “Concentration of unlabeled cannabinoids was generally low; however, THC was detected in 18 of the 84 samples tested,” according to the paper.
THC, or tetrahydrocannabinol, has its own medical applications but, unlike CBD, is psychoactive and can cause a “high.”
Unknowingly ingesting THC, Bonn-Miller said, could result in side effects such as trouble sleeping and cognitive impairment. It could also have unintended consequences, such as positive drug tests.
“As things stand now, the supplement industry overall is not regulated,” CNN Chief Medical Correspondent Dr. Sanjay Gupta said. “You don’t always know what you’re getting, how much you’re getting or even if the active ingredients are in there at all. With medical marijuana, it is almost the opposite situation at the federal level. It is highly regulated.”
Bonn-Miller said increased regulation is exactly the kind of change he hopes his study will initiate.
“If the FDA regulated this industry, we would be way better off,” he said. “They’re good at regulating things. When you go and buy a prescription at a pharmacy, you know what you’re getting. … (It’s the) same thing for food. When you get a pack of Doritos or a Hershey bar, you know what it is.”
Perhaps in a sign of what’s to come, last week the FDA issued warning letters to four companies that the agency said are “illegally selling products (derived from marijuana) online that claim to prevent, diagnose, treat, or cure cancer without evidence to support these outcomes.”
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Until these products are officially regulated, it’s buyer beware.
Before purchasing any pot pills, potions or lotions, first check the laws where you live. Then, make sure you’re ordering from a reputable dealer. Don’t be fooled by bogus offers or sham celebrity endorsements.
Unless you’re fully confident in the ingredients of the product, Bonn-Miller suggests following the adage “start low, go slow” — referring to dosage. Of course, your best bet is to always talk to your doctor before starting or stopping any medications or supplements, including CBD.
Retirement home residents take a trip to a producer
Forget bingo, tea dances and seaside trips. Residents from a chain of Seattle retirement homes are going on Pot for Beginners tours to learn about and buy cannabis in the city, where its now legal.
Connie Schick said her son roared with laughter when he heard she was joining a field trip to a cannabis-growing operation, an extraction plant and shop. The 79-year-old, who smoked the odd joint in the 70s, wanted to know how legalisation has changed the way the drug is used and produced.
Schick was one of eight women, from their late 60s to mid-80s, who descended from a minibus emblazoned with the name of their assisted living centre, El Dorado West, outside Vela cannabis store last Tuesday.
You can only play so many games of bingo, said Schick. My son thought it was hilarious that I was coming here, but Im open-minded and want to stay informed. Cannabis has come so far from the days when you smoked a sly joint and got into trouble if they found out. We used to call it hemp then and didnt know its strength. It just used to make me sleepy, so I didnt see the point.
Schick, who uses a wheelchair after suffering a stroke, is interested in the therapeutic effects of cannabis. Its so different now. There are so many ways you can take it, and all these different types to help with aches and pains.
They used to say it was a gateway drug to other things, like cocaine Lots of peoples views are changing.
Much of this is attributed to the ageing of the baby-boomer generation, who dabbled with the drug when they were young and are returning to it for medical or recreational use as it becomes legal and more normalised. Cannabis is now legal for medical use in 29 states and for medical and recreational use in eight (since 2012 in Seattle and the rest of Washington state).
Most of the women on the tour were more interested in the medical use, although Denise Roux, 67, said: I would like to buy it to get high too but Im a cheap high, it doesnt take much.
A seminar over sandwiches was held for thegroup as they sat in front of the large windows of the cultivation room, where they could see scores of plants growing under intense lighting.
They were told about the different strains: uplifting sativa plants and more sedating indicas. They learned about tetrahydrocannabinol (THC), which gives a high, and cannabidiol (CBD) which does not, making CBD-rich cannabis appealing for medical use. A scientist in a lab coat who worked in the processing facility spoke about terpenes fragrant oils secreted by glands in the flower that give strains their different smells and flavours. Vials were sniffed and various ways to take cannabis were also covered, including smoking, vaporising and eating it.
Roux, a retired administrative assistant, said: Im a big Google girl, but I wanted to talk to people who know about it so I can understand it all better. I have an autoimmune disease, which stops my appetite, and Im interested in marijuana from that standpoint. She added she had used cannabis recreationally in the 80s and had returned to it to help with her illness. I use a vape. It makes me sleepy and its a pain control, and it gives me an appetite.
After the briefing, it was time for shopping. The store looked like an upmarket jewellers, with muted lighting and art on the walls, except the glass cabinets in the store were stocked with pre-rolled joints, edibles including chocolates and sweets, vape pens and bags of different strains of cannabis rather than diamond rings and necklaces.
Darlene Johnson, 85, a former nurse, perused their contents. On the advice of a bearded bud tender, she bought a deep tissue and joint gel and a tincture to put in drinks, which she hopes will help with her severe neck pain. I wanted a non-psychoactive option, she said. I dont want to get high. I used to work in the emergency room and saw people come in sick from taking too many drugs, though not usually marijuana.
Her friend, Nancy Mitchell, 80, has never tried cannabis. She has MS and had read that cannabis could help with her symptoms. I wanted to know more details, she said. My kids keep telling me, Mom, try it. I dont want to smoke things, but I see there are other ways.
Smoking is not allowed at El Dorado West. Village Concepts, which runs the chain, has a no-smoking policy and it is illegal to consume cannabis in public in the state.
The chains director of corporate development, Tracy Willis, said: There was one man who was smoking it on his patio and he refused to stop, so he had to leave. If youre using an edible, we dont have any issue with it, thats your own business. We treat it as a recreational thing.
The tours began in response to questions from residents.They wanted to know where it was sold, how much money was made from it, where it was grown, said Willis. Weve had a good reaction [to the tours] from nine out of 10 relatives, but some are horrified. One angry daughter said we were encouraging marijuana use. Her mother told her to butt out.
(CNN)As attitudes about marijuana shift around the world, researchers are warning parents that it’s risky to keep it around children, especially those who are too young to know what it is.
The number of children who were admitted to emergency rooms forunintentional marijuana intoxication increased by 133% in France over an 11-year period, according to a new study.
Marijuana intoxication can occur when a child accidentally ingests a marijuana product or inhales marijuana smoke. Symptoms can vary based on the child’s age and size but often include sleepiness, difficulty breathing, seizures or even coma. Effects usually last six to 24 hours.
Cannabis is illegal in France, but it has the highest rate of marijuana use in Europe, said Dr. Isabelle Claudet, lead author of the study, published Monday in the journal Pediatrics.
“And that means we are facing an increase in emergency admissions of marijuana intoxication and an increase in severe symptoms seen in children,” said Claudet, a pediatric emergency physician in Toulouse.
She and other researchers analyzed the number of Frenchchildren under 6 admitted to pediatric emergency departments because of unintentional cannabis intoxication and the number of cannabis-related calls involving children to French poison control centers.
From 2004 to 2014, 235 children were admitted to ERs with cannabis intoxication, and there was a 133% increase in the admissions rate for it. The number of calls to poison control centers related to cannabis exposure in children increased by 312% in the same period.
What concerns Claudet the most is that the concentration of the psychoactive chemical tetrahydrocannabinol, or THC, has been increasing in cannabis products in France.
“THC concentration in cannabis products has increased from 9% in 2004 to 20% in 2014,” she said. “I believe that’s why we’re facing more adverse effects in children.”
Over the 11-year span, the severity of symptoms in children admitted to emergency departments because of marijuana intoxication also increased.
Twenty times more severe cases were reported in 2014 compared with 2004, and and four times more severe cases were reported in 2014 compared with 2013. Of the 32 children reported to have gone into comas, 53% were admitted in 2014, and there were more cannabis-related admissions than any other type of pediatric emergency room admission.
The main cannabis product circulating on the French market is hashish or cannabis resin, a solid and very concentrated form of cannabis extract, usually sold in the form of sticks or balls. Users break off pieces, roll them in tobacco papers and smoke them.
Claudet believes the best way to decrease the number of pediatric marijuana intoxication cases in France is to decrease the concentration of THC in cannabis through regulation.
“And we have to also warn consumers and parents that it could be very dangerous for children to eat such products,” she said. “Because usually, parents think it’s not very harmful because they’re smoking it, and it relaxes them. But if a child ingests one stick or ball, they can become comatose.”
What about children in the US?
Recreational marijuana is legal in eight US states and the District of Columbia, and medical marijuana is legal in 29 states and D.C. Cannabis product trends in the United States are quite different from those in France, though high concentration of THC is still a concern, especially in edible products.
“The results of this Pediatrics study also makes sense with what we’ve been seeing in Colorado. With the marijuana industry increasing, there’s a lot of new products, a lot of concentrated products, that people vape or ingest, like the edible products, that are high in THC,” said Dr. G. Sam Wang, a pediatric toxicologist at Children’s Hospital Colorado in Aurora.
“And so we’ve been seeing a lot of kids who are more symptomatic and more intoxicated,” said Wang, who was not involved in the French research.
He found that in states where recreational or medical marijuana is legal, the number of pediatric marijuana intoxication cases reported to poison control centers increased by 30% each year from 2005 to 2011. Children in states where marijuana was legal had more severe symptoms and were more likely to be admitted to a critical care unit compared with those in states where marijuana was not legal.
In his Colorado study, Wang found that in the two years leading up to when recreational marijuana became legally available for purchase in 2014 and the two years after, rates of marijuana exposure cases in children increased. On average each year, there was a 34% increase in calls to poison control centers about marijuana exposures in Colorado and a 19% increase across the US. Forty-eight percent of the cases in Colorado were attributed to the ingestion of an edible marijuana product.
Wang said the higher number of cases in states where marijuana is legal can in part be attributed to the increased availability of marijuana products and the attractiveness of edible product labels, which often look like normal candy or cakes to a child.
“Usually, kids get into things that become more available, and usually, that happens when it’s a household product, like those laundry detergent pods, which were attractive,” Wang said. “It’s kind of the same situation with marijuana, where we think in states with legal marijuana, probably more households have it in their home, especially the food or edible marijuana products with bright labels, that makes it easier for kids to get into them.”
The US National Organization for the Reform of Marijuana Laws, or NORML, says that it is concerned about the inadvertent ingestion of cannabis products by children in both the US and France but that more regulation could help provide a solution: “It is our contention that the frequency of these incidences can be mitigated by the imposition of stricter regulatory controls, such as more stringent and overt product labeling and by limiting such products to single serving sizes.”
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Wang believes the key to ensuring the safety of children living around marijuana products is a combination of outreach and education. He tells parents to treat the marijuana like any other prescription or over-the-counter drug and keep it out of reach of children.
“Parents need to understand that kids can actually get sick from this stuff,” he said.
Several states with legal recreational marijuana, including Colorado, Oregon and Washington state, have also made child-resistant packaging a requirement for certain products.
Wang thinks this is also a step in the right direction, especially as other states or countries may be looking to legalize marijuana.
“They need to think about the unintended consequences of legalization, such as marijuana intoxication in children. So whether that’s education, packaging regulations, dose regulations,” he said. “Colorado had some of that in the beginning of legalization, but we also made mistakes. But I’m hoping that other places can learn from those mistakes and implement programs or rules at the outset.”