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Stall NM, Shi S, Malikov K, Wang S, Rochon PA, Hillmer MP, Zipursky JS. Edible Cannabis Legalization and Cannabis Poisonings in Older Adults. JAMA Intern Med 2024; 184:840-842. [PMID: 38767898 PMCID: PMC11106709 DOI: 10.1001/jamainternmed.2024.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 05/22/2024]
Abstract
This cross-sectional study examines the association between edible cannabis legalization and emergency department visits for cannabis poisonings in older adults.
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Affiliation(s)
- Nathan M. Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Ontario, Canada
- Women’s Age Lab and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Shengli Shi
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Kamil Malikov
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Sping Wang
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
| | - Paula A. Rochon
- Women’s Age Lab and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michael P. Hillmer
- Digital and Analytics Strategy Division, Ontario Ministry of Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Jonathan S. Zipursky
- Department of Medicine, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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2
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Manthey J, Klinger S, Rosenkranz M, Schwarzkopf L. Cannabis use, health problems, and criminal offences in Germany: national and state-level trends between 2009 and 2021. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01778-z. [PMID: 38502205 DOI: 10.1007/s00406-024-01778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
The German federal government plans to decriminalise cannabis. The impact of this policy on use prevalence, cannabis-related health and legal problems cannot be fully anticipated and should be viewed in context with current trends. We used routine data on (a) cannabis use (population-based surveys), (b) cannabis-related diagnoses (ICD-10 code F12) in outpatient medical settings and (c) minor law offences (registered violations against the narcotics law for possessing small amounts) to analyse age and sex-specific trends by federal state between 2009 and 2021. To enable comparisons across time and federal state besides crude prevalence rates, age-standardised rates were calculated. Between 2009 and 2021, the age-standardised prevalence of cannabis use (5.7-10.6%), rate of diagnoses (1.1-3.7 per 1,000), and legal offences (1.8-3.1 per 1,000) increased, with the largest increase noted for cannabis-related diagnoses. Relatively, increases were most pronounced for older users (40-to-59-year-olds: use and offences; 35-to-44-year-olds: cannabis-related diagnoses) and rather stagnant for minors. Cannabis use and health problems appear to be more pronounced in Northern and city states, while no clear geographic trend was observed for law offences. Cannabis-related outpatient treatment demand has risen more steeply than use prevalence suggesting an increasing challenge for the health care system. Despite rising rates for documented offences, the long-term implications of law violations on social and occupational life are poorly understood but may be considered for evaluations of the proposed law changes.
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Affiliation(s)
- Jakob Manthey
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
- Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251, Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Sinja Klinger
- Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251, Hamburg, Germany
| | - Moritz Rosenkranz
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251, Hamburg, Germany
| | - Larissa Schwarzkopf
- IFT Institut Für Therapieforschung, Mental Health and Addiction Research, Leopoldstrasse 175, 80804, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Ziemssenstrasse 5, 80336, Munich, Germany
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3
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Wolfe D, Corace K, Butler C, Rice D, Skidmore B, Patel Y, Thayaparan P, Michaud A, Hamel C, Smith A, Garber G, Porath A, Conn D, Willows M, Abramovici H, Thavorn K, Kanji S, Hutton B. Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature. PLoS One 2023; 18:e0281826. [PMID: 36800328 PMCID: PMC9937508 DOI: 10.1371/journal.pone.0281826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals. OBJECTIVE To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults. METHODS Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings. FINDINGS From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding. DISCUSSION The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.
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Affiliation(s)
- Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Institute of Mental Health Research at The Royal, University of Ottawa, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | - Alan Michaud
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Gary Garber
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Amy Porath
- Canadian Center for Substance Use and Addiction, Ottawa, Canada
| | - David Conn
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Baycrest Health Sciences, Toronto, Canada
| | - Melanie Willows
- Institute of Mental Health Research at The Royal, University of Ottawa, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Hanan Abramovici
- Health Canada, Office of Cannabis Science and Surveillance, Ottawa, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- * E-mail:
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4
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Klein TA, Dilley JA, Graves JM, Liebelt EL. Synthetic cannabinoid poisonings and access to the legal cannabis market: findings from US national poison centre data 2016-2019. Clin Toxicol (Phila) 2022; 60:1024-1028. [PMID: 35942512 DOI: 10.1080/15563650.2022.2099887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To investigate trends in synthetic cannabinoid exposures reported to United States (US) poison control centres, and their association with status of state cannabis legalisation. METHODS A retrospective study of National Poison Data System (NPDS) data from 2016 to 2019 identified and associated synthetic poisoning reports with annual state cannabis law and market status. State status was categorised as restrictive (cannabis illegal or limited medical legalisation), medical (allowing THC-containing medical cannabis use) and permissive (allowing non-medical use of THC-containing cannabis by adults). We categorised a subset of states with permissive policies by their implementation of legal adult possession/use and opening retail markets, on a quarterly basis. Mixed-effects Poisson regression models assessed synthetic exposures associated with legal status, first among all states using annual counts, and then among states that implemented permissive law alone using quarterly counts. RESULTS A total of 7600 exposures were reported during the study period. Overall, reported synthetic exposures declined over time. Most reported exposures (64.8%) required medical attention, and 61 deaths were documented. State implementation of medical cannabis law was associated with 13% fewer reported annual exposures. Adoption of permissive state cannabis policy was independently and significantly associated with 37% lower reported annual synthetic exposures, relative to restrictive policies (IRR: 0.63, 95% CI: 0.50-0.79). Among states with permissive law during the period, implementation of legal adult possession/use was associated with 22% fewer reported quarterly exposures. Opening of retail markets was associated with 36% fewer reported exposures, relative to states with medical cannabis only. CONCLUSIONS Adoption of permissive cannabis law was associated with significant reductions in reported synthetic cannabinoid exposures. More permissive cannabis law may have the unintended benefit of reducing both motivation and harms associated with use of synthetic cannabis products.
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Affiliation(s)
- Tracy A Klein
- College of Nursing, Washington State University, Vancouver, WA, USA
| | - Julia A Dilley
- Multnomah County Health Department, Oregon Health Authority, Portland, OR, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Erica L Liebelt
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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5
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Goncalves R, Labadie M, Chouraqui S, Peyré A, Castaing N, Daveluy A, Molimard M. Involuntary MDMB-4en-PINACA intoxications following cannabis consumption: clinical and analytical findings. Clin Toxicol (Phila) 2021; 60:458-463. [PMID: 34850659 DOI: 10.1080/15563650.2021.1994144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist (SCRA) that has recently emerged. Data regarding clinical presentations in the event of intoxication is scarce. This study presents MDMB-4en-PINACA identification in cannabis consumers with clinical and analytical descriptions. METHODS Between November 2020 and March 2021, all patients with unexpected or unusually severe effects and Poisoning Severity Score (PSS) greater than or equal to 2 after cannabis consumption were included. Blood and/or urine samples were collected for toxicological analysis. When available, drug material samples were also collected for analysis. RESULTS Between November 2020 and March 2021, 13 patients were included. All cases typically presented with altered mental status (n = 13), and nearly all had returned to a normal or quasi-normal state after around 11 h of observation. Neurological symptoms included headaches (n = 3), hallucinations (3), mydriasis (3), amnesia (2) and seizures (5). Psychiatric symptoms were paranoia (6) and anxiety (2). Digestive symptoms were nausea (2) and vomiting (6). No deaths were recorded. All patients were positive for the SCRA MDMB-4en-PINACA in urine, blood and/or drug material sample. Results from toxicology testing paired with case history showed the potential for MDMB-4en-PINACA to cause or contribute to different clinical disorders. Conclusions: This study highlights the risk of intoxication by SCRAs when taking low-THC cannabis products. Forensic scientists, public health and public safety officials, law enforcement personnel and clinicians should be aware of the impact that these emergent SCRAs may have in their work, especially MDMB-4en-PINACA.
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Affiliation(s)
- Ruben Goncalves
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, Bordeaux Cedex, France.,Univ. Bordeaux, INSERM U1219, BPH, Bordeaux Cedex, France
| | - Magali Labadie
- CHU de Bordeaux, Centre-Antipoison et Toxicovigilance de Nouvelle Aquitaine, Bordeaux Cedex, France
| | - Simon Chouraqui
- CHU de Bordeaux, Urgences adultes, Place Amélie Raba Léon, Bordeaux Cedex, France
| | - Alexandre Peyré
- CHU de Bordeaux, Centre d'addictovigilance, Place Amélie Raba Léon, Bordeaux Cedex, France
| | - Nadège Castaing
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, Bordeaux Cedex, France
| | - Amélie Daveluy
- Univ. Bordeaux, INSERM U1219, BPH, Bordeaux Cedex, France.,CHU de Bordeaux, Centre d'addictovigilance, Place Amélie Raba Léon, Bordeaux Cedex, France
| | - Mathieu Molimard
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, Bordeaux Cedex, France.,Univ. Bordeaux, INSERM U1219, BPH, Bordeaux Cedex, France
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6
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Choi NG, DiNitto DM. Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:612-622. [PMID: 33915068 DOI: 10.1080/00952990.2021.1908318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.Objectives: We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else's, or use other means.Methods: We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.Results: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use. Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53-6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47-7.76).Conclusion: Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation. Healthcare professionals should engage older adults in discussions of cannabis use and behavioral health needs.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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7
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Choi NG, DiNitto DM, Marti CN, Baker SD. Sex differences in cannabis forms and exposure reasons in cannabis-related poison control center cases aged 50. Clin Toxicol (Phila) 2021; 59:822-831. [PMID: 33475427 DOI: 10.1080/15563650.2020.1869756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT/OBJECTIVES A significant proportion of individuals aged 50+ in the U.S. use cannabis for medical or recreational purposes, sometimes with adverse effects. Given differences in cannabis use among men and women, we examined sex differences in (1) cannabis forms used, (2) exposure reasons, and (3) medical outcomes in older-adult poison control center (PCC) cases. METHODS Data came from the American Association of Poison Control Centers' National Poison Data System, 2009-2019. We focused on the 3633 cases aged 50+ in which plant and other non-synthetic cannabinoid cannabis forms were the only or primary substance. Logistic regression was used to examine associations of sex with cannabis forms. Multinomial logistic regression models were fit to examine associations of sex with exposure reasons (therapeutic errors/adverse reactions, intentional misuse/abuse, other) and medical outcomes (no-to-minimal, moderate, or major effects). RESULTS Females constituted 57.4% of cases. In multivariable analyses, female cases had 1.20 (95% CI = 1.01-1.43) greater odds of involving cannabis forms other than plant forms and 1.93 greater odds (95% CI = 1.66-2.24) of therapeutic errors/adverse effects compared to intentional misuse/abuse. Older age and occurrence in recreational-cannabis-legal states were positively associated with other cannabis forms. Older age, recreational and/or medical cannabis-legal states, CBD, pharmaceuticals, concentrated extracts, and chronic exposure were associated with higher odds of therapeutic errors/adverse effects. Sex was not significantly associated with medical outcomes. CONCLUSIONS Female cases compose a large share of PCC cases aged 50+ and are associated with higher odds of involving cannabis forms other than plants and therapeutic errors/adverse reactions compared to intentional misuse/abuse.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Lachenmeier DW, Habel S, Fischer B, Herbi F, Zerbe Y, Bock V, Rajcic de Rezende T, Walch SG, Sproll C. Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination? F1000Res 2019. [PMID: 32117565 DOI: 10.12688/f1000research.19931.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ 9-tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 181 food products of the German market (mostly CBD oils) confirmed this hypothesis: 21 products (12%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Inversely, CBD was present in the products below the no observed adverse effect level. Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC and not due to effects of CBD itself. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.
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Affiliation(s)
- Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Stephanie Habel
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Berit Fischer
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Frauke Herbi
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Yvonne Zerbe
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Verena Bock
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | | | - Stephan G Walch
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Constanze Sproll
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
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9
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Lachenmeier DW, Habel S, Fischer B, Herbi F, Zerbe Y, Bock V, Rajcic de Rezende T, Walch SG, Sproll C. Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination? F1000Res 2019; 8:1394. [PMID: 32117565 PMCID: PMC7029751 DOI: 10.12688/f1000research.19931.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ 9-tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 293 food products of the German market (mostly CBD oils) confirmed this hypothesis: 28 products (10%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC, with the safety of CBD itself currently being unclear with significant uncertainties regarding possible liver and reproductive toxicity. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.
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Affiliation(s)
- Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Stephanie Habel
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Berit Fischer
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Frauke Herbi
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Yvonne Zerbe
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Verena Bock
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | | | - Stephan G. Walch
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Constanze Sproll
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
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10
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Lachenmeier DW, Habel S, Fischer B, Herbi F, Zerbe Y, Bock V, Rajcic de Rezende T, Walch SG, Sproll C. Are side effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination? F1000Res 2019; 8:1394. [PMID: 32117565 PMCID: PMC7029751 DOI: 10.12688/f1000research.19931.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements, to avoid the strict rules of medicinal products. Side-effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ 9-tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the side-effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on crude hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 67 food products of the German market (mostly CBD oils) confirmed this hypothesis: 17 products (25%) contained Δ 9-THC above the lowest observed adverse effects level (2.5 mg/day). Inversely, CBD was present in the products below the no observed adverse effect level. Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC and not due to effects of CBD itself. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, full-spectrum hemp extracts as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety must obviously be challenged.
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Affiliation(s)
- Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Stephanie Habel
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Berit Fischer
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Frauke Herbi
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Yvonne Zerbe
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Verena Bock
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | | | - Stephan G. Walch
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Constanze Sproll
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
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11
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Lachenmeier DW, Habel S, Fischer B, Herbi F, Zerbe Y, Bock V, Rajcic de Rezende T, Walch SG, Sproll C. Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination? F1000Res 2019; 8:1394. [PMID: 32117565 PMCID: PMC7029751 DOI: 10.12688/f1000research.19931.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/31/2022] Open
Abstract
Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ 9-tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 181 food products of the German market (mostly CBD oils) confirmed this hypothesis: 21 products (12%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Inversely, CBD was present in the products below the no observed adverse effect level. Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC and not due to effects of CBD itself. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.
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Affiliation(s)
- Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Stephanie Habel
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Berit Fischer
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Frauke Herbi
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Yvonne Zerbe
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Verena Bock
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | | | - Stephan G. Walch
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Constanze Sproll
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
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12
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Lachenmeier DW, Habel S, Fischer B, Herbi F, Zerbe Y, Bock V, Rajcic de Rezende T, Walch SG, Sproll C. Are adverse effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination? F1000Res 2019; 8:1394. [PMID: 32117565 PMCID: PMC7029751 DOI: 10.12688/f1000research.19931.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements. Adverse effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to acid-catalysed cyclization of CBD to psychotropic Δ 9tetrahydrocannabinol (Δ 9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the adverse effects of CBD products may be residual Δ 9-THC concentrations in the products as contamination, because most of them are based on hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 362 hemp-based products of the German market (mostly CBD oils) confirmed this hypothesis: 39 products (11%) contained Δ 9-THC above the lowest observed adverse effect level (2.5 mg/day). Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ 9-THC, with the safety of CBD itself currently being unclear with significant uncertainties regarding possible liver and reproductive toxicity. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ 9-THC levels, hemp extracts or CBD isolates as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety and regulatory compliance must obviously be challenged, and a strong regulatory framework for hemp products needs to be devised.
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Affiliation(s)
- Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Stephanie Habel
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Berit Fischer
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Frauke Herbi
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Yvonne Zerbe
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Verena Bock
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | | | - Stephan G. Walch
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
| | - Constanze Sproll
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, 76187, Germany
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