Respiratory depression following an accidental overdose of a CBD-labeled product: A pediatric case report
Respiratory depression following an accidental overdose of a CBD-labeled product: A pediatric case report
Objective: To report a case of accidental cannabidiol (CBD) oil overdose in a pediatric patient.
Background: CBD is one of over 100 pharmacologically active compounds in the marijuana plant (Cannabis sativa). Its absence of psychoactive effects and the abundance of anecdotal claims of effectiveness across a wide variety of conditions in both mainstream and social media have created an incredible amount of public interest in CBD oil in recent years. Such interest has led to increased consumer availability. Despite this increased access, such sales remain illegal at the federal level. While sales of CBD products not approved by the Food and Drug Administration continue to rise, purity, potency, labeling, and delivery devices remain inconsistent. This may lead to an increased risk of adverse events. The following report describes a case of accidental CBD overdose in a pediatric patient leading to a stay in the pediatric intensive care unit.
Case summary: The patient initially presented to the urgent care and was quickly transferred to the emergency department after being found unresponsive after administration of a dose of CBD oil earlier in the day. After arrival, his mental status and respiratory drive continued to deteriorate, and he was ultimately intubated. He was eventually extubated and transferred out of the pediatric intensive care unit after 48 hours and discharged after 72 hours. This patient was found to have a urine 9-carboxy-11-nor-Δ-9-tetrahydrocannabinol concentration of 123 ng/mL, suggestive of consumption of a substantial amount of tetrahydrocannabinol. However, samples from the same batch ingested by the patient were tested by both the manufacturer and U.S. Food and Drug Administration and contained only trace amounts of THC.
Practice implications: As CBD oil use continues to rise, health care professionals should have an adequate understanding of current clinical evidence and state and federal legislation to counsel patients on CBD use in a practical and compassionate manner.
Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
As CBD oil use continues to rise, health care professionals should have an adequate understanding of current clinical evidence and state and federal legislation to counsel patients on CBD use in a practical and compassionate manner.
Frequently asked questions about CBD
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- Can CBD make you sick?
- Can CBD oil kill you?
- Can a dog overdose on CBD oil?
- Can CBD oil lower your blood pressure?
- What is the right amount of CBD?
Cannabidiol (CBD) has become one of the most popular products in the entire cannabis industry, showing up in local coffee shops, pharmacies, and legal marijuana dispensaries. Despite the explosive popularity of CBD, there is still a lot of confusion about what CBD is and how it affects humans. For example, some may wonder: Can you overdose on CBD?
CBD stands for cannabidiol, a non-intoxicating substance found in cannabis. Photo by: Gina Coleman/Weedmaps
In short, probably not, but there are associated risks. CBD is recognized as having a number of anti-inflammatory, anti-anxiety, and neuroprotective qualities, many of which can have positive effects on a broad range of health conditions. However, it’s still important to fully grasp not only the positive ways CBD can affect you, but also any of the potential side effects that may accompany the cannabinoid.
Can CBD make you sick?
If you consume pure CBD, you are unlikely to get sick or experience unpleasant side effects. A 2017 World Health Organization (W.H.O.) report concluded that CBD is “generally well-tolerated with a good safety profile,” and further stated that “in humans, CBD exhibits no effects indicative of any abuse or dependence potential.”
However, people participating in CBD-related studies have at times reported several side effects, including extreme sleepiness, decreased appetite, diarrhea, fatigue, convulsions, vomiting, and some abnormal results on liver function tests.
One such study was published in 2013 in the journal Current Drug Abuse Review as researchers reported on a phenomenon called Cannabinoid Hyperemesis Syndrome. This newly identified clinical syndrome coincides with chronic cannabis abuse and frequent episodes of nausea and vomiting, according to the authors of the study, all of whom are physicians. The researchers classified the prevalence of the syndrome as unknown, so further studies are needed to understand if such side effects are rare.
Of course, other factors could complicate the effects of CBD and could be responsible for adverse reactions. For example, adverse effects could stem from an interaction between CBD and the patient’s existing medications.
Other factors, such as an interaction between CBD and the patient’s existing medications, could complicate the effects of CBD and could be responsible for adverse reactions. Photo by: Gina Coleman/Weedmaps
On a similar note, the Harvard Health Blog published a post in 2018 regarding adverse effects caused by impurities or contaminants in the CBD, which could exist given the largely unregulated status of cannabis products. Following the passage of the 2018 Farm Bill, hemp-derived CBD products were legalized and placed under the jurisdiction of the United States Food and Drug Administration (FDA).
Can CBD oil kill you?
A 2017 review of clinical research published in Cannabis and Cannabinoid Research confirmed that CBD is generally very safe, particularly when compared to other drugs. In general, the biggest risk you likely run if taking a huge dose of CBD may be getting sleepy as the cannabinoid can have tranquilizing effects in large doses.
However, the journal Case Reports in Ophthalmological Medicine reported a CBD-linked fatality in 2019. According to the report, a 56-year-old woman presented with Stevens-Johnson Syndrome, a rare but serious disorder of the skin and mucous membranes. The patient had begun using a CBD extract spray one week prior to being admitted to a hospital emergency room, where she later died of septic shock.
The woman had reported consistent use of other CBD products over a 5-year period prior to this incident and it is unclear whether the new spray caused her to develop Stevens-Johnson Syndrome, though the authors of the report suspect that it did. The patient, however, had a complex medical history including coronary artery disease and hypertension, so linking her death directly to CBD may not illustrate the full picture.
The bottom line is that CBD appears unlikely to be fatal, but exceptions may exist and collaboration with your physician is essential before starting a regimen.
Can you overdose on CBD gummies?
Regardless of the CBD product you’re taking, the answer is still the same. If you’re wondering, “Can you overdose on CBD gummies?”, the answer is no. When you eat a CBD gummy, your body will metabolize the CBD differently than it will if you smoke or vape CBD. While this could change how long it takes the CBD to go into effect or how long the effects last, it won’t change the toxicity of CBD.
Can a dog overdose on CBD oil?
Interestingly, CBD has made significant headway into pet products. According to a PR Newswire report that circulated in early 2019, pet and animal product sales are expected to reach $125 million by 2022, making the sector one of the fastest-growing in the CBD market.
Within the rapidly growing pet CBD market, products for our furry friends are especially popular, which has led many pet owners to wonder, can a dog overdose on CBD oil? According to the American Kennel Club, there is not a lot of definitive evidence on how CBD affects dogs.
CBD may help improve appetite and promote heart health in dogs, and many CBD-infused dog treats and CBD oil for dogs are readily available on the market. Photo by: Gina Coleman/Weedmaps
Anecdotal evidence suggests that CBD oil can help treat pain and seizures in dogs, and that it has beneficial anti-inflammatory, anti-nausea, anti-anxiety, and anti-cancer properties, just as has been observed in humans. CBD may also help improve appetite and promote heart health in dogs, and many CBD-infused dog treats and CBD oil for dogs are readily available on the market.
So far, anecdotal evidence suggests that side effects of CBD overconsumption by dogs include dry mouth, lower blood pressure, and drowsiness. Without definitive evidence, it’s hard to say whether dogs can overdose on CBD. Recognizing that “we do not know what size dosage would be toxic,” the American Kennel Club suggests “to start out with small amounts and then closely monitor the effects” to make sure you don’t inadvertently give your dog too much CBD.
Can CBD oil lower your blood pressure?
Scientific studies to date have shown that CBD can help lower blood pressure. In a 2017 study conducted by the American Society for Clinical Investigation and published in the journal JCI Insight, researchers gave a group of subjects a dose of either 600 milligrams of CBD or a placebo. They then put subjects through a number of tests, analyzing blood pressure and other related body processes. Ultimately, they found that CBD reduced blood pressure levels compared with the placebo.
This could have some important implications on health, as a 2014 study published in the journal Current Hypertension Reports found that “high blood pressure is linked to higher risks of a number of health conditions, including stroke, heart attack and metabolic syndrome.”
What is the right amount of CBD?
So far, scientific research has not pinpointed any clear limits to how much CBD is too much. Dosages in studies cover a very broad range, from as little as 1 milligram to as much as 1,500 milligrams per day. Currently, no dosage has been identified as hazardous, but it is possible to abuse cannabis and you should seek medical intervention if CBD is interfering with how you function in daily life.
The key to dosing is figuring out how it affects your unique body. Every person is different, and since researchers have not identified any precise doses, the best thing to do is start slowly and pay attention to how your body reacts.
Fortunately, you can experiment with CBD confidently knowing you are unlikely to overdose or get sick from taking too much. Instead, you can focus on figuring out how much CBD will give you the type of experience and health benefits you seek.
CBD oil usually comes with a dropper to allow consumers and patients to measure out their dose. Photo by: Gina Coleman/Weedmaps
First-time users should start with a minimal dose of CBD (as small as one drop of oil or 5 milligrams per day) and gradually increase the dosage over time, while paying attention to the effects of different amounts. This process should be continued until the most effective dosage for your specific condition or ailment is achieved.
If you reach a point where you don’t feel significantly better by adding to your dosage, or you feel worse, then scale back the CBD and discuss your dosing options with your physician.
Frequently asked questions about CBD Copy article link to clipboard. Link copied to clipboard. Contents Can CBD make you sick? Can CBD oil kill you? Can a dog overdose on