Is It Safe to Vape CBD?
At least 26 people have been hospitalized by vaping CBD, and more were sickened. Here’s what to know about possible risks.
Last August, Erin Gilbert’s organs began to shut down. First her lungs, then her kidneys and liver. Medical staff at the hospital in Miami, where she had been airlifted, struggled to keep her alive. Just days earlier, Gilbert—a 35-year-old mother of three—had used her first CBD (cannabidiol) vaping product, a mango-flavored oil she says she purchased where she lives in St. Croix, U.S. Virgin Islands, according to a lawsuit filed in September.
CBD is a nonpsychoactive compound found in cannabis plants, which include hemp and marijuana, that is often used to ease anxiety, insomnia, and pain.
It’s now legal in the U.S.—thanks to legislation passed in 2018 that allows farmers to grow hemp and extract derivatives such as CBD from it—as long as the product contains no more than 0.3 percent THC (tetrahydrocannabinol). That’s the compound in cannabis that can get a person high when taken in larger amounts.
Gilbert had been vaping CBD for just four days when she developed a fever, shortness of breath, cough, vomiting, and diarrhea, and went to a St. Croix emergency room. There she went into acute respiratory failure and had to be moved to Miami, according to legal documents in her ongoing lawsuit against multiple defendants, including the alleged maker of the CBD product, JustCBD. But Gilbert’s condition worsened, and as her organs shut down, her blood became toxic. Serious clots restricting blood flow formed in her legs, both of which had to be amputated, the suit alleges.
Gilbert’s lawyers said that neither they nor their client would comment on the case at this time. Terry Fahn, a spokesperson for JustCBD, told CR that the company does not sell products in the U.S. Virgin Islands and that it “has received numerous reports of counterfeits” and it believes that Gilbert’s injuries may have stemmed from “using a counterfeit product illegally sold through the black market.”
The risks of vaping have garnered a lot of attention since last August, after the Centers for Disease Control and Prevention linked the products to a mysterious outbreak of more than 2,600 lung illnesses so serious that people had to be admitted to the hospital. Sixty people have died. The CDC says several thousand more people have probably been admitted to emergency rooms with complaints related to vaping.
The CDC traced many of the hospitalizations back to vitamin E acetate, used to dilute oils used in vaping. The vast majority of the illnesses involved products that contained nicotine or THC, especially those purchased illicitly, says Brian King, Ph.D., chief science officer with the CDC. After initially warning consumers to avoid all vaping products, on Jan. 17 the agency limited that advice to THC vape pens, especially those obtained from family, friends, online, and illicit dealers─because growing research found “a strong link between these products and the lung injuries,” King says.
But in at least 26 of the cases, people—like Gilbert—were hospitalized after they reported vaping only CBD, and more people probably went to the ER. In addition, many doctors, scientists, government officials, and even industry representatives remain concerned about vaping, especially CBD, for several reasons.
For one thing, beyond the dangers of vitamin E acetate, little is known about the long-term effect of inhaling several other chemicals often found in vaping oils, says Michelle Peace, Ph.D., a toxicologist and associate professor in the department of forensic science at Virginia Commonwealth University in Richmond who has studied and tested vaping oils.
For another, the devices themselves, when heated, can cause a chemical reaction in the vapor, posing further risk to the lungs—one reason the American Lung Association cautions people away from all vaping devices, says Erika Sward, national assistant vice president for advocacy at the association, which has long urged people to not vape at all.
Finally, there is little regulatory oversight of CBD in general and vaping it in particular. The FDA—which oversees tobacco products, including vaping ones—has not yet determined how it should regulate CBD vaping products.
The CBD industry has called for more FDA oversight, says Jonathan Miller, general counsel for the U.S. Hemp Roundtable, which represents CBD manufacturers and funds the industry’s certifying group, called the U.S. Hemp Authority. While the FDA provides some guidance on dietary supplements, foods, and cosmetics, it does not offer similar oversight of vaping products, he says. That lack of regulation on vaping prevents the U.S. Hemp Authority from certifying CBD vape oils, as it does for CBD topicals, tinctures, and edibles.
All those concerns take on added urgency now as the popularity of CBD continues to grow, and vaping remains one of the most popular ways of using it. Sales of CBD overall are expected to nearly triple in the next five years to $1.6 billion, according to the Brightfield Group, which tracks the CBD industry. And nearly a third of Americans who tried CBD in the past 24 months—an estimated 20 million people—said they vaped the substance, according to a January 2019 CR nationally representative survey of more than 1,000 U.S. adults. Even after the lung-injury crisis made headlines, fewer than a quarter of people who vape CBD said they changed their habits, according to the Brightfield Group.
Here’s what concerns experts the most.
While vitamin E in bootleg vaping products appears to be the main culprit in most of the reported injuries and deaths, there are other substances, even in legitimate vaping oils, that also raise concern.
Manufacturers sometimes add a solvent to an oil to make it inhalable by vape pens, the battery-powered devices that heat and vaporize the oil, says Neal Benowitz, M.D., a cardiologist and toxicologist at the University of California, San Francisco, who has studied cigarette smoking, cannabis, and vaping.
Two common ones are propylene glycol and vegetable glycerin, though manufacturers sometimes also use polyethylene glycol and what’s known as medium chain triglycerides (MCTs), such as coconut oil.
The long-term effect on human health of repeated use of these solvents is virtually unknown. There have been few animal or human studies on the safety of propylene glycol or vegetable glycerine when inhaled, especially long-term, according to a 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report.
Still, manufacturers use some solvents that the FDA had given a GRAS (“Generally Recognized As Safe,”) designation, Peace says. “But the chemicals were only considered safe by the FDA to ingest into your digestive tract, and have not been deemed safe to inhale into your lungs,” Peace says.
In fact, the FDA does not maintain a list of chemicals that are safe to inhale. “GRAS is a standard that applies to food,” says Stephanie Caccomo, an FDA spokesperson. “The FDA does not have a GRAS standard for tobacco products and/or ingredients.”
That’s a problem for CBD manufacturers, says Miller from the U.S. Hemp Roundtable. Without an FDA-approved list of substances that can be used in vaping, they’re on their own to figure out what chemical combinations work best. “Bad actors seize this gray area of regulation and can put out products solely to make a profit and without concern about public health or safety,” Miller says.
In addition to the solvents in vape oils being potentially dangerous by themselves, the byproducts that can be created when the solvents are heated to high temperatures are also dangerous. For example, heating propylene glycol can create formaldehyde, a known carcinogen, and acetaldehyde, a possible carcinogen, both of which are also present in cigarette smoke, Benowitz says.
Heating polyethylene glycol may create more of those two harmful chemicals than propylene glycol, vegetable glycerin, or MCTs, according to a 2017 study in the Journal of Alternative and Complementary Medicine. The study authors note that with just a single inhalation from a vape oil containing polyethylene glycol, a person’s intake of formaldehyde would be nearly the same as smoking an entire cigarette.
That’s not all. The device’s coil, when heated, can leak trace amounts of other dangerous compounds into the oil—primarily nickel and chromium but also arsenic, lead, and manganese, according to a 2018 Johns Hopkins Bloomberg School of Public Health study.
How much gets released depends on several factors, says Sward, at the American Lung Association. “Ultimately, what is inhaled into the user’s lungs can depend, based on the device used, its voltage, and even its temperature.”
The FDA has acknowledged the risks posed by chemicals leaking from vaping coils. When asked by CR what it was doing to address the problem, agency spokesperson Caccomo said that starting in 2020, manufacturers of new tobacco products, including vape pens, will have to submit applications and that the FDA will review the products’ components and toxicological profiles, and how they are manufactured.
But those new rules would apply only to tobacco vape products, not those that contain CBD.
Unstudied Flavor Additives
While there are more than 7,000 flavorings that can be added to CBD and other vaping oils, little is known about their safety, according to the NASEM report. In some cases the flavoring agents aren’t even listed in a product’s ingredients list. And like the solvents, the flavorings have not been cleared by the FDA for inhalation.
To address the possible danger—and because flavors such as fruit and mint might attract children and teens—the FDA recently banned flavorings except menthol and tobacco in most nicotine vaping products. The agency will now require manufacturers to provide evidence that their flavor additives are safe to be inhaled before they can be marketed and sold.
But again, because the FDA does not yet regulate CBD vaping, the ban does not apply to CBD products.
Easy Access for Teens
Among the more than 2,000 lung injuries reported with vaping overall, roughly 12 percent were in people under the age of 18. It’s unclear how many of those injuries were related to CBD-only products. But it is known that 214 of the reported lung injuries were in people who used CBD combined with either THC or nicotine, and that 16 of those were in children under 18.
Partly to reduce that risk posed by vaping, in December President Donald Trump signed legislation to raise the federal minimum age to purchase any tobacco product, including nicotine vapes, to 21, up from age 18. But, again, the new age rule does not apply to CBD vape products, which the CDC’s King says varies by state.
That’s troubling because many believe that any kind of vaping—whether THC, nicotine, or CBD—may be harmful for the development of teens or young adults.
“Youth lungs are especially susceptible to the damaging chemicals that can permanently alter their bodies,” says the ALA’s Sward. And nicotine products fundamentally alter brain development, according to the Surgeon General. The damage is not just for lung health but for brain development up until about age 25.
Read more about the other forms of CBD, such as creams and tinctures, that might not pose the same risks.
Consumer Reports investigates whether it’s safe to vape CBD. At least 26 people have been hospitalized by CBD, and more were sickened. Here’s what to know about the possible risks.
Benefits of CBD: What it Does and How it Helps
- What are the effects of CBD?
- What are the benefits of CBD?
- Should you vape CBD oil?
CBD is a compound found in cannabis plants that has a variety of known health benefits—notably the ability to relax and soothe the user. Unlike its cannabinoid relative THC, the effects of CBD (which is short for cannabidiol) are produced without intoxication. CBD is psychoactive—it reduces anxiety—but it doesn’t create a “high” like THC does.
Hemp has been cultivated for thousands of years for its fiber, and more recently as a source of CBD. The 2018 Farm Bill that legalized industrial hemp production in the U.S. pushed the already growing CBD industry into overdrive, and now CBD is legally available in most places in the country—as long as it contains less than 0.3% THC. Hemp-derived CBD doesn’t usually contain measurable amounts of THC.
CBD is extracted from industrial hemp or marijuana plants (both are cannabis) and processed for several methods of consumption. Vaping is the fastest way to experience the effects of CBD, because inhalation delivers your preferred CBD dose to the bloodstream and brain much more rapidly than other methods.
In addition to being absorbed more quickly, inhalation provides greater bioavailability, which means you can absorb more CBD from the same quantity than you would using other methods. While there is still more to learn about the long-term effects of vaping CBD, vaping is considered to be much safer than smoking, while being equally effective.
CBD e-liquid is sometimes called CBD oil, but it contains no actual oil, which can be dangerous to inhale. Like all e-liquid, CBD vape juice contains vegetable glycerin (VG) and propylene glycol (PG). But CBD tinctures and edible products contain actual oils, which are perfectly safe to swallow. (You can use CBD vape juice orally too, if you prefer.)
There is considerable research suggesting that cannabidiol produces positive effects that can treat a variety of conditions and symptoms. In this guide, we look at the most well-documented effects and benefits of using CBD oil.
What are the effects of CBD?
The most commonly reported effects of CBD are a sense of calm or relaxation, relief from pain or anxiety, and an overall improvement in mood. In high doses, CBD can induce drowsiness or sleep, but in small amounts, it can actually have the opposite effect, promoting alertness. These are the effects most CBD users seek:
- Relaxation or calmness
- Reduced anxiety and stress
- Improved mood
- Pain relief
- Sleepiness (in high doses)
- Alertness (in low doses)
CBD oil made from hemp typically doesn’t contain enough THC to get you high, but it can produce a strong sense of calm without the uneasiness, paranoia and other side effects some people experience from marijuana. That’s actually why a lot of people use CBD. Many users specifically take CBD oil for anxiety.
But there’s a caveat: the speed and intensity of these effects depend on how it’s consumed. The effects of vaping CBD come on faster. Even though the sensations will eventually be generally the same, a CBD oil tincture, or a CBD edible will take longer, and will probably require more CBD content to deliver the same benefits.
These are the most common ways of using CBD, listed from the fastest delivery to the brain and body to the slowest:
- Vaping in a mod with CBD vape juice, or using CBD oil pens or cartridges
- Vaping or smoking CBD-rich hemp flower or high-CBD cannabis strains
- Using CBD oil tinctures sublingually (under the tongue)
- Wearing a CBD transdermal patch
- Eating CBD gummies or edibles
- Swallowing CBD capsules or pills
- Using CBD creams or topicals
One last thing to remember is that the faster you absorb and process CBD, the more quickly it leaves your system. Vaping is the quickest way to feel the effects of CBD, and it’s also the quickest to process through your body. Edibles or other products that are processed through the liver and digestive system linger in your body for a longer time.
What are the benefits of CBD?
Scientific research suggests that CBD has a wide range of therapeutic properties. Here are some of the benefits and potential benefits studies show that CBD may provide for a variety of conditions.
Epilepsy and seizure disorders
As far back as 1973, research showed that CBD actively reduced or blocked convulsions in rodents, which was confirmed by other studies soon after. In later research, epileptic patients that received 200-300 mg of CBD per day had fewer seizures.
One of the most well-documented examples of CBD as an anti-convulsant was a young girl named Charlotte Figi who suffered from Dravet syndrome, a rare condition that conventional medication was unable to treat effectively. She was given a tincture derived from a low-THC/high-CBD cannabis strain, which was later named Charlotte’s Web in tribute to the young patient. Charlotte’s seizures were drastically reduced—from about 1,200 a month to just two or three.
In June 2018 the FDA approved Epidiolex, a CBD-based drug for treating Dravet and Lennox-Gastaut syndromes in patients two and older. Epidiolex is the first drug to gain FDA approval that contains a purified substance derived from cannabis. In April 2020, the Drug Enforcement Administration removed Epidiolex from the controlled substances list, making it much easier for doctors to prescribe the drug to epileptic patients.
One of the most common effects of vaping CBD oil is drowsiness, especially when administered in higher doses. An animal study conducted in the early 1970s first showed the sleep-inducing effects of CBD. In people with insomnia, CBD has been shown to increase sleep time when taken in a dose of about 160 mg. In non-insomnia patients, a similar effect was observed at much higher doses. In micro doses, CBD may promote alertness, instead of inducing drowsiness.
Multiple studies have shown that CBD can effectively treat anxiety. Research using advanced brain imaging has confirmed the anxiolytic effect of CBD. These mood-regulating effects of cannabidiol may also be used to treat depression. Researchers believe that CBD also has the potential to treat other anxiety disorders such as OCD and PTSD.
A 1982 study showed that CBD seemed to inhibit THC-induced symptoms associated with psychosis. Another study from the same year suggested a variety of neural pathways by which CBD might treat psychosis. Researchers believe that CBD can also be used to treat depression and other psychiatric disorders.
CBD is cardioprotective, showing a “tissue sparing effect” during chronic myocardial ischemia and reperfusion. British researchers have also shown that cannabidiol reduced the number of ischemia-induced arrhythmias in rats when given prior to ischemias. This research could prove beneficial to cardiovascular disease patients.
Israeli researchers believe that CBD’s anti-inflammatory properties could prove beneficial for treating type 2 diabetes. Because chronic inflammation can lead to insulin resistance, treatment of inflammation with CBD could improve metabolism and ward off diabetes. The scientists believe that the actions of CBD in the body could also be modified to work on other receptors, and that the compound might be used to treat other diseases caused or worsened by chronic inflammation.
Side effects from chemotherapy
THC has long been accepted as a therapy for nausea induced by cancer treatment. Marinol, a synthetic THC drug, has been approved for that purpose since 1985, and THC in various forms has been widely prescribed to cancer patients undergoing chemotherapy. But CBD may also serve as an equally effective treatment for nausea.
CBD interacts with receptors that release the neurotransmitter serotonin, which is partially responsible for causing nausea. In small doses, CBD can help reduce the symptoms of nausea. And an acidic form of CBD called CBDA may be an even more effective anti-nausea drug than CBD or THC, based on early animal studies.
Anti-oxidative and neuroprotective effects
CBD appears to have antioxidant and neuroprotective effects that are unrelated to the cannabinoid receptors. A 1998 study from the National Institute of Neurological Disorders and Stroke—a rare federally funded study on a Schedule 1 drug—found that CBD “may be a potentially useful therapeutic agent for the treatment of oxidative neurological disorders such as cerebral ischemia” (an artery blockage that can lead to strokes). CBD also shows promise as a therapy for neurological diseases like Parkinson’s.
Should you vape CBD oil?
CBD shows huge potential for treating a variety of medical conditions and diseases, and researchers have barely scratched the surface. When federal legalization of cannabis comes, research funding will open the floodgates, and scientists will begin to explore thousands of therapeutic possibilities for CBD and other cannabinoids.
But until then, many people have found that the currently known benefits of CBD can help them live better lives. If you decide CBD is right for you, there are many ways to use it—not just vaping, but also tinctures, and topical and edible CBD products.
Research shows that CBD provides a variety of benefits, including reducing inflammation and pain, and relaxing users suffering from anxiety.