CBD Oil Deaths

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A CDC report found that synthetic products sold as cannabidiol (CBD) had sickened dozens of users in the state, including so-called "Yolo CBD Oil." Synthetic cannabinoids have caused a large number of emergency presentations to hospitals for adverse cardiovascular events including numerous deaths, particularly for the more potent analogs acting on the CB<sub>1</sub> receptor. While smoked cannabis use is often associated with significant change …

Fake CBD Poisoned At Least 52 People In Utah Last Winter, Officials Say

According to the Centers for Disease Control (CDC), synthetic products marketed as cannabidiol (CBD) sickened at least 52 people in Utah last winter, sending 31 of them to emergency rooms.

This week, the agency released a report on a poisoning outbreak that occurred in the state between December 2017 and January 2018, and which it linked to one or more synthetic cannabinoids being sold as the genuine article. Users reported that they had purchased such products as “Yolo CBD oil” at regular smoking and/or head shops, or acquired them from friends.

Unlike the many poisoning victims of K2 and other chemicals sold as ‘synthetic marijuana’ (a.k.a. synthetic cannabinoids), all of the patients identified in the report believed they were consuming legally derived CBD, which experts maintain has little to no potential for psychoactive effects. The cannabinoid chemical is found in varying amounts in both marijuana and hemp, and has been shown to have significant potential applications (and some outright proven ones) in medicine.

As CBD’s reputation in certain areas has grown, many new users have sought out the chemical for an effective but benign way to help with pain, anxiety, or recovery from substance abuse, among other things.

Over the past several years, however, a growing range of unregulated products claiming to contain CBD have also been flooding state and national marketplaces, putting consumers at risk of wasting their money, or worse. Last year, the U.S. Food and Drug Administration moved to crack down on four CBD manufacturers and distributors, particularly focusing on the companies’ claims around cancer treatment.

The market surge on so-called CBD has also meant that would-be safe users of effective, actual cannabidiol are finding they need to do a lot of time-consuming research about each product (and often still cross their fingers) before swallowing companies’ claims.

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Eliezer, a 38 year old homeless heroin addict, smokes a K2 cigarette in the Bronx on May 4, 2018 in . [+] New York City. Eliezer often snorts his heroin instead of injecting as he feels it lessens the chances of overdosing on the drug. The Bronx was the borough with the highest number of overdose deaths in 2016 with 308 residents dying. (Credit: Spencer Platt/Getty Images)

In Utah, the CDC reported, “By the end of January 2018, suspected cases [of synthetic cannabinoid poisoning] were identified in 52 persons. Nine product samples (including one unopened product purchased by investigators from a store and brand reported by a patient) were found to contain a synthetic cannabinoid, 4-cyano CUMYL-BUTINACA (4-CCB), but no CBD.”

Roberta Horth, an officer with the CDC’s Epidemic Intelligence Service, and the report’s lead author, pointed out for Gizmodo that the range of easily tweak-able synthetic cannabinoids available in recent years seem to pose significantly more (and more unexpected) risks so far than organic cannabinoids such as THC, which can also produce negative psychological and physical side effects. She also noted that fatalities following the use of this particular formulation, 4-CCB, have already been reported in Europe.

Among the 52 people the CDC was able to identify as being part of the outbreak, t he top three symptoms experienced were altered mental status, nausea or vomiting, and seizures or shaking — symptoms or side effects which have not been linked to CBD, incidentally, but which CBD has been variously used to treat.

Regarding the recent Utah poisonings, the CDC report continued,

Eight of the tested products were branded as ‘Yolo CBD oil’ and indicated no information about the manufacturer or ingredients. Blood samples from four of five persons were positive for 4-CCB. Press releases were distributed to media outlets December 19–21, 2017, with a warning regarding the dangers of using the counterfeit product . The number of reported cases peaked during this outreach and dropped shortly thereafter.

Thirty-four suspected cases were reclassified as confirmed if the person reported use of a Yolo product or laboratory testing found 4-CCB. Approximately one quarter of persons were aged

Rapid identification and a coordinated response among state and local agencies contributed to control of the outbreak. This investigation highlights the hazards of consuming unregulated products labeled as CBD. States could consider regulating products labeled as CBD and establishing surveillance systems for illness associated with products labeled as CBD to minimize the risk for recurrences of this emerging public health threat.

Cannabis as a cause of death: A review

Synthetic cannabinoids have caused a large number of emergency presentations to hospitals for adverse cardiovascular events including numerous deaths, particularly for the more potent analogs acting on the CB1 receptor. While smoked cannabis use is often associated with significant changes in heart rate and cardiac output, amongst other physiological changes, it has been rarely considered in the forensic literature as a significant contributory or causal factor in sudden unexpected death. A review of case reports of admissions to hospitals for cardiovascular events was undertaken together with a review of epidemiological studies, and case reports of sudden death attributed, at least in part, to use of this drug. These publications show that use of cannabis is not without its risks of occasional serious medical emergencies and sudden death, with reports of at least 35 persons presenting with significant cardiovascular emergencies who had recently smoked a cannabis preparation. At least 13 deaths from a cardiovascular mechanism have been reported from use of this drug which is very likely to be an under-estimate of the true incidence of its contribution to sudden death. In addition, many cases of stroke and vascular arteritis have also been reported with the latter often involving a limb amputation. While it is a drug with widespread usage among the community with relatively few deaths when faced with a circumstance of very recent use (within a few hours), a positive blood concentration of THC and a possible cardiac-related or cerebrovascular cause of death this drug should be considered, at least, a contributory cause of death in cases of sudden or unexpected death.

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Keywords: Arrhythmias; Cardiovascular disease; Forensic; Heart disease; Myocardial infarction; Stroke.

Copyright © 2019 Elsevier B.V. All rights reserved.

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