Negative Side Effects Of CBD Gummies

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A Case of Toxicity from Cannabidiol Gummy Ingestion This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, CBD oil is considered to have a very high safety profile, but like any substance with the ability to change brain chemistry, its use can have some side effects. The Portland Clinic pharmacy team offers important cautions for those thinking about trying cannabidiol, more commonly known as CBD.

A Case of Toxicity from Cannabidiol Gummy Ingestion

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A 56-year-old male with no known history of substance abuse and no known prior medical conditions presented via ambulance to the emergency department after being found by coworkers with bizarre behavior, vomiting, and slurred speech. He had legally purchased cannabidiol (CBD) gummies marketed for pain and anxiety relief at a gas station several hours prior. Vitals upon arrival were temperature 36.8 Celsius, heart rate (HR) 79, respiratory rate (RR) 12, blood pressure (BP) 113/60, and oxygen saturation (O2) of 84% on room air that improved upon arousal. Physical exam showed an obese man in no acute distress with a depressed level of consciousness but who awoke to painful stimuli. Neuro exam was significant for dysarthric, hypophonic speech. Labs were significant for a primary respiratory acidosis with concomitant mild lactic acid elevation, normal bicarbonate, and normal anion gap. A comprehensive urine toxicology screen including cannabis was negative. Vital signs three hours after presentation deteriorated, showing: HR 47, RR 8-12, BP 88/52, O2 78%. Electrocardiogram (EKG) revealed sinus bradycardia. The patient progressively became more obtunded and required constant stimuli in order to maintain a patent airway. Non-invasive positive pressure ventilation was not administered due to persistent emesis.

The patient underwent supportive care with intravenous fluids, oxygen, anti-emetics, continuous stimulation, and close neurologic monitoring with full recovery by the following morning. Further, patient history revealed that he had consumed two packages of CBD gummies, totaling 370 mg total of CBD (serving size on the package was 30 mg). He felt the products were healthy and safe based on packaging and therefore did not believe they would have any adverse effects.

CBD is one of many cannabinoids found in marijuana and marijuana-derived products. It is generally considered safe unlike its more psychoactive counterpart, tetrahydrocannabinol (THC), which has been linked to seizures, respiratory depression, and cardiovascular complications. CBD has surged in popularity recently, being marketed in oils, capsules, and candies as a health supplement, claiming to treat a wide variety of medical conditions such as glaucoma, pain, and even having beneficial effects on cancer prevention. Most currently available studies do not look at isolated CBD nor their synthetic equivalents, and purity is not guaranteed, thus leading to unforeseen side effects and toxicities. Moreover, these compounds do not show on traditional toxicology screens, posing a diagnostic dilemma for physicians. This case of respiratory depression and cardiovascular compromise in a relatively healthy man is just one example of the importance of considering synthetic CBD toxicity in the differential diagnosis, as there is little data available for recognizing and treating this condition.

Introduction

Cannabidiol (CBD) is a rising trend in pop-culture. It can now be found in baked goods and candies, infused into coffees, and on the shelves of stores in cosmetics and oils. Benefits have been found for specific seizure disorders such as Lennox-Gastaut syndrome and Dravet syndrome; it is also being studied for its role in neuropathic pain [1-2]. The excitement over these treatments has spurred the production of a multitude of CBD-containing products that advertise a broad spectrum of clinical benefits such as improving arthritis-related pain, potential curative effects on cancers, to an overall improvement in well-being. While these claims are unfounded, the general consensus from the World Health Organization is that CBD is well-tolerated with a good safety profile [3]. This is a case report of a 56-year-old male who experienced significant neurologic, cardiovascular, and respiratory depression due to CBD product intoxication.

Case presentation

A 56-year-old male on no medications with no known history of substance abuse presented via ambulance to the emergency department after being found by coworkers with bizarre behavior, vomiting, and slurred speech. He had legally purchased “CBD gummies” marketed for pain and anxiety relief three hours prior to his presenting to the emergency department, hoping they would help relieve pain from a recent back injury (Figures ​ (Figures1, 1 , ​ ,2 2 ).

Bag of CBD gummies consumed by patient marketed as a healthy solution for pain relief. Per packaging, each gummy contained 15 mg CBD.

A second bag of CBD Gummies consumed by the patient and scanned into the chart upon arrival. Product reportedly contained 50 mg CBD, 44 mg B12, and 400 IU D3 per gummy.

Upon arrival, vital signs (VS) were significant for hypoxia which did improve upon arousal. [Table ​ [Table1 1 ]

Table 1

Initial Vital Signs
Temperature 36.8 degrees Celsius
Heart Rate 78 beats per minute
Respiratory Rate 12 breaths per minute
Blood Pressure 113/60
Oxygen Saturation 84% on room air

Physical exam showed an obese male in no acute distress with a depressed level of consciousness, but who awoke to painful stimuli. Neuro exam was significant for dysarthric, hypophonic speech. He was also noted to have non-bilious, non-bloody emesis intermittently. Arterial blood gas at that time showed a mild acute respiratory acidosis with normal anion gap, normal bicarbonate, and a mild lactic acid elevation (Table ​ (Table2 2 ).

Table 2

Arterial Blood Gas
pH 7.30
pCO2 50.4
pO2 83.3
Lactic Acid 2.4

Labs were obtained and were notable for leukocytosis and mildly elevated creatinine kinase (CK) and CKMB (Table ​ (Table3). 3 ). A comprehensive toxicology screen including cannabis was negative (Table ​ (Table4 4 ).

Table 3

WBC, white blood cell count; RBC, red blood cell count; Hb, hemoglobin; Hct: hematocrit; Na: sodium; K: potassium; Cl, chloride; CO2, bicarbonate; CK, creatinine kinase; CKMB, creatinine kinase-MB

(H) indicates an elevated level, (L) indicates a low level

Initial Laboratory Values
WBC (H) 17.8
RBC 4.65
Hb 14
Hct (L) 41.7
Platelets 208
Na 139
K 4.5
Cl 107
CO2 25
Anion Gap 7
CK (H) 341
Ca (L) 8.4
Serum Alcohol
Troponin
CKMB (H) 4.4

Table 4

AMPX, amphetamines; BAR20: barbiturates; BEN, benzodiazepines; CAN 50, cannabinoids; OPI, opioids; PCP, phencyclidine; COC, cocaine; METH, methamphetamine

Urine Drug Screen
AMPX Negative
BAR200 Negative
BEN Negative
CAN 50 Negative
OPI Negative
PCP Negative
COC Negative
METH Negative

He was admitted to the medical floor, and VS 3 hours after presentation deteriorated, showing bradycardia with a nadir HR of 47, bradypnea as low as 8, blood pressure of 88/52 mmHg, and oxygen saturation as low as 78%. EKG revealed sinus bradycardia (Figure ​ (Figure3). 3 ). Narcan was given multiple times without improvement. The patient progressively became more obtunded but was able to maintain a patent airway with intermittent, aggressive stimuli. He was transferred to the intensive care unit (ICU) for close monitoring and possible intubation. Non-invasive positive pressure ventilation was not administered due to continued emesis.

The patient underwent supportive care with intravenous fluids, anti-emetics, oxygen via nasal cannula, and continuous aggressive stimuli. The following day, 18 hours after admission, the patient was fully alert, oriented, and VS showed signs of improvement (Figures ​ (Figures4 4 – ​ -6). 6 ). The patient recalled consuming 2 entire packages of CBD gummies, totaling 370 mg of CBD (serving size on the package was 30mg). He felt the products were safe based on packaging and ate them as he would eat any other candy, not believing they would have any adverse effects.

Significant bradycardia observed at approximately 3 hours after initial presentation with spontaneous recovery at approximately 26 hours.

Patient became hypotensive almost immediately after presentation which remained persistent until spontaneous recovery began to be seen at approximately 17 hours post-presentation with full recovery seen by the 26-hour period.

Upon presentation, the patient demonstrated some bradypnea which became more pronounced and persistent in the 9-21 hours after initial presentation. Again, spontaneous recovery occurred at approximately the 26-hour mark.

Discussion

This patient suffered neurologic and cardiopulmonary depression as a result of acute CBD intoxication. He was in his usual state of health prior to consuming two packs of CBD gummies. His heart rate, respiratory rate, and blood pressure dropped abruptly shortly after presentation and then experienced spontaneous recovery around 18-26 hours later without any intervention other than supportive care. This pattern of onset and recovery is consistent with toxin ingestion presumably from the CBD gummies which was the only known variable compared with the patient’s typical routine. Due to the report given by his coworkers, it was initially suspected that CBD overdose was the cause for this intoxication, of which there are no known published cases. However, given the lack of regulation and heterogeneity of over-the-counter CBD products, it is unclear which substance or substances were to blame in this patient. Similar cases are likely to be seen as these products become more commercially available.

One such case published in the literature is that of a 9-year-old boy with history of medically refractory epilepsy, diabetes insipidus, hypothyroidism, hemiplegic cerebral palsy, arachnoid cyst resection, and hypothalamic hamartoma resection who experienced profound neurologic and respiratory depression after CBD oil ingestion. The patient was being administered 1 drop of CBD oil to the gums daily but had incidental ingestion of 5 mL on the day of presentation. Upon arrival to the emergency department, he was noted to by hypothermic with depressed mental status and Glasgow coma score of 4-5 as well as decreased respiratory drive, leading to intubation. Urine screening was notable for a metabolite of THC, but testing was not readily available for CBD nor for synthetic cannabinoids. Mass spectrometry analysis of samples of the CBD oil from the same batch showed differing amounts of both CBD and THC. While the patient recovered, the exact constituent which caused the clinical findings mentioned was not able to be established due to lack of consistent formulations, purity, and potency of the commercially available products [4].

When comparing the two cases, there are certain similarities and differences which are worth mentioning. The pediatric patient consumed CBD oil, whereas the 56-year-old man ingested CBD gummies. In both scenarios, more of the CBD-labeled product was consumed than was recommended, and both patients required short-term hospitalization. In the case of the pediatric patient, testing for urine THC metabolites was also available. Neither patient had access to point-of-care testing for CBD or synthetic cannabinoids.

The CBD industry is projected to reach sales of $23 billion by 2023 [5]. This surge is likely due to the excitement behind potentially new medical breakthroughs and the desire as a culture to shift towards therapies that are more “natural.” However, most products, such as the one purchased by this patient are unregulated. Products can contain varying amounts of CBD in addition to unstudied cannabinoids, THC, or toxins such as pesticides and heavy metals. A recent study found that only 31% of 84 CBD products sold online from 31 companies were labeled correctly regarding the concentration of CBD. Additionally, THC was found in 21% of samples among other cannabinoids [6].

With the lack of a known blood level at which CBD exhibits toxic effects and the possible contamination of the product with other cannabinoids and toxins, it is difficult to know whether this is a true CBD intoxication versus toxicity from one of the constituents found in the product. Contributing to this diagnostic dilemma is the fact that the majority of these products are synthetic which allows for a larger spectrum of cannabinoids and much higher concentrations than would be found in natural sources. Additionally, synthetic products do not appear on standard toxicology screening, as was the case in this patient [7] (Oral Presentation: Bass, DO, Jessica, Linz, MD, David. Hashing Out the Unknowns of the CBD Craze. 2019 SGIM Annual Meeting; 5/11/2019).

Conclusions

This is a case of profound neurologic, cardiac, and respiratory depression secondary to acute CBD product intoxication resulting in ICU admission. The patient’s lack of substance abuse history and unintentional overdose should raise concern for physicians as more people are consuming such products. The aggressive marketing of these products paired with the lack of regulation and quality control has the potential to cause a significant negative impact on public health. Clinicians should be aware of this when prompted for advice from patients as well as when treating patients with potential intoxication. Further research into these compounds is certainly indicated and regulation may be warranted for consumer protection.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

Are There Side Effects to CBD Oils, Pills, or Gummies?

The increasing prevalence of hemp-derived cannabidiol (CBD) products has necessitated the spread of information regarding its properties and — most importantly — whether it can be harmful. If you are brand new to the industry and looking to try something new, you are probably wondering: are there side effects to CBD oils, pills, or gummies? Thankfully, CBD is considered to have a very high safety profile, but like any substance with the ability to change brain chemistry, its use can result in potential side effects.

CBD is one of hundreds of compounds that are found in the cannabis plant, known as cannabinoids. These specialized molecules are designed to interact with specific internal receptors that are found throughout our brain and body. These cannabinoid receptors can influence many different processes regarding the modulation of other body systems, which is why people are affected when they consume cannabinoid compounds.

The Most common side effects of cbd

Those who are just learning about CBD may not realize that it does not have the ability to make you intoxicated. Tetrahydrocannabinol, or THC, is the only compound in cannabis that is capable of doing that. This is why hemp is ideal for extracting CBD oil, because it contains only trace amounts of THC, so users will not experience inebriation after its consumption.

However, several clinical trials have shown that patients who were treated with high doses of CBD (In some cases, over 1,300mg in a single day) had reported symptoms that ranged from mild to moderately severe, although nothing significantly life threatening. Research has so far indicated that the most common side effects of CBD can include things like queasiness, anxiety, fatigue, gastrointestinal issues, trouble with balance, dry mouth, and fluctuations in appetite or weight.

Nausea or vomiting

One reported side effect of CBD use is nausea, or vomiting. This can result from taking too high of a dose, which can be a different amount for each person as it is based on their individual biochemistry. For some new users, they may have trouble digesting the oil, which could potentially lead to an upset stomach.

When first trying out a CBD product, it is best to begin with the smallest dose possible, and work your way up. It is also important to note that when taking a tincture, it is necessary to hold the oil underneath your tongue for at least 1-2 minutes, or until the oil has been completely absorbed by the sublingual gland. In this way, the compounds are able to bypass the digestive system and go directly into the bloodstream.

Anxiety

Although many studies are currently underway to determine whether CBD helps with anxiety, some patients have indicated that it actually triggered rather than relieved their anxiety. This could be due to an overly high dose, although the quality of the CBD oil can have a huge effect as well. It may also correspond to the causes of individual stress or anxiety, whether they are due to external factors regarding lifestyle or internal body mechanisms that involve brain chemistry.

Tiredness

There has been a lot of research compiled regarding the use of CBD as a sleep aid, which makes sense as some users have reported excessive fatigue and tiredness associated with larger doses.

Diarrhea

A small percentage of users experienced gastrointestinal issues like diarrhea after consuming CBD. This may also be due in part to the carrier oil that is used as a preservative in CBD products. Different types of carriers can include olive oil, coconut oil, avocado oil, or propylene glycol, and some people might be sensitive to a particular type.

Dizziness

Although there have been a few instances of dizziness associated with CBD use, this may also be an effect of gastrointestinal issues due to sensitivity of other ingredients. This is why it is very important to research all of the ingredients for a particular product, in case of allergies or other components that may cause a reaction.

Dry Mouth

Because CBD oil can be absorbed through the sublingual gland, cannabinoids have the potential to influence saliva production. However, if a CBD product causes excessive dry mouth, it may also be an indication of higher amounts of THC, which is primarily associated with this kind of symptom.

Always check the batch lab reports of a particular product to ensure that it does not have more than 0.3% THC. Some states have allowed for medical use of CBD products that contain more than the federal maximum amount of THC, so that is definitely something to consider and be aware of.

Changes in Appetite or Weight

Some consumers say they have experienced changes in their appetite or weight after using a CBD product. Cannabis products are often used in palliative care for terminal patients as a way to stimulate appetite, and this is considered one of the most common side effects of cannabinoids.

When cbd side effects may occur

It has become so popular in part because of its high safety profile, but when CBD side effects may occur can depend on the quality of the CBD product being consumed. Unfortunately, there are a lot of disreputable companies out there who are looking to make a quick buck in such a fast growing industry. This means they possibly use inferior processes for extracting the oil — some techniques involve the use of harsh chemicals which strip the plant of its natural components, and these processes could potentially leave behind trace amounts of toxic compounds. Currently, CO2 extraction is considered one of the cleanest and most efficient methods for extracting CBD oil.

It is important when choosing a CBD product to ensure that the company provides independent lab tests to confirm the purity of the oil, and to make sure that it does not contain higher amounts of THC, which is federally illegal. Many companies may not want to pay for this, which can be a disadvantage because not all batches of oil will come out with the same concentrations of cannabinoids, and it is important to follow these guidelines in order to ensure that only minimal amounts of THC are in the product.

Is CBD fda approved?

So, is CBD FDA approved? Currently, the Federal Drug Administration is still weighing in on CBD, and has not yet approved its medical use. Part of the issue is the expensive involved with clinical trials, which can cost millions of dollars.

There has been significant confusion within the industry because while hemp products and CBD are federally legal through the 2018 Farm Bill, the FDA has yet to approve their inclusion as an ingestible health supplement. However, FDA officials are aware of the high demand and pervasive use of CBD products, which has prompted them to request users, health practitioners, and industry experts to give their own experiences and comments regarding this issue. They held the first in a series of hearings in the summer of 2019, where people were invited to share their views, and they had also maintained a public comment forum on the FDA website where people were encouraged to give their thoughts on the matter.

It is believed that it will only be a matter of time before the FDA officially approves CBD, but many feel the process is taking too long. The fact that there are no established guidelines means that less scrupulous companies are able to operate with minimal oversight, which ultimately puts consumers at risk.

It is important to continue pressuring the FDA to make significant progress with regard to this decision, and hemp advocates continue to pursue legal avenues that would force them to speed up the process. Until then, both companies and customers will be at risk from the unstable regulatory landscape.

Negative Side Effects Of CBD Gummies

If you’ve been thinking about trying cannabidiol — more commonly known as CBD — welcome to the rapidly growing club. Interest in CBD as a treatment for pain, insomnia, anxiety and other complaints has been rising steadily ever since Oregon and other states legalized cannabis (marijuana).

CBD is one of many natural chemical compounds found in cannabis, but unlike the plant’s other well-known chemical, THC, it has no psychoactive or mind-altering effects. Instead, CBD owes its popularity to its therapeutic effects. Before you try it, however, be aware that it carries potential risks, as well — especially if you take other medications or have liver problems.

CBD benefits

To date, the only FDA-approved use of CBD is a prescription medication called Epidiolex, which treats seizure disorders. Other over-the-counter uses, while widely promoted, need further study to support their claims. These include the following:

Insomnia

With its naturally sedating effects, CBD is used by many people as a sleep aid.

Anxiety and depression

CBD has shown promising results for many people with these issues.

Pain and inflammation

Some patients with arthritis and cancer find CBD helpful in reducing these symptoms.

CBD risks

Much remains unknown about how CBD works, its therapeutic benefits and its safety. For your own safety, it’s important to be aware of the known risks. They include the following:

CBD liver harm

CBD can be harmful to the liver. People with liver impairment should be cautious or avoid it.

CBD medication interactions

Because of its effect on the liver and liver enzymes, CBD can interfere with many medications, either increasing their levels in the blood to potentially toxic levels, or decreasing levels and reducing their effectiveness. Certain seizure medications, antidepressants, muscle relaxers, and drugs that can suppress the central nervous system (such as benzodiazepines, sleeping pills and opioids), among many other medications, may have strong interactions.

It’s important to talk to your doctor or pharmacist before using CBD to make sure you’re not taking a medication that will interact badly with it.

CBD drowsiness and other side effects

Because CBD causes drowsiness on its own, it also increases the drowsiness caused by other medications, including antihistamines (such as Benadryl), benzodiazepines (Xanax, Ativan, Valium), antipsychotics, antidepressants and opioids, as well as alcohol and supplements such as kava, melatonin and St. John’s Wort.

CBD’s sedating effects are similar to alcohol, so it’s not a good idea to use it if you need to drive or to do anything that requires mental alertness. Other common side effects of CBD include diarrhea and changes in appetite and mood.

CBD safety and regulation

Over-the-counter CBD products are not regulated by the FDA. Although most are extensively tested, there is still a possibility of error (such as the mix-up reported last September in The Oregonian), so be wary that products might not be 100% CBD as labeled.

Considering CBD? Talk to your doctor or pharmacist first

If you have questions about how your medications will interact with CBD, reach out to your doctor or local pharmacist for help. Pharmacists are great resources and can help come up with alternative therapies if CBD is not a good option for you.

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