EU drug agency flags CBD market issues in report on low-THC cannabis products
The European Union’s drug agency has signaled that it is mulling the legal and commercial status of CBD and cannabis-based products in Europe in a new report.
The Lisbon-based European Monitoring Centre for Drugs and Drug Addiction published the report on Monday, detailing the results of a study that kicked off in 2018 and aimed to provide insight into the open sale of low-THC products in Europe.
“The specific objectives were to identify and further explore the types of product available and the range of sales outlets, user profiles, associated harms and responses taken in different EU countries,” the authors wrote.
The Centre took note of several glaring issues with the marketing and promotion of some CBD products across Europe, including:
As of February, 1st this year “low-dose cannabidiol (CBD)” has been available in the now lesser regulated ‘OTC’ (over the counter) space.
The TGA had been ‘dancing’ with the ‘vote for medicine’ campaign, and whilst not fully endorsing it, has ushered in a sub-set of classification and rescheduled this particular cannabinoid. Now, this new line certainly opens the door to significantly greater promotion and use of a substance still not fully understood – and a product certainly with clouds over both efficacy and safety – regardless of ‘anecdotal testimony’
Australia’s Therapeutic Goods Administration (TGA) announced their down-scheduling of “low-dose cannabidiol (CBD)” from a Schedule 4 substance to a Schedule 3 substance in mid-December of last year, a decision that just went into effect this Monday, February 1.
This particular jump is a monumental one for Australian CBD producers and customers alike, since it marks the divide between prescription-only (Schedule 4) and over-the-counter (Schedule 3) status.
In order to qualify for this down-scheduling, CBD products have to meet Schedule 3 criteria, chief among which is the requirement on pharmacists to adhere to the newly increased 150mg/day maximum daily dose.
Once a product is approved by the TGA, it is placed in the Australian Register of Therapeutic Goods (ARTG), and can thereafter be sold over the counter.
Of course, cannabis derived formulations have no curative properties of any kind, and formulations for useful ‘medical application’ are very sparce despite, the now decade long thorough investigation, and at very best current preparations may only alleviate some conditions, but not without potential harmful and/or long-term side-effects. The placebo effect of cannabis-based therapeutics is widely known, and whilst a placebo that does no other harms, can be very beneficial on a subjective level, ones that do have detrimental potential are only emerging, and the trade off of one alleviated symptom for another is not good medicine – particularly when net health outcome may be worse.
Whilst we are all excited about, and look forward to, advances in science and medicine that truly benefit our health, not just alleviate a symptom (or worse simply a ‘felt need’) we want to ensure that best-practice science, not market-driven greed and hype (historically a source of many pharmaceutical catastrophe’s) are what drive health-care compassion.
It’s important all consumers keep across all the research – the good, bad and ugly, and make wise beneficial decisions for both short and long-term.
It is very concerning that you are continuing to push the falsehood that youth and teen usage in Colorado is going down. I am a practicing physician in Southern Colorado. Our substance abuse has risen in ALL ages. I am attaching a copy of my long term study data. We are the only level 2 hospital in Southern Colorado. I have tracked all urine drug screens done in our hospital over the last 8 years. Data included in the included powerpoint goes to the end of 2019. Please note that we had a marked increase in positive drug screens since 2013 (one year prior to legalization). The most recent health kids survey shows a rise in teen and youth usage (https://cdphe.colorado.gov/healthy-kids-colorado-survey-data-tables-and-reports ).
Please, it is so very important that you understand the harms that are the end point of increasing the usage of cannabis. Let your politicians/ministers know - I leave, once again, the opportunity for them to come spend a day with me in the emergency department - see the real end point of liberalization of drugs. The saddest part is when these children start cannabis here, they are starting with high potency products, which are clearly addictive and harmful to kids brains. Our community (and I am 100% sure your communities) can not afford the costs of drug treatment programs for everyone becoming addicted.
Please take the time to read my brief powerpoint. Look at the data. There are over 40,000 urine drug screens recorded. There is no downward trend of drug usage in our community - over the last year, you will note a small decrease in the number of those testing positive for opioids and this reflects a community effort to decrease prescription opioids as well as the fact that the urine drug screens used here do not detect fentanyl. You will also note, that the level of those testing positive for opioids did not return to the baseline of 2013 (prior to legalization). Communities simply can not afford to have so many people addicted to drugs. Australia will be no different than the US.
Q: And where, again, has legalization of marijuana helped our drug problem??
A: It hasn't
Please see 2020 provisional drug overdoses from CDPHE. And please, do not blame COVID, although the 2020 data does show increases in alcohol and cannabis use, drug overdoses, and deaths during the pandemic.
Drug overdoses in Colorado strongly correlate with legalization of marijuana
Drug Deaths in Colorado since marijuana legalization (2014)
Co-use of alcohol and marijuana and beliefs among teens
New Research in impact of cannabis legalization on teen consumption is predictably concerning. One of the single greatest drug-use promoting mechanisms is permission. Parents ‘join in’ the permission paradigm, simply by following the unchallenged notion that… “if the government made it legal, it can’t be all bad – right?”
A significant post-legalization increase in past-30-day co-use in 2016 in counties with the highest retail outlet density.
Significant post-legalization increases in perceived risk and parent approval of alcohol and marijuana use.
Legalization and greater retail availability of both marijuana and alcohol were positively associated with co-use among teens, and beliefs favorable to alcohol and marijuana use.
Says lead author, Dr. Grisel García-Ramírez: "Our results suggest that adolescents living in communities with greater retail availability of recreational marijuana and alcohol may have greater indirect access to these substances through diversion, as it is illegal for them to purchase and use them. So, their primary sources are likely to be social rather than commercial."
Brownies are among the most common food products infused with marijuana, however, almost any food product may be infused with marijuana and eaten.
In addition to placing marijuana directly in food, marijuana-infused cooking oil can be used when frying or searing food, and marijuana-infused butter can be spread directly on prepared food.
These marijuana edibles are more common in states that have legalized marijuana and also states that permit medical marijuana use.
(Shop window with cannabis products. Photo by nickolette)
IS EATING MARIJUANA MORE DANGEROUS THAN SMOKING MARIJUANA?
YES! There is high potential for overdose from marijuana edibles.
The effects from smoking marijuana only takes minutes. Edibles, however, take between 1-3 hours because food is absorbed into the bloodstream through the liver. Because it takes longer, the user may end up consuming longer amounts of the drug while thinking the drug isn't working.
The amount of THC, the active ingredient in marijuana, is very difficult to measure and is often unknown in these food products.
If the user has other medications in his or her system, their body may metabolize different amounts of THC, causing THC levels in the bloodstream to dangerously increase five-fold.
Overdose symptoms from eating marijuana are often more severe than symptoms of an overdose from smoking marijuana.
WHAT ARE THE NEGATIVE EFFECTS OF MARIJUANA EDIBLES?
Impaired motor ability
ARE MARIJUANA EDIBLES FREQUENTLY USED?
In recent years, vaping and edible use has increased among U.S. students while marijuana smoking has decreased, according to data from the Monitoring the Future study.
Share on PinterestOverconsumption of cannabis can happen more easily when it’s used in edible form and it can have adverse effects on a person’s health, especially in youths and older adults. Getty Images
Both young and older adults are at greater risk of overconsumption and accidental ingestion of cannabis edibles.
Unlike inhaled cannabis, ingested cannabis must be digested first before being absorbed.
This delay can lead inexperienced users to inadvertently overconsume because they might not feel the intended effects immediately.
Despite their appearance, cannabis edibles — sweet treats like gummies and chocolate bars infused with tetrahydrocannabinol (THC), the primary psychoactive component of marijuana — can be risky for some users.
They may look just like candy, but these potent products definitely aren’t for kids. And that’s part of the problem.
In a new article appearing in the Canadian Medical Association Journal, researchers outlined the most prominent risks associated with cannabis edibles for different users and found that young people are among the most at-risk when it comes to overconsumption and accidental ingestion.
The other most at risk: older adults.
And for those two groups, there are some serious potential adverse health problems that can sometimes result in a trip to the emergency room or just a really, really bad day.
In places where marijuana is legal recreationally and there’s data available, cannabis edibles still remain just a small part of the overall industry. However, in some cases, as in Colorado, they’ve put a disproportionate number of people in the hospital.
There are specific reasons for that, some of which are owed to the difference in how the body processes cannabis based on how it’s consumed.
How cannabis edibles affect you differently
It’s well established that cannabis edibles take significantly longer than inhaled marijuana to enter the bloodstream.
Smoking results in a near instantaneous onset, whereas consuming cannabis commonly takes between 30 to 60 minutes. But that can vary depending on many different factors including the user’s metabolism and the contents of the edible itself.
“Overconsumption is a significant concern because of the delayed time to onset of its intended effects. Unlike inhaled cannabis, ingested cannabis must be digested first before being absorbed, and once it has been ingested, it’s on board, which means people might not feel effects immediately and hence inadvertently overconsume,” said Dr. Lawrence Loh, MPH, an author of the research and faculty member at the University of Toronto.
Other significant factors in determining how quickly an edible could kick in include: sex, weight, diet, and tolerance to cannabis.
But overconsumption also presents specific risks for different age groups, as outlined in the new Canadian report.
For youths, the risks outlined include panic attacks, psychosis, and hyperemesis syndrome — a serious condition that results in uncontrollable vomiting.
There are also potential long-term effects from cannabis consumption beginning at a young age, including “impaired brain development and poor mental health.”
Older adults, the other at-risk group outlined in the report, may experience increased cognitive impairment, risk of falls, heart arrhythmia, and various drug interactions.
According to Loh, these two groups are at higher risk because, “[They] have different metabolic rates and pharmacokinetics than other groups and hence respond differently… For seniors, many may have other conditions that might place them at risk of overconsumption and other indirectly related health issues.”
Rais Vohra, the Medical Director for California Poison Control System Fresno Madera District, told Healthline that his experience in dealing with emergencies associated with cannabis edibles are consistent with findings in the report.
He emphasized how important it is to keep these products out of the hands of children in order to avoid accidental exposure.
“What we really try to repeat over and over again is that kids and cannabis don’t mix. We really should be treating these edibles like we do alcoholic beverages and prescription medications and really trying to keep them out of the hands of toddlers and children who can accidentally ingest them,” he said.
And prevention is the best measure because when it comes to treating cannabis overconsumption, there are few options besides just riding it out.
What’s the best way to treat marijuana toxicity?
“There’s really no antidote to marijuana toxicity. So, whenever somebody is having these effects of marijuana intoxication you really have to just give them supportive care and let time do its thing,” said Vohra.
“As their body metabolizes the cannabis they will become normal again. It may take a day or two and in the meantime they may require intensive supportive care,” he added.
Vohra said that when it comes to marijuana overconsumption he commonly recommends “home observation,” meaning a trip to the ER probably isn’t necessary.
However, for some extreme cases — particularly in young children and infants — a visit to the hospital is a good idea.
Good regulation of cannabis edibles is the first step in making sure no one ever ends up in the ER because of them.
In Canada, these regulations demand that edibles are stored in plain, child-resistant packaging and require a standardized health warning sign on them.
“Common sense and best business practices dictate that in a legally regulated adult-use market, cannabis-infused edible products ought to be readily distinguishable from non-infused products by their packaging. Moreover, such products ought to be properly and accurately labeled for potency and cannabinoid content and served in childproof packaging,” said Paul Armentano, the Deputy Director of the National Organization for the Reform of Marijuana Laws (NORML).
Armentano was not affiliated with the report.
The report also calls for more widespread community-based education around edible cannabis and encourages physicians to more openly discuss marijuana usage with their patients.
“I think that any step that we add to ensure safety, they all synergize. At the community level people just need education and reminders in many different forms that these products can be hazardous,” said Vohra.
FEEDBACK: Written by Gigen Mammoser on January 13, 2020 — Fact checked by Jennifer