1

contains CBD too, as well as an additional

chemical called tetrahydrocannabinol, or

THC, which gives marijuana its

psychoactive properties. Hemp contains

almost no THC.

CBD does not cause any of the

psychoactive effects associated with

marijuana. Neither hemp nor CBD can

make a user ‘high.’

Is it legal?

The 2018 Farm Bill made it legal for

farmers to grow hemp, although there are

still many regulations and restrictions.

Hemp fibers are used in textiles, paper,

plastics, and other products. Hemp can

also be used for grain. But most hemp is

grown for its flowers which are the source

of CBD. Laws about CBD are confusing and

Cancer. Chronic pain. Epilepsy. Multiple

sclerosis. Stress. Anxiety. Sore muscles.

Acne. Insomnia. Sex-drive. Inflammation.

Menstrual cramps. Arthritis. Depression.

High blood pressure. Alzheimer’s disease.

Parkinson’s disease. Schizophrenia.

Addiction. Diabetes. Irritable bowel

syndrome. Smoking cessation.

These are all conditions that proponents

say can be helped by CBD oil. This product

is surging in popularity and can be

purchased in many forms including pills,

tinctures, skin creams, cosmetics, food,

beverages, powders, massage oils, and

suppositories. There are even products for

pets. But does this “miracle drug” really

work? Is it safe? Here’s what toxicologists

at the Blue Ridge Poison Center want you

to know about CBD.

What is it?

CBD stands for cannabidiol (pronounced

can-uh-bid-EYE-all), a chemical extracted

from the hemp plant. Hemp is very similar

to the marijuana plant. Both fall under the

same plant genus: cannabis. Marijuana

Featured this issue

CBD Oil

National Poisoning

Prevention Week

News and Notes

News & Notes from The Blue Ridge Poison Center February 2020 www.brpc.virginia.edu

THE ANTIDOTE

CBD Oil: What Does a Toxicologist Want You to Know?

BRPC Staff:

Director

Christopher Holstege, MD

Nursing Director

Beth Mehring, MSN

Medical Toxicologists

Andy Baer, MD

Heather Borek, MD

Nathan Charlton, MD

Justin Rizer, MD

Medical Toxicology Fellow

Marissa Kopatic, MD

Jennifer Ross, MD, MPH

Epidemiologist

Saumitra V. Rege, PhD

Poison Specialists

Andre Berkin, BSN, CSPI

Michael Brookshire, BSN, RN

Jenni Goodwin, BSN, CSPI

Jennifer Horn, BSN, CSPI

Sue Kell, Ph.D, M.Ed, CSPI

Teresa Kinzie, RN, CSPI

Kathy Mayo, RN, CSPI

Lisa Turner, BSN, RN

Scott Wiley, BSN, CSPI

Steven Yoder, BSN, CSPI

Public Health Educator

Kristin Wenger, MA, BS

Administrative Specialists

Heather Collier

Teresa Dorrier

continued page 2

POISON TRIVIA

Urushiol is the sap produced by all

parts of the poison ivy plant. It may

cause an itchy, blistering rash when

skin is exposed to it. How long can it

remain active on a garden shovel?

A. 3 hours

B. 3 days

C. 1 year Answer on pg. 4

2

vary by state, by locality, and by circumstance. The

FDA has determined that products containing THC or

CBD cannot be sold legally as dietary supplements, nor

can they be sold between states.7 Whether or not

foods and other products to which CBD has been

added can be sold legally within a state depends on

that state’s laws and regulations. Regardless, laws and

regulations seem to be rarely enforced as consumers

can easily purchase CBD products online and almost

any place they buy groceries, medicines, or

supplements.

Does it work?

Researchers have been looking at the possible

therapeutic uses of CBD. The strongest scientific

evidence so far is for its effectiveness in treating two

childhood epilepsy syndromes: Dravet syndrome and

Lennox-Gastaut. In numerous studies, CBD was able to

reduce the number of seizures, and in some cases it

was able to stop them altogether. Recently the FDA

approved the first (and only) prescription CBD

medicine for these conditions, Epidiolex (see below).

There is some evidence that CBD may help with other

conditions, too, particularly chronic pain,

inflammation, anxiety, and insomnia. However, it’s

too soon to say for certain that CBD is effective

therapeutically. Study results are inconclusive. “There

is still a lack of quality studies done on humans, and a

lack of long-term safety data,” says Dr. Heather

Borek, medical toxicologist at the Blue Ridge Poison

Center. What about all the people who claim CBD

helped them? Dr. Borek cautions against relying on

user claims alone that CBD is a “magic bullet” for all of

continued from front— CBD Oil: What Does a Toxicologist Want You to Know?

News and Notes

Coming soon! March 15-21,

2020 is National Poisoning

Prevention Week. The BRPC

will be honoring the week by

inviting all pharmacies to

include a magnet and

information on safe drug

disposal in every prescription filled during the week. If

you are a pharmacist and want to participate, or if you

want to distribute magnets at your school, place of

business, or community, contact Education Coordinator

Kristin Wenger at KLW2S@VIRGINIA.EDU or 434-982-

4386. All supplies are free! You may also order them

directly from our website: www.brpc.virginia.edu.

An FDA ban on flavored

vapes went into effect this

month. The ban aims to

reduce soaring numbers of

teens who are taking up

vaping and becoming

addicted to nicotine, even

when they did not have a prior

cigarette habit. Studies show

that children and teens are attracted to the sweet,

fruity, candy flavors which have been so popular. The

ban, however, has a couple of loopholes. One: the ban

does not apply to tobacco and menthol flavors. Two:

the ban does not apply to disposable, unrefillable

devices. Wasting no time at all, new products have

sprung up and are attracting huge numbers of young

buyers. Leading the way are, among others, Puff Bar

and Hype Bar, which are imported from China. The

new disposable devices a) are cheaper, and b) contain

a higher nicotine concentration than many of the

refillable products they are replacing, such as the

Juul®. Read the article in the New York Times.

3

those health conditions: “Such claims are compelling,

but do not tell the whole story. Did a person’s health

condition improve because of the CBD, or was it

something else? Was it a placebo effect? Would the

condition have improved on its own even without the

CBD? Does the person making the claim have a

financial stake in CBD products? Only careful, peer-

reviewed research can give us reliable answers.”

Other questions that can only be answered by more

scientific research include:

Is it safe for children? Senior adults? People with

pre-existing health conditions?

What is an effective dose?

Can you overdose on CBD?

What are the possible side effects?

CBD can be ingested, absorbed through the skin,

vaped, smoked, and chewed as a gum. Do these

methods all affect the body the same way?

What are the long-term effects of using CBD?

What other medications or products react poorly

with CBD?

Is CBD addictive?

Can users develop a tolerance to CBD? Will they

experience withdrawal?

Note that at this time, non-prescription CBD products

are not approved by FDA for the diagnosis, cure,

mitigation, treatment, or prevention of any disease.5

From pg. 2— CBD Oil: What Does a Toxicologist Want You to Know?

What could be the harm in trying it?

This is also difficult to answer without more studies.

CBD products are not regulated. There is no oversight

from the U.S. Food and Drug Administration (FDA)

assuring that these products contain what they

advertise on the label. Several studies have

performed laboratory testing on random selections of

products purchased both online and in person.

Results showed that at least half of the time, the

concentration of CBD found in a product was much

higher or lower than the label said.4,5 Surprisingly,

some samples were found to contain THC, the active

compound in marijuana. This could lead to users

experiencing unintended changes in mood, thought,

or behavior; suffering injuries; or even failing urine

drug screens.

Studies have also found that CBD products may be

contaminated with harmful substances.4,5

Contaminants may include things that were added

illicitly to increase the amount, weight, or potency of

a product so it can be sold for more money.

Contaminants may also include substances like

pesticides, heavy metals such as lead and arsenic,

molds, or bacteria which find their way into the

product during poor production practices.

Are there any side effects?

Side effects of CBD have been reported and include

nausea, fatigue, diarrhea, weight changes, and

Side by side: hemp (far left)

and marijuana (immediate left).

Taxonomically, the two are the

same species of cannabis, but

have been bred selectively into

separate varieties which

contain different amounts of

cannabidiol and other

chemicals.

Hemp. (Image: U.S. Fish and Wildlife) Marijuana. (Image: NIDA)

4

irritability.1,2 Some have experienced health effects

serious enough to require hospitalization. It is not

clear whether the side effects were from the CBD or

from contaminants in the product.

The drug may interact with some over-the-counter

(OTC) aids, dietary supplements, and CBD prescription

medications, especially those that warn against

consuming grapefruit. CBD may also disrupt an

enzyme called cytochrome P450 complex. This

disruption can affect the liver's ability to break down

toxins, increasing the risk of liver toxicity.2

According to the American Association of Poison

Control Centers (AAPCC), poison centers nationwide

have seen an increase in calls about CBD cases, up

from 3 in 2014 to 1,526 in 2019.6

Bottom Line:

CBD has been shown to help with some forms of

childhood epilepsy.

There may be other health benefits as well, but

there may also be some risks. More research is

needed.

Since CBD products are unregulated, there is no

way to know for certain what the purity or

concentration of a particular product is, regardless

of what its label says. (Note: this does not apply to

the prescription drug Epidiolex which is highly

regulated.)

From pg. 3— CBD Oil: What Does a Toxicologist Want You to Know?

This free, quarterly newsletter is courtesy of the Blue Ridge Poison Center, serving Southwestern and Central Virginia and

the Shenandoah Valley. We encourage you to print, post, forward, or share in any way. Questions or comments? Contact

Kristin Wenger, Health Educator, Blue Ridge Poison Center, University of Virginia Health: 434-982-4386 or

klw2s@virginia.edu.

POISON TRIVIA ANSWER: C) Handling contaminated items has been known to cause rashes up to a year later. It is im-

portant to wash any tools, clothing, or other objects that may have touched poison ivy to remove the oil.

Dr. Borek advises anyone who wishes to try CBD to

first discuss it with their primary health care

provider, taking care to list all their other

medications and supplements so that known drug

interactions can be avoided. If any unexpected

symptoms arise, they should report them and seek

medical advice. Users may also contact the Blue

Ridge Poison Center for help: 1-800-222-1222.

Poison Safety Tips & More! www.brpc.virginia.edu @blueridgepoison Find us on Facebook

SOURCES:

1. Hazekamp A. The Trouble with CBD Oil. Med Cannabis Canna-

binoids 2018;1:65–72. (DOI:10.1159/000489287).

2. Johnson J. (April 29, 2017). Everything You Need to Know

About CBD Oil. Medical News Today.

https://www.medicalnewstoday.com/articles/317221#what_is

_cbd_oil.

3. Greenspoon, P. (August 27, 2019). Cannabidiol (CBD): What We

Know and What We Don’t. Harvard Health Publishing.

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-

we-know-and-what-we-dont-2018082414476

4. Hazekamp A, Epifanova S: Grote variatie in samenstelling can-

nabisolie noopt tot regels. Pharmaceutisch Weekblad 2017;

152: 16–18.

5. U.S. Food and Drug Administration. Warning Letters and Test

Results for Cannabidiol-Related Products. (2019).

https://www.fda.gov/news-events/public-health-

focus/warning-letters-and-test-results-cannabidiol-related-

products

6. Cannabidiol. National Poison Data System, American Associa-

tion of Poison Control Centers. (2019). https://aapcc.org/CBD-

Alert

7. Cannabis (Marijuana) and Cannabinoids: What You Need to

Know. Dec. 5, 2019. NCCIH Pub No. D508. National Center for

Complementary and Integrative Health. National Institutes of

Health.