Over the past few years, America has been overtaken by everything cannabis. From stores opening in Massachusetts selling everything from smokable product to edibles to states like Rhode Island considering legalizing recreational marijuana, it seems like the pot storm is steamrolling the country. And along with this comes the new miracle elixir, Cannabidiol, better known by the initials – CBD.
If you believe the publicity, CBD oil is the cure for everything from mental health issues to epilepsy and even acne – and, there is medical research to support some of these claims. This blog is not necessarily about the efficacy of CBD, but more about how it is being sold and marketed – and its eerie similarities to a substance that had just as big a roll out some four decades ago called DMSO, a product that had serious health consequences for some of its users.
But first, what is CBD?
CBD oil is the concentrated extract from the flowers and leaves of the cannabis plant that is dissolved into sunflower, hemp or olive oil. There does appear to be some promising medicinal value to CBD and a drug containing this substance has been marketed to control epileptic seizures in children.
Researchers state that CBD oil can turn on the cannabinoid receptors in the
brain (yes, your brain does have cannabinoid receptors and your body even has naturally circulating levels of endocannabinoids).
CBD has also been found to interact with the serotonin receptors in the brain (serotonin is a neurotransmitter that appears to play a role in some brain and mental health disorders, including anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias, and even epilepsy) which may explain why this substance could have beneficial effects for those with mental health disorders.
CBD has even shown an ability to bond with pain receptors, something that is especially promising, given the current focus on opioid over-prescribing. But, given that CBD is an extract from the marijuana plant, will the user get high?
If the user has pure CBD oil, the answer to that is no.
The active ingredient in marijuana that causes the psychoactive effect is Tetrahydrocannabinol (THC), one of over one hundred cannabinoids identified in the cannabis plant. The cannabinoids in CBD do not fit into the THC receptor in the brain and therefore will not cause the “high” that most marijuana users seek.
Pure CBD oil appears to be beneficial for multiple medical conditions but the problem today is that this substance is not regulated and therefore lacks federal oversight in its manufacturing, marketing, strength and recommended use. Because of this, label regulations are lacking and consumers have no idea what they are buying, how it is made and in some cases, where it is made. And it has been reported that some of these oils being sold could contain small amounts of THC.
Just how out of control is the CBD oil craze? Well consider this, bottles of the “miracle cure” can be found for sale in gas stations, convenience stores, antique stores, airport gift shops and flea markets. I think it would be safe to assume that the cashiers who check you out at these locations did not attend medical school nor could they explain the pro's and con's of the brand of CBD oil they are peddling.
As mentioned earlier, the marketing of CBD oil in 2019 is reminiscent of a similar craze that took hold beginning in the late 1970s and carried on for over a decade for a substance called DMSO, a topical oil that came with similar cure-all claims.
DMSO, Dimethyl sulfoxide, was first discovered in 1866 by a Russian chemist
as a by-product of paper making. In the 1940s, this chemical was developed commercially and used as an additive in antifreeze, paint and household cleaners. By the late 1970s, DMSO was being touted as a way to manage cancer symptoms and pain, heal tumors, prevent joint pain and said to have “magical” anti-inflammatory properties -- among other medical uses. And, like CBD oil, DMSO did have some legitimate medical uses.
DMSO was an oily substance that was rubbed on the skin (and some people ingested it) and within moments of applying this substance, a strong and pungent garlic odor would be detectable on the user’s breath that lasted for hours. The most remarkable property of DMSO was its ability to immediately penetrate the skin and transport any chemicals present into the body, including drugs, dyes, pollutants and even perfumes.
Like CBD oil, DMSO was unregulated and started showing up in health food stores, convenience stores, gyms, gas stations and any place where there was a high volume of consumer traffic. Newspaper and magazine reporters wrote articles on the "curative" properties of the substance and anyone who raised concerns about its properties were shouted down and called naysayers.
The DMSO for sale at retail outlets was extremely high priced, so those in the know began buying it at hardware stores where it was an ingredient in industrial degreasers and much cheaper when purchased in that form. It soon gained cult status and was being used by older adults for joint pain and became the sweetheart of athletes, from the high school level to professional athletics.
At that time, I was active as a competitive powerlifter when the DMSO craze hit the training facility. One of the biggest problems facing most athletes who trained with heavy weights was joint pain and inflammation of the tendons. The most popular medication in the gym at the time was Butazolidine (called Bute),a powerful non-steroidal anti-inflammatory drug that was extremely effective in treating fever, pain, and inflammation in the body. Butazolidin was also a go-to medication for seniors with arthritis at the time.
Unfortunately, Butazolidine was also extremely toxic and like today’s opioids, came under scrutiny for the number of prescriptions that were written for it. By the 1980s, it was no longer approved for use in the United States. Enter DMSO and its transport properties.
Because Butazolidin was no longer available, athletes began mixing DMSO with other less powerful anti-inflammatories and applied it directly to the body. Seniors began using it as a way to control joint pain and also mixed it with over the counter medications in order to deliver the punch they needed to deal with the pain they were experiencing.
But as promising as DMSO was, serious side effects began to emerge. At least two competitive powerlifters I knew became extremely ill and were diagnosed with toxic hepatitis, an inflammation of the liver in reaction to certain substances to which it is exposed. Toxic hepatitis can develop within hours or days of exposure to a toxin or may take months. It can also result in permanent damage to the liver and in some cases, liver failure can occur.
But it was just not athletes who suffered illnesses from DMSO use, older adults began experiencing problems as well. DMSO was found to be synergistic (increased the desired effect of a medication) when combined with some drugs including heart medicines, blood thinners, steroids and sedatives. Those with liver, kidney or heart conditions, diabetes and asthma were strongly advised not to use this substance.
As the negatives of DMSO came to light, its popularity fell off but was still used and widely available. Then came the news of the Gloria Ramirez, who became known as the Toxic Lady.
It was 1994 when the 31-year-old Ramirez was rushed to the emergency room at the General Hospital in Riverside, California. Her symptoms were puzzling to the ER staff – a rapid heartbeat, drop in blood pressure and she was incoherent. Attempts to stabilize her were unsuccessful.
When medical personnel removed her clothing to apply a defibrillator, they noticed that her body was covered with an oily substance. They then smelled a garlicky odor on her breath. When blood was drawn, a strong smell of ammonia was detected, and small particles of a manila colored substance was seen floating in her blood sample.
Then, the attending medical staff began to have problems. One by one, they began to feel sick and some lost consciousness. A few even reported being temporarily paralyzed.
It appeared that Ramirez, who had recently been diagnosed with late stage cervical cancer, had covered her body with DMSO in an attempt to control the pain she was experiencing. Sadly, she died later that night. But why would DMSO cause the problems it did for this patient and why did the medical staff have such a reaction to her? Was this a case of mass hysteria? Apparently not.
When doctors researched what had happened in this case, what they found was shocking. It appeared that when DMSO was exposed to oxygen, as it was when the patient was being treated, it changed the chemical structure of DMSO from dimethyl sulfone to dimethyl sulfate, an extremely toxic chemical. Dimethyl sulfate’s effects on the human body include destruction of cells in the eyes, lungs and mouth as well as convulsions, delirium and paralysis. This certainly explained the reactions in the emergency room that night but also left them wondering how many people using oxygen and DMSO experienced damage.
The DMSO craze was on the wane anyway at that point and this story helped push the substance back underground, and it later lost its appeal as safer anti-inflammatories made their way onto the market.
Today, DMSO is still available over the counter in some locations and is contained in FDA approved medications, mostly due to its ability to rapidly penetrate the skin. It is used to treat painful conditions such as headache, inflammation, osteoarthritis, rheumatoid arthritis, and severe facial pain called tic douloureux. It is also used either alone or in combination with a drug called idoxuridine to treat pain associated with shingles.
Now to be fair, most of the serious illnesses associated with DMSO were the result of industrial strength DMSO being sold by retail outlets. This form of the product was not only extremely powerful but loaded with impurities and not designed for human use. Although CBD oil does not appear to have the same dangerous properties as DMSO, the concern still lies with retail establishments selling a product with medical implications that is unregulated and may not be pure. Add to this, CBD oil is still early in its research and other side effects may exist that are not yet known.
But what is known is that pure CBD oil does have some proven medical properties. Let's take a look at these properties and how CBD oil is being used.
In 2018, the FDA approved a drug called Epidiolex, which contains CBD and is used to treat two types of pediatric epilepsy. Obviously, the drug companies
were required to follow a strict approval process which included multiple studies that yielded positive results. Those who have been prescribed this medication report extremely favorable outcomes.
And, as we stated earlier, there is some evidence in mice that CBD can be used to treat multiple mental health disorders, including PTSD (based on serotonin levels). But…it’s a big leap from the lab to humans so the companies doing the research are applying to gain approval for human trials.
In the Allentown area of Pennsylvania, Dr. Bruce Nicholson, the director of Pain Specialists of the Lehigh Valley, told reporters that CBD appeared to be a better anti-inflammatory than some of the corticosteroids. Nicholson added, “...some studies also suggest that CBD oil can function as a nerve protectant and treat nerve injury pain, but because it is not legal in every state, it's been difficult to research."
Dr. Rachel Nazarian, a dermatologist, has found some dermatological uses for CBD. “[It] has multiple uses in improving inflammatory conditions like eczema, including improving wound healing, itch, and pain, and has even been reported to improve a rare blistering disorder of skin," she said.
But, with what little research has been done on CBD, some side effects have come to light, most which have implications for seniors. These include:
Dry Mouth – A 2006 study showed that this substance activated saliva receptors causing a decrease in saliva production. For younger adults, this may not be a major issue but for seniors, a lack of saliva production can lead to problems taking medications, eating solid foods and even lead to mouth infections.
Low Blood Pressure – High doses of CBD (concerns with buying over the counter unregulated CBD with varying strengths), can cause a small drop in blood pressure when first used. Again, for younger adults, not a major issue but could have implications for seniors who are taking low blood pressure medications.
Dizziness – This may or may not be connected with the blood pressure lowering properties of CBD, however, given the fall dangers in the elderly, it is something to be aware of.
Nausea – Those who ingested the product reported some nausea but it is reported to be a rare occurrence – something interesting given the fact that one of the benefits that is touted about CBD is its ability to relieve nausea and increase appetite in patients receiving cancer treatments.
Sleepiness – CBD is also marketed as a “natural” sleep aid, so this effect should not be surprising. However, for seniors who may be taking medications like benzodiazepines, increased drowsiness could magnify the effects of this class of medications and present with increased fall dangers. And here’s another problem with CBD oil, it may take several hours for the effects to be felt. So users may feel nothing and take more. Again, being unregulated and with varying strengths, knowing how CBD oil will affect someone is hard to predict.
Increase in Parkinson’s Tremors – Some of the current research, although it is early, seems to indicate that high doses of CBD can worsen the muscle tremors in those with Parkinson’s. Although other studies show that lower doses are safe, those using CBD oil need to speak with their doctor before using it.
Headaches – Wait a minute, isn’t CBD touted as a headache cure? Yes, and it appears that those who present with headaches as a side effect may be the result of purchasing lower quality CBD that contains impurities. Again, research into this is early.
Interactions with other drugs – At this point, the studies into this are so early, any discussion would be speculation. But one thing is important, CBD’s apparent ability to control some forms of epilepsy may require the user to adjust their anti-seizure medications.
Liver Issues – Incomplete studies indicate CBD could harm the liver. In about one out of ten people using this substance, medical providers have detected increases in liver enzymes and about two to three percent of these people had readings so high that it indicated the possibility of liver damage. And for seniors, the liver loses its ability to filter with age and such damage could lead to a serious medical problem.
The above side-effects are those that are currently known. As research into CBD moves forward, we may or may not find more issues with this substance. But one thing is certain, seniors should not take any supplement without discussing it with a doctor.
"We need to be concerned with what our seniors are buying. Many do not know that even vitamin supplements can have adverse effects on their bodies when used with some of the medications they are taking," said Attorney RJ Connelly. "Buying unregulated supplements or health care products without the knowledge of its manufacturer or varying strengths could have dire consequences. No one, especially seniors, should take any over the counter medicinal products without seeing their medical provider first."
As the CBD craze continues, counterfeit oils are springing up in stores that claim it is pure CBD oil. However, some of these substances contain THC, the psychoactive component of marijuana and can cause users to have unpleasant side-effects. Watch this video for additional information.
The major concern right now with CBD is the fact that it is unregulated meaning its potency and purity could vary widely from place to place and some may even contain THC. Even worse, money could be spent purchasing a product that may not even contain CBD. So how do you protect yourself?
Check the Source – those who know, including well respected online medical websites, state that CBD oil that has been manufactured in the USA, Canada or Europe appear to be the safest product.
Check the Purity – The product should be more than 50% CBD oil – with no trace amounts of THC.
Don’t Buy Cheap – You get what you pay for, and good quality will cost you.
Get it From a Doctor – This is the gold standard for two reasons. First, if you are buying it from a doctor, you can probably rest assured that the product is real and safe. Second, your doctor will also review the other medications you are taking and discuss with you if using CBD is safe.
As this blog was being written, the State of North Carolina took aim at the sale of unregulated CBD oil.
Television station WCET News 6 reported that North Carolina regulators are following the lead of New York City regulators ordering restaurants not to sell food products containing CBD oil.
According to WECT, within the next week, state regulators plan to start sending warning letters to businesses selling CBD-infused food and beverages, making unapproved health claims about CBD, or selling CBD in nutritional supplements in violation of Food and Drug Administration rules about the compound.
Joe Reardon, assistant commissioner for Consumer Protection with the Department of Agriculture and Consumer Services, stated, “CBD is now a drug, so it is illegal to add a drug to food. The recent spike in unregulated products containing CBD or other cannabis compounds is putting consumers at risk.”
He added that FDA approval of the CBD-based drug Epidiolex to treat severe epilepsy changed how the chemical was regulated. Expect other states to follow the lead of North Carolina.
The bottom line? Before using any health care product, talk with a medical professional first. CBD could very well be a medical miracle but ask yourself, would you buy heart medications at the corner store or take advice on treating a brain tumor from a mechanic? Let them stick to what they are experts at - repairing cars and let our medical professionals sort out the effectiveness of CBD oil and where it should be obtained. Until the research is complete, we need to tread this path cautiously.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.