A poisoning outbreak traced to synthetic cannabinoids sickened at least 52 people in Utah and sent 31 to the emergency room this past winter, reveals a new report released Thursday by the Centers for Disease Control and Prevention. But unlike other recent outbreaks, the victims weren’t trying to buy synthetic weed: They had bought what they thought was cannabis oil that only contained cannabidiol (CBD), the non-psychoactive ingredient of weed. And many had purchased these products from traditional smoke shops.
Around the beginning of last December, according to the CDC report, the Utah Poison Control Center came across five cases of people visiting the ER with symptoms of seizures, confusion, and hallucinations. Just before the symptoms began, the patients had all taken a product marketed to contain CBD. Products that contain only CBD are created to not have the psychoactive effects commonly associated with THC. Eventually, state and federal health and law enforcement officials formed a task force that found at least 52 similar cases had occurred within the state from October 2017 to the end of January 2018.
CBD is thought by some to help treat certain conditions, such as pain and depression (though evidence to support many of these claims is lacking). This April, a committee of outside experts assembled by the Food and Drug Administration unanimously voted to approve the first CBD-based drug to treat certain epileptic seizures. While CBD use can cause some unpleasant side effects, like nausea, it doesn’t cause the sort of symptoms doctors were seeing.
Eventually, lab testing of the products the patients had used found no traces of CBD, but they did find 4-cyano CUMYL-BUTINACA (4-CCB), a synthetic cannabinoid meant to mimic the effects of THC. Of the nine products that tested positive for 4-CCB, eight were branded “Yolo CBD oil.” But the products had no labels indicating who had manufactured them or even what ingredients they was supposed to contain. Four of the five patients whose blood was tested also had 4-CCB in their systems, as did an unopened CBD product purchased by the task force from the same store and brand a patient had bought.
“Synthetic cannabinoids, such as 4-CCB, act on the same receptors as THC, but the effects of synthetic cannabinoids can be unpredictable and severe or even life-threatening,” lead author Roberta Horth, an officer with the CDC’s Epidemic Intelligence Service, told Gizmodo via email. “Based on reported side effects of 4-CCB in case-patients, they appear to be more severe than THC. Fatalities following use of 4-CCB have been reported in Europe.”
In interviews with the victims, all of whom survived, 33 said they had used Yolo-brand oil. Thirty-four people also said they had bought their product from a smoke shop, while eight said they had gotten it from a friend. Thirty-five said they bought it for recreational use, while 15 said it was for medicinal use. And 38 people used the oil by vaping it, while another nine placed it under the tongue.
While the outbreak of CBD poisoning seems to have ended, the CDC officials warn there’s little preventing from it happening again, thanks to lax regulations in how the products are produced or tracked after they reach store shelves.
“Because CBD is illegal at the federal level there is no regulation of product quality at that level. Some states allow for the sale and possession of CBD; however, regulation differs in each jurisdiction,” Horth said. “Products being sold in Utah at the moment are not done so legally so there is no way to ensure that these products are safe.”
As a result, up to a third of CBD products might be incorrectly labeled, Horth added, referencing a 2017 study in JAMA.
Horth noted that Utah’s senate has passed a bill that would allow these products to be sold legally under a new framework. And last December, 4-CCB was also temporarily added to the list of controlled substances via emergency powers invoked by Hawaii law enforcement officials following several drug seizures by officials that same month.
At the moment, it’s thought the 4-CCB was intentionally used as a replacement for CBD in these products, and the investigation to track down where it came from is still ongoing, Horth said. But though some stores have voluntarily pulled their stock of Yolo-branded oils, the threat of more cases is real.
“It is possible that other products could contain 4-CCB or other dangerous synthetic cannabinoids,” she said.