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A range of synthetic marijuana chemicals linked to hospitalizations, comas, and deaths have been found in CBD gummies and vape cartridges. 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, Laced weed is another way to describe cannabis that has been altered with another substance. Despite what sensationalist headlines would

Synthetic Marijuana Found In CBD Products Across Multiple States

CBD gummies and vape cartridges laced with synthetic marijuana have been found in Maryland, Louisiana and 11 other states, according to a new AP investigation.

CBD edibles and vapes spiked with a variety of synthetic marijuana compounds have found their way to consumers in Louisiana, Maryland and nearly a dozen other states, according to a nationwide Associated Press investigation into unregulated cannabidiol products. Synthetic marijuana, often marketed as K2 or Spice, has been linked to mass hospitalizations and other health emergencies across the U.S. and Europe. While they have nothing to do with cannabis plants, synthetic marijuana chemicals somewhat mimic the activity of cannabinoids, but they are significantly more potent. Adverse reactions to synthetic marijuana range from fainting and dizziness to vomiting, heart and lung illness, coma, and even death.

Investigation Uncovers CBD Vape Cartridges and Edibles Spiked with Synthetic Marijuana

The U.S. hemp-derived cannabidiol industry is growing rapidly, thanks to the lifting of the ban on hemp products. But unregulated, untested CBD products still dominate the market. And while many products come from reputable companies that are as transparent as possible about their manufacturing processes, some originate from sources that are lacing products with dangerous synthetic chemicals.

The term synthetic marijuana is somewhat of a misnomer. It’s a catch-all term for unknown chemical mixtures sprayed on or added to smokable herbs and flowers and typically inhaled or ingested, hence its association with cannabis. These drugs provide a cheap, intense and dangerous high. And now, investigators are finding them in CBD vape and edible products.

AP’s investigation began with a nationwide survey of law enforcement. That survey revealed that at least 128 of 350 CBD products labs tested contained synthetic “marijuana.” Gummy bears accounted for 36 of those 128. The rest were vape products. AP says most of the testing occurred in Southern states. And in Mississippi, labs detected fentanyl in some products labeled CBD.

Through the survey, AP obtained a list of brands and products containing synthetic marijuana. It then sent reporters to purchase those products in retailers across the U.S. and have them tested. In all, AP turned up contaminated CBD products in 13 states. Some of the products could be purchased online and shipped anywhere in the U.S.

Because the investigation focused on suspect brands and products, its results don’t represent the CBD market as a whole. Still, the report highlights the dangers of untested cannabidiol products at a time when the U.S. is still dealing with a string of vape-linked illnesses and deaths.

Green Machine, Yolo Vape Cartridges Found Containing Synthetic Marijuana

AP reporters have so far tested about 30 suspicious cartridges purchased at convenience stores mostly located in Southern states. Lab tests showed that 10 of the 30 contained synthetic marijuana, including Juul-compatible Green Machine CBD pods and Yolo CBD vape cartridges. Test results found the cartridges contained chemicals linked to multiple deaths in Europe and dozens of hospitalization in the U.S., spanning states from Utah to Louisiana to Maryland.

One of those cartridges, sold at a mom-and-pop convenience store, the 7 to 11 Store, put a young man in a coma in South Carolina. Jay Jenkins said two puffs of a vape cartridge he thought contained CBD induced hallucinations and made him feel like he was dead. According to Jenkins’ medical records, he suffered acute respiratory failure after being rushed to the hospital, where he fell into a brief coma.

There are no consistencies in terms of the chemicals found or the products contaminated with them, either. Products found to contain no synthetic marijuana in one state tested positive for them in another. For Green Machine CBD pods, for example, four of seven tested positive for synthetic marijuana.

Furthermore, investigators had little luck tracking down anyone to hold accountable for the spiked CBD products. Retailers typically point higher up the supply chain, placing blame with producers and manufacturers. The absence of any regulatory oversight makes it very difficult to track down the people behind the laced CBD products. As a result, the American Association of Poison Control Centers has listed CBD as “an emerging hazard.”

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.

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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.

How to tell if your cannabis is laced

Laced weed is another way to describe cannabis that has been altered with another substance.

Despite what sensationalist headlines would have you believe, verifiable cases of laced cannabis are exceedingly rare.

If you’re reading this article in a post-smoking panic – take a deep breath. It is possible the anxiety and worry you’re experiencing is from the THC itself, not a contaminant. Now take another couple deep breaths and have a bite of a snack or a sip of drink.

While examples of laced cannabis are rare, it has happened and the dangers can be real.

How can you tell if your weed is laced?

It can be hard to tell if your cannabis is laced by looking at it, if not impossible. Some substances will change the odor or the appearance of the bud, while others won’t leave a trace. Avoid any cannabis that looks like it has been powdered, dusted, coated or sprayed. If your bud smells strange or harsh, like chemicals, it may have been laced or contaminated.

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Of course, discerning what has been sprayed or powdered on cannabis flower can be difficult to the untrained eye. Because cannabis has a pungent odor, often even described as gas, diesel, or fuel, not everyone will be able to identify an abnormal odor. And because cannabis can naturally appear to be covered in crystals due the the resin-filled glands on the outside of the flower – the trichomes – the average consumer may not be able to distinguish them from powder or sprayed on chemicals.

But smell and appearance can’t catch everything and the only sure way to tell if cannabis has been laced is with a series of laboratory tests. If you’re unsure about the quality of your cannabis or suspect for whatever reason that it may have been laced, err on the side of caution and throw it out – even if it hurts!

What could weed be laced with?

There are a number of substances that weed could be laced with.

It’s important to remember that it’s rare to come into contact with laced weed, even on the illegal market. People sell drugs to earn a profit, not to harm people.The practice of mixing in harder drugs like opiates with weed is quite uncommon because these harder drugs are inherently more profitable than cannabis. Therefore, unless the dealer is openly selling laced cannabis at a higher markup, there would be very little economic incentive to lace weed with hard drugs. This is not to say that it doesn’t happen, but simply that this is not a common business tactic; and given the risks of consuming laced weed (which can include death), this can even put drug dealers at risk of being prosecuted for selling tainted drugs.

  • Opioids
    • Fentanyl
    • Heroin
    • Stimulants
      • Cocaine
      • Crack
      • Methamphetamine
      • Psychedelics drugs
        • LSD (Acid)
        • PCP (Angel dust)
        • Ketamine
        • Cannabinoids
          • -K2/Spice (synthetic cannabinoids)
          • -Byproducts of Delta-8 production
          • Other substances (aka contaminated)
            • Crushed glass
            • Laundry detergent
            • Food coloring
            • Embalming fluid 1

            Can edibles be laced?

            Yes, edibles can also be laced. In April of 2022, a woman in the United Kingdom died after eating a gummy made from synthetic cannabinoids. If you suspect you or a friend has ingested laced edibles, contact emergency services.

            However, it’s important to note that a high-dose of THC infused edibles can also cause intense experiences. High doses of THC can have intensely unpleasant (but not fatal) side effects including anxiety, paranoia, vomiting, shortness of breath and overall discomfort. Some people who green out on THC even report thinking they “were going to die.”

            Symptoms of having smoked laced weed

            Symptoms of having smoked laced weed will depend on what other substance was in the bud.

            Assuming you know what it feels like to be high, remember that high levels of THC can cause anxiety and paranoia. These symptoms are normal and somewhat common with weed. But if you notice other abnormal symptoms like chest pain, passing out, slurred speech, profound sedation or hallucations, seek medical attention and consider tossing the weed if there is no other explanation for these symptoms.

            Of particular concern are side effects typically associated with opioid use rather than cannabis. The World Health Organization defines three symptoms of an opioid overdose:

            • pinpoint pupils
            • unconsciousness
            • reduced, shallow breathing (known respiratory depression)

            If you notice these symptoms in anyone after smoking cannabis, contact emergency medical professionals.

            Additionally, it is rare that cannabis causes visual and auditory hallucinations, and experiencing these during a THC-induced high may suggest laced weed, or it could be related to an underlying risk of experiencing psychosis. In this case, it is best to avoid THC and discuss this experience and alternatives to cannabis with a health professional. 2

            How to avoid laced weed

            • In the legal market, you can usually request a COA (certificate of analysis) to see the lab test results for your flower, prerolls, and edibles.
            • If you don’t have access to the legal market, get to know your source. Are you buying from the grower themselves or someone else down the supply chain?
            • Avoid pre-ground weed if you don’t know your source, as it can be easier to lace than whole buds.
            • Trust your instincts. If you suspect for any reason your bud has been tampered with, throw it out.
            • Always try a small amount of any new cannabis before diving in, especially if it was bought from an unknown source.
            • Grow your own. There is no better way to know that weed is grown right and clean than doing it yourself

            Bottom line

            The easiest way to avoid laced weed is to grow your own bud or get a COA on legal cannabis products. But this isn’t always possible, so it’s important to be aware of the rare but potential risks. Consume cannabis mindfully and avoid products when you don’t know where they’re coming from. Monitor your dosage when trying new products and remember don’t freak out; cases of laced cannabis are few and far between.

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