Episode Description: Continuing from our previous episode, we continue exploring the basic question, "Is Cannabis Safe?", this time focusing on contaminants that could be found in Cannabis or Cannabis products. We speak with biochemist Dr. Anthony Smith about what contaminants labs are commonly finding in Cannabis. We also speak with herbal scientist, Travis Simpson, about his concerns regarding Cannabis processing operations and the potential contaminants that may be introduced to products through bad manufacturing practices. Finally we talk again with neurologist and cannabinoid researcher, Dr. Ethan Russo, to discuss the "vaping crisis" that has claimed the lives of as many as 37 people in the United States and affected nearly 2000 users. This is part two of a three part series exploring the question, "Is Cannabis Safe?"
You’re listening to the Curious About Cannabis Podcast.
Hey everybody, this is Jason Wilson with the Curious About Cannabis podcast. Thanks so much for tuning in once again. This episode is part two of a three-part series exploring Cannabis safety and harm reduction. If you haven’t listened to the first part of this series, I really recommend stopping this episode and going back to listen to this series from the beginning.
Previously we explored some of the main chemicals in Cannabis, the adverse health risks associated with Cannabis, and how Cannabis can interact with medications. Today we will be focusing on a critical topic that has a huge impact on the safety of Cannabis products – Cannabis contaminants.
What contaminants might be found in Cannabis products?
Anthony Smith is a biochemist that has spent that last five years analyzing Cannabis products for potency and purity in labs all across the United States and Canada.
[ANTHONY INTERVIEW SEGMENT]
Before we continue, let’s talk a little more about pesticides. Many pesticides are designed to disrupt the nervous systems or hormone signaling in insects. The problem is that this same effect can happen in humans, if someone is exposed to enough of a certain pesticide for long enough periods of time. Additionally, some pesticides, like myclobutanil, a common fungicide, can degrade into toxic compounds like hydrogen cyanide when heated.
You might be thinking, what’s the big deal about pesticides in Cannabis? Aren’t we already exposed to pesticides through our food? Well, that’s true, but the problem relates to the way in which Cannabis is consumed. When you eat something, your body works hard to ensure that any toxins are captured, broken down, and excreted from the body before they have a chance to reach your blood stream. But when you smoke something, you are bypassing those metabolic processes, and the compounds that enter the lung will pass directly into the blood stream. So essentially when you smoke you are bypassing your body’s natural defense systems that might otherwise keep you safer.
It’s also really important to point out that many pesticides, as well as mycotoxins, can become concentrated in Cannabis extracts. The process of making a Cannabis concentrate can elevate contaminants like pesticides as much as 5 to 10 times the concentration found in the Cannabis flower, meaning that if you are consuming a Cannabis concentrate, you are potentially being exposed to much greater doses of contaminants than if you were consuming the Cannabis flower used to produce that concentrate. I also want to point out that it’s not enough to simply test Cannabis flower for contaminants prior to making a concentrate. It is possible for there to be very trace amounts of pesticides or other contaminants present in the flower that won’t show up on a standard contaminant screening – but when concentrated they suddenly become present in dangerous levels.
[BACK TO ANTHONY SMITH SEGMENT]
The leaching of contaminants  from cultivation, processing or packaging equipment is an issue that people working in the natural products industry have had to think about for quite some time. However some Cannabis companies are still learning about typical herbal processing and manufacturing best practices – putting consumers at risk. I spoke with Travis Simpson, an herbal scientist that has spent the past several years working with hemp in the Cannabis industry. He shared some of his concerns regarding contaminants from manufacturing and packaging equipment.
[TRAVIS SIMPSON SEGMENT]
One of the important things to note regarding most of these contaminants, including pesticides, metals, and mycotoxins, is that you won’t necessarily have an immediate reaction when you are exposed to these toxins. They can build up in the body over time, and you may not exhibit any symptoms for a long time before the body finally reaches a tipping point. So just because you may have consumed a Cannabis product and didn’t notice any adverse effects, that does not mean that you are not being exposed to harmful contaminants.
The takeaway from my discussions was clear – know the purity of your Cannabis before consuming. But this is easier said than done. There are still many places in the US and abroad that have not legalized Cannabis or established strict testing requirements for Cannabis. For users getting their Cannabis from the black market, they are left at the mercy of their supplier’s quality.
Unfortunately, this can sometimes lead to tragic consequences.
[ETHAN RUSSO SEGMENT]
Dr. Russo is referring to a recent string of fatalities linked to lung infections or lung damage associated with vape pens.
[“VAPE CRISIS” NEWS REEL]
At the time of this recording, there have been 29 recorded deaths, and over 1300 reported cases of lung infections or damage linked to vape pens. And these reports are growing at a rapid rate. While the exact culprit responsible for these illnesses and deaths has not yet been identified, investigators suspect it has to do with additives or contaminants.
[CONTINUE ETHAN RUSSO SEGMENT]
There is other evidence that contaminants in Cannabis have caused very serious problems for some people, which in rare cases has led to death. There are several case studies available of patients that contracted fatal lung infections, such as a condition called aspergillosis.  Aspergillosis is a condition where the spores of certain species of Aspergillus fungi get nestled in small scrapes and crevices in the lungs where they begin to grow, forming a fungal mass called an aspergilloma. This ultimately starts to break down lung function and can be fatal. In some fatal aspergillosis cases reported, contaminated Cannabis was deemed to be a contributing factor, and possibly the sole cause.
This is more common in immunocompromised users than regular healthy users, but that just highlights the tragedy here. Many people with serious health conditions are turning to Cannabis as a medicine – and those patients are the ones most vulnerable to the adverse health effects of consuming contaminated Cannabis.
So let’s review what we’ve learned so far:
Find out in the third and final part of this series where we finish our curious quest to discover, “Is Cannabis Safe?”
Citations and Resources
 “#01 Is Cannabis Safe? Part One”. The Curious About Cannabis Podcast. Natural Learning Enterprises. 2019. https://cacpodcast.weebly.com/episodes/01-is-cannabis-safe-part-one
 How Pesticides Work. Kentucky Pesticide Safety Education Program. http://www.uky.edu/Ag/Entomology/PSEP/12pesticides.html
 Kim et al. Exposure to pesticides and the associated human health effects. Science of the Total Environment. 2017. 575(1): 525-535.
 Product Safety Assessment: Myclobutanil. Dow Chemical. http://msdssearch.dow.com/PublishedLiteratureDOWCOM/dh_08d6/0901b803808d60fd.pdf?filepath=productsafety/pdfs/noreg/233-01023.pdf&fromPage=GetDoc
 Pond SM, Tozer TN. First-pass elimination. Basic concepts and clinical consequences. Clin Pharmacokinet. 1984. 9(1): 1-25.
 Huestis MA. Human Cannabinoid Pharmcokinetics. Chem Biodivers. 2009. 4(8): 1770-1804.
 Voelker R, Holmes M. Pesticide Use on Cannabis. Cannabis Safety Institute. 2015. https://cannabissafetyinstitute.org/wp-content/uploads/2015/06/CSI-Pesticides-White-Paper.pdf
 Williams et al. Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions. The American Journal of Clinical Nutrition. 2004. 80(5):1106-1122.
 Gargani et al. Too Many Mouldy Joints – Marijuana and Chronic Pulmonary Aspergillosis. Mediterr J Hematol Infect Dis. 2011. 3(1): e2011005.
 Ruchlemer et al. Inhaled medicinal cannabis and the immunocompromised patient. Support Care Cancer. 2015. 23(3):819-822.
 Gargani et al. Too Many Mouldy Joints – Marijuana and Chronic Pulmonary Aspergillosis. Mediterr J Hematol Infect Dis. 2011. 3(1): e2011005.
In this behind-the-scenes (BTS) full-length interview, I sit down to talk with Janna Champagne (aka Nurse Janna), a registered nurse and health educator specialized in Cannabis and cannabinoid therapy. In this conversation we talk about managing risks associated with Cannabis use, Cannabis interactions with medications, clinical outcomes that she has witnessed in patients using Cannabis, the struggle to overcome social stigma regarding Cannabis use, and much more.
About Nurse Janna:
Nurse Janna's focus is educating patients about holistic approaches to health, and natural alternatives to pharmaceuticals including cannabis therapy, and genetic screening/nutrigenomics. Her specialties include: Autism, Autoimmune Disorders, Inflammatory/Chronic Pain Syndromes,Neurological, Gastrointestinal, and Mental Health conditions. Janna's introduction to the cannabis industry began as a cannabis patient when she suffered a health collapse in 2012. Janna credits cannabis for helping to reduce her reliance on pharmaceuticals, and for supporting her ability to regain optimal health status.
Nurse Janna has worked with thousands of patients, with her combined focus of targeting epigenetic mutations (nutrigenomics) and addressing other causes of chronic illness (Endocannabinoid Deficiency) helps promote balance in the body systems naturally, with a goal of improved body synergy. Nurse Janna has completed the Cannabis Nurse courses at The Medical Cannabis Institute. She is also a founding member of the Cannabis Nurses Network, serving on their speaker’s bureau, through which she teaches at conferences and other events. Janna is an award-winning author, and her daughter’s Cannabis/Autism article was featured on the front page of a nationwide cannabis industry magazine in December 2017.
To learn more about Nurse Janna, visit:
Integrated Holistic Care
Cannabis Nurse Approved
Episode One: Is Cannabis Safe? Part One
Welcome to the very first episode of the Curious About Cannabis podcast! Briefly I wanted to introduce the podcast and let you know what to expect. There are two different types of podcast episodes that we’ll be presenting this season. Each primary episode, like this one, is a 20 – 30 minute beginner to intermediate educational episodes exploring a critical Cannabis topic or question.
Accompanying the primary episodes are behind-the-scenes episodes. A behind-the-scenes episode features a full-length interview or conversation between myself and a guest, typically running anywhere from 45 minutes to two and a half hours. These behind-the-scenes episodes are more for anyone wanting a deeper dive into some of the content covered in the primary episodes.
Each primary episode has accompanying show notes that feature the show transcript and citations so you can explore any of the topics we present more deeply in your own time.
I am really excited to finally be sharing this content with you. I hope you enjoy it and find it valuable. And with that, I present the first episode of the Curious About Cannabis podcast.
- Jason Wilson
You’re listening to the Curious About Cannabis Podcast
[NURSE JANNA SEGMENT]
The combined North American Cannabis market alone is expected to exceed 16 billion dollars in value in 2019. People all over the world are taking notice and becoming more curious than ever about Cannabis. The momentum of Cannabis legalization across the world does not seem to be slowing down. And as more places legalize Cannabis, broader demographics of Cannabis users are emerging.
As more and more people are trying Cannabis without fear of legal repercussions, I wanted to understand just how safe Cannabis products are or aren’t.
How safe is Cannabis, really?
Hey everybody, this is Jason Wilson with the Curious About Cannabis Podcast. Thanks for tuning in. Today we are going to be talking all about Cannabis safety and harm reduction in an effort to understand whether Cannabis is really as safe as many people claim.
To start our curious quest, we’ll be focusing on three main questions:
Let’s get started.
What’s in Cannabis?
Cannabis contains a lot of different chemicals. Depending on what research paper you read, there are anywhere from 400 to over 500 compounds that have been characterized in Cannabis so far.   But some researchers think there are likely far more chemicals in Cannabis, as well as other plants generally, than have been identified so far.
[KEVIN SPELMAN SEGMENT]
That’s Kevin Spelman, a molecular biologist and phytochemist that has dedicated his professional career to understanding why plants affect the body the way they do. And lately, he has had his eyes on Cannabis.
[KEVIN SPELMAN SEGMENT]
So despite what the scientific literature says, there very well may be a thousand or more chemicals found in Cannabis.
When Cannabis is burned, however…
[JUSTIN FISCHEDICK SEGMENT]
That’s Justin Fischedick, a natural products researcher that once burned Cannabis joints to see what was in the smoke…for science.
[CONTINUE FISCHEDICK QUOTE]
Cannabinoids, like THC or CBD, are by far the most abundant compounds found in the resins surrounding the female Cannabis flowers. To be accurate, these compounds actually start off in the plant as THCA and CBDA. When heated, THCA and CBDA change into their well-known counterparts, THC and CBD.
So how toxic is THC and CBD?
How toxic are cannabinoids?
In one now famous study in 1973, dogs were given THC orally in escalating doses all the way up to 9 grams of THC per kilogram of body mass in an attempt to find a lethal dose. To put that into perspective, it’s not uncommon for a lot of dogs to weigh somewhere between 20 and 30 lbs. In kilograms, that would be 9 – 14kg. For a 9kg dog, this study would have administered 81 grams of THC in a single dose. If we assume that a Cannabis cigarette, or joint, contains a gram of Cannabis containing 20% THC, that’s the equivalent of approximately 400 joints, or over 115 grams of concentrate…at once!
Now, let’s jump forward from 1973 to 1988 – there was a petition to try to reclassify the legal status of Cannabis. Cannabis was and is currently at the time of this recording considered a schedule one drug by the Drug Enforcement Agency. This category of drugs is reserved for drugs with no accepted medical use and a high propensity for abuse. Other drugs in this category include things like heroin and bath salts.
Well, in the 80s there was a push to reschedule Cannabis, and administrative law judge Francis young issued a report commenting on the issue. In his report, he stated: “…in order to induce death, a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette…A smoker would theoretically have to consume nearly 1500 pounds of marijuana within about fifteen minutes to induce a lethal response.”
By that measure, the carbon monoxide and tar exposure would end up causing problems before the cannabinoids in the Cannabis would.
But that was THC. What about CBD? As recently as this year, in 2019, a report was issued claiming that CBD was identified as being toxic for the liver. Publications like Forbes promoted headlines reading “CBD Causes Liver Damage”. So is this something Cannabis consumers need to be concerned about?
[ETHAN RUSSO SEGMENT]
I had the chance to talk about the safety of CBD with Dr. Ethan Russo, a neurologist and cannabinoid researcher that worked as a medical advisor for the development of two cannabinoid pharmaceuticals, Sativex and Epidiolex. Epidiolex, specifically, is a pure CBD pharmaceutical.
[ETHAN RUSSO SEGMENT]
If you look up the LD50 for Cannabidiol, you’ll typically find data reporting intravenous doses of over 200mg/kg. It would be extremely difficult to get that much CBD in your bloodstream through typical consumption methods. For an average human that weighs 65kg, or around 144lbs, 200mg/kg equates to a dose of approximately 13,000mg, or 13 grams of pure CBD – in the bloodstream. Consider that CBD-rich Cannabis contains approximately 10-20% CBD, or 100 to 200 mg of CBD per gram of Cannabis flower. So if you consume a gram of CBD-rich Cannabis flower, you are getting exposed to maybe 200mg of CBD at best. Ignoring the fact that CBD is not very bioavailable and much of the CBD you consume is simply excreted , 200mg is approximately 1.5% of 13 grams.
To put this into better context, for caffeine, the LD50 is 200mg/kg of oral caffeine (that’s not to say that it is the same as the 200mg/kg LD50 that I mentioned for CBD. Keep in mind that the CBD LD50 is intravenous. this is actually a lot lower than the CBD LD50, because not all of the orally consumed caffeine will make it into the bloodstream), which would be like drinking somewhere between 75 and 100 cups of coffee back to back. While for nicotine, the LD50 is around 8 – 13mg/kg, or over half a gram of nicotine. That’s about 40 cigarettes. 
You may be saying, okay sure, it may be difficult to overdose on THC or CBD, but Cannabis contains a lot more chemicals than THC – and you’d be right! So just how many reported deaths are there associated with Cannabis use?
While many advocates of Cannabis claim that there have been no deaths attributed to Cannabis – that is not exactly true, however the number is still very low. Like extremely low. We don’t know the exact numbers, but there have been a handful of case studies reported that have linked fatal heart attacks and lung infections with Cannabis use, but these reports have been difficult to confirm definitively.      And yet according to some estimates there are nearly 100 million people in the United States alone that admit to having at least tried Cannabis once, and over 30 million are classified as regular users – and that’s just based on how many people are willing to admit their own Cannabis use on a survey.
So, we are looking at a handful of possible fatalities linked to Cannabis use, compared to tens of millions of users in the United States alone. Let’s assume 1 out of 10 million users were to die from Cannabis use in some way, that would mean that you would have a 0.00001% chance of dying from Cannabis use, and even that’s an exaggerated number. You would have a much greater chance of dying by getting into a car crash or getting struck by lightning.
What are the health risks of Cannabis?
So, okay, it is unlikely that anyone is going to experience a lethal overdose of Cannabis, but what about other health risks?
[REEFER MADNESS SEGMENT]
All reefer madness and propaganda aside, there are a variety of research papers out there that have summarized the common health risks of Cannabis use.
One common symptom of Cannabis use is dry mouth, also called xerostomia. Xerostomia can negatively affect mouth health if not managed properly and can lead to changes to the bacteria and fungi that live in our mouths, potentially leading to gum disease, tooth decay, bad breath, and even an altered sense of taste. Now, many may assume that the dry mouth effect from Cannabis use is related to smoking, but this does not seem to be the case. The dry mouth effect is directly linked to the stimulation of cannabinoid receptors in the body, regardless of how you choose to use Cannabis.
Another thing Cannabis affects directly is blood pressure. Interestingly enough, Cannabis can lead to lower blood pressure with repeated use, but at high dosages, Cannabis can cause elevated blood pressure and heart rate, which can be particularly problematic for users that have a prior history of heart issues, such as high blood pressure or previous occurrence of heart attacks. This effect is made worse by smoking.
Additionally, if you are smoking Cannabis, you also run a greater risk of experiencing chronic bronchitis and emphysema.
THC-rich Cannabis can cause motor coordination disruption, potentially increasing the risk of falls, home or workplace accidents, and car wrecks. However, this effect tends to be more mild in frequent users that have built up tolerance.
THC-rich Cannabis can present several psychological health risks to users, including memory disruption, anxiety, fear, and paranoia. When it comes to the negative psychological effects of Cannabis, new or infrequent users are more likely to experience these effects compared to regular users. Additionally Cannabis can act as a precipitating event for mental health problems to reveal themselves in younger users – but we will talk more about that later.
Although Cannabis has gained popularity for being a potential treatment for seizure and tremor conditions like epilepsy and Parkinson’s, there has been some research that has revealed that Cannabis could actually exacerbate these conditions in as much as a third of the population.
In addition to these risks, there is also a condition that can develop in chronic users, usually in users that have been using high THC Cannabis regularly for two years or more, called Cannabinoid Hyperemesis Syndrome.
[CHS NEWS REEL]
The good news is that for anyone that may experience this condition, it typically goes away if you simply stop consuming Cannabis for a while. However, there are some reported cases where users that stopped using Cannabis to recover, re-experienced the nausea and vomiting symptoms when they starting using Cannabis again.
Cannabinoid hyperemesis syndrome is a somewhat controversial condition. Some people claim that it is likely caused by contaminants in Cannabis products, rather than the cannabinoids found in Cannabis. However, this has not been substantiated, as of yet. Also, in states that have legalized Cannabis use, reports of this condition are starting to become more prevalent as people become more comfortable talking about their Cannabis use with their health care providers. So, potentially this condition is actually more widespread than once thought. We just don’t really know, yet.
How might Cannabis interact with other medications?
The next topic I wanted to explore is drug interactions with Cannabis.
[NURSE JANNA INTERVIEW SEGMENT]
That’s Janna Champagne, a registered nurse who over the past several years has focused her attention almost exclusively on Cannabis.
[CONTINUE NURSE JANNA SEGMENT]
Other health care professionals I spoke with said that they are particularly concerned about interactions with things like blood thinning medications, chemotherapy drugs, epilepsy drugs, and immune system therapy drugs, like HIV treatments.
Some of this concern regarding drug interactions relates to CBD more than THC. And this has everything to do with a thing called “the grapefruit effect”. It’s been long known that certain foods and medications can change the way the body metabolizes things, like other foods and drugs. This effect is so well known with grapefruit that some drugs even have a grapefruit warning on them. If you ever see a grapefruit warning on a medication, it is referring to this potential interaction that could occur where compounds in the grapefruit can slow down the liver’s ability to metabolize a lot of different medications by inhibiting a group of enzymes called the P450 enzymes. This inhibition will cause the levels of medications in the blood to rise. For people taking drugs with narrow safety windows, this can be very problematic.
Well, it turns out that CBD exhibits this same effect, the grapefruit effect.  Anyone using CBD, particularly high doses of CBD, along with other medications should be particularly cautious and work with a healthcare professional to stay safe.
So, while it seems like Cannabis is relatively safe compared to a lot of other things, like coffee, there are some serious drug interactions that can occur.
[CONTINUE NURSE JANNA SEGMENT]
Let’s review what we’ve learned so far:
Join me in part two of this series as we explore the health risks of contaminants and additives in Cannabis products. Until next time, thanks and take it easy.
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