Hemp is seriously complicating the cannabis world. This is making it harder to treat patients and to safeguard the public health. There is a range of historical reasons that have led us to this quagmire but regardless of the history and rationale, we have to understand the current situation and how that affects our patients.
The problem is that there are different rules for “hemp” than for “marijuana” despite the fact that they are the same plant. Hemp is defined as cannabis that has been bred to produce less than 0.3% THC (by dry weight). It is allowed to produce all the other cannabinoids and the federal rules allow those cannabinoids to be chemically altered after the fact into whatever someone wants. Not surprisingly then, CBD from hemp has been converted into an array of intoxicating cannabinoids including delta-7 THC, delta-8 THC, delta-9 THC, delta-10 THC, and other compounds like HHC and THCO-acetate.
What are the Rules for Hemp?
The problem with the hemp rules is that they stop there. There’s no further regulation to assure safety. Further there are several components to safety which are often conflated or overlooked.
There are really two key questions that need to be addressed:
- Are hemp-derived cannabinoids produced in a safe manner? Meaning are there contaminants in the product from either the hemp itself (pesticides, or heavy metals) or from the conversion process (byproducts, isomers, etc.).
- Are the cannabinoids themselves safe for human use? Many of these molecules are novel – they do not exist in the plant or elsewhere in nature – for examples, delta-7 or delta-10 THC. Others may exist but in such small quantities that there is no research on safety of that molecule in isolation from other molecules or at levels presented in commercial products. For example, delta-8 THC which has not been researched independent of delta-9 THC.
Since the hemp industry has no regulation at this time, it’s impossible to answer either question. Hence it is the Association of Cannabinoid Specialists’ recommendation, at this time, that no hemp-derived products be used in human beings for any purpose.
Are hemp-derived cannabinoids produced in a safe manner?
Question number 1 is not difficult to address. Regulation can lead to solutions, as they have in the pharmaceutical world as well as in state-legal cannabis programs. Regulation of hemp (which, of course, is undesirable to hemp producers as it increases their cost of production) needs to mandate testing and reporting that ensures purity. State-legal programs, while not all the same and not all successful, have generally provided regulations that ensure basic purity of the products marketed in their state. Some additional approaches to testing would be required to address the type of impurities potentially found subsequent to the conversion processes, but this is entirely feasible.
Many states have tried to ban hemp-derived cannabinoids and federal courts have blocked these attempts. More reasonable and likely more effective approaches that are just now being considered include requiring that hemp products be sold through state-legal dispensing systems and meeting state-legal safety requirements. Assuming modification of the state requirements to capture impurities from the conversion process, this would seem to be an effective manner in which to assure purity.
A crucial sidebar is to note that attempts to restrict hemp-derived products have also been erroneously focused on whether the cannabinoid in question is intoxicating or not. This is wrong-thinking because cannabis causes intoxication, so unless we’re going to go back to absolute prohibition over some moral concern about intoxication, hemp-derived products are not problematic because of intoxication. It’s wrong-thinking because it does not address the two questions above: it does not address purity of the product nor does it address the safety of the cannabinoid regardless of whether it causes intoxication. Many non-intoxicating chemicals cause disease in humans like cancer, birth defects, or heart disease.
Are the cannabinoids themselves safe for human use?
Questions number 2 is the real problem. Even if we could guarantee purity and we put aside the wrong-thinking around intoxication, we still can’t answer the question of safety based on the molecules themselves. Most of these molecules, whether novel or not, have very little data yet.
It is not yet known if delta-7, delta-8, or delta-10 THC could cause cancer. It is not yet known if naturally occurring CBG, CBC, or any number of other cannabinoids could cause cancer. We have pretty good data on the safety of one cannabinoid only: delta-9 THC.
It’s important to remember that no medication is safe. The only medication that would be safe is one that does nothing at all, and then we wouldn’t define it as a medication. Blood pressure medications have risks, Insulin has risks, opioids have risks, and so does delta-9 THC. However, the risks of all of these molecules has been studied, in humans, for extended periods of time and are relatively known. It is then the job of the clinician to use these medications in a manner that provides the best benefit and the least risk, and to educated the patient about both the pros and cons.
We can’t really do this with these other cannabinoids. We don’t know the risk, nor do we have evidence of their benefit. We cannot live up to the requirement for Informed Consent if we cannot provide this information.
So, what should we, as clinicians, be doing now?
- Use products where regulation is in place to assure purity
- Educate our patients to avoid hemp-derived products at this time
- Avoid products that have non-delta-9 THC cannabinoids
- Push for regulation that prioritizes uniform safety standards
- Push for regulation based on current scientific data
- Push for a research agenda and funding to address unknowns about safety and efficacy of cannabinoids
The cannabis industry, whether state-legal or hemp-derived, needs to mature and provide safe products. Ideally these products would have efficacy proven as well. The Association of Cannabinoid Specialists continues to work hard to reconcile these values for our patients and the public. Please consider joining our efforts, donating to support our campaigns, and speaking out with us for better regulation.