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In 2022, the FDA stated that "scientific studies show possible harm to the male reproductive system, including testicular atrophy, harm to the liver, and interactions with certain medications. The FDA has not found adequate information showing how much CBD can be consumed, and for how long, before causing harm. This is particularly true for vulnerable populations like children and those who are pregnant."[se 1]The full statement provides links to warning letters that the FDA sent to 5 companies, whom the FDA accused of marketing CBD-based products in a manner not consistent with safety or law. For instance, the first letter[se 2] did mark for disapproval a certain beverage product, which a third-party review describes as "a line of herbal teas in 12 oz. bottles infused with 33 mg of [CBD] extract";[se 3] in the letter, the FDA invites the reader to review the information on a web page the FDA has dedicated to cannabis-derived products (including CBD).[se 4] By 28 January 2023,[se 5] that page of resources included the following document:
Safety of CBD in Humans – A Literature Review (As of December 12, 2019)[se 6]
That document has a section titled "Safety related to ingestion", which states:
We reviewed four primary clinical trials that supported Epidiolex approval. In addition, a total of 94 trials (as of December 12, 2019) were identified through PubMed and ClinicalTrials.gov search that used single (34 trials) or repeated doses of oral CBD (60 trials); 30 of them were in patients with epilepsy or other seizure disorders. Twenty-four were silent on safety findings, while 21 trials included a conclusive statement (e.g., “CBD is well tolerated” from the author’s perspective) without providing detailed safety results. Below is a high-level summary of the notable safety findings in the repeated dose trials.
[…] ⬅ this is part of the content
The aforementioned summary lists a number of dosages used in various trials:
"One placebo-controlled trial assessed CBD’s effect at 750 and 1500 mg for 6 days."
"Repeated doses in [198] patients with epilepsy […] treated with 20 mg/kg/day CBD"
"Repeated doses in patients with [schizophrenia at] 600 mg/day for 6 weeks [or] 1000 mg/day for 6 weeks"
"Repeated doses in patients with […] fatty liver disease using 200, 400, or 800 mg/day CBD for 8 weeks"
The document goes on to state:
FDA’s review of the four randomized placebo-controlled trials describes Epidiolex’s attributable risks: somnolence (18%; 3% is severe), CNS adverse reactions such as agitation and sedation (1-4%), decreased appetite (16%), diarrhea (9%), and decreased weight (3%). Based on the information in these trials, the estimated risk of severe liver injury, irreversible liver failure that is fatal or requires liver transplantation, is 0.3 to 0.4%, although no cases of severe liver injury were reported. It also notes that it is clear that many patients will develop cannabidiol-induced adverse reactions; however, those observed in the development program would be expected to be detectable by patients and/or caregivers, self-limited, and reversible.
^"FDA Warns Companies for Illegally Selling Food and Beverage Products that Contain CBD". US Food and Drug Administration. 21 November 2022. Archived from the original on November 23, 2022. Retrieved 23 November 2022. These companies are selling CBD containing products that people may confuse for traditional foods or beverages which may result in unintentional consumption or overconsumption of CBD. CBD-containing products in forms that are appealing to children, such as gummies, hard candies and cookies, are especially concerning.
Undid revision 1186920713 by Bon courage (talk) It is not an unreliable source, and all of the information is germane to the section and topic within the section. It is highly useful contextual information.
If there is unnecessary detail, then perhaps that particular detail should be removed, or summarized better, or integrated more concisely in other parts of the text.
User 24.118.62.152 ("Author"), too, is a reader and editor of Wikipedia, and the very fact that Author wrote the text in question is proof that at least one reader finds this information valuable, and wishes that such information had been available from the very beginning—that is to say, at least one editor cared enough to have gone to the considerable effort to construct the text in question, along with its citations.
So, why should the opinion of Bon courage override the opinion of Author, especially when Author wants to supply information and Bon courage wants to hide information.
The disputed content is useful, because it expresses the context in which the FDA statement was made; it answers questions like the following:
Why did the FDA make such a statement?
What is the basis for the FDA's claims?
What are further sources of information that might be useful to a reader who would like to delve deeper into the subject of side effects and regulatory activity?
Author was completely unaware that the FDA's statement was the result of the FDA writing warning letters to various companies; when Author read the FDA's statement in full, Author wished that such information had been presented in the Wikipedia article, and so took the time to integrate such information for the benefit of future readers.
Why should future readers not benefit from this useful information?
The text in question appears in a section of the article titled "Side effects"; at the top of this section, it states:
Research indicates that cannabidiol may reduce adverse effects of THC, particularly those causing intoxication and sedation, but only at high doses.[44] Safety studies of cannabidiol showed it is well tolerated, but may cause tiredness, somnolence, sedation, diarrhea, or changes in appetite as common adverse effects with the most common being somnolence and sedation. Side effects of CBD are dose related.[45]Epidiolex documentation lists sleepiness, insomnia and poor quality sleep, decreased appetite, diarrhea, and fatigue.[6][46]
However, until Author introduced the disputed content, there was no information on either dosing or prevalence of side effects. These details, introduced by Author, are not undue, but are in fact very important, exactly as implied by the existing text.
Perhaps, editor Bon courage believes that such information could be better integrated into the existing text in this section; if so, then why doesn't Bon courage do that integration rather than lazily just delete everything? If Bon courage is uninterested in performing such work, then Bon courage should defer to Author, who was motivated enough to actually write the useful content in the first place.
While reading through the sources to construct the disputed content, Author attempted to be very careful about ensuring that the chronological availability of information is also represented accurately; that is to say, it is valuable for the reader of the article to be presented with the accurate context in which the FDA made its statement, and that context is dependent on when certain information was available to the FDA and to the companies who were being warned, and to the general public at the time of the warning.
More concretely, Author wondered:
What kind of product was the FDA warning about?
What was the dosage that was delivered by such a product?
How did that dosage compare to the dosages on which the FDA was basing its claims?
What exactly is the nature of the side effects that the FDA lists (what kind of liver problems, and what is the risk)?
When did the FDA know such information (especially with regard to the timing of the warning letters), and when was such information available to the public (especially via the FDA's website)?
Author was concerned that the FDA's warning letter may have prompted a company to change its product's dosage; consequently, Author found a third-party review of the product in question from around the time (and from before the warning letter), so as to ensure that the context of the warning letter could be presented as accurately as possible.
All of these questions are pertinent, and all of the answers are valuable; in short, the content in question is properly detailed, and no details are undue.
I'm sharing these resources as they might be useful for improving the article. I may use them for a future edit myself, but anyone is welcome to use these sources to edit the article in the meantime. -- Arthurfragoso (talk) 20:37, 27 March 2024 (UTC)[reply]
