Michelle Peace regularly monitors online message boards to see what people are vaping, what got them high, and what gave them bad side effects. As a toxicologist and vaping expert at Virginia Commonwealth University, part of her job is to evaluate how electronic cigarettes are being used for substances other than nicotine.

But the tip about online company Diamond CBD came via phone, she says—someone called and said they purchased a CBD product and got extremely high after taking it. CBD, or cannabidiol, is an ingredient in marijuana that is being studied for various health benefits, but one of its perks is that it’s not inebriating. It shouldn’t have made that person feel intoxicated.

“We thought, ‘Well maybe this kid was just fooling us, you know?” Peace tells me. “Maybe he got it from somebody who adulterated it. Nonetheless, we ordered a bunch of their products.”

In a new study in Forensic Science International, Peace and her co-authors published what they found. Out of nine CBD e-liquids from Diamond Gold, four contained a synthetic marijuana called 5-fluoro MDMB-PINACA (5F-ADB). One contained dextromethorphan, an ingredient in cough syrup.

Synthetic marijuana, also known as K2 or Spice, is a chemical that is different from naturally occurring cannabis, but binds to similar receptors in the brain, and can sometimes have similar psychoactive effects. It can be extremely dangerous. It’s a gamble what chemical compound you actually get when you buy synthetic marijuana, and it can cause side effects like agitation, confusion, dizziness, lack of coordination, sedation, and even seizures. In 2014, the Drug Enforcement Agency (DEA) reported 2311 incidents involving medical intervention or death involving 5F-ADB.

Dextromethorphan is used in cough syrups and can cause “agitation, ataxia, hypertonic, sedation and may produce dissociative hallucinations at high doses,” the new paper says. Teens are increasingly using it to get high, and it’s one of the most frequent over-the-counter causes of poisoning for people aged 13 to 18. In large doses, dextromethorphan is abused to achieve similar highs as PCP and ketamine.

Diamond CBD's website reads: All our products are carefully monitored throughout the production process, and include 100% natural, lab tested, CBD extracts.

Screenshot from Diamond CBD's website

CBD can be taken many ways, and one is by vaping it in an e-cigarette with a CBD e-liquid. People buy these vaping liquids in stores, and also in a growing number of online retailers.

Peace and her colleagues bought the same two products their caller had taken, Liquid Gold Strawberry and Diamond CBD Vape Additive, and seven more to test. They purchased them directly from diamondcbd.com. They analyzed the ingredients using Direct Analysis in Real Time Mass Spectrometry (DART-MS) and Gas Chromatography Mass Spectrometry (GC/MS)—both powerful and validated methods of separating and identifying chemicals.

All of the liquids did have CBD in them. But two contained THC, a compound in weed known to get you high and one that a pure-CBD product is not expected to contain more than .3 percent of. Meanwhile, a product called Diamond CBD Vape Additive was found to contain dextromethorphan, while Liquid Gold Jungle Juice, Liquid Gold Strawberry, and also the Diamond CBD Vape Additive contained the synthetic marijuana.

Diamond CBD did not respond after multiple attempts for comment. In an article from earlier this month, Consumer Reports wrote:

Diamond CBD’s chief executive officer, Kevin Hagen, told CR that current formulations of the products differ from those that were tested. He also said that the company’s products are subject to third-party testing and that as a result of Consumer Reports’ questions and the study findings, it planned to retest all its products and issue a recall if they are found to have been adulterated. “The company strives to provide the assurance that we supply the best, highest-quality products on the market,” Hagen said, adding that he supports regulation to ensure the safety and quality of CBD products.

It’s relatively common to find THC in CBD products, including vape liquids, says Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an Assistant Professor of Psychiatry at Harvard Medical School. A paper from 2017 in The Journal of the American Medical Association looked at a variety of online CBD products and found that only 30 percent were labeled to match what was actually in them. Some had more or less CBD than advertised, and some had additional compounds. 21 percent also had THC in them. This could have an important impact, for example, on a drug test taken for employment.

“The major issue would be problems or feelings associated with THC that you’re not anticipating, such as euphoria or paranoia or hallucinations, perhaps,” Hill says. “These are things that you’re not bargaining for.”

Finding the synthetic marijuana and dextromethorphan was unexpected and alarming, Peace says. “People are going to a website that claims purity, all-natural, nothing synthetic,” she tells me. “People are going on there who are looking for alternative therapies for seizures or pain, so they are health-compromised and they don't know that these products are potentially adulterated. There's no indication. There's no warning about it on the website. There are no reviews from users that say anything."

Taking synthetic marijuana alone is more harmful than taking it in conjunction with CBD—the latter can dampen some of the effects of the former, Hill says. “That's why we see so many people having so many problems with synthetics [alone],” he adds. “They will become psychotic, they could have hallucinations, things of that sort.”

The overall problem, Hill says, is the discrepancy between federal and state handling of CBD. Many states have legalized medical marijuana and CBD, but according the federal government, CBD is still illegal. (Though one formulation of CBD, Epidiolex, was recently approved by the FDA for to treat seizures associated with two forms of epilepsy.)

“I think one of the major misconceptions about CBD is that people feel, because they can get it online or they can get into the dispensary, that it's legal,” Hill says. “Technically all of the CBD aside from Epidiolex is federally illegal still.

In practice, this leads to inadequate regulation and oversight, in the same way that nutraceuticals and other over-the-counter supplements aren’t properly screened and labeled. “People are looking for these alternatives and they are not anticipating that they're going to take something that at the end of the day might send them to the hospital,” Peace says.

CBD is still being studied for various medical applications and needs more randomized clinical trials before it can be claimed as helpful for things like anxiety and pain. But if you find yourself wanting to try out CBD, which is relatively safe, Hill recommends seeking out a state-operated dispensary, which is obligated to have accurate labeling. Hill also says you should tell your doctor you’re taking CBD, so they know about any drug interactions or can help you navigate any potential side effects.