According to a preliminary assessment from the German Federal Institute for Risk Assessment (BfR), the prohibited use of synthetic cannabinoids in e-liquids can be assumed with high likelihood as reason for the observed symptoms. According to media reports, the patients admitted to have consumed cannabidiol (CBD). CBD is a weakly psychoactive cannabinoid. Already a year ago, the use of CBD liquids manipulated with psychoactive cannabinoids has been reported on from the USA. The users suffered from neurological symptoms as the youths in Bremerhaven.
Thus, both case series share similar symptoms - including the fact that no respiratory symptoms appeared - and the absence of fatal cases in contrast to earlier reports from the USA. The cases of poisoning in Bremerhaven can only be assessed to a limited extent by BfR due to the lack of sufficient available information. Further data, particularly regarding the products, additives, and devices used, are required for a toxicological risk assessment. At the moment, there are no hints that indicate the cause or enhancement of the symptoms of poisoning by e-cigarettes.
However, e-cigarettes in general, with nicotine or nicotine free, compromise health.