Online databases of injuries or adverse reactions from essential oils include 251 reports since 2013. American Association of Poison Control Centers report 51,279 incidents of poisoning by essential oils, including one death between 2011 and 2015 (at the date of posting , 2016 data is not available online). There is much debate within the aromatherapy community regarding: pregnancy safety, which oils are safe for children, and specific percentages for dilution. After assessment of the risks, the three main dangers seen in the data are not those but: neat usage of oils (dosage), ingestion, and accidental poisoning of children. New buyers of aromatherapy products, including single bottles of essential oils, need to be taught how to use and store them, safely. The referral to and role of the aromatherapist is often as safety consultant as noted by Jean Valnet, “I must at this stage make it clear that this in no way claims to replace the difficult art of the therapist ‘All is poison, nothing is poison’ said Paracelsus, and in reality the dosage is all-important, for natural essences used carelessly are just as likely to be toxic” (Valnet, 11) Any consumer education program needs to include aromatherapists and be: communicated in language consumers understand, in a format with which they are comfortable and familiar, and including learning tools they need to accomplish that. Consideration of industry use of child-resistant tops, as well as, evaluating new labeling standards might primarily address consumer learning and ultimately reduce essential oil injuries. The goal of this series of posts is to explore risk mitigation for essential oils.
Essential oil safety, a topic of much debate, floods social media, small blogs, and trade journals. Yet, there are few hard metrics regarding the scope of the problem. Further complicating establishing the extent of the issue, there is limited information regarding how the risks one takes with essential oils compares with those allopathic remedies with similar goals for use (ie: Peppermint (mentha x piperita)/ Eucalyptus (eucalyptus Radiata) blend versus Children’s Mucinex in a 3 year old). Effective consumer education is needed. However, without a clearly articulated problem statement, succinct guidelines built on consensus, and a systematic means of communication with the end consumer there is limited probability of the development of broad safety standards.
The Bards App: A Discussion
With two masters in education, my background lends itself towards the tools involved in teaching and learning. Former employment includes director of education for a health non-profit which interfaced the health community with commerce. The first item needed in education is to identify a goal or outcome, a learning target and how to measure it. In the context of this conversation the learning target are specific safety behaviors. This would be measured in the reduction of essential oil injuries. The setting of the goal was clear but how to do that can be both clear and obscure.
Robert Tisserand’s Essential Oil Safety 2 is the most widely relied upon source for safety information in the US aromatherapy community. However, it is written for the professional not the end user. Although comprehensive, it’s language is sometimes confusing such as the phrase do not use on or near the face of a child. Can you use it at all? Can you diffuse around children? In particular, with eucalyptus and peppermint, this became accepted to many in the aromatherapy community as do not use via inhalation under 10. Even after repeated clarification by Mr. Tisserand, many chose to see the statement and infographic as a change rather than refinement and many have stuck to their own more conservative interpretation. (Tisserand Institute, 2015)
Upon embarking in formal aromatherapist training, I noticed a safety and liability exposure in any potential business I would set up, due to the lack of accessible information to the end buyer. Essential Oils Safety 2 was too complex and expensive for most customers I might have. Facebook and Google shouldn’t be the first line of education. Labeling of products is lacking in directions or safety measures. Part of the career I foresaw was to create custom blends and products but more was empowering my friends, family and customers to make their own wellness decisions. Providing them the tools to do so is a value I hold dearly.
If I were to break down my safety recommendations into a few short sentences these are the ideas I think an educated consumer should know (All of my orders are accompanied by a business card with this information).
1. The small bottles of oils are concentrates. They need to be diluted if placed on skin.
2. All oils are not safe for everyone. Some oils should not be used around children, while pregnant, while taking blood thinners etc..
3. The top risks for problems with oils:
- Internal use
- Overuse causing reactions, called sensitization
- Not keeping out of the reach of children
- Irritating skin due to improper use
- Breathing issues
If lack of consumer education tools aimed at safety and usage was a problem that I was finding, it seemed to me that others might be facing it as well. This gap in the aromatherapy trade and essential oil industry, could potentially impede on my ability to participate in this profession. So, I created a safety and usage mobile program called The Bard’s App available on iphone and Android. The information was condensed from Essential Oil Safety 2 which was synthesized with information from Essence of Thyme Aromatherapy Certification 101 (Thompson, 2014). The info was ultimately cross-referenced with often conflicting recommendations of professional organizations world-wide (All references listed in About section within the App). The goal was to prevent injuries in the group of people participating in case studies for my training. The method was to give affordable access to this summary of safe use of essential oils for the new user. Included in the App are the topics: children, pregnancy, dilution, interactions, and first aid.
I asked all those with whom I consulted or for whom I blended, to purchase The Bards App. To my knowledge, not one injury or adverse reaction has occurred in three years with anyone buying from me or utilizing my services. This concurs with the summary of the Atlantic Institute’s Injury Report, that not one injury occurred under the care of a trained aromatherapist. Evaluating it from that perspective, the App has been a tremendous success in empowering end consumers who do not confer with me for each purchase. However, it has not been a financially viable investment for the small community which I serve. Although it has had great support from British Columbia Aromatherapy President Colleen Thompson and British NAHA Director Elizabeth Ashley Stearns, it has had limited traction to assist others in the greater aromatherapy community. From my evaluation, there are a few factors which have impacted support.
- Safety Positions: There is a difference in the interpretation of safety recommendations within the community. I might tend toward what might be considered, a less conservative side. For instance, cinnamon bark and wintergreen. There is even disagreement amongst my instructors on these oils. Many companies, professionals and Facebook groups have cinnamon bark listed as unsafe for children. Essential Oil Safety 2 does not list cinnamon bark as cautioned for children. It does note the need for a dermal maximum of .05% which would be less for a child. (Tisserand, 248). So, in The Bard’s App cinnamon is not on the list as an unsafe oil but one that is cautioned. It is also listed within the section on dilution as needing a lower maximum dilution. Wintergreen is banned from all use by some in the community. (Wormwood, 0). I do list it as unsafe for pregnancy and children under 10, as well as notate its lower maximum dilution with the section on dilutions and within the section on interactions reference specific drugs, summarizing with the statement that wintergreen contains the came cautions as Aspirin (a great example of how consumer education and labeling has been successful in reducing Reyes syndrome and clotting issues). These are two very effective oils, when used with prudence. I’d rather add the prudence than eliminate this option for people looking for wellness solutions that would rival allopathic options. Knowledge is key, “Aromatherapy is complex in many ways …. The oils used, although simple in that each is the pure, natural product of a single plant, are complex potent substances that need to be used with care, knowledge and experience”. (Lawless, 14). Although well referenced, my educated conclusions conflict with industry voices with better amplification than mine.
- Error: There were two errors within the original release. One was a formatting error where I imported a data set globally rather than to the specific field needed. The intention was to update the information regarding Peppermint and Eucalyptus as NAHA and Robert Tisserand both clarified positions after the App was created. However, all of the age phrases became under the age 10. All of them. Most should have read under the age 2. Secondly, I had two resources in front of me regarding dilution. The one I entered, had an error embedded in it as well. Although the dilution rate difference with Essential Oil Safety 2 was small, it still was a difference. Both were corrected within a month of launch, but the damage was done to consumer trust in the aromatherapy community.
- Low-Budget. The program I used to create the App was the most affordable and affordable I could find. It is not a sleek App and many look for flashy and free with Apps. It is neither. The font is small and there is no way to increase the size any more. Reviews of it were poor. Not of the content, but it’s looks. But it is functional and educational, in my humble view. I do not think most people are looking for functional and educational, they are looking for bells and whistles and no investment.
- I am not an aromatherapy maven. According Malcolm Gladwell in his book, The Tipping Point, mavens are “information specialists”, or “people we rely upon to connect us with new information”. They accumulate knowledge, especially about the marketplace, and know how to share it with others. A maven is “almost pathologically helpful”, further adding, “he can’t help himself”. I am a maven, “a maven is someone who wants to solve other people’s problems, generally by solving his own” which is why I made The Bard’s App after-all. (Gladwell, 61-63) But I am not a maven in the aromatherapy community. I am a no name. A maven helps tinker and refine, they are known. The aromatherapy trade and essential oil industry have limited advertising opportunities. Unless one gets a champion – a maven- I have yet to see how new products successfully come to market. I have no maven and any movement for consumer education, will also need one.
My next step has been to add a section on all doTERRA oils. The Atlantic Instititute’s Injury Report shows that the majority of injuries reported come from the company doTERRA. This is not controlled for market share. Adding this information to the App, is an effort to equip new representatives seeking more knowledge. The end goal again, to areduce or prevent injuries. I have an account with doTERRA and written permission to link to doTERRA and use their logo, so perhaps mine will be a voice that is an ally while speaking some safety into this ever growing community. This recently revamped version contains a full section dedicated to dōTERRA oils: blends and singles. It also has a new section on blending which denotes scent notes: top, middle, base. At this point I do not believe this will increase any sales. Those whose skin crawls with the mention of dōTERRA will neither purchase nor recommend the App. Those entrenched in dōTERRA who throw caution to the wind will neither purchase nor recommend the App. Does that make the endeavor unworthy of undertaking? Clearly, I do not think so. My goals have not been to make this App a main stream of income but a means to support my greater goals.
While safety recommendations lie on a moving pendulum, no App will be accepted in the greater community that doesn’t have a leader delivering them and at this time it must be very conservative in interpretation of safety data.
Part one of this series concluded:
Data from trade resources and National Poison Control document well over 50,000 injuries in the past six years. 72% of injuries, that is 37,073 injuries are to children and overwhelmingly accidental. This is the problem. I would argue that the fact that an oil has a child-resistant lid on it inherently communicates that it is to be handled with care.
Child-resistant caps might address the problem and meet recommendations to effectively communicate with the essential oil consumer. In order to prevent and reduce injuries and adverse effects, perhaps the essential oil industry and aromatherapy trade might find a few items of consensus and focus directly on those few items, such as risk mitigating packaging. This might be a means to create critical mass and foster future discussions throughout the industry on other safety issues.
This second installment suggests:
Any consumer education program needs to be communicated in language consumers understand, in an environment they are familiar with, and with the tools they need to accomplish that. Safety should not be proprietary. Could a mobile app do that? Could it address a clearly articulated problem statement, be built on succinct guidelines built on consensus, and a systematic means of communication with the end consumer? This was my experiment and in a small arena, it appears to have had success. Perhaps, this is an effective way to communicate with the vast majority of consumers but it must be championed by a thought leader who also had the skills of a consensus builder.
Bio: Nancy, a formally trained aromatherapist, holds two masters in education and developed the national gluten-free curriculum GREAT as the director of education for the health non-profit Beyond Celiac. Nancy lives with celiac disease and lupus and incorporates a strict gluten-free diet and essential oils into her wellness choices. She can be contacted at: Nancy@TheBardsApothecary.com and http://www.TheBardsApothecary.com. Nancy created The Bards App (available for both iphone and Android) as an accessible and affordable educational tool for the end consumer.
NOTE: Since this post was written, on 12/11/17 Robert Tisserand Essential Training Facebook Page posted the following: “One year ago, the Tisserand Institute launched its Safety Pages, together with a detailed Adverse Reaction Database. The database now has 60 cases, many accompanied by photos. Most of these are skin reactions, but we are now vetting some cases of inhalation.
The reports are verified with the person who filed them, and commented on by Robert Tisserand, who offers insights into why the reaction happened, and what lessons can be learned.
Please bear in mind this database is not meant to scare you off using aromatherapy, but rather to point to potential dangers. Perhaps the main take-away is that virtually any essential oil can cause an adverse skin reaction, and the concentration makes a difference – undiluted application carries a higher risk. Most users will never experience such reactions, but we are advocating for safe use – minimizing risk without taking away benefits.”
Resources for series of posts:
American Association of Poison Control Centers National Poison Data System Annual Report 2012 Retrieved from: https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2012_NPDS_Annual_Report.pdf
American Association of Poison Control Centers National Poison Data System Annual Report 2013 Retrieved from: https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2013_NPDS_Annual_Report.pdf
American Association of Poison Control Centers National Poison Data System Annual Report 2014 Retrieved from: https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2014_AAPCC_NPDS_Annual_Report.pdf
American Association of Poison Control Centers National Poison Data System Annual Report 2015 Retrieved from: https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2015_AAPCC_NPDS_Annual_Report_33rd_PDF.pdf
American Herbal Products Association: Trade Requirement and Guidance Policy for Labeling of Undiluted Essential Oils Used Topically and Offered for Retail Sale. Retrieved from: http://www.ahpa.org/Portals/0/PDFs/Policies/Guidance-Policies/AHPA_Labeling_Undiluted_Essential_Oils_Topical.pdf?ver=2016-04-26-145908-950
AP Press. (2016) Tennessee Poison Control Center warns of toxicity of essential oils.
Atlantic Institute of Aromatherapy Injury Report. Retrieved from: http://aromatherapyunited.org/injury-reports/injury-reports-2016/
Baker, N. (2015) The Bards App. Retrieved from: http://www.thebardsapothecary.com/the-bards-app.html
Center for Justice and Democracy. McDonalds’ Hot Coffee Case – Read the Facts NOT the Fiction. Retrieved from: McDonalds’ Hot Coffee Case – Read the Facts NOT the Fiction
Coscarelli, J. (2014) New York Magazine. Falling Air Condition Hits Woman in Head, Reigniting Every New Yorker’s Mostly Irrational Fear. http://nymag.com/daily/intelligencer/2014/09/nyc-fear-falling-air-conditioners.html
doTERRA (2014) Approved Claims List. Retrieved from: https://doterra.com/US/en/flyers-approved-claims-list
FOX13 News Salt Lake City. (2016). Retrieved from: http://fox13now.com/2016/12/26/poison-control-calls-related-to-essential-oils-doubled-since-2011/
Gladwell, M.(2005) Blink. New Your, NY. Little, Brown and Company. Audiobook.
Gladwell, M. (2002) The Tipping Point. New York, NY. Little, Brown and Company.
Lawless, J. (1997) The Complete Illustrated Guide to Aromatherapy. Barnes and Noble.
Mancini, M. (2014). The Surprising Origins of Child Proof Lids. http://mentalfloss.com/article/54410/surprising-origins-child-proof-lids
National Association for Holistic Aromatherapy. Safety Information.
Retrieved from https://www.naha.org/explore-aromatherapy/safety/
Price, S. (1987) Practical aromatherapy: How to use essential oils to restore vitality. London, UK. Harper Collins Hammersmith.
Schnaubelt, K. (2011) The Healing Intelligence of Essential Oils
Rochester, VT, Healing Arts Press
Shutes, J. & C. Skipper. (2015). French Aromatherapy Certification Course. School for Aromatic Studies.
Tisserand Institute Adverse Reaction Database (ARD) Retrieved from http://tisserandinstitute.org/safety/adverse-reaction-database/#introduction/
Tisserand Institute (2015) Are Eucalyptus and Peppermint Safe for Young Children? Retrieved from: http://tisserandinstitute.org/learn-more/kids-inhalation-safety/
Tisserand, R. & Young, R. (2014) Essential Oil Safety Second Edition, 147-163
New York, NY, Churchill Livingston Elsevier
Thompson, C. (2012) Aromatherapy Certification 101. Essence of Thyme. British Columbia, Canada.
Thompson, C. (2012) Aromatherapy Certification 201. Essence of Thyme. British Columbia, Canada.
US Department of Homeland Security. Ready. Risk Assessment. Retrieved from https://www.ready.gov/risk-assessment
United State Consumer Product Commission. (2013) Poison Prevention Packaging Act Business Guidance. Retrieved from: https://www.cpsc.gov/Business–Manufacturing/Business-Education/Business-Guidance/PPPA
Valnet, J MD (1990) The Practice of Aromatherapy Rochester, VT Healing Arts, Press.
Woodward, V.A. (1991) The Complete Book of Essential Oils and Aromatherapy. Novato, CA. New World Library.