A higher high

Two references we quote — in the New England of Journal of Medicine in 2018 and the British Medical Journal in 2019 — suggest that this is a wider trend. And more recent reports suggest that these increases are continuing, especially among teens. This is especially worrisome because of health issues such as EVALI, e-cigarette or vaping product use-associated lung injury.

The increasing popularity of vaping cannabis may relate to vaporizers facilitating discrete use of cannabis: the device can be easily concealed, it has the appearance of regular e-cigarettes, and it produces near odorless vapor. Vape from cannabis is described as more palatable and because vaporized cannabis products can deliver higher concentrations of THC than conventional cannabis, it is associated with a stronger high. Lastly, users may believe that vaping cannabis is less harmful than traditional ways of consuming cannabis. 

My personal opinion is ‘if it was possible, probably,’ but it’s likely not really possible at this point, and many researchers could argue that the possible benefits in terms of cessation must first be substantiated. Alternatively, we should be — and are in many jurisdictions — regulating the supply, making it difficult to buy vaping products by limiting who is a legal customer, where vapes are sold, where they can be used, and also trying to limit demand through education.

A small sample size makes the estimates imprecise (meaning the confidence intervals are wide). However, our prevalence estimates seem to be in the ballpark of  other recent studies. Self-reports can result in misclassification bias - the biggest issue here is whether people really understand what is in the liquid that they vape.

Yes, we are very interested in what we call ‘nicotine seekers,’ people who are looking for nicotine in multiple products. Use of multiple nicotine-containing products — cigarettes, e-cigarettes, mulling (cannabis and tobacco mixed), shisha, and other tobacco products—likely contributes to sustained nicotine dependence. We think that people might need to be far more aware of the nicotine content across all the products they consume, in order to make realistic assessments on how to quit. Trying to quit cigarettes while still consuming large quantities of nicotine in other products is likely to inhibit the ability to quit. That’s why we think health practitioners who want to help people quit should screen for use of all nicotine-containing products.