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Vichayanrat T, Chidchuangchai W, Karawekpanyawong R, Phienudomkitlert K, Chongcharoenjai N, Fungkiat N. E-cigarette use, perceived risks, attitudes, opinions of e-cigarette policies, and associated factors among Thai university students. Tob Induc Dis 2024; 22:TID-22-74. [PMID: 38737769 PMCID: PMC11087886 DOI: 10.18332/tid/186536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Although many countries, including Thailand, currently ban the sale of e-cigarettes, their use continues to rise, especially among young adults. Since the study of e-cigarette use among university students is limited, this study aimed to determine factors associated with e-cigarette use and explore university students' attitudes toward e-cigarettes, perceived risk, and opinion of e-cigarette policies. METHODS This cross-sectional study was conducted among undergraduate students using convenience sampling in a university, in central Thailand from November 2022 to February 2023. A self-administered online questionnaire was distributed to 19 faculties representing health sciences, science and technology, social and arts faculties, and the International College. RESULTS A total of 548 students completed the online questionnaire, and 20.4% reported ever using e-cigarettes, while 40% of e-cigarette users were unsure about the nicotine content. About 28% agreed, and 22% were unsure whether e-cigarettes could help quit smoking. Most students perceived that e-cigarettes are addictive and harmful, while about half of the participants agreed with the policy related to e-cigarettes in Thailand. Students with positive attitudes towards e-cigarettes were more likely to use e-cigarettes (AOR=1.15; 95% CI: 1.08-1.22), and those with lower perceived risk (AOR=0.89; 95% CI: 0.82-0.96) and who disagreed with e-cigarettes policy (AOR=0.93; 95% CI: 0.89-0.97) were more likely to use e-cigarettes. Personal income and having friends who use e-cigarettes were the significant predictors for e-cigarette use, while studying in the faculty of science and technology was a predictor of using e-cigarettes last month. CONCLUSIONS Although the perceived risk was high, about half of the students thought that e-cigarettes could help them quit smoking and were unsure or disagreed with e-cigarette banning policies. Attitude, perceived risk, policy opinions, personal income, and having friends who used e-cigarettes, were associated with e-cigarette use. Thus, correcting misunderstandings and increasing risk perceptions about e-cigarettes must be advocated among university students.
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Affiliation(s)
- Tippanart Vichayanrat
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Warungkana Chidchuangchai
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Ford MA, Lapham GT, Matson TE, Luce C, Oliver MM, Binswanger IA. Comparing Cannabis Use for Pain to Use for Other Reasons in Primary Care Patients. J Am Board Fam Med 2024; 36:996-1007. [PMID: 37907351 PMCID: PMC11124549 DOI: 10.3122/jabfm.2023.230163r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Medical cannabis is commonly used for chronic pain, but little is known about differences in characteristics, cannabis use patterns, and perceived helpfulness among primary care patients who use cannabis for pain versus nonpain reasons. METHODS Among 1688 patients who completed a 2019 cannabis survey administered in a health system in Washington state, where recreational use is legal, participants who used cannabis for pain (n = 375) were compared with those who used cannabis for other reasons (n = 558) using survey and electronic health record data. We described group differences in participant characteristics, use patterns, and perceptions and applied adjusted multinomial logistic and modified Poisson regression. RESULTS Participants who used cannabis for pain were significantly more likely to report using applied (50.7% vs 10.6%) and beverage cannabis products (19.2% vs 11.6%), more frequent use (47.1% vs 33.1% for use ≥2 times per day; 81.6% vs 69.7% for use 4 to 7 days per week), and smoking tobacco cigarettes (19.2% vs 12.2%) than those who used cannabis for other reasons. They were also significantly more likely to perceive cannabis as very/extremely helpful (80.5% vs 72.7%), and significantly less likely to use cannabis for nonmedical reasons (4.8% vs 58.8%) or report cannabis use disorder symptoms (51.7% vs 61.1%). DISCUSSION Primary care patients who use cannabis for pain use it more frequently, often in applied and ingested forms, and have more co-use of tobacco, which may differentially impact safety and effectiveness. These findings suggest the need for different approaches to counseling in clinical care.
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Affiliation(s)
- Morgan A Ford
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
| | - Gwen T Lapham
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
| | - Theresa E Matson
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
| | - Casey Luce
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
| | - Malia M Oliver
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
| | - Ingrid A Binswanger
- From the Kaiser Permanente Colorado Institute for Health Research, Aurora, CO (MAF, IAB), Kaiser Permanente Washington Health Research Institute, Seattle, WA (GTL, TEM, CL, MMO), Department of Health Systems and Population Health, University of Washington, Seattle, WA (GTL), Colorado Permanente Medical Group, Aurora, CO (IAB), Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (IAB), Department of Health Systems Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IAB)
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3
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Tituana NY, Clavijo CG, Espinoza EF, Tituana VA. E-cigarette use-associated lung injury (EVALI). Pneumologie 2024; 78:58-69. [PMID: 37857323 PMCID: PMC10791482 DOI: 10.1055/a-2161-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 10/21/2023]
Abstract
The prevalence of vaping has overtaken conventional cigarettes as the most frequent form of nicotine consumption among 15-24-year olds. There are currently a large number of both legitimate and illegitimate products and suppliers offering more than 8000 different flavors of vape on the market, whose additives are not tested, studied or regulated and whose safety and toxicity profile remains unknown. In vitro studies have demonstrated a dose-dependent decrease in the viability of normal human bronchial epithelial cells after exposure to vapor from electronic vape devices.Short- and medium-term studies to date indicate that vapor-induced pulmonary lesions are the most serious and commonly reported side effect; such lesions include bilateral ground glass opacities in lung bases with subpleural preservation, bilateral infiltrates, pleural effusion, pneumomediastinum and nodular opacities. Cases of EVALI have been described in patients with daily exposure, as well as in users who reported having been exposed to these substances at least once a month. The most frequently inhaled substances are THC, flavored liquids of unknown content, and nicotine.The clinical manifestations of dyspnea and cough are the most frequent respiratory symptomatology, in addition to constitutional manifestations such as fever and chills, and gastrointestinal manifestations such as vomiting, nausea, abdominal pain and diarrhea. To these can be added the presence of tachypnea, tachycardia, elevated blood pressure, hypoxia, leukocytosis with neutrophilia and elevated ESR.
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Affiliation(s)
- Nathaly Yessenia Tituana
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
| | - Claudia Gabriela Clavijo
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
| | - Evelyn Fernanda Espinoza
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
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Renger L, Pathmanathan K, Glynn R, Laupland KB. Cannabis use in the intensive care setting: A scoping review. J Crit Care 2023; 78:154397. [PMID: 37544047 DOI: 10.1016/j.jcrc.2023.154397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Cannabis is the most used recreational drug worldwide, and is increasingly used for medicinal purposes, however little is known about its impact on patients in intensive care units (ICU). Our objective was to identify key themes in the literature surrounding cannabis in the ICU and identify future research priorities. METHODS Four databases were systematically searched for literature investigating the impact of cannabis, and evidence for its therapeutic use, in adult ICU patients. RESULTS Of 2589 articles screened, 22 articles were included for analysis. Cannabis-associated admissions were primarily related to an outbreak of vaping associated lung injury, and synthetic cannabinoid toxicity. Studies on the impact of cannabis use on outcomes were mostly limited to trauma and burns populations, with an inconsistent mortality benefit, and a trend towards increased pain scores and analgesic requirements found. There is minimal research on its therapeutic uses in ICU, with two trials investigating the use of a synthetic cannabinoid in patients with severe traumatic brain injury, with ultimately no significant effect on intracranial pressure found. CONCLUSIONS There is a paucity of studies investigating the impact of cannabinoids or their therapeutic uses in critically ill patients, with further research in this area needed.
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Affiliation(s)
- Laura Renger
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Kevin Pathmanathan
- Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rosie Glynn
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
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Petrella F, Rizzo S, Masiero M, Marzorati C, Casiraghi M, Bertolaccini L, Mazzella A, Pravettoni G, Spaggiari L. Clinical impact of vaping on cardiopulmonary function and lung cancer development: an update. Eur J Cancer Prev 2023; 32:584-589. [PMID: 36942844 DOI: 10.1097/cej.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The word 'vaping' is used to define the usage of electronic cigarettes or other instruments to inhale a wide variety of heated and aerosolized substances. Although proposed as a less dangerous and oncogenic alternative than standard nicotine products, e-cigarettes and vaping devices are quite far from being considered benign. In fact, although vaping devices do not generate carcinogenic agents as polycyclic aromatic hydrocarbons produced by the combustion of standard cigarettes and their liquids do not present tobacco-related carcinogens like nitrosamines, there is nowadays clear evidence that they produce dangerous products during their use. Several different molecular mechanisms have been proposed for the oncogenic impact of vaping fluids - by means of their direct chemical action or derivative products generated by pyrolysis and combustion ranging from epithelial-mesenchymal transition, redox stress and mitochondrial toxicity to DNA breaks and fragmentation. In this review we focus on vaping devices, their potential impact on lung carcinogenesis, vaping-associated lung injury and other clinical implications on cardiovascular, cerebrovascular and respiratory diseases, as well as on the psychological implication of e-cigarettes both on heavy smokers trying to quit smoking and on younger non-smokers approaching vaping devices because they are considered as a less dangerous alternative to tobacco cigarettes.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI)
- Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Lugano (CH), Switzerland and
| | - Marianna Masiero
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS
| | - Antonio Mazzella
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Pintori N, Caria F, De Luca MA, Miliano C. THC and CBD: Villain versus Hero? Insights into Adolescent Exposure. Int J Mol Sci 2023; 24:ijms24065251. [PMID: 36982327 PMCID: PMC10048857 DOI: 10.3390/ijms24065251] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Cannabis is the most used drug of abuse worldwide. It is well established that the most abundant phytocannabinoids in this plant are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These two compounds have remarkably similar chemical structures yet vastly different effects in the brain. By binding to the same receptors, THC is psychoactive, while CBD has anxiolytic and antipsychotic properties. Lately, a variety of hemp-based products, including CBD and THC, have become widely available in the food and health industry, and medical and recreational use of cannabis has been legalized in many states/countries. As a result, people, including youths, are consuming CBD because it is considered “safe”. An extensive literature exists evaluating the harmful effects of THC in both adults and adolescents, but little is known about the long-term effects of CBD exposure, especially in adolescence. The aim of this review is to collect preclinical and clinical evidence about the effects of cannabidiol.
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Affiliation(s)
- Nicholas Pintori
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Francesca Caria
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Maria Antonietta De Luca
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-6758633
| | - Cristina Miliano
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
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Abdallah B, Lee H, Weerakoon SM, Messiah SE, Harrell MB, Rao DR. Clinical manifestations of EVALI in adolescents before and during the COVID-19 pandemic. Pediatr Pulmonol 2023; 58:949-958. [PMID: 36530031 PMCID: PMC9878061 DOI: 10.1002/ppul.26283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION E-cigarette, or vaping, product use-associated lung injury (EVALI) results from inhaling the aerosol of e-cigarettes and has similar clinical features to coronavirus disease 2019 (COVID-19). EVALI case counts since the declaration of the COVID-19 pandemic is unknown. METHODS A retrospective electronic health record chart review of adolescents hospitalized at one institution with EVALI was conducted. Clinical characteristics and hospital course of patients hospitalized during the pandemic were compared to those prepandemic. RESULTS The clinical presentation of adolescents hospitalized prior-to (n = 19) and during the COVID-19 pandemic (n = 22) were similar with respect to constitutional, respiratory, and gastrointestinal symptoms. All patients hospitalized during the pandemic were tested for COVID-19 at least once. Only one patient had a positive SARS-CoV-2 RT-PCR test result. Thirty-one out of 39 patients treated with corticosteroids had clinical improvement within 24 h (79%). Patients hospitalized during the pandemic had a shorter median length of stay (5 vs. 7 days, p < 0.01), and were less often discharged with home oxygen (1 vs. 6 patients, p = 0.04). Pulmonary function tests improved pre- to postcorticosteroid treatment and postcorticosteroid to follow-up. CONCLUSIONS Eliciting a history of vaping in adolescents presenting with constitutional, respiratory, and gastrointestinal symptoms is important to identify EVALI cases, which have continued throughout the COVID-19 pandemic. A shorter length of stay with less need for mechanical ventilation and home oxygen in adolescents hospitalized during the pandemic may reflect increased familiarity with EVALI characteristics. Corticosteroids led to clinical and pulmonary function improvement.
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Affiliation(s)
- Bayan Abdallah
- Department of Pediatrics, University of Texas Southwestern Medical Center, Division of Pulmonology and Sleep Medicine, Dallas, Texas, USA.,Children's Health System of Texas, Dallas, Texas, USA
| | - Harin Lee
- University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Sitara M Weerakoon
- University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, Texas, USA.,Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, Texas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, Texas, USA.,Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, Texas, USA
| | - Melissa B Harrell
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Devika R Rao
- Department of Pediatrics, University of Texas Southwestern Medical Center, Division of Pulmonology and Sleep Medicine, Dallas, Texas, USA.,Children's Health System of Texas, Dallas, Texas, USA
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Amann L, Kruse E, Lazard AJ, Reboussin BA, Wagoner KG, Romero-Sandoval EA. CBD Retailers in NC Promote CBD Online to Treat Pain Violating FDA Rules About Medical Claims and Offer Low-CBD/High-Price Products. J Pain Res 2022; 15:3847-3858. [PMID: 36514481 PMCID: PMC9741853 DOI: 10.2147/jpr.s384996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Cannabidiol (CBD) products are available nearly nationwide in the US and can coexist with medical or recreational programs. North Carolina (NC) is an example of a state with a program dedicated to integrating hemp cultivation and medicinal CBD exclusively, containing a multitude of retailers selling it as a primary product. The Food and Drug Administration (FDA) mandates that non-FDA approved CBD products cannot be marketed using medical or health-related claims and has sent warning letters to retailers violating these terms. We aim to characterize the online content of the NC CBD market by analyzing retailers' websites to determine whether hemp/CBD shops comply with FDA regulations in terms of medical claims and analyze the claimed CBD content and price of products offered online. Methods We randomly selected three CBD retailers from the ten most populated cities of NC. We analyzed their website content: product type, medical claims, other disclaimers, price, and CBD content. Results We found that edible, oral, inhalable, and topical products are offered in similar proportions. Word analysis of product description revealed that "pain" and "pain relief" were the most common medical claim, followed by inflammation and anxiety. Health claims were mostly related to wellbeing. Other attributes indicate that products are associated with pleasant flavors or sensations (ie, cool, lavender, delicious, honey, menthol), which resembles the strategies used for tobacco advertisement. Most products (61%) claimed to contain less than 1000 mg of CBD. The median price of products ranged from $15-30 per 300 mg. We found a positive correlation between CBD content and price. Discussion Our data demonstrate that the NC online CBD market does not comply with FDA regulations, primarily targets patients with pain, inflammation, or anxiety, and offers products with low CBD concentration and high prices. New policies should limit the access and online promotion of non-pharmaceutical grade CBD products.
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Affiliation(s)
- Lindsay Amann
- Department of Anesthesiology, Pain Mechanisms Laboratory; Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Elizabeth Kruse
- Department of Anesthesiology, Pain Mechanisms Laboratory; Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, 27514, USA,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel HIll, NC, 27599, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - E Alfonso Romero-Sandoval
- Department of Anesthesiology, Pain Mechanisms Laboratory; Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA,Correspondence: E Alfonso Romero-Sandoval, Pain Mechanisms Laboratory, Anesthesiology, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA, Tel +1 336-716-2725, Fax +1 336-713-2616, Email
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Shi J, Dai W, Chavez J, Carreno J, Zhao L, Kleinman MT, Arechavala RJ, Hasen I, Ting A, Bliss B, Monterrosa Mena JE, Kloner RA. One Acute Exposure to E-Cigarette Smoke Using Various Heating Elements and Power Levels Induces Pulmonary Inflammation. Cardiol Res 2022; 13:323-332. [PMID: 36660061 PMCID: PMC9822672 DOI: 10.14740/cr1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background Electronic cigarettes (eC) may not be entirely benign. There is a lack of data on the effect of a single acute exposure of eC vapor using various heating sources and power settings upon lung injury. The purpose of this study was to determine if an acute exposure with eC vapor heated with different heating elements and power levels induced inflammatory changes in the lungs and heart. Methods Rats were exposed to pure air or received a single, 4-h exposure to eC vapor. The devices used either a stainless steel (SS) or nichrome (NC) heating element randomized to a low or high atomization power (45 versus 70 W). Rats were euthanized within 48 h of exposure. Results The eC groups showed accumulation of inflammatory cells in bronchial lumen, near the pleura, and within the alveolar spaces. The numbers of inflammatory cells per field in the lung parenchyma were significantly greater in the rats exposed to eC groups vs. the air group. There were significantly higher inflammatory gene expression changes in the lungs of animals assigned to 70 W power. We observed that eC vapor generated using burnt coils were toxic and could cause acute respiratory distress and myocarditis. Conclusion In conclusion, one 4-h exposure to eC vapor, in the absence of vitamin E oil or nicotine, significantly increased lung inflammation. Effects were seen after exposures to vapor generated using SS and NC heating elements at either high or low power. Vapor from devices with burnt coils can negatively affect the heart and lung.
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Affiliation(s)
- Jianru Shi
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
| | - Wangde Dai
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
| | - Jesus Chavez
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Juan Carreno
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Lifu Zhao
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Michael T. Kleinman
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Rebecca J. Arechavala
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Irene Hasen
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Amanda Ting
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Bishop Bliss
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | | | - Robert A. Kloner
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
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Makki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC PRIMARY CARE 2022; 23:38. [PMID: 35240989 PMCID: PMC8895539 DOI: 10.1186/s12875-022-01651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mounting evidence suggests the safety and efficacy of medical marijuana (MM) in treating chronic ailments, including chronic pain, epilepsy, and anorexia. Despite incremental use of medical and recreational cannabinoids, current limited evidence shows generalized unpreparedness of medical providers to discuss or recommend these substances to their patients. Herein, the present study aims to examine internal medicine residents' knowledge of marijuana and their attitude towards its medical use. METHODS This is a descriptive cross-sectional study. A survey with 12 standardized queries was created and distributed among the internal medicine residents from Mount Sinai Morningside-West (MSMW) program from July 2020 to December 2020. Participants included preliminary and categorical residents from post-graduate years one to three. The survey consisted of self-assessment of residents' knowledge on the indication, contraindication, adverse effects of MM. RESULTS Eighty-six (59%) out of 145 residents completed the questionnaire. Despite most trainees (70%) having considered certifying the use of MM for their patients, over 90% reported none to little knowledge on its use. Approximately 80% of the surveyed residents expressed willingness to receive an appropriate educational curriculum. CONCLUSION To the best of our knowledge, this is the first study that indicated a critical lack of medical marijuana-related knowledge in surveyed internal medicine residents. In a population with growing cannabis consumption, physician training on the indication, toxicity, and drug interaction of cannabinoids is warranted.
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Affiliation(s)
- Iman Makki
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Binbin Zheng-Lin
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maanit Kohli
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Division of Hospital Medicine, Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, 1000 10th Ave, New York, NY, 10019, USA.
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11
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.
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Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
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12
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Baker MM, Procter TD, Belzak L, Ogunnaike-Cooke S. Vaping-associated lung illness (VALI) in Canada: a descriptive analysis of VALI cases reported from September 2019 to December 2020. Health Promot Chronic Dis Prev Can 2022; 42:37-44. [PMID: 35044143 PMCID: PMC9067012 DOI: 10.24095/hpcdp.42.1.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to explore demographic and clinical characteristics of vaping-associated lung illness (VALI) cases reported in Canada from September 2019 to December 2020; compare the epidemiology of VALI cases in Canada to e-cigarette or vaping product use-associated lung injury (EVALI) cases in the US; and examine possible explanations for differences between the two countries. METHODS A federal/provincial/territorial task group developed a national outbreak definition, minimum dataset and case report form for identification and surveillance of VALI cases in Canada. Descriptive analysis explored the characteristics and epidemiology of reported VALI cases. RESULTS Of the 20 VALI cases reported, none resulted in a death. Of all cases, 5 (25%) involved youth aged 15 to 19 years, 10 (50%) adults aged 20 to 49 years and 5 (25%) aged 50 years and older. Sixty percent of patients were men. Half (50%) required breathing assistance. Three-quarters (75%) reported using nicotine-containing vaping products, and 40% reported use of cannabis-containing vaping products; of those who reported frequency of vaping, most (71%) reported vaping daily. VALI cases were reported at a lower prevalence (0.9 per million) than EVALI (8.5 per million). Demographics and vaping behaviour also differed. CONCLUSION VALI cases were reported in Canada between September 2019 and December 2020; however, there was a much lower prevalence and they may have been caused by different factors from the EVALI outbreak in the US. The factors influencing VALI in Canada are complex and multifactorial. Research is needed to understand the short- and long-term health effects of nicotine and cannabis vaping.
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Affiliation(s)
| | | | - Lisa Belzak
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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13
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Abstract
Purpose of Review The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults. Recent Findings Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same. Summary Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-022-00413-y.
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14
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Roberts E, Copeland C, Robson D, McNeill A. Drug-related deaths associated with vaping product use in the United Kingdom. Addiction 2021; 116:2908-2911. [PMID: 33751729 DOI: 10.1111/add.15468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Between March 2019 and February 2020 there was an outbreak of acute lung injury associated with vaping tetrahydrocannabinol (THC), contaminated with vitamin E acetate, in the United States. To date, there has been no comprehensive study of drug-related deaths associated with vaping products in the United Kingdom. We aimed to identify any trends in drug-related deaths associated with vaping product use in the United Kingdom. METHODS We retrospectively identified any deaths associated with the use of vaping products reported to the UK National Programme on Substance Abuse Deaths (NPSAD). This contains voluntarily reported information from UK Coroners on more than 42 000 deaths related to psychoactive drugs, other than nicotine or caffeine, which occurred between 1997 and 2020. RESULTS Two drug-related deaths were reported which were associated with vaping products, one person having died in 2017 and one in 2018. Both decedents were men currently serving prison sentences in England and were aged 26 and 42 years at the time of death. Both deaths were associated with recent use of Synthetic Cannabinoid Receptor Agonists (SCRAs), with no other substances found to be implicated in death. No details regarding the type of vaping products were available. CONCLUSIONS In a UK sample (1997 to 2020) of 42 000 deaths related to psychoactive drugs other than nicotine or caffeine, only two deaths were associated with vaping products, and those involved use of synthetic cannabinoid receptor agonists.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and the South London and the Maudsley NHS Foundation Trust, UK
| | - Caroline Copeland
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Deborah Robson
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Prasad KN, Bondy SC. Electronic cigarette aerosol increases the risk of organ dysfunction by enhancing oxidative stress and inflammation. Drug Chem Toxicol 2021; 45:2561-2567. [PMID: 34474637 DOI: 10.1080/01480545.2021.1972680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An electronic cigarette is a rechargeable device that produces an inhaled aerosol containing varying levels of nicotine, and inorganic and organic toxicants and carcinogenic compounds. The aerosol is generated by heating a solution of propylene glycol and glycerin with nicotine and flavoring ingredients at a high temperature. The e-cigarette was developed and marketed as a safer alternative to the regular cigarette which is known to be injurious to human health. However, published studies suggest that the aerosol of e-cigarette can also have adverse health effects. The main objective of this review is to briefly describe some consequences of e-cigarette smoking, and to present data showing that the resulting increased oxidative stress and inflammation are likely to be involved in effecting to lung damage. Other organs are also likely to be affected. The aerosol contains varying amounts of organic and inorganic toxicants as well as carcinogens, which might serve as the source of such deleterious events. In addition, the aerosol also contains nicotine, which is known to be addictive. E-cigarette smoking releases these toxicants into the air leading to inhalation by nonsmokers in residential or work place areas. Unlike regular tobacco smoke, the long-term consequences of direct and secondhand exposure to e-cigarette aerosol have not been extensively studied but based on available data, e-cigarette aerosol should be considered harmful to human health.
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Affiliation(s)
| | - Stephen C Bondy
- Center for Occupational and Environmental Health, University of California, Irvine, CA, USA
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16
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Callahan SJ, Lanspa MJ, Blagev DP. Is COVID-19 masking the ongoing youth vaping crisis? Expert Rev Respir Med 2021; 15:1089-1091. [PMID: 33980122 PMCID: PMC8410660 DOI: 10.1080/17476348.2021.1929927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sean J. Callahan
- University of Utah Health, Salt Lake City, Utah
- George E. Wahlen Department of Veteran’s Affairs, Salt Lake City, Utah
| | - Michael J. Lanspa
- Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah
| | - Denitza P. Blagev
- University of Utah Health, Salt Lake City, Utah
- Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah
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17
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Availability and Promotion of Cannabidiol (CBD) Products in Online Vape Shops. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136719. [PMID: 34206501 PMCID: PMC8295837 DOI: 10.3390/ijerph18136719] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Vaping products containing cannabidiol (CBD), a cannabis-derived compound used in wellness products and available in all 50 US states, were recently implicated in outbreaks of poisonings. Little is known about the commercial availability of CBD products in vape shops (i.e., stores that sell e-cigarettes). To document the availability and marketing of CBD products in online vape shops, in June 2020, we used the Google Chrome browser without cached data to collect the first two pages of search results generated by five Google queries (n = 100 search results) indicative of shopping for vaping products (e.g., "order vapes"). We then determined whether and what type of CBD products could be mail-ordered from the returned websites, and whether any explicit health claims were made about CBD. Over a third of the search results (n = 37; 37.0%) directed to vape shops that allowed visitors to also mail-order CBD. These shops sold 12 distinct categories of CBD products-some with direct analogs of tobacco or cannabis products including CBD cigarettes, edibles, flowers, pre-rolled joints, and vapes. Two vape shops made explicit health claims of the therapeutic benefits of CBD use, including in the treatment of anxiety, inflammation, pain, and stress. The abundance and placement of CBD in online vape shops suggests a growing demand and appeal for CBD products among e-cigarette users. Additional surveillance on the epidemiology of CBD use and its co-use with tobacco is warranted.
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18
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Guo W, Vrdoljak G, Liao VC, Moezzi B. Major Constituents of Cannabis Vape Oil Liquid, Vapor and Aerosol in California Vape Oil Cartridge Samples. Front Chem 2021; 9:694905. [PMID: 34368078 PMCID: PMC8333608 DOI: 10.3389/fchem.2021.694905] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
During the E-cigarette or Vaping product use Associated Lung Injury (EVALI) outbreak of August 2019 to February 2020, the California Department of Public Health, Food and Drug Laboratory Branch received numerous cannabis vape oil cartridge investigation samples from throughout the state. Many of these products were directly linked to patients; others were collected as part of investigations. We determined the major ingredients and additives in twelve unused cannabis vape oil cartridge samples obtained before (n = 2) and during the EVALI outbreak (n = 10) in California from September 2018 to December 2019. We tested for major constituents in vape oil liquid, vape oil vapor, and vape oil aerosol phases. A nontargeted Gas Chromatography Mass Spectrometry direct injection screening method was developed for vape oils, a headspace heating module used for vape oil vapors and a solid-phase microextraction (SPME) vaping rig for aerosols generated by vaping. We have identified more than 100 terpenes and natural extracts, 19 cannabinoids, and other potential toxic additives such as Vitamin E Acetate, Polyethylene Glycols, and Medium Chain Triglycerides. We determined more terpenes and minor cannabinoids can be produced via vaporizing and aerosolizing the vape oil. Delta9-THC and potential toxic additives were found at lower levels in the vapor and aerosol than in the vape liquid.
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Affiliation(s)
- Weihong Guo
- Food and Drug Laboratory Branch, California Department of Public Health, Richmond, CA, United States
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19
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Almeida-da-Silva CLC, Matshik Dakafay H, O'Brien K, Montierth D, Xiao N, Ojcius DM. Effects of electronic cigarette aerosol exposure on oral and systemic health. Biomed J 2021; 44:252-259. [PMID: 33039378 PMCID: PMC8358192 DOI: 10.1016/j.bj.2020.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/19/2020] [Accepted: 07/21/2020] [Indexed: 12/27/2022] Open
Abstract
Conventional cigarette smoke harms nearly every organ of the body and is the leading cause of death in the United States and in the world. Decades of research have associated conventional cigarette smoke with several diseases and death. Heavily marketed, electronic nicotine delivery systems such as electronic cigarettes (e-cigarettes) are available in a variety of flavors and high nicotine concentrations. In 2019, a severe lung disease outbreak linked to e-cigarette use led to several deaths, which was called electronic-cigarette or vaping product use-associated lung injury (EVALI). Even though the trend of e-cigarette use among teens continues to increase, information on the effects of e-cigarette smoke on oral and overall health are still scarce. This review discusses the possible health effects due to unregulated e-cigarette use, as well as the health effects of second-hand smoke and third-hand smoke on non-smokers.
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Affiliation(s)
| | - Harmony Matshik Dakafay
- Department of Biomedical Sciences, University of the Pacific, Arthur Dugoni School of Dentistry, San Francisco, CA, USA
| | - Kenji O'Brien
- Dental Surgery Program, University of the Pacific, Arthur Dugoni School of Dentistry, San Francisco, CA, USA
| | - Dallin Montierth
- Dental Surgery Program, University of the Pacific, Arthur Dugoni School of Dentistry, San Francisco, CA, USA
| | - Nan Xiao
- Department of Biomedical Sciences, University of the Pacific, Arthur Dugoni School of Dentistry, San Francisco, CA, USA
| | - David M Ojcius
- Department of Biomedical Sciences, University of the Pacific, Arthur Dugoni School of Dentistry, San Francisco, CA, USA.
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20
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Adhikari R, Koritala T, Gotur R, Malayala SV, Jain NK. EVALI - E-Cigarette or Vaping Product Use-Associated Lung Injury: A Case Report. Cureus 2021; 13:e13541. [PMID: 33815967 PMCID: PMC8007202 DOI: 10.7759/cureus.13541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The use of electronic cigarettes among the young adult and adolescent population has increased over the past decade. Vaping is the process of inhaling an aerosol that is produced by heating a liquid or wax containing substances, such as nicotine, cannabinoids (e.g., tetrahydrocannabinol (THC), cannabidiol), flavoring, and additives (e.g., glycerol, propylene glycol) using an e-cigarette. A multistate epidemic associated with vaping prompted the Centers for Disease Control and Prevention (CDC) to issue an official health advisory on e-cigarette or vaping product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion with no specific diagnostic test. We present a case of EVALI before the COVID-19 pandemic time in a 23-year-old immunocompetent male student with an eight-year history of vaping. He presented to the emergency department with fever, shortness of breath, tachypnea, nausea, and diarrhea. The patient had no past medical history. The patient denied illicit drug abuse or known drug allergies. The patient was admitted with a diagnosis of sepsis and pneumonia. The patient’s urine drug screen was positive for cannabinoids with a history of vaping. Community-acquired pneumonia due to Legionella, Pneumococcal, Mycoplasma bacteria was ruled out. Influenza A/B, Parainfluenza, Rhino, and Adenoviruses were negative. A computed tomographyscan of the chest showed bilateral infiltrates. He was treated with high dose steroids, empiric antibiotics, high flow oxygen and managed in ICU for seven days. The patient was discharged on tapering doses of steroid and counseled to quit vaping. EVALI outbreak is strongly linked to vitamin E acetate in vaping products. EVALI is a diagnosis of exclusion with a history of vaping and responds well to steroids.
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Affiliation(s)
- Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
| | | | - Raghavender Gotur
- Internal Medicine, Cape Fear Valley Harnett Hospitalist Group, Lillington, USA
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21
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Attfield KR, Chen W, Cummings KJ, Jacob P, O'Shea DF, Wagner J, Wang P, Fowles J. Potential of Ethenone (Ketene) to Contribute to Electronic Cigarette, or Vaping, Product Use-associated Lung Injury. Am J Respir Crit Care Med 2020; 202:1187-1189. [PMID: 32551843 DOI: 10.1164/rccm.202003-0654le] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Wenhao Chen
- California Department of Public Health Richmond, California
| | | | - Peyton Jacob
- University of California San Francisco San Francisco, California and
| | | | - Jeff Wagner
- California Department of Public Health Richmond, California
| | - Ping Wang
- California Department of Public Health Richmond, California
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22
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Aberegg SK, Cirulis MM, Maddock SD, Freeman A, Keenan LM, Pirozzi CS, Raman SM, Schroeder J, Mann H, Callahan SJ. Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use-Associated Lung Injury Among Patients Treated at an Academic Medical Center. JAMA Netw Open 2020; 3:e2019176. [PMID: 33156346 PMCID: PMC7648253 DOI: 10.1001/jamanetworkopen.2020.19176] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE e-Cigarette, or vaping, product use-associated lung injury (EVALI) has caused more than 2800 illnesses and 68 deaths in the United States. Better characterization of this novel illness is needed to inform diagnosis and management. OBJECTIVE To describe the clinical features, bronchoscopic findings, imaging patterns, and outcomes of EVALI. DESIGN, SETTING, AND PARTICIPANTS This case series of 31 adult patients diagnosed with EVALI between June 24 and December 10, 2019, took place at an academic medical center in Salt Lake City, Utah. EXPOSURES e-Cigarette use, also known as vaping. MAIN OUTCOMES AND MEASURES Symptoms, laboratory findings, bronchoscopic results, imaging patterns, and clinical outcomes. RESULTS Data from 31 patients (median [interquartile range] age, 24 [21-31] years) were included in the study. Patients were primarily men (24 [77%]) and White individuals (27 [87%]) who used e-cigarette products containing tetrahydrocannabinol (THC) (29 [94%]). Patients presented with respiratory (30 [97%]), constitutional (28 [90%]), and gastrointestinal (28 [90%]) symptoms. Serum inflammatory markers were elevated in all patients. Bronchoscopy was performed in 23 of 28 inpatients (82%) and bronchoalveolar lavage (BAL) revealed the presence of lipid-laden macrophages (LLMs) in 22 of 24 cases (91%). BAL samples tested positive for Pneumocystis jirovecii (3 patients [13%]), rhinovirus (2 patients [8%]), human metapneumovirus and Aspergillus (1 patient each [4%]); all except human metapneumovirus were determined to be false-positives or clinically inconsequential. The exclusive or dominant computed tomography (CT) pattern was organizing pneumonia in 23 of 26 cases (89%). Patients received antibiotics (26 [84%]) and corticosteroids (24 [77%]), and all survived; 20 patients (65%) seen in follow-up showed marked improvement, but residual symptoms (13 [65%]), radiographic opacities (8 [40%]), and abnormal pulmonary function tests (8 of 18 [44%]) were common. CONCLUSIONS AND RELEVANCE In this case series, patients with EVALI characteristically presented with a flu-like illness with elevated inflammatory markers, LLMs on BAL samples, and an organizing pneumonia pattern on CT imaging. Bronchoscopic testing for infection had a high incidence of false-positive results. Patients had substantial residual abnormal results at early follow-up. These data suggest a limited role for bronchoscopy in typical presentations of EVALI without risk factors for alternative diagnoses and the need for careful longitudinal follow-up.
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Affiliation(s)
- Scott K. Aberegg
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City
| | - Meghan M. Cirulis
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
| | - Sean D. Maddock
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
| | - Andrew Freeman
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
| | - Lynn M. Keenan
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Cheryl S. Pirozzi
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
| | - Sanjeev M. Raman
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
| | - Joyce Schroeder
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
| | - Howard Mann
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
| | - Sean J. Callahan
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
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23
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Rice SJ, Hyland V, Behera M, Ramalingam SS, Bunn P, Belani CP. Guidance on the Clinical Management of Electronic Cigarette or Vaping-Associated Lung Injury. J Thorac Oncol 2020; 15:1727-1737. [PMID: 32866653 PMCID: PMC7455516 DOI: 10.1016/j.jtho.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
In the summer of 2019, there was a rise in clusters of adolescents and young adults in the United States reporting to emergency departments with acute respiratory distress related to use of e-cigarette (electronic cigarette) or vaping. The number of patients with e-cigarette or vaping-associated lung injury continued to rise through the summer before peaking in September 2019. Through the efforts of state and federal public health agencies, officials were able to define the condition, identify the relationship of the respiratory injury to tetrahydrocannabinol-containing products, and stem the rise in new cases. In this report, we present a comprehensive review of the clinical characteristics and features of patients with e-cigarette or vaping-associated lung injury and guidelines for patient care and management to inform and navigate clinicians who may encounter these patients in their clinical practice.
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Affiliation(s)
- Shawn J Rice
- Department of Medicine Penn State College of Medicine, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Victoria Hyland
- Department of Medicine Penn State College of Medicine, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Madhusmita Behera
- Department of Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Paul Bunn
- Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Chandra P Belani
- Department of Medicine Penn State College of Medicine, Penn State Cancer Institute, Hershey, Pennsylvania.
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24
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Vaping cartridge heating element compositions and evidence of high temperatures. PLoS One 2020; 15:e0240613. [PMID: 33075091 PMCID: PMC7571715 DOI: 10.1371/journal.pone.0240613] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Identifying the functional materials inside vaping devices can help inform efforts to understand risk. While nicotine E-cigarette components and metals have been characterized in several previous studies, the internal component compositions of tetrahydrocannabinol (THC) cartridge designs are not as well known. The 2019-20 e-cigarette or vaping product use associated lung injury (EVALI) outbreak has been associated with THC devices containing vitamin E acetate (VEA), possibly mediated by chemical reactions with internal cartridge components and high filament temperatures. METHODS We investigate the composition and internal components of 2019 EVALI patient-associated THC vaping devices compared to other THC and nicotine devices from 2016-19, specifically the metal, ceramic, and polymer components likely to be exposed to heat. To do this, we have disassembled forty-eight components from eight used and unused vaping devices under a microscope and analyzed them using X-ray fluorescence, scanning electron microscopy, and Fourier-transform infrared micro-spectroscopy. CONCLUSIONS The two THC cartridges used by EVALI patients exhibited evidence of localized high temperatures, including charring of the ceramic heating elements and damaged wire surfaces. The newer THC cartridges possessed more ceramic and polymer insulation than older THC or nicotine devices. The combination of ceramics, metals, and high temperatures in newer THC cartridges is consistent with conditions hypothesized to produce VEA reactions during vaping. Nickel and chromium components were detected in all devices, and others contained copper, lead, tin, gold, silicon-rich rubbers, or fluorinated microplastics. These components have the potential to thermally degrade and volatilize if heated sufficiently. These findings do not imply that harmful exposures would occur under all usage conditions, and are most relevant to harm reduction efforts based on avoiding higher internal temperatures. This study was limited to a small sample of cartridges obtained from investigations. Future work should test more device types and internal temperatures under controlled usage conditions.
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Leas EC, Hendrickson EM, Nobles AL, Todd R, Smith DM, Dredze M, Ayers JW. Self-reported Cannabidiol (CBD) Use for Conditions With Proven Therapies. JAMA Netw Open 2020; 3:e2020977. [PMID: 33057645 PMCID: PMC7563067 DOI: 10.1001/jamanetworkopen.2020.20977] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022] Open
Abstract
Importance Use of cannabidiol (CBD) has markedly increased in the past 5 years, concurrent with marketing claims that over-the-counter CBD can be used to treat almost any health condition. However, the reasons why individuals use CBD remain unclear. Objective To assess whether individuals are using CBD for diagnosable conditions that have evidence-based therapies. Design, Setting, and Participants This case series assessed claimed treatment applications reported by CBD users in public testimonials shared on the Reddit forum r/CBD. The r/CBD forum was selected because it includes a large, naturally occurring sample of 104 917 registered individuals who publicly discuss their experiences using CBD. All r/CBD posts were obtained from January 1, 2014, through August 31, 2019. A random sample of posts was drawn (n = 3000) and filtered to include posts in which self-identified CBD users testified why they take CBD (n = 376). Exposures Self-reported use of CBD for medicinal purposes. Main Outcomes and Measures Cannabidiol testimonials were divided into 11 subcategories corresponding with the condition's medical subspecialty and 2 subcategories corresponding with wellness benefits. Posts were allowed to receive more than 1 label. Results Of the 376 posts labeled as testimonials, 90.0% (95% CI, 86.8%-92.8%) of testimonials claimed that CBD treated the individual's diagnosable conditions. Psychiatric conditions (eg, autism or depression) were the most frequently cited subcategory, mentioned in 63.9% (95% CI, 59.0%-69.1%) of testimonials, followed by orthopedic (26.4%; 95% CI, 21.8%-31.1%), sleep (14.6%; 95% CI, 11.3%-18.5%), and neurological (6.9%; 95% CI, 4.4%-9.6%) conditions. Testimonials also claimed that CBD treated gastroenterological conditions (3.9%; 95% CI, 1.9%-6.1%), as well as addiction, cardiological, dermatological, ophthalmological, oral health, and sexual health conditions (<2.0% each). By contrast, just 29.5% (95% CI, 24.8%-34.2%) of testimonies claimed any wellness benefit, with most citing mental wellness (eg, "quieting my mind") (29.5% [95% CI, 24.2%-34.4%]); 1.4% (95% CI, 0.3%-2.8%) claimed a physical wellness benefit (eg, "exercise performance"). Conclusions and Relevance The findings of this case series suggest a need for regulation of factors associated with CBD being used to treat diagnosable conditions, engagement of health care professionals with patients on their potential CBD use, and implementation of public health campaigns that encourage the public to seek treatment advice from health care professionals regarding evidence-based therapies.
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Affiliation(s)
- Eric C. Leas
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
| | - Erik M. Hendrickson
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Alicia L. Nobles
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Rory Todd
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - John W. Ayers
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
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Corona G, Sansone A, Pallotti F, Ferlin A, Pivonello R, Isidori AM, Maggi M, Jannini EA. People smoke for nicotine, but lose sexual and reproductive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproduction. J Endocrinol Invest 2020; 43:1391-1408. [PMID: 32323225 DOI: 10.1007/s40618-020-01257-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically review the impact of smoking habits on cardiovascular (CV) as well as on male sexual and reproductive function and to provide updated evidence on the role of electronic cigarettes (e-Cig) on the same topics. METHODS A comprehensive Medline, Embase, and Cochrane search was performed including the following words: smoking, CV system, CV risk, erectile dysfunction (ED), and male fertility. Publications from January 1, 1969 up to February 29, 2020 were included. RESULTS Smoking has a tremendous negative impact on CV mortality and morbidity. Current smoking behavior is also negatively associated with erectile dysfunction (ED) and impaired sperm parameters. E-Cig can release significantly lower concentrations of harmful substances when compared to regular combustible cigarettes. Whether or not the latter can result in positive CV, sexual, and fertility outcomes is still under study. Preliminary studies showed that exposure to e-Cig leads to lower vascular damage when compared to the traditional cigarette use. However, data on the long-term effects of e-Cig are lacking. Similarly, preliminary data, obtained in animal models, have suggested a milder effect of e-Cig on erectile function and sperm parameters. CONCLUSION Available evidence showed that e-Cig are much less dangerous when compared to the traditional tobacco use. However, it should be recognized that the risk related to e-Cig is still higher when compared to that observed in non-smoking patients. Hence, e-Cig should be considered as a potential tool, in the logic of harm reduction, to reduce the CV, sexual and fertility risk in patients refractory to the fundamental, healthy choice to definitively quit smoking.
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Affiliation(s)
- G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - A Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Ferlin
- Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - R Pivonello
- Division of Endocrinology, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.
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Pankow JF, Duell AK, Peyton DH. Free-Base Nicotine Fraction α fb in Non-Aqueous versus Aqueous Solutions: Electronic Cigarette Fluids Without versus With Dilution with Water. Chem Res Toxicol 2020; 33:1729-1735. [PMID: 32255343 PMCID: PMC9968495 DOI: 10.1021/acs.chemrestox.0c00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An important design aspect of electronic cigarettes ("e-cigarettes") is the nature of the acid/base chemistry in the e-liquid phase. E-liquids having formulations similar to those of early products are mixes of propylene glycol/glycerol (PG/GL) plus free-base (fb) nicotine and (usually) flavor chemicals that are either rather weak or non-acid/base actors in PG/GL. The fraction of nicotine in the fb form is denoted (αfb)e-liquid, with a possible range of 0 < (αfb)e-liquid < 1. For e-liquids of an early design, (αfb)e-liquid ≈ 1. Because e-cigarette aerosols high in fb nicotine are harsh upon inhalation, many commercial e-liquids now also contain variable levels of an acid additive (e.g., benzoic acid, levulinic acid, etc.) to protonate the nicotine and form dissolved "nicotine salts": (αfb)e-liquid values significantly less than 1 are now common. A framework is developed for predicting αfb values in a given medium based on the following: (1) acid/nicotine ratios and (2) overall acid + nicotine protonation constant (Koa) values. This framework is required for understanding (1) e-liquid design in regard to how acid additives affect (αfb)e-liquid values, and (2) why (αfb)e-liquid values cannot, in general, be measured by any method that involves significant dilution with water.
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Affiliation(s)
- James F. Pankow
- Department of Chemistry Portland and Department of Civil and Environmental Engineering Portland, State University Portland, Oregon 97207-0751, United States
| | - Anna K. Duell
- Department of Chemistry Portland, State University Portland, Oregon 97207-0751, United States
| | - David H. Peyton
- Department of Chemistry Portland, State University Portland, Oregon 97207-0751, United States
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Armatas C, Heinzerling A, Wilken JA. Notes from the Field: E-cigarette, or Vaping, Product Use-Associated Lung Injury Cases During the COVID-19 Response - California, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:801-802. [PMID: 32584801 PMCID: PMC7316321 DOI: 10.15585/mmwr.mm6925a5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Gurley BJ, Murphy TP, Gul W, Walker LA, ElSohly M. Content versus Label Claims in Cannabidiol (CBD)-Containing Products Obtained from Commercial Outlets in the State of Mississippi. J Diet Suppl 2020; 17:599-607. [DOI: 10.1080/19390211.2020.1766634] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bill J. Gurley
- School of Pharmacy, National Center for Natural Products Research University of Mississippi, University, MS, USA
| | | | - Waseem Gul
- ElSohly Laboratories Inc., Oxford, MS, USA
| | - Larry A. Walker
- School of Pharmacy, National Center for Natural Products Research University of Mississippi, University, MS, USA
- ElSohly Laboratories Inc., Oxford, MS, USA
| | - Mahmoud ElSohly
- School of Pharmacy, National Center for Natural Products Research University of Mississippi, University, MS, USA
- ElSohly Laboratories Inc., Oxford, MS, USA
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