Electronic Nicotine Delivery Systems and E-Liquid Modifications to Vape Cannabis Depicted in Online Videos

Use of ENDS devices and modifications to vape cannabis among adolescents and young adults who also vape nicotine

BACKGROUND

Electronic nicotine delivery systems (ENDS) are the most used tobacco product among adolescents and young adults (AYAs) and are increasingly used to vape cannabis. It is unclear what vaping devices and ENDS modifications are used most frequently by AYAs who vape both nicotine and cannabis.

METHODS

AYAs (aged 14-29) reporting ENDS use in the past 30 days were recruited via Qualtrics (N = 1,011). We conducted three multivariable logistic regression models examining differences in likelihood of: 1) vaping cannabis in the past 30 days; 2) mixing cannabis and nicotine liquids; and 3) using nicotine devices to vape cannabis; based on type of vaping device used most often, controlling for age, socio-economic status, gender, race, frequency of ENDS use, and other cannabis use.

RESULTS

40 % (n = 405) of AYAs reported vaping both nicotine and cannabis in the past 30 days. AYAs who used vape pens most often were more likely to have vaped cannabis concentrates in the past 30 days compared to individuals using disposable vapes (aOR = 2.72, 95 %CI = 1.75-4.21, p < 0.001). AYAs who used open systems most often (i.e., vape pens, mods, or e-hookah) were more likely than individuals using closed systems (i.e., disposable vapes, rechargeable pods or cigalikes) to combine nicotine and cannabis e-liquids (aOR = 2.03, 95 %CI = 1.43-2.89, p < 0.001) or use a nicotine device to vape cannabis (aOR = 1.66, 95 %CI = 1.17-2.34, p = 0.005).

IMPLICATIONS

Co-use of cannabis and nicotine via similar devices, particularly vape pens and other open-systems, warrants collaborative regulatory efforts to mitigate co-use of both substances, with a particular need for increased regulation of cannabis vaping products.

When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice

ABSTRACT

Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.

Awareness and interest in cannabis use for cancer management among cancer survivors

BACKGROUND

We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment-related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management.

METHODS

This was a cross-sectional study of adult cancer survivors (N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted.

RESULTS

Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends (18%). The odds of being aware of cannabis use for cancer management was lower among male compared to female survivors (adjusted odds ratio [AOR]: 0.61; 95% confidence interval [CI]: 0.41-0.90), non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 0.36; 95% CI: 0.21-0.62), and survivors who do not support the legalization of cannabis for medical use compared to those who do (AOR: 0.10; 95% CI: 0.04-0.23). On the other hand, the odds of being interested in cannabis use for cancer management was higher among non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 1.65; 95% CI: 1.04-2.62), and among cancer survivors actively undergoing cancer treatment compared to patients on non-active treatment (AOR: 2.25; 95% CI: 1.74-2.91).

CONCLUSION

Awareness of cannabis use for cancer management is high within the cancer survivor population. Results indicated health care providers are leading information source and should receive continued medical education on cannabis-specific guidelines. Similarly, tailored educational interventions are needed to guide survivors on the benefits and risks of cannabis use for cancer management.