Predictors of Adult E-Cigarette Users Vaporizing Cannabis Using E-Cigarettes and Vape-Pens

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.

THC vapor inhalation attenuates hyperalgesia in rats using a chronic inflammatory pain model

Humans use cannabinoid drugs to alleviate pain. As cannabis and cannabinoids are legalized in the U.S. for medicinal and recreational use, it has become critical to determine the potential utilities and harms of cannabinoid drugs in individuals living with chronic pain. Here, we tested the effects of repeated THC vapor inhalation on thermal nociception and mechanical sensitivity, in adult male and female Wistar rats using a chronic inflammatory pain model (i.e., treated with Complete Freund's Adjuvant [CFA]). We report that repeated THC vapor inhalation rescues thermal hyperalgesia in males and females treated with CFA, and also reduces mechanical hypersensitivity in CFA males but not females. Many of the anti-hyperalgesic effects of chronic THC vapor were still observable 24 hours after cessation of the last THC exposure. We also report plasma levels of THC and its major metabolites, some of which are cannabinoid type-1 receptor (CB1) agonists, after the first and tenth days of THC vapor inhalation. Finally, we report that systemic administration of the CB1 inverse agonist AM251 (1mg/kg; i.p.) blocks the anti-hyperalgesic effects of THC vapor in males and females. These data provide a foundation for future work that will explore the cells and circuits underlying the anti-hyperalgesic effects of THC vapor inhalation in individuals with chronic inflammatory pain. PERSPECTIVE: Cannabinoids are thought to have potential utility in the treatment of chronic pain, but few animal studies have tested the effects of chronic THC or cannabis in animal models of chronic pain. We tested the effects of repeated THC vapor inhalation on chronic pain-related outcomes in male and female animals.

Prevalence and socio-demographic correlates of multi-modal cannabis use among young adults who currently use cannabis

Cannabis use is common in young adulthood, yet little is known about the prevalence and patterns of multi-modal (i.e., use of more than one mode) cannabis use.

Objective

We aimed to (1) determine the past 30-day prevalence of five modes (smoke, vape, edible, dab, other) of cannabis use, (2) describe the prevalence of multi-modal cannabis use (single vs. dual vs. poly-modal), and (3) identify socio-demographic correlates of multi-modal use among young adults.

Method

Participants were 764 22-30-year-olds who currently used cannabis from Wave 9 (Spring 2019) of the Marketing and Promotions Across Colleges in Texas Project. Participants were 25.11 years old on average (SD = 1.81), 63.6% female, 38.7% identified as non-Hispanic white, 30.6% as Hispanic/Latino, 13.0% as Asian and 9.4% as Black, and 8.2% identified with two or more races or another race/ethnicity. Bivariate analyses and a multinomial regression were used to examine study questions.

Results

Smoking was the most common mode of cannabis use followed by vaping and then edibles. Nearly 43% of participants reported single-modal cannabis use, 33% reported dual-modal use, and 24% reported poly-modal use. Males and those identifying as non-heterosexual were at a greater risk than their counterparts for using multiple modes of cannabis. Participants identifying as Black were at a reduced risk for poly-modal compared to single-modal use.

Conclusion

Multi-modal use is common among young adults who currently use cannabis, indicating a need for universal efforts aimed at all young adults. Tailored interventions aimed toward those at elevated risk for multi-modal use also are needed.

Amyotrophic Lateral Sclerosis and Pain: A Narrative Review from Pain Assessment to Therapy

Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive muscle weakness, spasticity, atrophy, and respiratory failure, with a life expectancy of 2-5 years after symptom onset. In addition to motor symptoms, patients with ALS have a multitude of nonmotor symptoms; in fact, it is currently considered a multisystem disease. The purpose of our narrative review is to evaluate the different types of pain, the correlation between pain and the disease's stages, the pain assessment tools in ALS patients, and the available therapies focusing above all on the benefits of cannabis use. Pain is an underestimated and undertreated symptom that, in the last few years, has received more attention from research because it has a strong impact on the quality of life of these patients. The prevalence of pain is between 15% and 85% of ALS patients, and the studies on the type and intensity of pain are controversial. The absence of pain assessment tools validated in the ALS population and the dissimilar study designs influence the knowledge of ALS pain and consequently the pharmacological therapy. Several studies suggest that ALS is associated with changes in the endocannabinoid system, and the use of cannabis could slow the disease progression due to its neuroprotective action and act on pain, spasticity, cramps, sialorrhea, and depression. Our research has shown high patients' satisfaction with the use of cannabis for the treatment of spasticity and related pain. However, especially due to the ethical problems and the lack of interest of pharmaceutical companies, further studies are needed to ensure the most appropriate care for ALS patients.

The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping

Objective

Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping.

Method

College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used.

Results

Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC.

Conclusions

Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Parallel trajectories of vaping and smoking cannabis and their associations with mental and physical well-being among young adults

BACKGROUND

Vaping and smoking are common modes of using cannabis (THC) among young adults, but little is known about how patterns of cannabis vaping and smoking unfold over time or how using one or both types of products may differently affect mental and physical well-being. This study examines parallel processes of cannabis vaping and smoking over 5 years and mental and physical outcomes in a sample of young adults.

METHODS

Annual surveys were conducted between 2016 and 2022 with a mostly California-based cohort of 2428 young adults. Parallel process growth mixture models examined trajectories of past-month frequency of cannabis vaping and smoking from ages 20 - 25. Classes were extracted based on parallel trajectories of vaped and smoked product use. Models assessed differences in self-reported mental (anxiety, depression) and physical (ailments, subjective overall) well-being outcomes in young adulthood across classes, adjusting for demographic characteristics and mental and physical well-being at pre-baseline (average age 19).

RESULTS

Four cannabis vaping/smoking classes emerged: low use of cannabis (84.7%), decreasing smoking, low-moderate vaping (7.1%), stable moderate smoking, decreasing vaping (4.6%), and rapid increasing dual use (3.4%). Classes were similar on physical well-being indicators in young adulthood. The rapid increasing dual use class showed higher anxiety and depressive symptoms compared to other classes.

CONCLUSION

Progression to higher frequency of both vaping and smoking cannabis in young adulthood may contribute to poorer mental well-being compared to other use patterns. Targeted efforts to reduce dual vaping and smoking in young people who use cannabis may be needed.

Social media use and cannabis vaping initiation among US youth

BACKGROUND

Youth cannabis vaping has increased in recent years, and there is growing evidence of cannabis vaping content on social media. This study investigated if social media use is associated with the initiation of cannabis vaping among US youth, using the youth dataset from Population Assessment of Tobacco and Health (PATH) Study Waves 4 (2016-2018) and 5 (2018-2019).

METHODS

Using youth respondents who never vaped cannabis at Wave 4 (N=8357), we conducted a multivariable logistic regression analysis on initiation of cannabis vaping at Wave 5 (i.e., ever-vaped cannabis) by frequency of social media use, after controlling for covariates (e.g., sociodemographic, other tobacco and substance use).

RESULTS

In this analytic sample, 66.5% reported daily social media use, 16.2% reported non-daily and 17.3% reported 'not having a social media account' or 'no social media use' at Wave 4. Further, 14.0% (n=1183) initiated cannabis vaping at Wave 5. In the multivariable logistic regression model, daily social media use (vs. never use; aOR=2.68; 95% CI=2.05, 3.49) and non-daily social media use (vs. never use; aOR=1.54; 95% CI=1.14, 2.09) at Wave 4 were associated with cannabis vaping initiation at Wave 5.

CONCLUSIONS

Our evidence suggests that social media use by youth is associated with cannabis vaping initiation among youth in subsequent years, even after controlling for other risk factors. Consistent surveillance and regulation of cannabis vaping-related content on social media, as well as prevention efforts, including counter-messaging on social media about the potential harms of cannabis vaping, are critically needed.

Exploring Differences in Daily Vaping of Nicotine and Cannabis among People Who Use Drugs in New Zealand

Background: Little is known about daily vaping of different substances, particularly cannabis. Aim: To explore daily vaping of cannabis and nicotine products in a sample of people who use drugs in New Zealand. Method: The online New Zealand Drug Trends convenience survey (N = 23,500) was promoted to those aged 16+ via a targeted Facebook™ campaign, with 9,042 reporting vaping in the past six months. Multivariate logistic regression models were fitted to identify predictors of daily vaping of: (i) nicotine e-liquids, (ii) no-nicotine e-liquids, (iii) cannabis e-liquids/oils, (iv)cannabis herb. Results: Forty-two percent of past 6-month vapers used a vaporizing device "daily or near daily" (n = 3,508). Nicotine was most common substance used by daily vapers (96%), followed by dry herb cannabis (12%), no-nicotine e-liquids (10%) and cannabis e-liquid (6%). Daily vaping of no-nicotine e-liquids was associated with abstinence from tobacco use. Frequency of cannabis use was negatively correlated with daily vaping of nicotine liquids and positively correlated with daily vaping of no-nicotine and herbal cannabis. Younger age strongly predicted daily vaping of nicotine and no-nicotine liquids, but the reverse association was observed for daily vaping of herbal cannabis. Māori were less likely to daily vape cannabis herb than NZ Europeans. Daily vaping of both cannabis e-liquid and cannabis herb was associated with medicinal cannabis use. Conclusion: Daily vapers of nicotine and cannabis differed by several characteristics. Younger age group is at risk of daily vaping nicotine and non-nicotine, while herbal cannabis vaping is associated with older and medicinal use, suggesting a need for a nuanced vape policy response.

Marijuana use behaviors on Texas college campuses

There is limited contemporary research examining marijuana use behaviors that occur on college campuses.

PURPOSE

This study aimed to determine: (1) What is the prevalence of marijuana use on college campuses, (2) where are students commonly using marijuana on college campuses, (3) what are the sociodemographic characteristics of students most likely to use marijuana on a college campus, and (4) how do these findings vary between modes of marijuana use (i.e., vaped versus another mode)?

METHODS

Participants were 14,005 college students (aged 18-25) enrolled in 19 Texas colleges during spring 2022 (Mean age = 20.16; 65.81% female; 30.85% non-Hispanic white, 42.08% Hispanic/Latino, 27.07% another race/ethnicity; 75.81% heterosexual).

RESULTS

Nearly 40% of students ever used marijuana and of these students, over 26% ever used marijuana on their college campus. Although the most common mode for marijuana use was smoking, the majority of students that used marijuana on a college campus reported vaping marijuana (64.89%). Students that ever vaped marijuana on campus were 2.35 times more likely than those that used marijuana via other modes to use marijuana in a public location on campus (i.e., not in a dormitory).

CONCLUSIONS

Findings indicate that marijuana use on college campuses is common and suggest that the ability to vape marijuana may increase marijuana use on college campuses, including in public locations such as classrooms and libraries. College campuses may consider increasing anti-marijuana enforcement efforts, especially those aimed at decreasing electronic vaping device use in general, in order to prevent and decrease marijuana use.

Vaping motivations: Association of behavioral inhibition and behavioral activation systems with nicotine and cannabis vaping among adolescents

BACKGROUND

Despite copious information on the hazards of nicotine and cannabis, many adolescents report vaping nicotine and cannabis. To advance knowledge on the precursors of vaping behaviors, this study examined the association of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities with nicotine and cannabis vaping among adolescents.

METHODS

Data were part of a longitudinal survey on substance use and mental health among adolescents and included 2,467 11th grade students from 10 public high schools in California. Participants completed a 20-item scale assessing BIS (one aspect) and BAS (three aspects: drive, fun-seeking, reward responsiveness) sensitivities at baseline and reported their past 30-day nicotine and cannabis vaping at baseline and again at 6-month follow-up. Unadjusted and adjusted (controlled for demographic characteristics and product-specific baseline vaping) regression models estimated vaping risk at follow-up by BIS/BAS scores at baseline.

RESULTS

Bivariate analyses showed participants who vaped nicotine had significantly higher drive and fun-seeking scores (p < 0.05); and cannabis vapers had lower BIS and reward responsiveness scores (p < 0.05) compared to non-users. Higher fun seeking scores was associated with increased odds (OR = 1.15, 95 %CI = 1.03-1.29) of nicotine vaping and higher reward responsiveness scores reduced odds (OR = 0.89, 95 %CI = 0.79-0.99) of nicotine vaping. Higher scores on BIS was associated with decreased the odds (OR = 0.91, 95 %CI = 0.84-0.99) of cannabis vaping.

CONCLUSION

Different behavioral motivations should be targeted when developing interventions designed to reduce nicotine and cannabis vaping among diverse adolescents.

Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada

Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.

Vaping preferences of individuals who vaporise dry herb cannabis, cannabis liquids and cannabis concentrates

In 2019 an estimated 200 million people aged 15-64 used cannabis, making cannabis the most prevalent illicit substance worldwide. The last decade has seen a significant expansion in the cannabis vaporiser market, introducing cannabis vaporisation as a common administration method alongside smoking and ingestion. Despite reports of increased prevalence of cannabis vaporisation there has been little research into the use of these devices. To remedy the current dearth of data in this area this study utilised an anonymous online survey of individuals who self-reported past cannabis vaporisation. The respondents (N = 557) were predominantly young (<35 years) and male. Most (91.4 %) stated they had ever vaped dry herb cannabis, 59.1 % reported vaporisation of cannabis oil or liquids, and 34.0 % reported vaporisation of cannabis concentrates. This study identifies the types of vaporisation devices (including brands and models) employed by cannabis vapers, as well as the vaporisation temperatures and puff durations commonly used for dry herb, cannabis liquids and cannabis concentrates. To the best of our knowledge, this is the first time the usual operating temperatures of these vaporisation devices and user specific consumption patterns such as puff duration have been reported for cannabis vaping. This information will allow for a more realistic understanding of patterns of recreational use and improve experimental conditions in research settings to reflect the user's context.

E-cigarette use and intentions related to psychological distress among cigarette, e-cigarette, and cannabis vape users during the start of the COVID-19 pandemic

Background

This study examines associations between psychological distress, intentions to use e-cigarettes, and cigarette smoking, e-cigarette use, and cannabis consumption through e-cigarette use among a diverse sample of U.S. young adults.

Procedures

Young adults (N = 314; 72.5% female) were recruited to complete an online survey during the first few months of the COVID-19 pandemic.

Results

Associations between psychological distress and cigarette smoking, e-cigarette use, cannabis vaping, and intentions to use e-cigarettes were found. Current e-cigarette use (OR = 1.23, 95% CI 1.17, 1.28, p < .001; 7.5%) and cannabis vaping (OR = 2.03, 95% CI 1.88, 2.18, p < .001; 10%) was higher among female, possibly due to the significantly higher psychological distress reported among females. Interactions between intentions to use e-cigarettes and psychological distress variables were found for all smoking and vaping behaviors.

Conclusions

Public health efforts should increase focus on providing psychological services for young adults to improve coping strategies that are alternative to smoking and vaping behaviors.

Frequency of adolescent cannabis smoking and vaping in the United States: Trends, disparities and concurrent substance use, 2017-19

AIM

To quantify the trends in frequent and occasional cannabis vaping, demographic differences and concurrent nicotine and alcohol use.

DESIGN

Observational study. Survey-weighted multinomial logistic regression models assessed trends and disparities in past 30-day cannabis use. Trends were assessed overall and by sex, race/ethnicity, parental education and urbanicity. Multinomial logistic regression models also estimated associations of cannabis use (none, use without vaping, use with vaping) with past 2-week binge drinking and past 30-day nicotine/tobacco use.

SETTING

United States, 2017-19.

PARTICIPANTS

Participants in the national Monitoring the Future (n = 51 052) survey.

MEASUREMENTS

Past 30-day frequent cannabis use (six or more times/30 days) and past 30-day occasional use (one to five times/30 days), with and without vaping.

FINDINGS

Past 30-day frequent cannabis use with vaping and occasional use with vaping rose from 2017 to 2019. Past 30-day frequent and occasional cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socio-economic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g. prevalence among Hispanic/Latino adolescents). Adolescents who reported smoking and vaping nicotine, and 10+ occasions of binge drinking, were 42.28 [95% confidence interval (CI) = 33.14-53.93] and 10.09 (95% CI = 4.51-22.53) times more likely to report past 30-day cannabis use with vaping, respectively, compared with no use.

DISCUSSION

Cannabis use without vaping appears to be declining among adolescents in the United States, while cannabis use with vaping is accelerating; frequent cannabis vaping is especially increasing, with consistent increases across almost all adolescent demographic groups. Cannabis use among US adolescents remains highly associated with other substance use.

Characteristics of Adults Who Use Both Marijuana and E-Cigarette, or Vaping, Products: A Cross-Sectional Study, Utah, 2018

OBJECTIVES

Among young people, dual use of marijuana and e-cigarette, or vaping, products (EVPs) is linked with using more inhalant substances and other substances, and poorer mental health. To understand antecedents and potential risks of dual use in adults, we analyzed a representative adult population in Utah.

METHODS

We used data from the 2018 Utah Behavioral Risk Factor Surveillance System (n = 10 380) and multivariable logistic regression to evaluate differences in sociodemographic characteristics, comorbidities, and risk factors among adults aged ≥18 who reported currently using both EVPs (any substance) and marijuana (any intake mode), compared with a referent group of adults who used either or neither.

RESULTS

Compared with the referent group, adults using EVPs and marijuana had greater odds of being aged 18-29 (adjusted odds ratio [aOR] = 12.44; 95% CI, 6.15-25.14) or 30-39 (aOR = 3.75; 95% CI, 1.73-8.12) versus ≥40, being male (aOR = 3.29; 95% CI, 1.82-5.96) versus female, reporting ≥14 days of poor mental health in previous 30 days (aOR = 2.30; 95% CI, 1.23-4.32) versus <14 days, and reporting asthma (aOR = 2.09; 95% CI, 1.02-4.31), chronic obstructive pulmonary disorder (aOR = 2.94; 95% CI, 1.19-7.93), currently smoking cigarettes (aOR = 4.56; 95% CI, 2.63-7.93), or past-year use of prescribed chronic pain medications (aOR = 2.13; 95% CI, 1.06-4.30), all versus not.

CONCLUSIONS

Clinicians and health promotion specialists working with adults using both EVPs and marijuana should assess risk factors and comorbidities that could contribute to dual use or associated outcomes and tailor prevention messaging accordingly.

Who mixes tobacco with cannabis and does mixing relate to nicotine dependence?

BACKGROUND

Cannabis users who mix tobacco with cannabis are exposed to nicotine in the tobacco. We identified characteristics of young adult cannabis users who mix and investigated whether mixing frequency is associated with nicotine dependence (ND).

METHODS

Data were collected in self-report questionnaires in 2017-20 from 788 young adults (44% male; mean (SD) age 30.6 (1.0) years) participating in a longitudinal investigation of the natural course of ND. Using multivariable logistic regression, we assessed whether any of 16 sociodemographic, lifestyle, psychosocial or other characteristics were associated with mixing among 313 past-year cannabis users. We also assessed whether mixing frequency was associated with ND among 289 past-year cannabis users who had ever smoked cigarettes controlling for age, sex, and other sources of nicotine (i.e., number of cigarettes smoked, other tobacco products, second-hand smoke exposure).

RESULTS

Of 788 participants, 40 % (n = 313) reported past-year cannabis use. Of these, 150 (48 %) reported mixing. Younger age, lower education and income, past-year cigarette use, use of other tobacco products and illicit drugs, poor coping skills and gambling were associated with mixing. Number of ICD-10 ND criteria endorsed was associated with mixing < weekly (b(95 % CI) = 0.3(0.02,0.7)) and weekly/daily (0.5(0.1,0.9)) after controlling for other sources of nicotine.

CONCLUSION

Mixing is associated with ND and therefore may threaten tobacco control efforts by rendering quitting cigarette smoking more difficult among smokers who mix tobacco with cannabis. Mixing tobacco with cannabis should be considered as an additional source of nicotine exposure in studies of ND in young people.

The Quantitation of Squalene and Squalane in Bronchoalveolar Lavage Fluid Using Gas Chromatography Mass Spectrometry

Chemicals of unknown inhalational toxicity are present in electronic cigarette and vaping products. E-cigarettes typically contain nicotine and other relatively hydrophilic chemicals while vaping products typically contain cannabinoids and other hydrophobic chemicals. For example, vaping products can include hydrophobic terpenes such as squalane (SQA) and squalene (SQE). However, little is known about the SQA and SQE transmission from liquid to aerosol. SQA and SQE are used in commercial products that are applied dermally and ingested orally, but limited information is available on their inhalational exposure and toxicity. We developed and validated a quantitative method to measure SQE and SQA in bronchoalveolar lavage fluid to assess if these chemicals accumulate in lung epithelial lining fluid after inhalation. Calibration curves spanned a range of 0.50–30.0 µg analyte per mL bronchoalveolar lavage fluid. Recoveries were found to be 97–105% for SQE and 81–106% for SQA. Limits of detection were 0.50 μg/ml for both SQE and SQA. The method was applied to bronchoalveolar lavage fluid samples of patients from the 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and a comparison group. Neither SQA nor SQE was detected above the method LOD for any samples analyzed; conversely, SQA or SQE were reproducibly measured in spiked quality control BAL fluids (relative standards deviations <15% for both analytes). Further applications of this method may help to evaluate the potential toxicity of SQA and SQE chronically inhaled from EVPs.

A gas chromatography-mass spectrometry method for quantifying squalane and squalene in aerosol emissions of electronic cigarette, or vaping, products

Numerous chemicals of unknown inhalational toxicity have been measured in electronic cigarette, or vaping, products (EVPs). In addition, little is known about the liquid-to-aerosol transmission and deliveries of these chemicals, including oil-like terpenes such as squalene (SQE) and squalane (SQA). To provide information on the aerosol deliveries of these compounds from EVPs, we developed and validated a quantitative method to measure squalene and squalane in EVP aerosol emissions. Validation parameters include measurement repeatability (SQA and SQE %RSD <6%), intermediate precision (SQA: %RSD 11%, SQE: %RSD 17%), accuracy (SQA: 86-107%, SQE: 104-113%), matrix effects, method robustness, and analyte stability. Limits of detection were 6.06 ng/mL puffed air volume for both squalene and squalane. The method was used to measure squalene and squalane in aerosol emissions of 153 EVPs associated with case patients from a recent outbreak of e-cigarette, or vaping, product use associated lung injury (EVALI). The EVPs analyzed were organized into nicotine, cannabidiol, and tetrahydrocannabinol products by the percentage of nicotine, cannabidiol, and tetrahydrocannabinol in total particulate matter after vaping. In case-associated tetrahydrocannabinol products the detection rates and mean concentrations were 82.4% and 33.0 ng/mL puffed air for squalene and 4.41% and 7.80 ng/mL puffed air for squalane.

Self-reported changes in cannabis vaping among US adolescents and young adults early in the COVID-19 pandemic

Cannabis vaping may increase susceptibility to COVID-19 infection and related outcomes; however, little is known about the impact of the pandemic on cannabis vaping among US young populations. This study examined self-reported changes in cannabis vaping since the pandemic and factors associated with changes. A national, cross-sectional survey was conducted among 4,351 US adolescents and young adults (13–24 years old) in May 2020. Of those, 1,553 participants who reported ever vaping cannabis were included in the analytic sample. Binary outcome was self-reported increase in cannabis vaping (more hours/times of vaping in a day) vs. no change/quitting/reducing/switching. Weighted logistic regression examined associations between independent variables (i.e., risk perceptions of vaping, cannabis dependence, and stress/anxiety) and the outcome, controlling for sociodemographic factors. Overall, 6.8% reported increasing cannabis vaping since the pandemic, 37.0% quitting or reducing vaping in general, and 42.3% no change. Participants were more likely to report increased cannabis vaping if they perceived “Vaping is safer than smoking cigarettes” (Adjusted Odds Ratio [AOR] = 3.66; 95%CI = 1.43–9.38), reported more dependence on cannabis vaping (AOR = 1.59; 95%CI = 1.11–2.27), and were female (AOR = 2.80; 95%CI = 1.23–6.36). Those perceiving “Vaping cannabis can cause lung injuries” were less likely to increase cannabis vaping (AOR = 0.37; 95%CI = 0.18–0.76). Findings indicate that adolescent and young adult ever-cannabis vapers were more likely to report decreasing vaping generally than increasing cannabis vaping and most did not change use during the early pandemic. Educational campaigns should address potential health risks of cannabis vaping and focus on lung health to reduce use among young people during and following the pandemic.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE

College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency.

METHOD

A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]).

RESULTS

Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition.

CONCLUSIONS

Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Profiles of Nicotine and Cannabis Exposure among Young Adults with Asthma

There is a paucity of data on nicotine and cannabis use among young adults (YAs) with asthma. This study aimed to do the following among YAs with asthma: (1) describe YAs' active and passive exposure to nicotine and cannabis; (2) identify latent classes of active use of nicotine and cannabis; and (3) explore predictors of class membership (i.e., demographics, parental and friend use of nicotine and cannabis, and hours of environmental exposure to tobacco smoke, e-cigarette vapor, and marijuana smoke). YAs with asthma (N = 178) self-reported on nicotine and cannabis exposure and the included covariates. Latent class analysis was used to identify latent classes of lifetime nicotine and cannabis use. High rates of nicotine and cannabis use among YAs with asthma were found: 37% reporting a lifetime history of using both nicotine and cannabis. Regarding past year use, 25% had smoked cigarettes, 40% had used e-cigarettes, and 35% had used cannabis. Five classes of lifetime use were identified. The largest class was a non-user class (53%); the other four classes indicate concerning patterns of nicotine and cannabis use. The most consistent predictor of being in a class characterized by more nicotine and cannabis exposure (versus being in the non-user class) was past week exposure to cannabis smoke. This is the first study to identify classes of lifetime nicotine and cannabis use, and examine predictors of class membership, among YAs with asthma. There is a critical need to address environmental and active tobacco and marijuana exposure among YAs with asthma.

Cannabis Legalization and Adolescent Use of Electronic Vapor Products, Cannabis, and Cigarettes

OBJECTIVES

Cannabis legalization may have unintended consequences, such as effects on prevalence of adolescent use of other substances. We hypothesize that in states that have legalized recreational cannabis (RCL states), electronic vapor product use ("vaping"), cannabis, and cigarette use among adolescents is more prevalent than in states that have only legalized medical cannabis (MCL states) and states that have neither legalized recreational nor medical cannabis (NL states).

METHODS

Data are from the Center for Disease Control's 2017 Youth Risk Behavior Surveillance Survey (n = 107,665), a nationally representative survey of US high school students. We categorized student responses by cannabis legalization status of the state in which they lived at time of survey, then tested associations between cannabis legalization status and adolescent vaping, cannabis, and cigarette use, using logistic regressions.

RESULTS

Students in RCL states were significantly more likely to report current vaping behaviors compared to NL students [odds ratios (OR's) 2.07-2.21]. Students in cannabis-legal states were significantly more likely to report ever or currently using cannabis compared to NL students (OR's 1.27-1.40). MCL students were significantly less likely to report current cigarette smoking (OR = 0.86) compared to NL students.

CONCLUSIONS

Adolescents in cannabis-legal states were more likely to report vaping and cannabis use compared to adolescents in NL states. Public health officials, policymakers, and clinicians should consider the associations between cannabis legalization and adolescent vaping, cigarette, and cannabis use patterns.

Exploring the Association of e-Cigarette and/or Cannabis Use with Heavy Episodic Drinking among Ontario Adults

Background: The use of electronic cigarettes and cannabis has significantly increased in recent years, which raises public health concerns. There are also concerns about the association of these substances with drinking behaviors. The main objective of the present study is to examine the association of e-cigarettes and/or cannabis use with heavy episodic drinking (HED) among Ontario adults. Methods: The sample consisted of 5,564 adults from the Monitor Survey in 2018 and 2019. Cannabis and e-cigarette use reflected any use of the substances in the past 12 months. HED was defined as consumption of four/five or more drinks on a single occasion at least monthly in the past 12 months. Odds ratios (OR) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Results: Overall, the prevalence of HED was 17.5% in 2018 and 2019. Among participants who reported both e-cigarette and cannabis use, about one-half (50.4%) reported HED at least monthly. Adjusting for covariates, the odds of HED were 5.71 (95%CI, 3.92-8.30) times higher among those who reported both e-cigarette and cannabis use compared to those who used neither substance. Conclusions: The use of e-cigarettes and cannabis are significantly associated with heavy episodic drinking among adults, indicating that those who engage in the dual use of e-cigarette and cannabis may be an important group to target with intervention programs.

Patterns of Cannabis Use among Canadian Youth over Time; Examining Changes in Mode and Frequency Using Latent Transition Analysis

Background: Historically substance use literature has focused on smoking as the main mode of cannabis consumption, so there are knowledge gaps surrounding current understanding of edibles and vaping. These alternative modes of cannabis use are already common among Canadian youth; however, little is known about how these cannabis use patterns change over time. Methods: This study examined the mode (smoking, eating/drinking, vaping) and frequency of cannabis use among a large sample of Canadian youth who participated in 2017-2018 and 2018-2019 data collection waves of the COMPASS study. Using latent transition analysis, this sample consisting of 18,824 youth in grades 9-12 were categorized into cannabis use classes stratified by sex, and their transition between these classes over the one-year period was examined. Results: Three cannabis use classes were identified (occasional multimode, regular multimode, and smoking) alongside one nonuse class. Among youth who reported cannabis use at baseline, transitioning to a multimode group, and/or increasing frequency of multimode use was likely over the one-year period. Conclusions: These findings may highlight a key leverage point for harm-reduction strategies which aim to prevent cannabis related harms associated with high frequency use.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE

College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency.

METHOD

A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]).

RESULTS

Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition.

CONCLUSIONS

Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Low Self-Control and Vaping: The Mediating Role of Health and Risk Perceptions

BACKGROUND

Research has shown independent attention in the role of self-control and health/risk perceptions toward vaping in predicting vaping use among youth and young adults. Yet, there are good theoretical notions to believe that low self-control, perceptions toward vaping, and self-reported vaping are intertwined.

OBJECTIVES

To examine whether three different health/risk perceptions toward vaping mediate the effect of low self-control on vaping use among young adults.

METHODS

A survey was administered to 325 undergraduate students attending a large university in the Midwest (Mean age = 19.5; 60.4% female; 73.1% White). Single and multiple mediation modeling strategies were used to assess the mediation hypothesis.

RESULTS

Logistic regression results indicate that individuals with low self-control are more likely to vape (O.R. = 1.041, p < .05). Further, when health/risk perceptions are included in the models individually and simultaneously, it reduces the effect of low self-control on vaping between 15% and 37.5%, and renders low self-control to become non-significant.

CONCLUSIONS

Findings suggest the impact that harm/risk perceptions toward vaping have in engaging in this behavior. Thus, preventative efforts should target potential sources, such as media and advertisements, that may shape young adults' perceptions toward vaping.

State marijuana policies and vaping associated lung injuries in the US

BACKGROUND

The United States' 2019 outbreak of e-cigarette or vaping-associated lung injuries (EVALI) was linked to an additive most common in informally-sourced vaporizable marijuana concentrates. This study estimates how states' recreational and medical marijuana policies related to their 2019 EVALI incidence and residents' likelihood of vaping as their primary mode of marijuana use.

METHODS

Multivariable negative binomial regressions estimated associations between states' total 2019 EVALI cases and marijuana policies: recreational legalization, medical legalization only, and whether medical-only policies allowed home cultivation, prohibited combustible use, or had operational dispensaries. Logistic regressions used survey data from the Behavioral Risk Factor Surveillance System's 2016-2019 marijuana supplements to assess how these policies related to past-30-day marijuana users' selection of vaping as their primary mode of use.

RESULTS

EVALI incidence was 42% lower in recreational marijuana states (95%CI=0.339,0.993), versus a positive but statistically insignificant association with medical legalization alone. Adjusting for policy attributes revealed heterogeneity: among medical-marijuana-only states, EVALI incidences were > 60% lower where laws allowed home cultivation (aIRR=0.374; 95%CI=0.196, 0.715). Similarly, among past-30-day marijuana users, odds of vaping as one's primary mode of use were > 40% lower in medical-only states where home cultivation was allowed versus prohibited (aOR=0.588; 95%CI=0.365,0.946).

CONCLUSIONS

Marijuana policy attributes linked to lower EVALI incidences were also associated with reduced likelihoods of vaping as one's primary mode of use. As additives in informally-sourced vaping concentrates could drive future EVALI cases, marijuana policy design should account for effects on mode of use in licit and illicit markets, to limit the scope of future outbreaks.

A qualitative study on the impact of COVID-19 on the behavior and attitudes of smokers and non-smokers in South Korea

BACKGROUND

The COVID-19 pandemic has affected all aspects of human society, including education, culture, and the economy, and has also introduced changes in people's health behaviors such as drinking alcohol, nutrition intake, and practicing healthy living. This study conducted qualitative research in the Korean context to examine the changes in the smoking behavior of smokers and secondhand smoke exposure of non-smokers during the COVID-19 pandemic.

METHODS

Focus group interviews were conducted with 36 Korean participants (18 men and 18 women). The groups were composed of cigarette smokers, e-cigarette users, heated tobacco product users, and non-smokers.

RESULTS

During the pandemic, it was found that there was an increase in the frequency of use, irrespective of the tobacco product, in users who refrained from social interaction and worked or studied from home. Users who continued to be socially active increased the amount used with each usage. Smokers showed a tendency to avoid smoking rooms and to smoke alone in places unoccupied by people. In addition, non-smokers' exposure to secondhand smoke did not decrease, but since non-smokers used masks, they reported more relief from the risk of exposure to secondhand smoke than before.

CONCLUSIONS

Despite smokers being a high-risk group for COVID-19, the risk did not result in smoking cessation among smokers. Therefore, policies and educational campaigns to raise awareness about the dangers of smoking and to encourage smoking cessation are needed in the future.

Demographic and substance use-related differences among high school adolescents who vape cannabis versus use other cannabis modalities

BACKGROUND

Vaping is the second most common modality of using cannabis following smoking. We examined differences in demographics and substance use behaviors between adolescent cannabis vapers and those exclusively using other cannabis modalities.

METHODS

In 2019, 4875 students from six Connecticut high schools completed school-wide, online surveys. Past-month cannabis users (n = 931; 52.8% female, 16.38(1.27) years old, 44.9% non-Hispanic White) reported on cannabis modalities used (e.g., combustible, vaporizable, edible) and were classified as cannabis vapers or non-vapers. Cannabis vapers reported on device type used to vape cannabis: a cannabis-specific device or modified/hacked e-cigarette. Unadjusted and adjusted relationships were examined to identify demographic and substance-related differences between cannabis vapers and non-vapers.

RESULTS

56.3% of past-month cannabis users reported vaping cannabis. Cannabis vapers reported using both cannabis-specific vaporizers (91.9%) and modifying/hacking e-cigarettes (23.7%). Cannabis vapers, relative to other cannabis users, were more likely to be male, White, initiate cannabis use at a younger age; endorse past-month use of all cannabis modalities, alcohol, and e-cigarettes; and report smoking and dabbing cannabis more frequently; consuming more drinks per drinking day; and using e-cigarettes at a younger age and more frequently.

CONCLUSIONS

Relative to other cannabis modalities, vaping was associated with increased use of several cannabis products and other substances. Adolescent past-month cannabis users reported modifying e-cigarettes to vape cannabis. Findings suggest that regulations should be implemented to prevent e-cigarettes from being modifiable for use with cannabis and highlight the importance of assessing different cannabis use modalities, as vaping was associated with distinct substance-related risks.

Phytocannabinoids and schizophrenia: Focus on adolescence as a critical window of enhanced vulnerability and opportunity for treatment

The recent shift in socio-political debates and growing liberalization of Cannabis use across the globe has raised concern regarding its impact on vulnerable populations such as adolescents. Concurrent with declining perception of Cannabis harms, more adolescents are using it daily in several countries and consuming marijuana strains with high content of psychotropic delta (9)-tetrahydrocannabinol (THC). These dual, related trends seem to facilitate the development of compromised social and cognitive performance at adulthood, which are described in preclinical and human studies. Cannabis exerts its effects via altering signalling within the endocannabinoid system (ECS), which modulates the stress circuitry during the neurodevelopment. In this context early interventions appear to circumvent the emergence of adult neurodevelopmental deficits. Accordingly, Cannabis sativa second-most abundant compound, cannabidiol (CBD), emerges as a potential therapeutic agent to treat neuropsychiatric disorders. We first focus on human and preclinical studies on the long-term effects induced by adolescent THC exposure as a "critical window" of enhanced neurophysiological vulnerability, which could be involved in the pathophysiology of schizophrenia and related primary psychotic disorders. Then, we focus on adolescence as a "window of opportunity" for early pharmacological treatment, as novel risk reduction strategy for neurodevelopmental disorders. Thus, we review current preclinical and clinical evidence regarding the efficacy of CBD in terms of positive, negative and cognitive symptoms treatment, safety profile, and molecular targets.

Tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product use behaviors among adults after the onset of the 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI)

INTRODUCTION

During the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) outbreak, patient data on tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (EVP) use was collected, but data on non-affected adult product use after the onset of the EVALI outbreak is limited. This study describes adult THC-EVP use after EVALI began.

METHODS

THC-EVP use data came from an 18-state web-based panel survey of adult THC- and nicotine-containing EVP users conducted February 2020. Unweighted descriptive statistics were calculated; logistic regression assessed correlates of use.

RESULTS

Among 3,980 THC-EVP users, 23.5% used THC-EVPs daily. Common brands of THC-EVPs used were Dank Vapes (47.7%) and Golden Gorilla (38.7%). Reported substances used included THC oils (69.6%), marijuana herb (63.6%) and THC concentrate (46.4%). Access sources included: recreational dispensaries (41.1%), friend/family member (38.6%) and illicit dealers (15.1%). Respondents aged 45-64 years had lower odds for daily use compared with those aged 25-34 years (aOR = 0.73; 95% CI = 0.60, 0.90). Compared with White respondents, Asian respondents had lower odds (aOR = 0.55; 95% CI = 0.36, 0.84) and Black respondents higher odds (aOR = 1.48; 95% CI = 1.17, 1.86) of daily use. Respondents odds of daily use and accessing THC-EVPs through commercial sources were higher among states with legalized nonmedical adult marijuana use compared to states without.

CONCLUSIONS

Almost half of respondents reported daily or weekly THC-EVP use, and accessed products through both informal and formal sources, even after EVALI began. Given the potential for future EVALI-like conditions to occur, it is important to monitor the use of THC-EVPs and ensure effective education activities about associated risk.

Cannabis use and electronic cigarette use: The role of dual use on use frequency and related problems

Despite high rates of use of both cannabis and electronic nicotine delivery systems (ENDS), little is known about the role of cannabis use among ENDS users and of ENDS use among cannabis users. This study tested whether dual use was related to more frequent use, use-related problems, and negative affect. Among cannabis users (n=315), ENDS was associated with more frequent cannabis use, cannabis-related problems, anxiety, and depression. Among ENDS users (n=156), cannabis was associated with more frequent ENDS use, ENDS-related problems, and anxiety. Overall, ENDS use is common among cannabis users and cannabis use is common among ENDS users. Further, use of both of these substances is related to more use, use-related problems, and negative affect, especially anxiety.

Correlates of the use of electronic devices to vape cannabis in a cohort of young Swiss male reporting current cannabis use

BACKGROUND

Information about correlates of cannabis vaping in Europe is scarce.

METHODS

In a cohort of 1613 Swiss young males currently using cannabis, we used logistic regression, adjusting for age, linguistic region and education to assess the association between sensation seeking, substance use and sociodemographic variables with cannabis vaping.

RESULTS

Mean age was 25.38 years, 60.4% had post-secondary education and 57.3% lived in French-speaking cantons; 26.3% met criteria for nicotine dependence, 16.0% met criteria for alcohol use disorder and 34.9% used illicit drugs other than cannabis; 27.4% used cannabis at least twice a week and 27.8% met criteria for cannabis use disorder (CUD). Ninety-four participants (5.8%) reported cannabis vaping (of them 87.4% reported infrequent cannabis vaping). In the adjusted analysis, using joints with no tobacco {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.45 (1.02-1.76)}, water pipe with [aOR (95% CI) = 1.70 (1.29-2.24)] and without tobacco [aOR (95% CI) = 2.15 (1.60-2.87)], cannabis mixed with food [aOR (95% CI) = 1.61 (1.29-2.02)], using cannabis >2 times a week [aOR (95% CI) = 3.73 (2.40-5.81)], meeting criteria for CUD [aOR (95% CI) = 4.19 (2.70-6.50)], using illicit drugs other than cannabis [aOR (95% CI) = 1.88 (1.23-2.87)], weekly number of alcohol drinks [aOR (95% CI) = 1.01 (1.00-1.03)] and living in the German-speaking area of Switzerland [aOR (95% CI) = 2.70 (1.71-4.25)] were associated with higher odds of cannabis vaping; post-secondary schooling [aOR (95% CI) = 0.37 (0.16-0.86)] and vocational training [aOR (95% CI) = 0.41 (0.17-0.99)] (as opposed to primary schooling) were associated with lower odds of cannabis vaping.

CONCLUSION

Cannabis vaping might be a marker of riskier behaviours among cannabis users.

Effects of Δ⁹-tetrahydrocannabinol (THC) vapor inhalation in Sprague-Dawley and Wistar rats

An inhalation system based on e-cigarette technology produces hypothermic and antinociceptive effects of Δ⁹-tetrahydrocannabinol (THC) in rats. Indirect comparison of some prior investigations suggested differential impact of inhaled THC between Wistar (WI) and Sprague-Dawley (SD) rats; thus, this study was conducted to directly compare the strains across inhaled and injected routes of administration. Groups (N = 8 per strain) of age-matched male SD and WI rats were prepared with radiotelemetry devices to measure temperature and then exposed to vapor from the propylene glycol (PG) vehicle or THC (25-200 mg/mL of PG) for 30 or 40 min. Additional studies evaluated effects of THC inhalation on plasma THC (50-200 mg/mL) and nociception (100-200 mg/mL) as well as the thermoregulatory effect of intraperitoneal injection of THC (5-30 mg/kg). Hypothermic effects of THC were more pronounced in SD rats, where plasma levels of THC were identical across strains, under either fixed inhalation conditions or injection of a mg/kg equivalent dose. Strain differences in hypothermia were largest after i.p. injection of THC, with SD rats exhibiting dose-dependent temperature reduction after 5 or 10 mg/kg, i.p. and the WI rats only exhibiting significant hypothermia after 20 mg/kg, i.p. The antinociceptive effects of inhaled THC (100, 200 mg/mL) did not differ significantly across the strains. These studies confirm an insensitivity of WI rats, compared with SD rats, to hypothermia induced by THC following inhalation conditions that produced identical plasma THC and antinociception. Thus, quantitative, albeit not qualitative, strain differences may be obtained when studying thermoregulatory effects of THC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adolescent nicotine and marijuana vaping activity and the use of other illicit substances

PURPOSE

Previous research links cigarette use and marijuana use in adolescence with the use of other illicit substances. Limited research, however, has explored whether vaping nicotine and marijuana, along with using these substances through multiple modes of delivery (traditional cigarette/marijuana use and vaping) is associated with the use of other illicit substances in adolescence.

PROCEDURES

This study addresses this gap in the literature by employing negative binomial regression to examine the relationships between three categories of nicotine users (traditional cigarettes only, nicotine vaping only, and dual mode nicotine use), three categories of marijuana users (traditional marijuana use only, marijuana vaping only, and dual mode marijuana use), and the use of other illicit substances in a sample of Florida middle school and high school students.

FINDINGS

Our findings reveal that nicotine vaping and dual mode use of both nicotine and marijuana are associated with the use of a greater variety of illicit substances compared to non-users.

CONCLUSIONS

In conclusion, our findings suggest that dual mode use of nicotine and marijuana are associated with greater likelihood of using other illicit substances. The implications of these findings for future research are discussed.

Clearing the Haze: What Do We Still Need to Learn about Electronic Nicotine Delivery Systems?

Electronic nicotine delivery systems (ENDS; i.e., electronic cigarettes, e-cigarettes, vaping devices, vape pens) were introduced to the U.S. market in 2007 as a potential harm reduction alternative for people who smoked combustible cigarettes. Since that time, ENDS popularity grew very quickly, particularly among individuals who smoke cigarettes. However, young people and never smokers also started using ENDS, cohorts for whom these products were not intended. There are now a broad range of devices and e-liquid constituents. ENDS devices vary considerably in their design and generation of potentially toxic chemicals, with higher power devices likely much more hazardous than lower power devices. This landscape may further change after September 9, 2020, when all ENDS manufacturers are required to submit a premarket tobacco product application to the FDA to obtain authorization for marketing. Research has not kept pace with this rapidly changing technology and important questions remain regarding the relative benefits versus risks of ENDS. In light of these challenges, we propose key ENDS research priorities to address these gaps.

Availability of substances for use in personal vaporisers on three online cryptomarkets

BACKGROUND

Personal vaporisers are gaining popularity as an alternative route of administration for a range of substances. Online cryptomarkets are becoming increasingly popular among people who use substances due to their perceived anonymity, ease of use, and reduced risk of violence compared to traditional face-to-face dealers. We examined the diversity of substances marketed for use in a personal vaporiser on these marketplaces.

METHODS

Vaping related listings were extracted from three online cryptomarkets ('Agartha', 'Cryptonia', and 'Tochka') using The Onion Router browser. Data collection occurred between October and November 2019.

RESULTS

We identified 1929 listings from 201 unique sellers. The top product on Agartha, Cryptonia, and Tochka were vape cartridges prefilled with the e-liquid (70.4 %, 39.4 %, 52.3 % respectively). The most common substance in these products was cannabis oil (96.1 %, 82.1 %, 87.8 %), followed by synthetic cannabinoids (3.7 %, 9.7 %, 9.8 %) and psychedelic substances (0.2 %, 6.4 %, 1.2 %). Vendors were primarily from the USA. Many products offered worldwide shipping (96.3 %, 42.4 %, 51.2 %).

CONCLUSION

Vaping products listed on online cryptomarkets in 2019 primarily contained cannabis oils. Future studies should continue to examine cryptomarkets to identify emerging trends of substances that can be used in personal vaporisers.

A vapor exposure method for delivering heroin alters nociception, body temperature and spontaneous activity in female and male rats

BACKGROUND

The ongoing crisis related to non-medical use of opioids makes it of continued importance to understand the risk factors for opioid addiction, the behavioral and neurobiological consequences of opioid exposure and to seek potential avenues for therapy. Pre-clinical rodent models have been critical to advancing understanding of opioid consequences for decades, but have been mostly limited to drug delivery by injection or by oral dosing. Inhalation, a significant route for many human users, has not been as well-established.

METHOD

We adapted an e-cigarette based exposure system, previously shown efficacious for delivery of other drugs to rats, to deliver heroin vapor. Effectsin vivo were assessed in male and female Sprague-Dawley rats using a warm-water assay for anti-nociception and an implanted radiotelemetry system for evaluating changes in body temperature and spontaneous activity rate.

RESULTS

Inhalation of vapor created by heroin 100 mg/mL in the propylene glycol (PG) vehicle significantly slowed tail-withdrawal from a 52 °C water bath, bi-phasically altered activity, and increased temperature in male and female rats. Inhalation of heroin 50 mg/mL for 15 min produced significant effects, as the lower bound on efficacy, whereas inhalation of heroin 100 mg/mL for 30 min produced robust effects across all endpoints and groups.

CONCLUSIONS

This work shows that e-cigarette devices deliver psychoactive doses of heroin to rats, using concentrations of ∼50-100 mg/mL and inhalation durations of 15-30 min. This technique may be useful to assess the health consequences of inhaled heroin and other opioid drugs.

A mixed-methods approach to understanding overdose risk-management strategies among a nationwide convenience sample

BACKGROUND

This mixed-methods study compared drug use histories between individuals who had a reported non-fatal overdose to individuals who did not and described the overdose risk-management strategies as they were experienced by a sample of people who use drugs (PWUD). Shifts from non-medical prescription opioid use (NMPOU) to the use of heroin and synthetic opioids have been implicated in national increases in overdose incidences in the United States. However, relatively limited data exists regarding the narrative experiences of the evolving overdose risk management strategies among a nationwide sample of PWUD.

METHODS

Data recruitment was conducted via Amazon's mTurk crowdsourcing technology and was collected through semi-structured interviews that occurred in 2019. Participants (N = 60) with a history of NMPOU with transition to heroin or fentanyl use were recruited.

RESULTS

Participants reporting a previous non-fatal overdose were more likely to report a history of injection drug use, a history of heroin injection, greater overdose risk knowledge, and current medication for opioid use disorder (MOUD) use. Qualitative analysis revealed that participants attempted to mitigate overdose risk in primarily three ways: 1) self-regulation; 2) harm reduction; and 3) passive approach. Self-regulatory measures included administering small or incremental dosing, being mindful of personal tolerance limits, and avoiding the initiation of injection drug use. Harm reduction measures used to protect from overdose included carrying Narcan and relying on trusted drug-suppliers as references to drug purity. A passive approach indicated that participants relied on "luck" or divine support systems where religiosity and faith were endorsed as factors that mitigated personal overdose risk.

CONCLUSION

Participants reported successful overdose mitigation via self-regulation, which may suggest that PWUDs were capable at managing their drug use amid the overdose crisis. The importance of the drug-supplier relationship was critical to many in reducing their overdose risk as formal harm reduction services (e.g., safe injection sites) remain inaccessible in the U.S. Implications for drug policy and harm reduction interventions are discussed.

Marijuana Vaping in U.S. Adults: Evidence From the Behavioral Risk Factor Surveillance System

INTRODUCTION

As of February 18, 2020, states have reported 2,807 cases of e-cigarette, or vaping, product use-associated lung injury to the Centers for Disease Control and Prevention. Most cases involved cannabinoids. This study identifies current risk factors for adult marijuana vaping by analyzing 2017 and 2018 Behavioral Risk Factor Surveillance System data.

METHODS

Data on 8,255 people who recently used marijuana were analyzed in September 2019. Sample-weighted multivariate logistic regressions considered a binary indicator for vaping as the primary method of marijuana use. Adjusting for demographic controls, regressions assessed the association between marijuana vaping and marijuana use for medical purposes (versus nonmedical only), current conventional cigarette use, current nicotine e-cigarette use, and 2 mental health variables. Demographic controls were binary indicators for female sex, Hispanic ethnicity, race, and having completed ≥1 year of college.

RESULTS

Odds of marijuana vaping were higher among those who reported using for medical purposes (AOR_{age18-24years}=3.8, 95% CI=1.91, 7.67; AOR_{age25-54years}=1.8, 95% CI=1.02, 3.08; AOR_{age55-64years}=2.3, 95% CI=0.75, 7.07) and lower among people who smoked combustible cigarettes (AOR_{age18-24years}=0.2, 95% CI=0.06, 0.65; AOR_{age25-54years}=0.2, 95% CI=0.10, 0.26; AOR_{age55-64years}=0.1, 95% CI=0.05, 0.34). Vaping nicotine e-cigarettes was associated with greater odds of vaping marijuana for adults aged 25-54 years (AOR=4.6, 95% CI=2.70, 7.78) but not those aged 18-24 years (AOR=0.9, 95% CI=0.33, 2.26).

CONCLUSIONS

Among people who use marijuana, adults reporting medical marijuana use were more likely to vape as their primary mode of consumption, whereas conventional cigarette smokers were less likely to do so. Use of nicotine e-cigarettes was associated with a greater likelihood of vaping marijuana for adults aged 25-54 years.

Explication of CB1 receptor contributions to the hypothermic effects of Δ9-tetrahydrocannabinol (THC) when delivered by vapor inhalation or parenteral injection in rats

The use of Δ⁹-tetrahydrocannabinol (THC) by inhalation using e-cigarette technology grows increasingly popular for medical and recreational purposes. This has led to development of e-cigarette based techniques to study the delivery of THC by inhalation in laboratory rodents. Inhaled THC reliably produces hypothermic and antinociceptive effects in rats, similar to effects of parenteral injection of THC. This study was conducted to determine the extent to which the hypothermic response depends on interactions with the CB₁ receptor, using pharmacological antagonist (SR141716, AM-251) approaches. Groups of rats were implanted with radiotelemetry devices capable of reporting activity and body temperature, which were assessed after THC inhalation or injection. SR141716 (4 mg/kg, i.p.) blocked or attenuated antinociceptive effects of acute THC inhalation in male and female rats. SR141716 was unable to block the initial hypothermia caused by THC inhalation, but temperature was restored to normal more quickly. Alterations in antagonist pre-treatment time, dose and the use of a rat strain with less sensitivity to THC-induced hypothermia did not change this pattern. Pre-treatment with SR141716 (4 mg/kg, i.p.) blocked hypothermia induced by i.v. THC and reversed hypothermia when administered 45 or 90 min after THC (i.p.). SR141716 and AM-251 (4 mg/kg, i.p.) sped recovery from, but did not block, hypothermia caused by vapor THC in female rats made tolerant by prior repeated THC vapor inhalation. The CB₂ antagonist AM-630, had no effect. These results suggest that hypothermia consequent to THC inhalation is induced by other mechanisms in addition to CB₁ receptor activation.

Characterizing the polytobacco behaviors of sexual minority young adult college students

INTRODUCTION

Polytobacco use is a growing concern; users are exposed to cumulatively more nicotine, increasing their risk for dependence and long-term use. More sexual minority (SM) young adults report polytobacco use than their heterosexual peers, yet no studies explore how their tobacco patterns vary across the diverse product landscape. The purpose of this study was to characterize SM young adults' patterns of tobacco use and nicotine dependence, and explore co-occurring risk factors for polytobacco use.

METHODS

Participants were 609 SM Texas college students. Latent class analysis identified subgroups of tobacco users based on their tobacco use behaviors and an indicator of nicotine dependence. Multinomial logistic regression identified associations between individual-level variables and the probability of membership in various user classes.

RESULTS

Tobacco use clustered in four classes: non-users, non-addicted cigarette users, non-addicted e-cigarette users, and addicted polytobacco users. Polytobacco users had an increased probability of depressive symptoms and cannabis use relative to non-users, and more binge alcohol use than all other groups. Non-addicted cigarette users had an increased probability of binge alcohol use, cannabis use, and being non-Hispanic White relative to non-users, and an increased likelihood of cannabis use relative to non-addicted e-cigarette users. Non-addicted e-cigarette users had an increased probability of binge alcohol use relative to non-users.

CONCLUSIONS

SM young adults' tobacco use varies across the diverse product landscape. Failing to account for a range of tobacco behaviors and nicotine dependence prevents tailoring interventions that should also address concerns such as depressive symptoms, cannabis use, and binge alcohol use.

Contribution of alcohol- and cigarette-related cues to concurrent reinforcer choice in humans

Drug-related cues have been extensively studied for their contributions to decision-making processes involving drug consumption. Less studied is how drug-related stimuli may impact decisions involving outcomes not directly related to substance use. Studies using concurrent choice tasks have demonstrated that cocaine and cannabis cues result in robust and selective biases for monetary reinforcers contiguous with those cues. The purpose of this study was to provide a conceptual replication of these findings with alcohol and cigarettes. Participants recruited using crowdsourcing completed a cued concurrent choice task involving presentation of two cues (one drug and one neutral) followed by concurrent monetary offers below each image. Alcohol (Experiment 1; N = 103) and cigarette (Experiment 2; N = 256) visual cues were evaluated. Participants with hazardous alcohol use and current cigarette use showed greater-than-indifference selection for the alcohol- (p = .004) and cigarette-cued (p = .02) monetary choices, respectively. Qualitative responses indicated that the most popular rationale for responding was "image quality" despite images having no explicit impact on the reinforcer received. Low alcohol use (p = .03) and non-cigarette using controls (p < .001) showed an avoidance bias with lower-than-indifference selection for drug-cued choices. These findings replicate and extend observations that spatially contiguous drug-related cues can bias decisions involving concurrently presented non-drug reinforcers.

Type of e-liquid vaped, poly-nicotine use and nicotine dependence symptoms in young adult e-cigarette users: a descriptive study

BACKGROUND

Data are lacking on type of e-liquid vaped among e-cigarette users. Further, few studies assess all sources of nicotine used by e-cigarette users to assess whether poly-nicotine use relates to nicotine dependence (ND). The objectives were to describe young adult e-cigarette users by: (i) type of e-liquid vaped; (ii) poly-nicotine use; (iii) ND symptoms; and (iv) attempts to quit conventional cigarettes.

METHODS

Data were available in cycle 23 of a longitudinal investigation on the natural course of cigarette smoking and ND. A total of 775 young adults (44% male; mean (SD) age 30.5(1.0)) completed mailed self-report questionnaires in 2017-20.

RESULTS

Of 775 participants, 149 (19.2%) reported past-year e-cigarette use. Overall, 55.0% of e-cigarette users had used cannabis-containing e-liquid (31.5% vaped cannabis e-liquid exclusively); 50.4% used nicotine-containing e-liquid (23.5% vaped nicotine e-liquid exclusively); and 39.9% used e-liquid without nicotine (8.7% vaped e-liquid without nicotine exclusively). Most e-cigarette users (82.6%) used other nicotine-containing products including conventional cigarettes (72.5%); 60.8% reported ND symptoms, rising to 79.4% among those who vaped nicotine-containing e-liquid. Finally, 29.0% tried to quit conventional cigarettes using e-cigarettes in the past-year, but only 16.7% found them helpful.

CONCLUSIONS

E-cigarettes now appear to appeal to a broader market than smokers who want to quit. More than half of young adult e-cigarette users vaped cannabis-containing e-liquid in the past year while only one-quarter had used e-cigarettes to assist with cessation. Most e-cigarette users used multiple nicotine-containing substances (including combustible cigarettes) which were associated with reports of ND symptoms.

Hospitalizations and Deaths Associated with EVALI

BACKGROUND

As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC).

METHODS

In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients.

RESULTS

Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death.

CONCLUSIONS

Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.

Vaporization of Marijuana Among Recreational Users: A Qualitative Study

OBJECTIVE

Vaporization of marijuana products, or "vaping," has become a prevalent mode of administration and is typically perceived to hold unique benefits compared to combustible administration methods. Such positive beliefs regarding marijuana vaporization may contribute to its abuse liability. This qualitative study examined cognitions pertaining to vaping among recreational marijuana users.

METHOD

Focus groups were conducted with frequent marijuana users (N = 31; five groups; six to seven per group; M = 5.0 days/week marijuana use). Three topic areas were queried during discussions with the goal of revealing factors that may contribute to the abuse liability of vaporization. These comprised differences between smoking and vaporizing marijuana products, perceived advantages of vaporization, and perceived disadvantages of vaporization. Focus groups lasted approximately 60 minutes and followed a semistructured agenda; the sessions were audio recorded and transcribed for an applied thematic analysis. An executive summary of each group was made and key themes pertaining to vaporization were summarized.

RESULTS

Several themes emerged, including differences between smoking and vaporizing marijuana, convenience, discretion, and efficiency of vaping, perceived health benefits, the absence of traditional smoking rituals, and the high cost of vaporization devices.

CONCLUSIONS

Several factors appear to promote marijuana vaporization, including device aspects (e.g., discreet, convenient), the subjective high, economical efficiency, and perceived harm-reducing and health-promoting effects. These qualitative data highlight unique cognitions about marijuana vaping that may substantially increase its abuse liability. Quantitative research is needed to examine the extent to which cognitions about marijuana vaporization contribute to actual use patterns and problematic behaviors.