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Gould A, Dargan PI, Wood DM. An Internet Snapshot Survey Assessing the sale of Synthetic Cannabinoid Receptor Agonists for use with Electronic Vaping Devices. J Med Toxicol 2024; 20:271-277. [PMID: 38839732 PMCID: PMC11288222 DOI: 10.1007/s13181-024-01013-0] [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: 02/29/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Synthetic cannabinoid receptor agonists (SCRAs) are associated with significant toxicity and are increasingly used in electronic vaping devices. We assessed the availability of SCRA vaping products to UK purchasers on the surface web. METHODS An internet snapshot survey was performed between October 2022 and January 2023 on 'google.com' using the search terms "buy c-liquid vape", "buy herbal incense vape liquid", "buy cannabis vape liquid", "buy hashish vape liquid", "buy K2 vape liquid". RESULTS 62 websites selling 128 SCRA vaping brands were identified. Most were purportedly based in the USA (41 websites, 66%) and most sold other controlled substances. Purchase incentives offered included discreet packaging (38, 61%), discounts for bulk purchase (34, 55%) and tracked delivery (30, 48%). Many websites stated SCRA products were: not for human consumption (41, 66%), for research purposes only (15, 24%), or legal (28, 45%). Websites sold a median (IQR) of 16 (7-25) SCRA vaping brands. Almost all were bottles of vaping liquid (1220/1225, 99.6%). The most common bottle size was 5mL (60%), the median (IQR) total volume of SCRA liquid per sale was 50mL (10-200mL). Median (IQR) price was £3.39/mL (£2.01/mL- £5.29/mL). Price decreased with increasing volume purchased (£6.58/mL for ≤ 5mL, £1.60/mL for > 200mL). CONCLUSION SCRA vaping products are easily obtainable online, in both small and bulk quantities. Information provided to purchasers on safety and legality is lacking or misleading. Further studies are needed to confirm the chemistry of these products. Policymakers should consider steps to limit the potential harm caused by the purchase and use of these products.
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Affiliation(s)
- Allon Gould
- Respiratory Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
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2
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Kutzler J, Polettini AE, Bleicher S, Sauer C, Schultis W, Neukamm MA, Auwärter V. Synthetic cannabinoids in hair-Prevalence of use in abstinence control programs for driver's license regranting in Germany. Drug Test Anal 2024; 16:518-531. [PMID: 37731292 DOI: 10.1002/dta.3578] [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: 06/03/2022] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
Although the use, structural variety, and prevalence of synthetic cannabinoids (SCs) have steadily increased on the drug market, they are rarely analyzed in abstinence control programs for driver's license regranting. The aim of this study was to determine the SC prevalence in these programs by analyzing hair samples collected between March 2020 and March 2021 from various regions in Germany, mainly Bavaria (40%). Specimens were analyzed quantitatively for drugs of abuse and qualitatively for 107 SCs. Hair samples were screened by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and to search for unknown SC analogs, positive samples were additionally screened by liquid chromatography-high resolution time of flight mass spectrometry (LC-qTOF/MS). The analysis of 5097 hair samples resulted in 181 SC detections (3.6%), showing a wide range of 44 SCs, with up to 13 different compounds found in a single sample. The most prevalent compounds were 5F-MDMB-PICA and MDMB-4en-PINACA; furthermore, 10 new substances not initially covered by LC-MS/MS analysis were detected by LC-qTOF/MS. The SC positivity rate was comparable to cocaine (5.4%) and amphetamine (2.6%). Only in 35 cases (0.7%), SC analysis was requested by the clients, highlighting the insufficient coverage of SC consumption in the studied collective. In summary, hair sample analysis proved to be a valuable tool to monitor the use of SCs. In order to keep pace with newly emerging SC analogs, an up-to-date analytical method is essential. Prospectively, SCs should be more routinely screened in hair analysis for abstinence control to avoid cannabis substitution by SCs.
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Affiliation(s)
- Johannes Kutzler
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Postgraduate Course for Toxicology and Environmental Toxicology, Institute for Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Aldo Eliano Polettini
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
- Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Sergej Bleicher
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Christoph Sauer
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Wolfgang Schultis
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Merja A Neukamm
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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3
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Baweja R, Mills-Huffnagle S, Jernigan A, Chongtham N, Waschbusch D, Waxmonsky JG. Synthetic Marijuana: Assessment of Usage, Motivation and Associated Risks in Adolescent Substance Users. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241254258. [PMID: 38764525 PMCID: PMC11102655 DOI: 10.1177/29768357241254258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/23/2024] [Indexed: 05/21/2024]
Abstract
Objectives Use of Synthetic and designer products, including synthetic marijuana (SM), among adolescents poses a major risk to public health. Little is known about the motivating factors of synthetic substance use in adolescents. This study examined the motivations, predictors, perceived risks and benefits, and differences with SM versus natural marijuana among adolescents. Methods Between April 2016 and May 2018, a convenience sample of adolescents receiving substance use treatment from a local counseling center completed an anonymous survey to assess the use of natural and synthetic marijuana use, the Strengths and Difficulties Questionnaire to assess levels of current psychiatric symptoms and the Community Assessment of Psychic Experiences-Positive Scale to assess symptoms of psychosis. Results A total of 80 adolescents (age range of 14-18 years; 71% male; 53% Caucasian) completed the study. Of these, 39 (49%) reported natural marijuana use (natural marijuana users) and 41 (51%) reported both synthetic and natural marijuana use (dual users). The most commonly reported reasons for using SM were its low cost and reduced risk of detection. Participants who were familiar with SM and reported a desire to avoid detection on drug tests were likelier to use SM (all P < .05). Dual users reported more benefits and risks associated with SM use when compared to natural marijuana users (P ⩽ .05). The use of SM also heightened the perceived medical risks of natural marijuana, including seizures and respiratory issues (P < .05), compared with natural marijuana users. While dual users self-reported more conduct (P = .009) and externalizing problems (P = .024) when compared to natural marijuana users, there were no group differences in psychotic symptoms, nor correlations with the frequency of synthetic or natural marijuana use and psychotic symptoms except that persecutory ideation correlated with the frequency of natural marijuana use during the past 12 months (rp = 0.28, P = .04). Conclusions These results suggest that reports of cost savings, and lack of detection on urine drug screens are common reasons for SM use in adolescents despite being aware of the risks of using SM. Perceived benefits of using synthetics and other novel substances appear diverse, and merit further exploration as a better understanding of what motivates adolescents to use specific novel substances may guide prevention and treatment efforts.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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4
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Su A, Albarran Garcia D, Li M, Ogbonna C, Tsang T, Tsang A, Bantug C, Tom W, Harris B. Clinical course and treatment interventions for adolescents who vaped during the COVID-19 pandemic. BMJ Case Rep 2023; 16:e255844. [PMID: 37931960 PMCID: PMC10632801 DOI: 10.1136/bcr-2023-255844] [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] [Indexed: 11/08/2023] Open
Abstract
Vaping nicotine and marijuana have been increasing among adolescents in the past 5 years. Tetrahydrocannabinol is the psychoactive cannabinoid in marijuana. The COVID-19 pandemic created gaps in healthcare access and visits, making it difficult to collect accurate data on adolescent vaping, willingness to quit and methods used to quit. In addition, the literature lacks information regarding effective evidence-based treatment measures for adolescents who vape. In this report, we seek to address this using two patient cases and detailing the interventions a managed care organisation enacted during this timeframe. Our investigation revealed a relationship between social stressors and vaping among teens. Addressing these underlying stressors and eliciting and treating mental health symptoms and polysubstance use appears to be critical to curbing vaping.
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Affiliation(s)
- Alex Su
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Daisy Albarran Garcia
- Pediatrics, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California, USA
| | - Mandy Li
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Chinyere Ogbonna
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Thomas Tsang
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Alex Tsang
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Chynna Bantug
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Wynnyee Tom
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Brooke Harris
- Pediatrics, Addiction Medicine Recovery Services, Graduate Medical Education, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
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5
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Lin A, Dent GL, Davies S, Dominguez ZM, Cioffredi LA, McLemore GL, Maxwell JR. Prenatal cannabinoid exposure: why expecting individuals should take a pregnancy pause from using cannabinoid products. Front Pediatr 2023; 11:1278227. [PMID: 37886232 PMCID: PMC10598870 DOI: 10.3389/fped.2023.1278227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Cannabinoid use in all populations is increasing as legalization across the United States continues. Concerningly, there is a lack of caution provided by medical providers to pregnant individuals as to the impact the use of cannabinoids could have on the developing fetus. Research continues in both the preclinical and clinical areas, and is severely needed, as the potency of delta-9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, has increased dramatically since the initial studies were completed. Thus far, clinical studies raise compelling evidence for short term memory deficits, impulse control issues, and attention deficiencies following prenatal cannabinoid exposure (PCE). These changes may be mediated through epigenetic modifications that not only impact the current offspring but could carry forward to future generations. While additional studies are needed, a pregnancy pause from cannabinoid products should be strongly recommended by providers to ensure the optimal health and well-being of our future generations.
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Affiliation(s)
- Alexis Lin
- Gustavus Adolphus College, Saint Peter, MN, United States
| | - Gelonia L. Dent
- Department of Mathematics, Medgar Evers College, CUNY, Brooklyn, NY, United States
| | - Suzy Davies
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Zarena M. Dominguez
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | | | | | - Jessie R. Maxwell
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
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Kitzman JM, Mesheriakova VV, Borucki AN, Agarwal R. Substance Use Disorders in Adolescents and Young Adults: History and Perioperative Considerations From the Society for Pediatric Pain Medicine. Anesth Analg 2023:00000539-990000000-00608. [PMID: 37450650 DOI: 10.1213/ane.0000000000006623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Substance use disorders (SUDs) are on the rise in children and young adults in the United States. According to reports, over 40 million people aged 12 and older had a diagnosed SUD in 2020.1 A recent report from the Centers for Disease Control and Prevention (CDC) found that overdose death in children aged 10 to 19 years old increased 109% from 2019 to 2021.2 Given the rapidly increasing prevalence of SUD, anesthesiologists will almost certainly encounter children, adolescents, and young adults with a history of recreational drug use or nonmedical use of prescription opioids in the perioperative period. Since the perioperative period can be a particularly challenging time for patients with SUD, anesthesiologists can tailor their perioperative care to reduce rates of relapse and can serve as both advocates and educators for this vulnerable patient population. This article examines the history of SUD and physiology of substance use in children, adolescents, and young adults, including reasons why young people are more susceptible to the addictive effects of many substances. The coronavirus disease 2019 (COVID-19) pandemic impacted many aspects of life, including increased social isolation and shifted dynamics at home, both thought to impact substance use.3 Substance use patterns in the wake of the COVID-19 pandemic are explored. Although current literature is mostly on adults, the evidence-based medical treatments for patients with SUD are reviewed, and recommendations for perioperative considerations are suggested. The emphasis of this review is on opioid use disorder, cannabis, and vaping particularly because these have disproportionately affected the younger population. The article provides recommendations and resources for recognizing and treating adolescents and young adults at risk for SUD in the perioperative period. It also provides suggestions to reduce new persistent postoperative opioid use.
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Affiliation(s)
- Jamie M Kitzman
- From the Department of Anesthesiology, Division of Pediatric Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Veronika V Mesheriakova
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California San Francisco, San Francisco, California
| | - Amber N Borucki
- Department of Anesthesiology, University of California San Francisco, San Francisco, California
| | - Rita Agarwal
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Stanford University School of Medicine, Stanford, California
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Marchetti B, Bilel S, Tirri M, Corli G, Roda E, Locatelli CA, Cavarretta E, De-Giorgio F, Marti M. Acute Cardiovascular and Cardiorespiratory Effects of JWH-018 in Awake and Freely Moving Mice: Mechanism of Action and Possible Antidotal Interventions? Int J Mol Sci 2023; 24:7515. [PMID: 37108687 PMCID: PMC10142259 DOI: 10.3390/ijms24087515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
JWH-018 is the most known compound among synthetic cannabinoids (SCs) used for their psychoactive effects. SCs-based products are responsible for several intoxications in humans. Cardiac toxicity is among the main side effects observed in emergency departments: SCs intake induces harmful effects such as hypertension, tachycardia, chest pain, arrhythmias, myocardial infarction, breathing impairment, and dyspnea. This study aims to investigate how cardio-respiratory and vascular JWH-018 (6 mg/kg) responses can be modulated by antidotes already in clinical use. The tested antidotes are amiodarone (5 mg/kg), atropine (5 mg/kg), nifedipine (1 mg/kg), and propranolol (2 mg/kg). The detection of heart rate, breath rate, arterial oxygen saturation (SpO2), and pulse distention are provided by a non-invasive apparatus (Mouse Ox Plus) in awake and freely moving CD-1 male mice. Tachyarrhythmia events are also evaluated. Results show that while all tested antidotes reduce tachycardia and tachyarrhythmic events and improve breathing functions, only atropine completely reverts the heart rate and pulse distension. These data may suggest that cardiorespiratory mechanisms of JWH-018-induced tachyarrhythmia involve sympathetic, cholinergic, and ion channel modulation. Current findings also provide valuable impetus to identify potential antidotal intervention to support physicians in the treatment of intoxicated patients in emergency clinical settings.
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Affiliation(s)
- Beatrice Marchetti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Giorgia Corli
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Elisa Roda
- Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy; (E.R.); (C.A.L.)
| | - Carlo Alessandro Locatelli
- Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy; (E.R.); (C.A.L.)
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterrranea Cardiocentro, 80122 Napoli, Italy
| | - Fabio De-Giorgio
- Section of Legal Medicine, Department of Health Care Surveillance and Bioetics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
- Collaborative Center for the Italian National Early Warning System, Department of Anti-Drug Policies, 00186 Rome, Italy
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8
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Chaffee BW, Couch ET, Wilkinson ML, Donaldson CD, Cheng NF, Ameli N, Zhang X, Gansky SA. Flavors increase adolescents' willingness to try nicotine and cannabis vape products. Drug Alcohol Depend 2023; 246:109834. [PMID: 36963159 PMCID: PMC10121941 DOI: 10.1016/j.drugalcdep.2023.109834] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Certain product characteristics, such as flavor, may increase adolescents' willingness to try vaped nicotine and cannabis (marijuana) products. METHODS A discrete choice experiment embedded within the 2021-2022 California Teens Nicotine and Tobacco Project Online Survey was administered to a non-probability sample of N = 2342 adolescents ages 12-17. Participants were sequentially presented four randomly-generated pairs of hypothetical vape products that varied in device type (disposable, refillable), content (nicotine, marijuana, "just vapor"), and flavor (seven options) and asked which of these (or neither) they would be more willing to try if a best friend offered. Conditional logistic regression quantified associations between product characteristics and participants' selections, including interactions by past 30-day use of e-cigarettes, marijuana, or both. RESULTS Candy/dessert, fruit, and fruit-ice combination flavors were all associated with greater willingness to try a vape product (versus tobacco flavor) among participants not using e-cigarettes or marijuana, those using only e-cigarettes, and those co-using e-cigarettes and marijuana. Among participants only using marijuana, the most preferred flavors were no flavor, candy/dessert, and icy/frost/menthol. Among participants not using e-cigarettes or marijuana, model-predicted willingness to try a displayed vape product was greater when products were sweet or fruit flavored than tobacco or unflavored, regardless of whether displayed options contained nicotine (fruit/sweet: 21 %, tobacco/unflavored: 4 %), marijuana (fruit/sweet: 18 %, tobacco/unflavored: 6 %), or "just vapor" (fruit/sweet: 29 %, tobacco/unflavored: 16 %). CONCLUSIONS In this online non-probability sample, flavors in nicotine and cannabis vape products increased adolescents' willingness to try them. Comprehensive bans on flavored vapes would likely reduce adolescent use.
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Affiliation(s)
- Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA.
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Monica L Wilkinson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Candice D Donaldson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Nancy F Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
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Holt AK, Poklis JL, Peace MR. The history, evolution, and practice of cannabis and E-cigarette industries highlight necessary public health and public safety considerations. JOURNAL OF SAFETY RESEARCH 2023; 84:192-203. [PMID: 36868647 PMCID: PMC10829760 DOI: 10.1016/j.jsr.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/29/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Alaina K Holt
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States; Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, Richmond, VA, United States.
| | - Justin L Poklis
- Department of Pharmacology & Toxicology, Virginia Commonwealth University, Richmond, VA, United States.
| | - Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States.
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10
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Hinds JT, Marti CN, Pasch KE, Loukas A. Longitudinal trajectories of marijuana use in tobacco products among young adult Texas college students from 2015 to 2019. Addiction 2023; 118:372-377. [PMID: 35971289 PMCID: PMC11232895 DOI: 10.1111/add.16027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/03/2022] [Indexed: 01/05/2023]
Abstract
AIMS To measure longitudinal trajectories of marijuana use in four tobacco/nicotine products (hand-rolled cigarettes/spliffs, cigars/blunts, hookah, and e-cigarettes) among young adult Texas college students from 2015 to 2019. DESIGN This study used six consecutive waves of data from the marketing and promotions across colleges in Texas project (Project M-PACT), a longitudinal study of the tobacco behaviors of young adult college students. The first four waves were collected every 6 months (fall 2015-spring 2017), and the final two waves were conducted yearly (spring 2018 and 2019). Growth curve models measured trajectories of marijuana use in tobacco products across the 3.5-year period. SETTING AND PARTICIPANTS A total of 4857 young adults from 24 colleges in the largest metropolitan areas of Texas, United States (Austin, Dallas, Houston, and San Antonio): mean age = 21.0, SD = 2.3; 64.2% assigned female; 36.1% non-Hispanic white, 31.0% Hispanic, and 33.0% other or combination race/ethnicity. MEASUREMENTS Participants completed online surveys assessing their past 6-month use of marijuana in four tobacco products of interest (spliffs, blunts, hookah, and e-cigarettes) and socio-demographic variables (sex, race/ethnicity, age, 2-year/4-year college attendance, and sexual and gender minority identity). FINDINGS Observed vaping marijuana in e-cigarettes approximately doubled between the spring of 2015 and the spring of 2019, from 11.8% to 23.9% following a quadratic time trend (linear OR = 0.84, 95% CI = 0.73-0.97, quadratic OR = 1.18, CI = 1.13-1.22). This same time period saw a quadratic decline in using marijuana in hookah (P < 0.001) and no changes in using hand-rolled cigarettes/spliffs or cigars/blunts for marijuana delivery. CONCLUSIONS The popularity of nicotine e-cigarettes appears to be expanding the avenues for marijuana delivery among young adults in Texas, United States.
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Affiliation(s)
- Josephine T Hinds
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
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11
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Aly AS, Mamikutty R, Marhazlinda J. Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1678. [PMID: 36360406 PMCID: PMC9689130 DOI: 10.3390/children9111678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed. METHODS Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth. RESULTS The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise. CONCLUSION the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.
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Affiliation(s)
- Ameera Syafiqah Aly
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Rokiah Mamikutty
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Synthetic Cannabinoids and Cannabis: How the Patterns of Use Differ: Results from the European Web Survey on Drugs. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
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Moustafa AF, Rodriguez D, Pianin SH, Testa SM, Audrain-McGovern JE. Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents. Am J Prev Med 2022; 63:60-67. [PMID: 35365396 PMCID: PMC9232951 DOI: 10.1016/j.amepre.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern. METHODS This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021. RESULTS A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03). CONCLUSIONS From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.
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Affiliation(s)
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Stephen H Pianin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon M Testa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet E Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Wadsworth E, Craft S, Calder R, Hammond D. Prevalence and use of cannabis products and routes of administration among youth and young adults in Canada and the United States: A systematic review. Addict Behav 2022; 129:107258. [PMID: 35124565 DOI: 10.1016/j.addbeh.2022.107258] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND The current systematic review aimed to summarize the literature on the prevalence of routes of administration and cannabis products used among youth and young adults in Canada and the United States (US). METHODS Five academic databases were searched in April 2020 and February 2021. Peer-reviewed articles were included if they were a population-based quantitative observational study describing the prevalence of a cannabis product or route of administration among youth and young adults in Canada or the US. Risk of bias was assessed using Hoy and colleagues' risk of bias assessment tool. A narrative review was conducted. RESULTS Twenty-six studies were identified for the following routes of administration: smoking (n = 16), vaping (n = 21), dabbing (n = 3), oral (n = 13), topical (n = 1); and products: dried flower (n = 2), and concentrates (n = 8). Smoking had the highest prevalence rates among youth and young adults; however, rates of use appeared to reduce over time. Conversely, prevalence of vaping appeared to increase over time. Fewer studies focused on oral or dabbed cannabis but those that did reported prevalence estimates of approximately a third among recent cannabis consumers. DISCUSSION The heterogeneity of cannabis routes of administration restricted our ability to collate average prevalence estimates. In jurisdictions where non-medical cannabis is legal, policymakers should provide guidance and education to youth on each type of product and routes of administration. OTHER Funding for this study was provided by a Canadian Institutes of Health Research (PJT-153342). The current review was registered with PROSPERO (CRD42020169275).
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Use of electronic cigarettes and heated tobacco products during the Covid-19 pandemic. Sci Rep 2022; 12:702. [PMID: 35027590 PMCID: PMC8758672 DOI: 10.1038/s41598-021-04438-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 02/06/2023] Open
Abstract
Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April–May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03–2.34), cannabis users (OR 2.35; 95% CI: 1.33–4.13), gamblers (OR 3.34; 95% CI: 2.18–5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00–2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06–0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22–4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.
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Sangster-Carrasco L, Blitchtein-Winicki D. Association of lifetime e-cigarette and/or tobacco use and last year cannabis use among university students: A cross-sectional secondary analysis of a national survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000452. [PMID: 36962355 PMCID: PMC10022225 DOI: 10.1371/journal.pgph.0000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The accelerated increase in the use of e-cigarette by university students in recent years has incremented nicotine use in addition to tobacco, but it is not known whether the use of cannabis is related to these alternatives. This study analyzes the association between the use of electronic cigarettes and/or tobacco and the use of cannabis in the last 12 months. An analytical cross-sectional study conducted based on the III Andean epidemiological study on drug consumption among university students in 2016. A multivariate analysis performed using a generalized linear family model and the log Poisson link option. The results were shown as Prevalence Ratios (PR) in raw (PRc) and adjusted (PRa) models, and the analysis also employed 95% confidence intervals (95% CI) for the percentages. SETTING Ten Peruvian universities. PARTICIPANTS University students' lifetime. EXPOSURE Participants' e-cigarette and/or tobacco consumption, based on questions about consumption of tobacco and e-cigarettes. Participants were categorized into those consuming: only e-cigarettes, only tobacco, both, or neither. OUTCOME The use of cannabis by participants in the last 12 months. Among the university students who met the inclusion criteria (n = 3981), the prevalence of using both e-cigarettes and tobacco (dual) throughout life was 11.6% (95% CI: 10.1 to 13.3), and only e-cigarettes was 1.2% (95% CI: 0.7 to 1.8). The use of cannabis in the last 12 months was 5.2% (95% CI: 4.1 to 6.5). Results of this study found a sequential probability gradient of cannabis use, where those with dual use had 58.5 times more probability of having used cannabis in the last 12 months (PRa 58.5, 95% CI: 20.9 to 163.7, p <0.001) compared to those who used none; whereas those who used only tobacco were 33.3 times more likely to have used cannabis in the last 12 months (PRa 33.3, 95% CI: 11.9 to 93.2, p <0.001), those who reported using only e-cigarette had 9.8 times more probability of having used cannabis in the last 12 months (PRa 9.8, 95% CI: 1.6 to 60.4, p = 0.014). We found an increase in the probability of having used cannabis in the last 12 months among university students who reported tobacco and/or e-cigarettes use. A sequential probability gradient was found and it showed that, in comparison to students who informed being nonusers of tobacco and/or e-cigarette, university students who were lifetime dual users were most likely to having used cannabis in the last 12 months, followed by those reporting an exclusive lifetime use of tobacco, as well as those students who reported an exclusive lifetime use of e-cigarettes. It is necessary to raise awareness of the association of tobacco and e-cigarette use with an increased possibility of using cannabis. Studies are needed in different cultural contexts to investigate the progression of electronic cigarette and/or tobacco use, as well as their dosage, intensity of use, concurrent use, and neurological and behavioral mechanisms that are related to the use of cannabis and other illegal drugs that may increase dependence and mental health problems.
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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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Kligerman SJ, Kay FU, Raptis CA, Henry TS, Sechrist JW, Walker CM, Vargas DB, Filev PD, Chung MS, Digumarthy SR, Ropp AM, Mohammed TL, Pope KW, Marquis KM, Chung JH, Kanne JP. CT Findings and Patterns of E-Cigarette or Vaping Product Use-Associated Lung Injury: A Multicenter Cohort of 160 Cases. Chest 2021; 160:1492-1511. [PMID: 33957099 PMCID: PMC8546241 DOI: 10.1016/j.chest.2021.04.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND E-cigarette and vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns. Relative frequencies and associations with vaping behavior are unknown. RESEARCH QUESTION What are the frequencies of imaging findings and CT patterns in EVALI and what is the relationship to vaping behavior? STUDY DESIGN AND METHODS CT scans of 160 subjects with EVALI from 15 institutions were retrospectively reviewed. CT findings and patterns were defined and agreed on via consensus. The parenchymal organizing pneumonia (OP) pattern was defined as regional or diffuse ground-glass opacity (GGO) ± consolidation without centrilobular nodules (CNs). An airway-centered OP pattern was defined as diffuse CNs with little or no GGO, whereas a mixed OP pattern was a combination of the two. Other patterns included diffuse alveolar damage (DAD), acute eosinophilic-like pneumonia, and pulmonary hemorrhage. Cases were classified as atypical if they did not fit into a pattern. Imaging findings, pattern frequencies, and injury severity were correlated with substance vaped (marijuana derives [tetrahydrocannabinol] [THC] only, nicotine derivates only, and both), vaping frequency, regional geography, and state recreational THC legality. One-way analysis of variance, χ2 test, and multivariable analyses were used for statistical analysis. RESULTS A total of 160 patients (79.4% men) with a mean age of 28.2 years (range, 15-68 years) with EVALI underwent CT scan. Seventy-seven (48.1%), 15 (9.4%), and 68 (42.5%) patients admitted to vaping THC, nicotine, or both, respectively. Common findings included diffuse or lower lobe GGO with subpleural (78.1%), lobular (59.4%), or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and CNs (36.3%) were common. PBV sparing was associated with younger age (P = .02). Of 160 subjects, 156 (97.5%) had one of six defined patterns. Parenchymal, airway-centered, and mixed OP patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) patients, respectively. Acute eosinophilic-like pneumonia (six of 160, 3.8%), DAD (nine of 160, 5.6%), pulmonary hemorrhage (six of 160, 3.8%), and atypical (four of 160, 2.5%) patterns were less common. Increased vaping frequency was associated with more severe injury (P = .008). Multivariable analysis showed a negative association between vaping for > 6 months and DAD pattern (P = .03). Two subjects (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, and state legality of recreational use of THC. INTERPRETATION EVALI typically causes an OP pattern but exists on a spectrum of acute lung injury. Vaping habits do not correlate with CT patterns except for negative correlation between vaping > 6 months and DAD pattern. PBV sparing, not previously described in acute lung injury, is a common finding.
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Affiliation(s)
- Seth J Kligerman
- Department of Radiology, University of California, San Diego, San Diego, CA.
| | - Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, TX
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | - Travis S Henry
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Jacob W Sechrist
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | | | | | - Alan M Ropp
- Department of Radiology, University of Virginia, VA
| | | | - Kristen W Pope
- Department of Radiology, University of Kansas Medical Center, KS
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | | | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, WI
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