A Preliminary Characterization of Cannabis Oil Use and Vaporization Among Individuals Who Use for Medical Purposes: A Pilot Study

Abstract

Little is known about the naturalistic use of cannabis oil vaporization, a high potency product with the ability to be administered discreetly. This pilot study evaluated the feasibility of utilizing a ‘smart’ vaporizer and application to assess the timing, frequency, socioenvironmental factors, and substance use involved in cannabis oil vaporization. Adults with a medical cannabis registration card were recruited from a dispensary in Rhode Island and completed a two-week study monitoring period using the Gram1 vaporizer, followed by a post-study qualitative interview. The sample included 9 adults who were predominantly male (89%), 100% White, and 100% non-Hispanic. The Gram1 collected topographical vaping data, and the cellphone application utilized ecological momentary assessment (EMA) to assess socio-environmental factors and other substance use. Qualitative interview data was coded, and illustrative quotations were selected to support quantitative findings. A total of 224 vaping sessions were recorded reflecting 76.4% of the study monitoring period. There was an average of 1.79 vaping sessions per day across all days. Participants took 8.76 puffs on average (SD=8.23) per vaping session, and the session lasted 2.59 minutes on average (SD=4.19). Regular vaporization was exhibited across days of the week and hours of the day. EMA reports indicated that smoking cannabis flower was the most common additional mode of cannabis administration. This study utilized a naturalistic design with novel topographical data and EMA to characterize cannabis oil vaporization. These findings establish the feasibility of collecting objective, momentary data to better understand use behaviors which are critical to informing safe consumption.

1.0. Introduction

The prevalence of cannabis use has been on the rise, with 18% of Americans (48.2 million) reporting past-year use (SAMHSA, 2020). This recent rise in cannabis use reflects the changing landscape of legalization in the United States. As of this writing, 37 states, three territories, and the District of Columbia have legalized the use of cannabis for medical purposes, (State Medical Cannabis Laws, 2022). Among modalities of cannabis administration, vaporization (i.e., “vaping”) has become increasingly prevalent, partly following the recent rise of e-cigarette use (United States Department of Health and Human Services, 2014). Cannabis vaping is defined by the heating of liquid, oil, or plant material and combining with water vapor in order to release aerosolized cannabinoids including THC (Tashkin, 2018), and has been shown to be favored for medicinal use (Baldassarri et al., 2020). While research to date has examined the prevalence of and motivations for cannabis vaporization, relatively little is known about how this information translates to naturalistic use.

Lifetime and past-month prevalence of vaping is estimated at 61% and 37% respectively for individuals who use cannabis in a large representative survey in the U.S. (N=2910) (Lee et al., 2016). Demographics for those who have vaped show that those individuals are approximately 29 years old on average and primarily Caucasian (63.4%) males (63.4%) (Lee et al., 2016). These findings are consistent with online survey data (N=557) spanning across 24 countries which found that individuals who vape were predominantly young (<35 years) and male (Morgan et al., 2022). Approximately half (49.1%) of their sample reported both medicinal and recreational use, and an additional 13.5% reported vaporizing cannabis for medicinal purposes only (Morgan et al., 2022). Notably, individuals under the age of 18 were excluded from participation in that study. Similar demographics were found within a large survey sample (N=1485) from the state of Michigan showing that individuals who vape for medicinal purposes were approximately 45 years old on average, Caucasian (87.1%) males (57.2%) with at least some college education (65.8%) (Cranford et al., 2016).

Among those who primarily vape cannabis, 71.5% reported doing so for medicinal purposes (Baldassarri et al., 2020). There are several reasons people who use cannabis for medical purposes may prefer to vape as their primary mode of consumption. Vaporization performs similarly in its uptake of THC compared to smoking (Hazekamp et al., 2006), for which peak concentration is reached within ten minutes and predictable decay makes self-dosing possible (Grant et al., 2012). Further, the use of cannabis oil, as opposed to flower, for vaporization allows for a substantially higher THC uptake (Spindle et al., 2019), potentially to maximize psychoactive effects. Previous work has demonstrated that this may be particularly relevant for medicinal use as individuals prefer to derive a greater effect from less product (Loflin & Earleywine, 2014) leading to concerns regarding the reinforcement and addictive potential of cannabis oil. However, vaporization as a method of administration is thought to minimize the carbon monoxide and combustive consequences of smoking (Abrams et al., 2007; Grant et al., 2012) suggesting further elucidation of the health consequences of cannabis oil vaporization is needed. Previous qualitative work has found that people who use medical cannabis cite minimization of health consequences and feasibility of medication dosing and administration as primary motivators for vaping (Aston et al., 2019). Other findings have also identified general benefits to cannabis vaporization such as reduced odor compared to the combustion of cannabis, ease of use, reduced cost due to efficiency of use, and reduced secondhand exposure (Shiplo et al., 2016).

Despite the popularity of cannabis use for medical purposes and the increase in vaporization specifically, what is missing from the literature is a comprehensive picture of how cannabis oil vaporization is utilized naturalistically. Several foundational cannabis vaporization behaviors have not been examined across days or within-session. This dearth of information includes timing, frequency, and socioenvironmental factors contributing to use, such as when, how often, for how long, with how many puffs, for what reason(s), and under which contexts people vape. In addition, little real-time information is available about the vaporization of cannabis for medical reasons in conjunction with other substance use. Most work to date has relied on self-reported recall to depict co-occurring substance use. This gap in naturalistic research leaves notable deficits in understanding how individuals are self-medicating, a behavior that is becoming increasingly common for those managing chronic conditions with cannabis oil vaporization. In addition, the bulk of data available are cross-sectional in nature. Naturalistic studies are needed to characterize the experiences of individuals who choose cannabis vaping daily as a mode of medical cannabis administration. Further, qualitative data are needed to contextualize these behaviors and explain use beyond the general motivations and medical considerations that have been explored to date.

To our knowledge, this exploratory pilot study was the first of its kind to utilize a naturalistic design with novel ecological momentary assessment (EMA) and topographical data to explore the basic yet unanswered questions surrounding cannabis oil vaporization in real time.

2.0. Method

2.1. Participants

Adults with a medical cannabis registration card (N = 9) were recruited from a cannabis dispensary in Rhode Island for a 14-day prospective pilot study on cannabis vaping behaviors that involved the use of a ‘smart’ vaporizer. Study inclusion criteria included being between the ages of 18-65, having vaped cannabis oil at least four times in the past month, and having access to an Android mobile device. Participants were excluded if they were currently seeking treatment or intending to reduce cannabis use, currently pregnant, endorsing symptoms of severe mental illness, unstable living environment, or exhibited an inability to provide written informed consent in English.

2.2. Procedures

Recruitment occurred between May 2019-January 2020, during which the purchase of cannabis was legal only for medicinal use in Rhode Island. The intended recruitment sample for this exploratory pilot study was N=15 to account for within-person analyses of EMA data. A recruitment booth was set up inside the dispensary staffed by the research team. Interested individuals completed a brief screening questionnaire to determine eligibility. All eligible participants were provided the opportunity to enroll in the study. Written informed consent was obtained prior to initiation of the study protocol. During the consent process, individuals were informed that study participation involved use of a smart vape device (Gram1, as seen in Figure 1.) for ad libitum vaping and an associated smart phone application (i.e., “app”) for a 14 day monitoring period; that the Gram1 vaporizer would be their primary device for cannabis vaping during the study; and that participation required purchase and use of a specific oil cartridge. Oil cartridges (0.5 grams) were prepared specifically for the purposes of this study using “Code Blue” (50% indica, 50% sativa mixture, with 60.03% THC, 0.57% CBD). All cartridges used in the study came from the same batch, and a further breakdown of cannabinoid content can be found in the supplementary materials (Table A1). All study procedures were approved by the Institutional Review Board at Brown University (#1805002049). Study data and analytic code are available upon request. This exploratory pilot study was not preregistered. We have reported how we determined our sample size, all relevant data exclusions, all manipulations, and all measures in the study.

Figure 1.

Gram1 ‘Smart’ Vaporizer Device

Enrolled participants were scheduled for a subsequent onboarding appointment that occurred at the dispensary. Participants provided demographic information, completed self-report assessments of cannabis use history, and were administered a brief psychosocial assessment to confirm eligibility. Participants were introduced to the Gram1 vaporizer and app and shown how to use them. The Gram1 device connected to the cell phone app via Bluetooth and collected topographical vaping data while in use. The cell phone application was used for ecological momentary assessment.

Participants were able to earn up to a total of $150 in cash for participation in this study, in addition were permitted to keep the Gram device upon study completion (valued at $150). Regarding the cash payment schedule, participants were compensated: $20 for completion of the baseline visit, $1 for each of the morning and random reports (for up to $4 a day), a $10 bonus for every seven consecutive days that >90% EMA compliance was maintained (total of $20), a. $14 bonus if EMA compliance was >90% for all 14 study days, and $40 for completion of the post-study interview. Participants were not compensated for vaping.

2.3. Measures

Baseline Assessment.

The baseline assessment captured self-reported use of cannabis and other substances, vaping behaviors, qualifying conditions for a medical cannabis card, and other socioeconomic and demographic information pertinent to characterizing this sample of individuals who vape cannabis for medical purposes. All baseline assessments were conducted in Qualtrics.

EMA Assessments.

Participants were sent one EMA report in the morning and three EMA reports randomly throughout the day. In addition, they were required to complete a pre-vape report and asked to complete a post-vape report every time they chose to vape.

The morning report included items assessing for sleep, substances consumed since last report, quantity of those substances and time consumed if applicable, and internal antecedents such as urges to vape, pain, and anxiety. The item assessing substance use (“What substances have you consumed since the last report?”) included the response options: 0=None; 1=Cigarettes; 2=Alcohol; 3=Smoked cannabis; 4=Vaped cannabis flower; 5=Ingested cannabis; 6=Vaped cannabis oil with an alternative device; 7=E-Cigarettes; 8=Opiate; 9=other (text entry). All other items used Likert-scale response options except to respond to the final question (“Is there anything else you would like us to know right now?”) which was text entry.

The random reports mirrored the morning report but did not assess sleep. The random report additionally assessed for external antecedents including location (“Where are you?) and social context (“Who are you with?”). The items assessing for location had the following response options: 1=At home; 2=At a part, 3=At work, 4=At a friend’s house, 5=At a bar, 6=In a car, 7=outside, 8=Other (text entry). The item assessing for social context had the following response options: 1=Alone 2=Partner; 3=Friend(s); 4=Other (text entry).

The pre-vaporization report mirrored the random report but did not include the final open-text option for participants to provide additional information. The post vaporization report only included the items assessing internal antecedents.

All surveys took approximately one minute to complete. 87.3% of EMA surveys were valid. Those that were omitted were excluded for a variety of reasons (e.g., a random report was completed right before or after vaping, a morning report was completed after a vaping session, or illogical timestamps were produced from cellphone device error).

Objective Vaping Behavior.

Vaping behaviors were ultimately categorized at three levels: puff behavior, daily vaping frequency, and vaping occurrences across the week. The Gram1 device contains nichrome coils, typically 1.8-2.0 ohms, and outputs 7 watts. The Gram1 device was not temperature controlled. It was able to sample, record, and log date and time-stamped data by sending digital “pulses” at a sampling rate of 50ms. Flow data captures the initiation of use with changes in the device’s voltage and similarly detects when the session has ended. Illogically timestamped data due to cellphone device error were omitted. Vaping data was binned into episodes based on the initiation of flow through the Gram1 device and self-reported conclusion reports as well as cessation in puffing data after 10 minutes. Puff behavior was directly measured by Gram1 puff flow (topography), including puff duration (i.e., length of time for each inhalation in seconds), and puff count (i.e., number of inhalations). At the daily vaping frequency level, vape “episodes” were coded based on initiation of flow via Gram1 (i.e., episode start) and self-reported conclusion of vaping verified by end of flow (i.e., episode end), and a continuous count of vaping episodes per day reflects frequency of vaping. The presence or absence of flow data on any given day reflects whether vaping occurred.

Post Study Assessment.

A semi-structured exit interview was conducted to evaluate cannabis oil use behaviors and preferences, the Gram1 as a vaporizer, and the app. The application and the vaporizer device were rated on a scale of 1-10, with 10 being more favorable. A trained graduate student conducted the interviews in person and the audio recordings were later transcribed verbatim.

2.4. Data Analytic Plan

Descriptive statistics were calculated for each of the following levels of data collection: baseline self-reports, EMA self-reports, and objective Gram1 reports. Self-reported baseline data included characteristics of the sample. EMA reports included substance use outside of the Gram1 device and socioenvironmental factors (e.g., physical location, presence of others). Lastly, objective reports through the Gram1 device captured vaping occurrences across the week, within-day, and within-session. Within-session descriptive statistics included number of puffs and session duration.

The semi-structured exit interviews were transcribed verbatim and identifying information was removed, if applicable. A qualitative coding structure was developed utilizing the semi-structured agenda and the quantitative aims to label and synthesize data on the following topics: timing and frequency of use, vaping location, presence of others while vaping, acceptability of the mobile application, and acceptability of the vaporizer. Two research assistants, unfamiliar with the details of the study, coded each manuscript by category to identify a comprehensive list of perspectives on each topic. Selected quotations were then reviewed and agreed upon by two authors to ensure all perspectives were captured. Illustrative quotations are presented alongside quantitative findings to reflect these perspectives.

3.0. Results

3.1. Sample Characteristics

The quantitative sample included 9 adults who were White (100%), non-Hispanic (100%), predominantly male (89%), and endorsed chronic pain (67%) as a qualifying condition for the medical marijuana registration card. Eight participants completed the qualitative post-study interview; one was lost to follow up. Participants primarily reported being between the ages of 40-65, the majority of whom had full-time jobs (30+ hours a week). Full demographic information can be found in Table 1. Cannabis use history for the sample can be found in supplementary materials (Table A2).

Table 1.

Individual-Level Demographic Variables

		N=9
	N	Percent
Age Range
18-25	2	22.22%
26-39	3	33.33%
40-65 years	4	44.44%
Sex
Male	8	88.89%
Female	1	11.11%
Marital Status
Single/ never married	4	44.44%
Married	4	44.44%
Unmarried, living with partner	1	11.11%
Race
American Indian or Alaska Native	0	0.00%
Asian American	0	0.00%
Black or African American (non-Hispanic)	0	0.00%
Native Hawaiian or Pacific Islander	0	0.00%
White (Caucasian)	9	100.00%
Ethnicity
Non Hispanic or Latino	9	100.00%
Hispanic or Latino	0	0.00%
Education
High school diploma	1	11.11%
GED	4	44.44%
Some college	1	11.11%
Associate’s degree	2	22.22%
Bachelor’s degree	1	11.11%
Employment
Full-time (30+ hours/week)	5	55.55%
Unemployed, disabled	2	22.22%
Unemployed, out of work	1	11.11%
Homemaker	1	11.11%
Income
$0-$29,999	4	44.44%
$30,000-$59,999	2	22.22%
$60,000-$89,999	1	11.11%
$90,000 or more	2	22.22%

3.2. Objectively Measured and Subjectively Reported Timing and Frequency of Use Behaviors

Prospective vaping behavior was documented objectively via the Gram1 device. Taken together, participants vaped a total of 76.4% of all prospective study monitoring days. Though this ranged from 31%-100%, four of the nine participants vaped daily during the two-week study monitoring period. There was an average of 1.79 vaping sessions per day across all days, with the lowest average being 0.75 sessions per day, and the highest average being 4.31 sessions per day. Participant-level objective use data are presented in Table 2. Participants reported consistent use across days, but variability existed in how participants approached their within-day use behaviors. Figure 2 graphically presents idiosyncratic cannabis vaping across the 24-hour day by participant. Some participants reported intermittently using “the vaporizer mainly throughout my whole day” (#006) while others reported using “prophylactically as well as after the pain sets in” (#011). One participant noted use “goes with my pain cycles.…about…every four hours I feel the urge to [use]” (#015).

Table 2. Objectively Measured Vaping Behaviors.

Objectively measured vaping behaviors using the ‘Gram1’ vaporizer device during the two-week prospective monitoring period.

Participant	% of Days Vaped	Sessions per Day Mean (SD)	Sessions per Day on Vaping Days Mean (SD)	Session Duration (s) Mean (SD)	Number of Puffs per Session Mean (SD)	Number of Puffs per Day on Vaping Days Mean (SD)	Puff Duration (s) Mean (SD)	Interpuff Interval Mean (SD)
P003	68.75%	0.75 (0.58)	1.09 (0.30)	58.42 (40.86)	7.08 (3.37)	6.10 (3.28)	5.29 (1.34)	11.91 (6.34)
P004	31.25%	0.81 (1.56)	2.60 (1.82)	41.83 (39.51)	5.33 (2.80)	8.00 (5.66)	5.19 (1.98)	17.70 (6.07)
P005	100.00%	1.77 (1.09)	1.77 (1.09)	10.68 (5.33)	2.05 (1.43)	1.83 (1.19)	6.95 (2.52)	5.80 (4.20)
P006	50.00%	1.45 (2.60)	2.91 (3.08)	79.93 (83.17)	8.64 (4.52)	13.09 (14.04)	6.22 (2.33)	8.37 (8.12)
P009	100.00%	4.31 (2.95)	4.31 (2.95)	94.87 (105.09)	7.54 (5.87)	18.50 (15.64)	4.69 (2.43)	4.79 (6.34)
P011	88.24%	1.12 (0.60)	1.27 (0.46)	37.47 (85.72)	2.37 (1.38)	2.57 (1.16)	4.13 (1.65)	12.14 (6.51)
P014	71.43%	1.36 (1.34)	1.90 (1.20)	360.16 (204.87)	24.63 (11.26)	53.33 (42.24)	2.20 (1.40)	7.47 (7.80)
P015	100.00%	3.36 (2.17)	3.36 (2.17)	440.00 (432.35)	12.05 (6.55)	31.12 (28.88)	4.89 (3.58)	6.98 (9.29)
P017	100.00%	1.93 (1.39)	1.93 (1.39)	77.00 (117.12)	6.43 (7.11)	13.33 (30.15)	3.20 (3.01)	3.17 (5.97)
All	76.43%	1.79 (2.05)	2.34 (2.05)	155.44 (251.34)	8.76 (8.23)	16.43 (16.53)	4.06 (2.98)	6.81 (8.08)

Figure 2. Vape Sessions by Hour of the Day.

Total number of vaping sessions across the two-week study monitoring period by hour of the day.

The average session length was approximately 2.59 minutes (SD=4.19 min) ranging from 10.68 seconds (SD=5.33 seconds) to 440.00 seconds (SD=432.35 seconds). The average number of puffs per vape session was 8.76 (SD=8.23), ranging from 2.05 puffs (SD=1.43) to 24.63 puffs (SD=11.26). In reference to the timing per puff, the average puff duration was 4.06 seconds (SD=2.98), and individual puff duration averages ranged from 2.20 seconds to 6.95 seconds. One participant indicated that both puffs and vaping sessions were short in duration, noting “I’m not going to actually actively hit this thing for like 30 seconds to a minute…it’s just because it’s so strong that I…won’t sit there and just like sesh with it you know it’s more just something I use to like medicate really” (#003). Interpuff intervals were 6.81 (SD=8.08) on average ranging from individual averages of 3.17 seconds between puffs to 17.70 seconds between puffs. Participant-level and aggregate data for all vaporization behaviors can be found in Table 2.

3.3. Objectively Measured and Subjectively Reported Socioenvironmental Factors

Participants reported vaping cannabis oil alone 67.9% of the time on average, followed by vaping with a partner 24.2% of time. A graphic depiction of participant responses can be found in Figure 3. Most participants preferred to vape alone including one participant who reported “I don’t let anybody hit mine [vaporizer]…I’m a little stingy” (#006) and another said “I usually vaporize alone…Vaporizing is actually quite expensive. I’m not trying to share my medicine” (#009). Those who did share typically did so with another medical patient, like #003 who reported “my brother and roommate both are medical patients as well so it’s like pretty…prevalent throughout our whole house” Alternatively, one might vape with a spouse, like another participant who reported “The only other person I’m ever with is my wife when I’m using it. It’s not socially I guess. We share vaporizers and cartridges and different strains and what not” (#011).

Figure 3. Reported Instances of Social Environment Across all Participants.

Total number of instances in social environment across all participants during the two-week monitoring period.

Participants reported being at home 69.5% of time, followed by vaping at work 11.7% of the time. Aggregate data on location are presented in Figure 3. In reference to geographic location, many participants highlighted the discreetness and convenience of vaporization, including one participant who commented use could happen “…anywhere outside really. You can’t smoke in public, you can’t walk down the street and smoke a joint, but you could with a vape pen” (#014). Another participant echoed this sentiment, noting “you can keep it in your pocket and use it anywhere pretty much” (#006).

3.4. Additional Cannabis and Substance Use

During the prospective monitoring period, there were 170 total instances of self-reported substance use outside of the Gram1 device. This included 128 instances of additional cannabis use; 94 of which involved smoked cannabis. There were 20 instances of ingesting cannabis, 10 instances of vaping cannabis oil with another device, and 4 instances of vaping cannabis flower. Other reported substance use included 25 instances of e-cigarette use, 13 instances of alcohol use, 3 instances of cigarette use, and one instance of opiate use. Figure 4 graphically presents instances of Gram1 vaporizer use and other substance by participant.

Figure 4. Self-Reported Substance Use During Study Monitoring Period.

Total number of instances of self-reported additional substance use across the two-week study monitoring period.

3.5. Acceptability and Feasibility of Vaporizer and Application

The average rating of the vaporizer was 7.4 (range: 5-10). Four participants reported a greater number of cannabis vaporization days in the past two weeks at their baseline assessment than the objective vaping days recorded during the prospective monitoring period. Four participants reported fewer number of cannabis vaporization days, and one participant reported consistent usage across the previous two weeks and the prospective two weeks. The primary concerns among individuals who reported lower ratings of the Gram1 device were technological difficulties and preferences for the way in which alternative devices are styled or puffed. Discrepant opinions were offered on the device being “bulky” (#005) and “clean, sleek, a nice elegant design” (#015). The majority of participants endorsed at least minor complaints of the battery life reporting that it “doesn’t stay charged very long” (#015). One participant was particularly impressed by the safety implications of requiring Bluetooth connectivity to turn the device on and another noted that because of this feature “it doesn’t burn oil all of the time” (#006).

Six participants provided explicit rankings for the application producing a mean of 7.4 (range: 4 – 10). The other two participants perspectives are reflected, but they did not provide numerical ratings. Some reported that the app was “really cool” (#003) and the surveys were “convenient and fast” (#006). Another participant summarized “it was concise, it wasn’t real long, it wasn’t a pain. It was fine” (#015). The primary complaints were technological difficulties with the application and the brief window for completing random reports. One participant stated, “If I’m at work and I have a phone down I’m not one to constantly be looking at my phone” (#011).

4.0. Discussion

As legalization shifts and cannabis vaping prevalence continues to rise, it is imperative to understand how individuals are utilizing high potency cannabis oil and what factors influence that use. Objective, preliminary data was leveraged to characterize naturalistic use revealing participants vaped most days, and vaping sessions occurred throughout the day. Most participants reported consistent use as a part of their daily routine or to prevent or respond to symptoms such as pain. This is consistent with previous qualitative work among individuals with a medical cannabis card (Berey et al., 2023) This use routine warrants investigation in larger samples, as previous work has suggested more frequent use is associated with more potent products, and method of administration was the link between high potency products and negative health outcomes (Prince & Conner, 2019). These use behaviors are consistent with previous work describing that fast-acting, predictable decay allows for titrated dosing throughout the day (Grant et al., 2012). Vaping sessions lasted approximately two and half minutes on average which was consistent with subjective reporting by participants that vaping is not a behavior with extended duration, and convenience can be leveraged over other modalities. THC potency was 60% in the current investigation suggesting consistent use of high-potency products within and across days. Given that the majority of study participants reported medicinal use for pain management, future experimental work should take this level of THC concentration into consideration when developing an ecologically valid assessment of the efficacy of cannabis oil vaporization for pain.

Literature to date on topographical information, including puff duration and inhalation patterns, for cannabis oil vaporization is extremely limited. In this sample, puff duration was approximately 4 seconds on average. This duration is greater than previous topographical examinations of cannabis cigarette smoking which revealed an average puff duration of 1.3 seconds (McClure et al., 2012), but more closely reflect previous survey work finding respondents estimated their cannabis oil vaporization puff duration to be 5.1 seconds on average (Morgan et al., 2022). This self-report accuracy of consumption contradicts previous pilot work utilizing an electronic nicotine delivery system where the device recorded twice as many puffs, or “hits,” as participants reported taking through ecological momentary assessment (Li et al., 2021). Comparable data regarding puff count is not yet available in the cannabis vaporization literature, but participants in this sample typically took approximately nine puffs per vaping session. This is fewer than previous in-lab paradigms examining topographical behaviors for cannabis smoking, which found an average of 13 puffs (McClure et al., 2012). However, the cannabis THC concentration was 3% as opposed to the 60% used in this current investigation, and previous ecological work has suggested individuals titrate based upon THC concentration (Van der Pol et al., 2014). Though, this is an area of future exploration as puff volume was titrated but survey work has shown that cannabis users do not estimate a difference in puff duration depending upon THC concentration (Morgan et al., 2022).

To our knowledge, this is the first study to assess naturalistic, real-time reports of socioenvironmental context when vaping. Participants in this investigation were at home and alone most frequently. Participants’ qualitative reports suggest that cost and disinterest in sharing medicine may contribute to these findings. Though not directly reported by participants in this study, ongoing stigma toward cannabis usage even for medicinal purposes may contribute, as individuals may want to hide usage from peers (Leos-Toro et al., 2018). Indeed, previous qualitative work examining medical cannabis vaporization behaviors has cited the discretion of vaporization as a benefit of this mode of administration (Aston et al., 2019). Qualitative work during the first year of the pandemic found young adults were more likely to consume cannabis alone (Dumas et al., 2020) and vape cannabis when experiencing social isolation (Islam et al., 2022) suggesting this pattern may apply more broadly. Taken together, while cannabis vaporization convenience and discretion can be leveraged, this sample reflects at home and independent usage most often.

In terms of additional cannabis use, participants most commonly reported smoking cannabis, which is consistent with previous findings suggesting that multiple modes of administration are often utilized by the same individual (Baldassarri et al., 2020; Knapp et al., 2019). Ingesting cannabis was the next most frequently reported mode of administration. Although vaping may be more favorable for titrating and quick-release, edibles and other forms of ingested cannabis are slower acting and may be more desirable for longer effects (Grant et al., 2012). Alternatively, additional cannabis use through other modalities could represent a more social engagement, as most participants indicated that vaping was not a social behavior but still endorsed using recreationally. Generalizability is limited due to the homogenous nature of the sample. Outside of additional cannabis use, e-cigarette and alcohol use were the most commonly reported. An epidemiological review has reported up to 90% of cannabis users have smoked a cigarette at some point in their lives (Agrawal et al., 2012), but future work would benefit from investigating these relationships in the context of vaping specifically at the momentary level for medicinal purposes.

Although this pilot study offered a novel design and began to answer critical questions surrounding characterization of cannabis oil vaping for medicinal purposes, it is not without limitation. This proof-of-concept study was based on a small, racially and ethnically homogenous sample with limited generalizability. Interpretations of these findings should be limited to suggestions for feasible future work utilizing a naturalistic design. That said, sample demographics appear to broadly represent individuals who vape cannabis for medicinal purposes (Cranford et al., 2016; Lee et al., 2016; Morgan et al., 2022). Exact age at time of participation was not determined. Requisite future work in a larger, more diverse sample should also capture age at time of participation as it may affect use behaviors. Study participation required the use of an Android device. The addition of self-selected vaporization cartridges would add to the ecological validity by accurately reflecting how individuals self-medicate but for the purposes of standardization in this pilot study, all participants were asked to use the same cartridge type. As this was an exploratory pilot study, a decision was made to characterize the absence of flow through the Gram1 device for 10 minutes as the cessation of a single session. The fast-acting effects of cannabis oil vaporization as well as subjective reports by participants indicating a short session duration suggest that this may be an appropriate parameter for future work but will need to be further validated. Feasibility ratings were provided here for the sake of adding participant insights given this was the first study to use a ’smart’ vaporizer for cannabis consumption. Future work should explicitly examine how and to what extent usage of such a device changes vaporization patterns.

Future work should replicate and expand upon these findings by continuing to characterize cannabis vaporization behaviors as well as determine the efficacy of use for whom and under what conditions. Further characterizations in larger, more diverse samples of how people self-medicate will build foundational knowledge useful to ultimately establish normative use behaviors among those who use cannabis oil for medical purposes. Indeed, this is particularly imperative given the growing concerns over health consequences of the frequency and concentration of cannabis oil consumption. The findings from this novel study begin to characterize individuals who regularly and consistently use high THC cannabis oil for symptom management. These individuals are primarily using alone, with the exception of spouses and housemates, and are primarily using at home, though they endorse the convenience of vaporization especially in other locations. Participants are subjectively reporting prophylactic use, responsive use, and use as a part of daily routine. Future work should continue to include objective, naturalistic data paired with subjective momentary reporting as cannabis oil vaporization becomes increasingly prevalent. In light of ongoing legislative changes at the state-level regarding recreational cannabis use and the rise of vaporization specifically, research that investigates the naturalistic use and efficacy of cannabis oil vaporization for medicinal purposes will be critical to informing safe consumption.

Public Significance Statement:

This pilot study demonstrates that there are feasible ways of measuring cannabis oil vaporization and related factors in real-time. Assessment of naturalistic cannabis oil vaporization is especially critical because it is a high potency product with the ability to be administered discreetly. Preliminary findings indicate consistent use across days of the week and distinctive patterns of use throughout the day.