CONFIRMATION OF THE TRIALS AND TRIBULATIONS OF VAPING

Abstract

Responses to our article indicate consensus on the need for expedited scientific and regulatory action related to vaping of cannabis and other substances to curtail untoward public health impact and identify potential benefits. How to speed up science, increase knowledge and enact responsible regulatory policy poses a formidable challenge.

The responses to our paper on the emerging phenomenon of vaping cannabis confirmed the pressing need to understand more clearly its public health impact, but this should not keep us from implementing common-sense policies before all the data can be gathered. Dr Tashkin, the foremost expert on the toxicology of cannabis smoke, suggests that the health benefit of vaping cannabis is probably limited to a reduction in symptoms of bronchitis [1]. This may benefit cannabis users with compromised lung health, but overall produces fewer health benefits than those projected from using e-cigs to replace burning tobacco.

Fischer and colleagues speculate that proliferation of vaping devices could herald the development of novel and more hazardous cannabis formulations for use in these devices [2]. They reflect on how vaping may decrease the perceived risk associated with cannabis use, and thereby increase use and the negative consequences of misuse. Drawing from observations from Canada they warn that, as with e-cigs, consumers appear to be ahead of policy leaders, underscoring the urgent need to gain control over already well-established operations of the cannabis and vaping industries. One example of how to combat industry is the State of California’s Blue Ribbon Commission on Marijuana Regulation, which is adapting tobacco policies previously implemented successfully to control tobacco proliferation [3].

Dr Cox focuses on the need for increased regulation of the commercialization of vaporisers to minimize the adverse impact of vaping [4]. He reminds us of the tobacco industry’s huge commitment to developing vaping techniques, and long-standing interest in cannabis products, confirmed by a study of tobacco industry documents [5]. Dr Cox calls for a coordination of global research efforts on vaping of tobacco, cannabis and other substances to fill critical knowledge gaps and inform policy before Industry can exploit our ignorance. To this end, some aspects of good policy based on tobacco control, for example limits on the ability to market to teens, need not wait for new data.

Dr Gartner provides an Australian perspective that reminds us how difficult it can be to get policy right [6]. She educates the reader about ‘mulling’, the practice of mixing tobacco with cannabis to assist with the burning cannabis and provide a smoother taste. Mulling may increase the prevalence of tobacco use by serving as a gateway for tobacco initiation. Gartner suggests that vaping may reduce mulling which may, in turn, reduce tobacco use. Her point that we need to consider carefully the possible benefits of vaping alongside potential concerns is well taken.

Generally, most commentators agreed that the scientific and regulatory communities must ramp up efforts related to the vaping of cannabis, tobacco and even other substances, such as caffeine [7]. As the availability and popularity of vaping rockets ahead, many marketers will capitalize on its profitability with little regard for public health implications. Writing commentaries such as ours about this issue is easy; the more formidable challenge is how to speed up science, increase knowledge and get responsible regulatory policies enacted.