It Is Past Time to Consider Cannabis in Vaping Research

Two recent publications^1,2 in Nicotine and Tobacco Research have focused on measurement issues in electronic nicotine delivery system (ENDS) research among youth or young adults. Comparing lifetime use of “e-cigarettes” to specific endorsement of use of five different types of vaping devices, Morean et al. found that asking about the specific ENDS device type increased estimates of lifetime use from 35.8% to 51.3%.¹ The authors conclude that asking about the types of ENDS devices rather than “e-cigarettes” in general yields a more accurate estimate of the prevalence of lifetime ENDS use. In an online survey of young adults, colleagues and I showed participants five images of vaping devices and asked them to assign a name to each device in an open-ended question.² After categorizing each response into one of the five categories (ENDS-related, cannabis-related, non-ENDS tobacco product, don’t know, and everything else), we determined that the majority of participants understood the images as representing an ENDS, although images of the e-Go and mod devices were more commonly misidentified than images of the cigalike devices.

Conclusions from both of these publications highlight an important blind spot in youth and young adult ENDS research: the increasing prevalence of cannabis vaping. For example, Morean et al. conclude that asking about different ENDS devices increases acknowledgement of ENDS use; however, without specifying the drug in the device, we cannot be sure that a youth’s acknowledgement of using a “mod” but not an “e-cigarette” captures additional nicotine vaping rather than new cannabis vaping. In my recent publication, colleagues and I assumed that “vape” referred exclusively to a nicotine-containing product, without consideration of vaping other substances.

Cannabis vaping is increasingly common among youth. Between 2017 and 2019, all measures of cannabis vaping (lifetime, past 12 months, past 30 days) increased among US 8th, 10th, and 12th graders.³ Fourteen percent of 12th graders reported vaping cannabis in the past 30 days in 2019, nearly twice the prevalence of past 30-day cannabis vaping in that grade in 2018 (7.5%).³ While reports of youth nicotine vaping are still more common than youth cannabis vaping³, a significant proportion of youth cannabis vapers (and likely also young adult cannabis vapers) use a device that most readers of Nicotine and Tobacco Research would call an “electronic nicotine delivery system,” ignoring that this device could, in most cases, also be an “electronic cannabis delivery system.”

Nevada implemented legal recreational cannabis sales in July 2017. Upon visiting a cannabis dispensary near Lake Tahoe, I was surprised that vape oils, sealed cartomizers, pods, and disposable “cigalikes” made up a significant proportion of the recreational cannabis products on offer. All these products were labeled with terms that would be familiar to readers of this journal. Weedmaps (www.weedmaps.com), a website with online dispensary product menus, has a menu subheading for “vape pens” with product names like “Divorce Cake Vape Cartridge” at one Las Vegas area dispensary. All components are all 510-threaded so that tanks or batteries bought in dispensaries are interchangeable with “ENDS” components bought online or in vape shops. Assessing ENDS products as nicotine-only devices simply does not reflect users’ reality in the United States and other parts of the world such as Canada, where legal recreational cannabis vape products are available nationwide.

The importance of researching cannabis vaping was highlighted by the severe lung injuries of primarily teens and young adults in the United States, most likely due to use of unregulated cannabis vape products.⁴ Notably, many victims did not live in states where recreational cannabis sales are legal, or were under the legal age of purchase for recreational cannabis products. Co-use of cannabis and nicotine is common in youth and young adults.^5,6 Without precise assessment of use of both drugs and devices, a precise understanding of the individual and public health effects of vaping either drug will be difficult to achieve.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse at of the National Institutes of Health under grant number R15 DA047606. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Declaration of Interests

None reported.