Electronic Vaping Delivery of Cannabis and Nicotine

Excerpt

One of the latest public health controversies centers around the rising popularity of electronic nicotine delivery systems. These devices, most commonly called "e-cigarettes" or "vaporizers," aerosolize various combinations of glycerol, propylene glycol, flavorings, nicotine, or cannabis to be inhaled by consumers. The marketing strategy for e-cigarettes is a “healthier” alternative to traditional tobacco and a novel aid for smoking cessation, with little data to support these claims. For chronic tobacco users, these new devices may lead to harm reduction by reducing exposure to many of the harmful effects of tobacco smoke. On the other hand, novel nicotine users experience increased harm from the known hazards of nicotine consumption. These individuals may also experience unknown adverse health effects of different additives found in e-cigarettes.

Physicians throughout the United States began reporting surging cases of vaping-associated severe lung injury in 2019. Vaping-related lung injury commonly causes a severe respiratory compromise in previously healthy individuals, necessitating intubation or intensive care admission. The exact cause of the lung injury remains unknown but has prompted further concern about the safety and regulation of these devices and their additives. An additional problem lies with e-cigarette use among adolescents and young adults. Early research suggests that e-cigarette use poses a higher risk for subsequent tobacco use later in youth and adulthood. Other studies show increased respiratory symptoms, ie, chronic cough, wheezing, and bronchitis, with long-term use. Nicotine alone correlates with negative cardiovascular outcomes, including hypertension, coronary artery disease, and heart failure.

Most e-cigarette companies are subsidiaries of large tobacco companies. Perhaps the most nefarious concern lies with the ongoing efforts of tobacco corporations to rebrand themselves to target the developing market, which is the vulnerable adolescent population. Given the potential for benefit in specific populations and harm in others, more research is needed to delineate the true benefits of e-cigarettes as a smoking cessation aid versus the potential harm associated with long-term use.