Cannabis E-Cigs Good or Bad?

Hey Canna friends!

This will be my first cannabis related write up. As you may know, I'm all about herbal medicine which includes cannabis. Even as an artist, I help to promote cannabis based brands, BUT I do so with expertise. I am a current Medical Cannabis Science and Therapeutics student at University of Maryland. As I work to achieve my masters degree, I'm gonna to share with you some of my papers and discussions about medical cannabis. Keep in mind that although I'm in continued education, I am not a certified health practitioner and cannot give medical advice. I can only share what I know!

Soo Vaping, Let's get into it!

We see vaporizers everywhere. Some with nicotine, some with cannabis, and others with flavored smoke. Check out this paper I submitted last semester and see what you get from it.

Cannabinoid Delivery Via Vaping: Pros, Cons, Solutions

Prior to 2019's growing awareness of E-cigarette or Vaping Associated Lung Injury (EVALI) , electronic cigarettes and other vaporizing methods for cannabinoid delivery appeared to be a helpful alternative to traditional routes of administration. Contrary from smoking, which is the most common route of administration, vaping allows for a more discrete delivery limiting or eliminating the burning smell and simplifying users preparation for inhalation. Vaping also may contain isolate cannabinoids like THC, CBD, terpenes that can be used to attain a specific medical goal. Unfortunately, the benefits of vaping may be easily outweighed by its damage to the lungs. To continue utilizing vaping as route of cannabinoid delivery, it is necessary to understand the toxicity mechanisms of vaping along with solutions for improving formulations for vaping.

There are different forms of vaping. Cannabis flower vaping involves hot air being milled over cannabis to produce an aerosol (Atrash et al, 2021, p. 2170 ) Dabbing and Cannabis e-cigarettes (CEC) utilize cannabis extract or oil, and it is these forms of vaporizing that cause the highest concern. In order to create an extract for a vaping system, cannabis must go through a rigorous process that may include solvents needed for extraction and chemical additives for changing viscosity, flavor, and more. Using extraction solvents like butane, alcohol, or hexane may leave traces in the oil product. The use of some additives poses health concerns as their metabolites could be toxic. Although Propylene Glycol (PG), Vegetable Glycerin (VG) aka Glycerol are on the FDA's inactive ingredient list, allowing them in small concentrations, overheating may cause degradation of these ingredients resulting in toxicity. (NCIA, p.9_) The FDA and/or CDC also do not encourage the use of additives Polyethylene Glycol (PEG) and Vitamin E Acetate (VEA) for inhalation as well.

In general, CEC users may experience adverse effects of vaping commonly including respiratory symptoms, gastrointestinal symptoms, and other non-specific symptoms within days or weeks of use which may be related to vape liquid composition. (Dye, L.R., 2019, p.3) Even the ingredients that are Generally Regarded As Safe (GRAS) or that are non-harmful for topical application or ingestion could be harmful for inhalation. Highlighting VEA, it is an acetic ester derived from vitamin E and is used often in food and cosmetics. Unfortunately, tocopherols like VEA stick to the lung surfactant fluid in the lungs hindering oxygen gas transfer from air into the body. Significant amounts of inhaled VEA could lead to lung damage functional impairment, and death. (NCIA, 2020, p. 10) Terpenes are considered GRAS ingredients as they are benign at low concentrations. Alternatively, terpenes at high concentrations could be toxic and/or lead to hypersensitivity/ allergic reaction in the lungs.

Additives are not the only gateway to toxicity with vaping. Contamination by hardware is toxicity concern as well. Vape components assembled in unclean environments open the door for contaminants. Hardware may also contaminate cannabinoid inhalant solutions over time through leaching heavy metals, the process of materials with soluble constituents dissolving into the formulation, or chemical reactions causing corrosion. This can occur via the heating coils use to activate the cannabinoid solution within the vape.

Although there is significant concern about the use of vaporizers for cannabinoid delivery, vaping still has the potential to be a dependable resource for cannabis administration. Health-conscious suggestions for vape manufacturers would include eliminating the use of fillers/ additives such as PG, VG, PEG, and VEA which could cause chemical like damage to the lungs when used at high temperatures and inhaled. Additionally, to ensure little to no contamination, vape products should be manufactured in a clean environment and should use materials that have low reaction tendencies to cannabinoid formulations and are corrosion resistant. Methods of temperature control should be conceptualized to limit over-heating and degradation of ingredients. To promote user safety, emissions tests should along with concurrent potency and terpene testing, residual solvent and heavy metal testing, and microbial testing. Lastly, packaging should be transparent with ingredient information and reference points in the case of recall.

In total, the toxicity mechanisms of vaping should not be ignored, and it is the role of the vape manufactures, clinicians, and cannabis vape users to keep health at the forefront when using this route of administration. While the industry is rectifying the cons of vape products and its link to EVALI and other health conditions, it is priority that consumers take heed to cautions and patronize the state-regulated market as opposed to the illicit market to best ensure safety as recommended by the CDC. It is also necessary for clinicians to keep a close eye on CEC and vape users documenting health impacts along the way. Together consumers, clinicians, and manufacturers may be able to overcome issues of vape toxicity and keep vaping as a viable cannabinoid delivery option.

Sources:

Dye LR. Vaping hazards: What are the danger signs and how can we prepare? Elsevier Connect [Online]. Published October 8, 2019. Accessed March 13, 2020. Retrieved from https://www.elsevier.com/connect/vaping-hazards-what-are-the-danger-signs-and-how-can-we-prepare?sf222060145=1

Butt YM, Smith ML, Tazelaar HD, Vaszar LT, Swanson KL, Cecchini MJ, Boland JM, Bois MC, Boyum JH, Froemming AT, Khoor A. Pathology of vaping-associated lung injury. New England Journal of Medicine. 2019 Oct 31;381(18):1780-1. Also Available at https://www.nejm.org/doi/full/10.1056/NEJMc1913069

Meehan-Atrash, J., & Rahman, I. (2021). Cannabis Vaping: Existing and Emerging Modalities, Chemistry, and Pulmonary Toxicology. Chemical Research in Toxicology, 34(10), 2169–2179. https://doi.org/10.1021/acs.chemrestox.1c00290

National Cannabis Industry Commission (NCIA). Displacing the illicit cannabis market: Recommendation for safe vaping. NCIA [PDF Report]. Published January 2020. Accessed March 13, 2020. Retrieved from https://thecannabisindustry.org/wp-content/uploads/2020/01/NCIA-Safe-Vaping-WP_Jan27_v3.pdf