By Janelle Lassalle
You may have heard the term ‘vaping’ thrown around over the past few weeks.
Vaping refers to the inhalation of vapour created by a device known as a vaporizer. A vaporizer heats up starting material just below its boiling point without directly igniting it. This indirect heat releases compounds within the starting material (generally cannabis or nicotine) as vapour which can be inhaled and released back into the air as a fine mist.
While many consumers find vaping to be a gentler, more effective way to consume starting materials like cannabis¹ it’s still fraught with problems—namely, a lack of regulation and standardized safety practices.
The reason why the term is so ubiquitous these days is due to a recent outbreak of vaping related illnesses beginning in July of 2019². Patients have reported a variety of symptoms including shortness of breath, chest pain, fatigue, fever and vomiting³. The CDC notes that there have been 530 confirmed and probable cases in 38 states and the U.S. Virgin Islands, with seven deaths across six states. They’ve also noted that “a lung infection does not appear to be causing the symptoms.”³
Given the public’s fears sparked by recent health concerns surrounding vaping we’ve evaluated the effects of vaping tobacco/nicotine compared to cannabis below. We hope that this will help consumers make more educated purchasing decisions about their health and overall well-being.
Both nicotine and cannabis are popular vaping starting materials, though the devices used to consume each differ.
Devices used to vaporize nicotine began as nicotine delivery devices (NDDs), a term first introduced in 1997 by the R. J. Reynolds Tobacco Company⁴. This version of a nicotine vaporizer relied on a carbon based fuel element to vaporize nicotine held in the rod, with the user inhaling the vapour. While the device claimed “to deliver lower levels of smoke than conventional cigarettes”⁴, a study conducted by Labstat International Inc. in 2000 rejected these claims, stating that, “results showed that [the] Eclipse [nicotine delivery device] produced as much or more of the most potent carcinogens found in cigarette smoke, including nitrosamines, acetaldehyde, acrolein, and benzo(a)pyrene.”⁵
Electronic cigarette vaporizers as we know them today are also known as vapes or e-cigs. Invented by Chinese pharmacist Hon Lik in the early 2000s⁴, these vaporizers work by heating a liquid that can contain nicotine or cannabis to produce aerosol vapour that can be inhaled.
By 2013 many of the major tobacco companies had entered the e-cig market⁶. Many scientists, however, cite the increased use of e-cigs as a cause for concern, stating, “...the diffusion of e-cigarette (e-CIG) opens a great scientific and regulatory debate about its safety...A consensus on the best protocols for the e-CIG safety assessment is still far to be achieved, since the[re are such a] huge number of variables characterizing these products (e.g., flavouring type and concentration, nicotine concentration, type of the device, including the battery and the atomizer).”⁷
Cannabis based vaporization devices, however, devices tend to come in one of two models. These include a pre-filled concentrate based vape pen as well as a dry herb vaporizer intended for flower use.
Nicotine & Electronic Cigarettes
E-cig vaporizers were designed to imitate conventional cigarettes by delivering nicotine in a “toxin-free vapour”⁸. However current research notes that, “The EC [electronic cigarette plastic device] is a new product on the market and little is known about its safety and nicotine delivery efficacy”⁸.
The effects of nicotine—the main psychoactive ingredient found in tobacco—are well-documented, with research noting, “Tobacco addiction is the leading avoidable cause of disease and premature death in the U.S., responsible for >400,000 deaths annually”⁹.
The most notable effect is its potential for addiction as nicotine can “induce negative emotional symptoms during abstinence that contribute to a profound craving for nicotine”⁹. This negative emotional state is then negatively reinforced, leading to excessive drug intake and an increase in “anxiety-like behaviour”. Studies also show that nicotine withdrawal “dramatically decreases brain reward function and the efficacy of natural reinforcers in rodents”⁹.
While the exact mechanisms that underlie nicotine addiction are not fully understood⁹, a 2010 research paper published in Pharmacology Biochemistry and Behavior aimed to determine the effects of nicotine vapour in mice. Researchers discovered that intermittent exposure to nicotine vapour induced significant somatic withdrawal signs in rodents¹⁰.
Another research article published in 2015 detailed the ways in which e-cig/e-juice vapours affected mice. Mice that were exposed to aerosols produced by electronic nicotine delivery systems (ENDS or “e-cigs”) were found to produce larger amounts of pro-inflammatory cytokines¹¹.
The same research paper also gave a brief glimpse into how these nicotine based e-cigs affected human epithelial cells. The authors found that, “Exposure of human airway epithelial cells (H292) in an air-liquid interface to ENDS aerosols from a popular device resulted in increased secretion of inflammatory cytokines, such as IL-6 and IL-8”¹¹. They also added that human lung cells “exhibited stress and morphological change in response to treatment with ENDS/e-liquids. These cells also secrete increased IL-8 in response to a cinnamon flavoured e-liquid and are susceptible to loss of cell viability by ENDS e-liquids”¹¹. This is of particular concern as excessive production of pro-inflammatory cytokines such as interleukin-6 (IL-6) and interleukin-8 (IL-8) can induce inflammation that contributes to the progression of cancerous tumour growth¹².
A paper published in 2017 titled, “Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues” provided updated information on the subject¹³. Some of these findings include:
- E‐cigarette‐derived inhaled nicotine may contribute to the pathogenesis of periodontal and pulmonary diseases in particular via lung inflammation, injurious, and dysregulated repair responses.
- Nicotine is shown to have anti-proliferative properties and affects fibroblasts in vitro, which may interfere in tissue myofibroblast differentiation in e‐cig users. This will affect the ability to heal wounds by decreasing wound contraction.
- In periodontics, direct exposure to e‐vapour has been shown to produce harmful effects in periodontal ligament [a dense fibrous connective tissue] and gingival fibroblasts [the most abundant structural cell in periodontal tissue]
The authors concluded, “exposure to e-cig aerosols/juices incurs measurable oxidative and inflammatory responses in lung cells and tissues that could lead to unrealized health consequences”¹³.
Cannabis & Vaporizers
A research paper published in 2015 reviewed the current literature regarding vaporized cannabis. It began by noting that cannabis is most readily available to consumers in plant or flower form, adding that many cannabis smokers “often report respiratory problems. Many users experience symptoms of bronchitis including coughing, wheezing and tightness in the chest”¹.
The authors went on to state that health professionals should “consider making recommendations to their medicinal cannabis patients for vaporization of the plant, particularly for those who want the rapid relief that oral administration fails to provide”¹. They also explained that while more clinical trials were ultimately necessary “vaporization of cannabis is likely less harmful than smoking”¹.
Benefits Of Vaporizing Cannabis
Vaporizer devices heat up starting material without combusting it. This process “attempt[s] to sidestep potential respiratory risks”¹ as cannabinoids are released in a vapour rather than smoke. Another paper recognized that the lack of smoke associated with vaporizers conferred profound health benefits, stating, “...with the development of vaporizers, that use the respiratory route for the delivery of carcinogen-free cannabis vapours, the carcinogenic potential of smoked cannabis has been largely eliminated¹⁴.
Cannabis also poses other potential benefits thanks to the many therapeutic properties of cannabis compounds, one of which includes use of cannabis as a bronchodilator¹⁵.
The paper also cites an experiment that compared emissions from combustion vs vaporized cannabis which suggests that “vaporization reduces the delivery of toxic byproducts associated with the use of smoked cannabis”¹. Subsequent experiments also discovered a “statistically significant difference between the increase in CO exhaled following smoking cannabis versus vaporization”, concluding that, “these findings give further evidence that vaporization reduces exposure to gaseous combustion toxins”¹.
These findings were consistent with self-reported research which suggests users “experience less respiratory irritation when using a vaporizer compared with a classic burning technique”¹, adding that, “After controlling for other known risk factors, using a vaporizer was associated with fewer reported respiratory symptoms overall relative to other burning techniques”¹.
One clinical trial even notes that regular users who switched to vaporizing for one month reported “improved self-reported respiratory symptoms by a statistically significant 73%”¹.
The lack of combustion suggests that “vaporizers adequately reduce the risk of pulmonary symptoms” with the authors concluding, “the cannabis vaporizer appears to be an ideal harm-reduction approach to safer use”¹.
Potential Safety Concerns
While using cannabis with a vaporizer may potentially confer more health benefits than combusting it consumers should still proceed with caution. Of particular concern are additional harmful compounds that can be found in ‘street’ samples of illegal cannabis. Street samples of cannabis obtained by the National Institute on Drug Abuse revealed the presence of toxins like ammonia¹.
Another compound that’s appeared in unregulated/illegal underground cannabis products is vitamin E acetate. The compound was linked to a New York state health officials' investigation in which cannabis-containing vaping cartridges submitted by victims tested positive for vitamin E acetate¹⁶. While the FDA noted that "no one substance or compound, including vitamin E acetate, has been identified in all the samples tested” they also urged consumers to “avoid inhaling this substance”¹⁷.
Researchers also add that “a regulated market could help sidestep these problems”¹. The CDC has also provided a series of interim regulations for consumers to follow until more information has discovered. They urge “anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer”³. Adults who use e-cigarette devices are encouraged to carefully monitor themselves and reach out to healthcare professionals if they experience any symptoms.
Vaporizing is the act of inhaling vapour for recreational use. The use of e-cigarettes that contain nicotine e-juice can have a wide range of negative health effects including risk for addiction and an increase in anxiety-like behaviour.
Vaporization of cannabis is likely less harmful than smoking and is a gentler alternative for patients with respiratory problems. The act of vaping cannabis may reduce some of the risks associated with smoking including a decrease in carcinogenic potential. One trial found that users who switched to vaporizing for one month reported improved self-reported respiratory symptoms.
Potential negative health effects of cannabis vaporization centre around the addition of likely harmful compounds such as Vitamin E Acetate. Consumers are advised not to purchase unregulated cannabis products sold illegally or off the street, with the CDC adding consumers should not add any substances to these products that are not intended by the manufacturer.
Contact your healthcare professional if you have any questions about how vaporizing nicotine or cannabis can affect you.
- Loflin, Mallory, and Mitch Earleywine. “No smoke, no fire: What the initial literature suggests regarding vapourized cannabis and respiratory risk.” Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR vol. 51,1 (2015): 7-9.
- Radcliffe, Shawn. “Illnesses from Vaping Top 400, 5 Deaths Reported: What to Know.” Healthline, Healthline Media, 19 Sept. 2019, https://www.healthline.com/health-news/vaping-illness-top-400.
- “For the Public: What You Need to Know.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/need-to-know/index.html.
- Eun M. Lee, Jennifer L. Malson, Eric T. Moolchan, Wallace B. Pickworth, Quantitative comparisons between a nicotine delivery device (Eclipse) and conventional cigarette smoking, Nicotine & Tobacco Research, Volume 6, Issue 1, February 2004, Pages 95–102, https://doi.org/10.1080/14622200310001656911
- “New Scientific Study Contradicts R.J. Reynolds' Claims That Eclipse Is a 'Reduced-Risk' Cigarette.” Campaign for Tobacco-Free Kids, 20 Aug. 2019, https://www.tobaccofreekids.org/press-releases/id_0305.
- Grana, Rachel et al. “E-cigarettes: a scientific review.” Circulation vol. 129,19 (2014): 1972-86. doi:10.1161/CIRCULATIONAHA.114.007667
- Bengalli, Rossella et al. “Lung Toxicity of Condensed Aerosol from E-CIG Liquids: Influence of the Flavor and the In Vitro Model Used.” International journal of environmental research and public health vol. 14,10 1254. 20 Oct. 2017, doi:10.3390/ijerph14101254
- Maciej L. Goniewicz, Tomasz Kuma, Michal Gawron, Jakub Knysak, Leon Kosmider, Nicotine Levels in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 15, Issue 1, January 2013, Pages 158–166, https://doi.org/10.1093/ntr/nts103
- “CRF–CRF1 system activation mediates withdrawal-induced increases in nicotine self-administration in nicotine-dependent rats”. Olivier George, Sandy Ghozland, Marc R. Azar, Pietro Cottone, Eric P. Zorrilla, Loren H. Parsons, Laura E. O'Dell, Heather N. Richardson, George F. Koob. Proceedings of the National Academy of Sciences, Oct 2007, 104 (43) 17198-17203; DOI: 10.1073/pnas.0707585104
- “Exposure to Chronic Intermittent Nicotine Vapor Induces Nicotine Dependence.” Pharmacology Biochemistry and Behavior, Elsevier, 24 Apr. 2010, https://www.sciencedirect.com/science/article/pii/S0091305710001085.
- Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, McIntosh S, et al. (2015) Vapors Produced by Electronic Cigarettes and E-Juices with Flavorings Induce Toxicity, Oxidative Stress, and Inflammatory Response in Lung Epithelial Cells and in Mouse Lung. PLoS ONE 10(2): e0116732. https://doi.org/10.1371/journal.pone.0116732
- Ma, Yunfeng, et al. “IL-6, IL-8 and TNF-α Levels Correlate with Disease Stage in Breast Cancer Patients.” Advances in Clinical and Experimental Medicine : Official Organ Wroclaw Medical University, U.S. National Library of Medicine, 2017, https://www.ncbi.nlm.nih.gov/pubmed/28791816.
- Kellesarian, SV, et al. “Recent Updates on Electronic Cigarette Aerosol and Inhaled Nicotine Effects on Periodontal and Pulmonary Tissues.” Wiley Online Library, John Wiley & Sons, Ltd (10.1111), 30 Mar. 2017, https://onlinelibrary.wiley.com/doi/abs/10.1111/odi.12652.
- Melamede1, Robert. “Cannabis and Tobacco Smoke Are Not Equally Carcinogenic.” Harm Reduction Journal, BioMed Central, 18 Oct. 2005, https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-2-21.
- Tetrault, Jeanette M et al. “Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review.” Archives of internal medicine vol. 167,3 (2007): 221-8. doi:10.1001/archinte.167.3.221
- Neel, Joe. “CDC Says Number Of Possible Cases Of Vaping-Related Lung Illness Has Doubled.” NPR, NPR, 6 Sept. 2019, https://www.npr.org/sections/health-shots/2019/09/06/758337583/cdc-says-number-of-possible-cases-of-vaping-related-lung-illness-has-doubled.
- U.S. Food and Drug Administration. “Vaping Illnesses: Consumers Can Help Protect Themselves by Avoiding Tetrahydrocannabinol (THC)-Containing Vaping Products.” PR Newswire: Press Release Distribution, Targeting, Monitoring and Marketing, 6 Sept. 2019, https://www.prnewswire.com/news-releases/vaping-illnesses-consumers-can-help-protect-themselves-by-avoiding-tetrahydrocannabinol-thc-containing-vaping-products-300913542.html.