Pulmonology Advisor: How has the growing legalization of marijuana influenced the emerging vaping crisis?
Dr Tsai: We are now seeing more cases of patients who report vaping THC products, and this is in light of the recent outbreak of cases of individuals who have come in with severe respiratory illnesses from vaping.
Dr Neptune: Eleven states plus the District of Columbia have approved recreational marijuana, and 33 states plus the District of Columbia have approved medicinal marijuana.20 Despite this, there are no consensus polices or quality control targets. Each state has a different slate of policies and regulations governing the production and marketing of these products. This has resulted in an expanding armamentarium of cannabis-based products of different purity, composition, and consistency.
The recent evidence that a component of cannabis solutions might be implicated in several cases of vaping-related lung injury underscores the high risk of marijuana legalization without prudent nationwide oversight. In addition, because cannabis remains a Schedule I drug, rigorous observational and natural history studies are not being conducted or sufficiently supported by funding agencies.
Pulmonology Advisor: How should clinicians advise patients regarding the risks of vaping and smoking?
Dr Tsai: Clinicians should advise their patients that e-cigarettes with nicotine may potentially produce [fewer] toxic chemicals in the vapor, but that does not mean they are without long-term effects. Harmful toxins have been detected in the vapor, including formaldehyde, heavy metals, and diacetyl. At this time, vaping is still unregulated by the FDA, and the additives in the e-liquid can vary between products.
Dr Neptune: Given the lack of persuasive studies establishing e-cigarette efficacy that is comparable to current conventional therapies for tobacco dependence, and the recent concerns about serious respiratory toxicities, clinicians should discourage all patients from using these products.
Because smoking is the top preventable cause of premature death, we clinicians strenuously discourage youth and adults from smoking and should initiate smoking cessation therapy for all active smokers, regardless of whether they are ready to quit.
Pulmonology Advisor: What should be next steps in this area in terms of research, education, or otherwise?
Dr Tsai: More research is needed on vaping with THC products, as well as the long-term effects of e-cigarette use. Patients should be educated that vaping is not without harm and can still have potentially deadly effects.
Research priorities should include:
- Determine the toxicity of the most common components of e-cigarette solutions when delivered as a heated, inhaled vapor.
- Continue long-term observational studies of e-cigarette users to identify the late consequences of use.
- Develop new therapies that specifically address nicotine dependence in adolescents and teenagers.
Educational needs should include:
- Devise creative uses of social media to warn young people about the risks of e-cigarette use.
- Encourage the press to be discerning in their analyses of e-cigarette trials and clinical studies. There are many stakeholders that are not necessarily supportive of public health priorities.
The e-cigarette epidemic and recent lung injury crisis related to vaping reflect a failure of judicious federal regulation and fear of confronting powerful industries that do not serve public health interests. Everything that we are seeing was entirely predictable and preventable; that is the real tragedy.
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