43.3 Cannabis Vaping in Adolescents: A Review of Prevalence, Comorbidities, Appraisal of Lung Injury, and Long-Term Complications

Abstract

As of 2020, there were 2807 hospitalizations for electronic cigarette (e-cigarette)- or vaping-associated lung injury (EVALI) reported to the CDC, of which 15% were adolescents. As per a 2020 NIDA survey, there was a twofold increase in marijuana vaping in adolescents from 2017 to 2019. Recent studies have shown associations between marijuana smoking or vaping with bronchitis, increased risk of respiratory infections, and acute lung injury. Eighty-five percent of patients with vaping-associated lung injury had tetrahydrocannabinol (THC) or its metabolites in alveolar fluid samples. The objective of this study is to review the available literature on cannabis vaping in adolescents and understand the possible risks and pulmonary complications of vaping. We conducted a systematic review of literature using PubMed with keywords “cannabis” OR “marijuana,” “vaping” OR "e-cigarettes," “lung injury” OR “pneumonia,” in all fields. We included RCTs, cross-sectional studies, longitudinal studies, review articles, and case reports published until December 2020. The search resulted in 63 articles. After filtering for children and adolescents, 15 articles (2 cross-sectional surveys, 1 retrospective cohort, 7 case series or reports, 4 review articles, and 1 novel mental health metric) were identified for abstract and full paper review. We are currently conducting retrospective chart reviews of patients admitted to a tertiary care children’s hospital for lung infection or injury. Upon review of the selected 15 articles, there were no relevant longitudinal studies, which focused on the adolescents with e-cigarette- and cannabis-associated lung injuries or pneumonia. Out of the works that included adolescents, many focused on and surveyed only adults. The literature from PubMed about adolescent cannabis vaping was limited to a few case reports and case series. There are no comprehensive studies that have rigorously investigated cannabis vaping in adolescents. There needs to be more investigations into how e-cigarettes containing THC affects the adolescent population. Many complications have been associated with vaping of cannabis, nicotine, and combined products, such as COVID-19 susceptibility, EVALI, and pain and sedative management. More research needs to be done to explore these connections, especially in adolescents.