Marijuana Smoking Research Articles

Adverse Effects of Cannabinoids and Tobacco Consumption on the Cardiovascular System: A Systematic Review.

With the recent legalization of marijuana in several countries for recreational use, a controversial belief is spreading about it being "safe". In this systematic review, we decided to investigate this belief and present the adverse effects of marijuana and tobacco smoking on the cardiovascular system.We carried out an electronic search on databases including PubMed, PubMed Central, and Medline. Medical Subject Headings (MeSH) terms and different keywords were used for data collection. We included studies published in the last 10 years that were in English. All types of study subjects were accepted. Grey literature, books, case reports and case series, overlapping and duplicate studies, and studies older than 10 years were excluded.In this review, we included 18 studies, which we then separated into the "tobacco and cardiovascular disease" arm and the "cannabinoids and cardiovascular disease" arm. We had 11 and seven studies for each of the arms, respectively. The types of articles included in this review were traditional and systematic reviews and meta-analyses.After reviewing all the data included in this article, we found out that cannabinoid consumption has a more devastating effect on the cardiovascular system when compared to tobacco. The shocking fact was that in several cases, deadly adverse effects were observed in patients within a few hours after consumption or even during their first time using cannabinoids.

MTF: Cannabis use with vaping goes up, cannabis smoking down

More and more high schoolers are using marijuana by vaping, and fewer are using it by smoking, according to a recent study of the Monitoring the Future (MTF) survey conducted by the National Institute on Drug Abuse (NIDA). So the next time you hear someone say that marijuana use in teens is going down, ask them about the route of administration.

Impact of cannabis-infused edibles on public safety and regulation.

Popularity of cannabis-infused products has bloomed since legalization for recreational use of marijuana started. Consumption of cannabis edibles has steadily increased, as restrictions on recreational cannabis smoking have become tighter. This phenomenon enhanced the possibility of these products crossing the state line. The most psychoactive component of cannabis, ∆9-tetrahydrocannabinol (THC) is infused in "edibles" and linked to physiological and psychological effects. Consumers unfamiliar with these edibles may mistake them for non-THC containing products, causing unintended use or overconsumption. In addition, these cannabis-infused edibles are posing significant health risks. The FDA has recognized the potential dangers and recommended that cannabis remain as a Schedule I substance and illegal at the federal level. However, states maintain control of determining the legality of cannabis related products, and creating guidelines distinguishing cannabis edibles from the non-cannabis containing products. Recently, the State of Maine offers a blueprint for edible regulation that should be implemented in all states that are considering or have legalized marijuana.

Vaping cannabis among teens is up, smoking cannabis among teens is down

More and more high schoolers are using marijuana by vaping, and fewer are using it by smoking, according to a recent study of the Monitoring the Future (MTF) survey conducted by the National Institute on Drug Abuse (NIDA). And use of other substances, particularly nicotine and binge drinking of alcohol, is strongly associated with vaping cannabis.

When Hotel Guests Complain About Tobacco, Electronic Cigarettes, and Cannabis: Lessons for Implementing Smoking Bans.

We analyzed reviews on tripadvisor.com from a random sample of N = 477 hotels in ten large cities in the US to examine how well existing policies protect guests from exposure to tobacco, electronic cigarette, and cannabis (TEC) smoke. We examined the association between complaints per 100 reviews with hotel smoking policies, star rating, cost, brand, and location. Of all TEC complaints, 80% were associated with thirdhand smoke residue lingering in hotels from previous guests. Compared to the hotel brands with the best records, the two worst-performing brands had 3.4- and 3.6-times higher complaint rates (P < .001). Hotels with ≤2-star ratings had twice the complaints as higher-rated hotels (P < .001). Compared to 100% smokefree hotels, those offering designated smoking rooms had a 35% higher rate of complaints (P < .05). The success of some hotel brands demonstrates it is feasible to protect guests by fully committing to, implementing, and enforcing 100% smokefree building policies.

Association between ABCB1 rs2235048 Polymorphism and THC Pharmacokinetics and Subjective Effects following Smoked Cannabis in Young Adults

Genetic influences on acute responses to psychoactive drugs may contribute to individual variability in addiction risk. ABCB1 is a human gene that encodes P-glycoprotein, an ATP-dependent efflux pump that may influence the pharmacokinetics of delta-9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis. Using data from 48 young adults (aged 19–25 years) reporting 1–4 days of cannabis use per week who completed a placebo-controlled human laboratory experiment, we tested the hypothesis that the rs2235048 polymorphism of ABCB1 would influence acute responses to smoked cannabis. C-allele carriers reported on average greater frequency of weekly cannabis use compared to the TT genotype carriers (TC/CC mean ± SEM = 2.74 ± 0.14, TT = 1.85 ± 0.24, p = 0.004). After smoking a single cannabis cigarette to their desired high, C-allele carriers had higher area-under-the-curve (AUC) of both THC metabolites (11-OH-THC TC/CC = 7.18 ± 9.64, TT = 3.28 ± 3.40, p = 0.05; THC-COOH TC/CC = 95.21 ± 116.12, TT = 45.92 ± 42.38, p = 0.043), and these results were impact by self-reported ethnicity. There were no significant differences in self-reported subjective drug effects except for a greater AUC of visual analogue scale rating of drug liking (TC/CC = 35,398.33 ± 37,233.72, TT = 15,895.56 ± 13,200.68, p = 0.017). Our preliminary findings suggest that further work in a larger sample should investigate whether human ABCB1 influences cannabis-related phenotypes and plays a role in the risk of developing a cannabis use disorder.

Drugs of Misuse: Focus on Vascular Dysfunction.

Common drugs of misuse, including cannabis, opioids, stimulants, alcohol, and anabolic steroids, have strikingly disparate acute and chronic vascular effects, leading to a wide range of clinical cardiovascular presentations. Acute cannabis smoking has been associated with increased risk for myocardial infarction and ischemic stroke in otherwise healthy young people. However, it remains uncertain if people who exclusively smoke cannabis have increased risk for accelerated atherosclerosis similar to that found in people who exclusively smoke tobacco cigarettes. Cocaine and methamphetamines, both stimulants, increase risk for stroke, myocardial infarction, aortic dissection, and accelerated atherosclerosis, but only methamphetamine use is strongly linked to pulmonary hypertension. Chronic alcohol use is strongly associated with chronic hypertension and hemorrhagic stroke, but perhaps confers a lower risk for myocardial infarction. Finally, anabolic steroid use, presumably through adverse effects on circulating lipids and the hematopoietic system, is associated with increased risk for accelerated atherosclerosis and myocardial infarction. Physicians, especially cardiologists, emergency medicine, and internal medicine physicians, should be familiar with the short- and long-term vascular consequences of use of these substances, thereby ensuring appropriate, specific, and informed counselling and treatment.

Outcomes of lung transplantation from donors with a history of substance abuse

ObjectiveThe study objective was to determine whether donor substance abuse (opioid overdose death, opioid use, cigarette or marijuana smoking) impacts lung acceptance and recipient outcomes. MethodsDonor offers to a single center from 2013 to 2019 were reviewed to determine if lung acceptance rates and recipient outcomes were affected by donor substance abuse. ResultsThere were 3515 donor offers over the study period. A total of 154 offers (4.4%) were opioid use and 117 (3.3%) were opioid overdose deaths. A total of 1744 donors (65.0%) smoked cigarettes and 69 donors (2.6%) smoked marijuana. Of smokers, 601 (35.0%) had less than 20 pack-year history and 1117 (65.0%) had more than 20 pack-year history. Substance abuse donors were younger (51.5 vs 55.2 P < .001), more often male (65.6 vs 54.8%, P < .001), more often White (86.2 vs 68.7%, P < .001), and had hepatitis C (8.3 vs 0.8%, P < .001). Donor acceptance was significantly associated with brain dead donors (odds ratio, 1.56, P < .001), donor smoking history (odds ratio, 0.56, P < .001), hepatitis C (odds ratio, 0.35, P < .001), younger age (odds ratio, 0.98, P < .001), male gender (odds ratio, 0.74, P = .004), and any substance abuse history (odds ratio, 0.50, P < .001), but not opioid use, opioid overdose death, or marijuana use. Recipient survival was equivalent when using lungs from donors who had opioid overdose death, who smoked marijuana, or who smoked cigarettes for less than 20 patient-years or more than 20 patient-years, and significantly longer in recipients of opioid use lungs. There was no significant difference in time to chronic lung allograft dysfunction for recipients who received lungs from opioid overdose death or with a history of opioid use, marijuana smoking, or cigarette smoking. ConclusionsDonor acceptance was impacted by cigarette smoking but not opioid use, opioid overdose death, or marijuana use. Graft outcomes and recipient survival were similar for recipients of lungs from donors who abused substances.

Measuring PM2.5 concentrations from secondhand tobacco vs. marijuana smoke in 9 rooms of a detached 2-story house

The widespread legalization of recreational marijuana raises growing concerns about exposure to secondhand marijuana smoke. An important location for marijuana smoking is the home, but few measurements of air pollutant concentrations in the home are available for a marijuana joint fully smoked in one of its rooms. We used research grade calibrated real-time continuous PM2.5 air monitors in controlled 5-hour experiments to measure fine particle concentrations in the 9 rooms of a detached, two-story, 4-bedroom home with either a tobacco cigarette or a marijuana joint fully smoked in the home's living room. The master bedroom's door was closed, and the other bedroom doors were open, as was the custom of occupants of this residence. In two experiments with a Marlboro tobacco cigarette smoked by a machine in the living room, the 5-hour mean PM2.5 concentrations in 9 rooms of the home were 15.2 μg/m3 (SD 5.6 μg/m3) and 15.0 μg/m3 (SD 3.7 μg/m3). In contrast, three experiments with pre-rolled marijuana joints smoked in the same manner in the living room produced 5-hour mean PM2.5 concentrations of 38.9 μg/m3 (SD 10.6 μg/m3), 79.8 μg/m3 (SD 25.7 μg/m3) and 80.7 μg/m3 (SD 28.8 μg/m3). In summary, the average secondhand PM2.5 concentrations from smoking a marijuana joint in the home were found to be 4.4 times as great as the secondhand PM2.5 concentrations from smoking a tobacco cigarette. Opening 3 windows by 12.7 cm reduced the high PM2.5 concentrations from marijuana smoking by 67 %, but the PM2.5 levels still exceeded those produced by tobacco smoking with the windows closed.

Association between Prenatal Marijuana and Tobacco Smoke Exposures and Small for Gestational Age at Birth.

The aim of this study was to determine the association of prenatal marijuana exposure with and without tobacco smoke exposure and small for gestational age (SGA) at birth. We conducted a secondary analysis of the prospective Lifestyle and Early Achievement in Families (LEAF) cohort enrolled from 2010 to 2015. We included singleton nonanomalous liveborn pregnancies. We assessed marijuana use inclusive of any pregnancy urine specimen with a Δ9-THC-COOH concentration of more than 15 ng/mL by mass spectrometry, self-report on questionnaire, and/or electronic health record; and self-reported maternal tobacco use. Because of the high co-frequency of marijuana with tobacco exposure in pregnancy and the known association between tobacco and fetal growth restriction, we modeled the exposure as: both marijuana and tobacco (hereafter "co-use"), only marijuana, only tobacco, and neither (reference). Incidence of SGA in each group was compared with the neither group. The primary outcome was SGA less than 10th percentile, and secondarily less than 5th percentile, using parity-specific definitions per 2017 US natality reference data. Among 325 assessed mothers, 46% had neither exposure, 11% had only prenatal marijuana exposure, 20% only tobacco exposure, and 23% co-use exposure. A third (33%) of infants were SGA less than 10th percentile and 20% SGA less than 5th percentile. Marijuana exposure only was associated with an increased risk of SGA less than 10th percentile (43 vs. 26%; adjusted relative risk [aRR]: 1.66; 95% confidence interval [CI]: 1.02-2.69), and SGA less than5th percentile (30 vs. 13%; aRR: 2.26; 95% CI: 1.15-4.47). Tobacco was not associated with SGA less than 10th percentile, but was with SGA less than 5th percentile (26 vs. 13%; aRR: 2.01; 95% CI: 1.13, 3.56). Co-use was not associated with increased SGA risk in multivariate analysis, but was in sensitivity analysis when tobacco use was defined using a cotinine assay rather than self-report (SGA <10th percentile, aRR: 1.97; 95% CI: 1.24-3.15) and (SGA <5th percentile, aRR: 2.03; 95% CI: 1.09-3.78). Prenatal marijuana exposure in addition to tobacco may increase the risk of SGA. Given the rising prevalence of marijuana use in pregnancy, further research is warranted to understand how in utero marijuana exposure may impact fetal growth and birth weight with and without tobacco exposure. · Marijuana and tobacco are commonly used together in pregnancy.. · Prenatal marijuana and tobacco exposure may increase the risk of a small for gestational age infant.. · Further research is warranted to understand how in utero marijuana exposure impacts fetal growth..

Assessing the influence of cannabis and alcohol use on different visual functions: A comparative study

This study aimed to assess and compare the influence of alcohol intake and cannabis smoking on different visual functions. A total of 64 young and healthy volunteers took part in the study. All undertook several randomised experimental sessions in which different visual functions, namely distance stereopsis, retinal straylight, visual discrimination capacity, and contrast sensitivity, were tested. Cannabis smokers (N = 30) took a baseline session and a session after smoking a cannabis cigarette, whereas alcohol users (N = 34) underwent a baseline session, a session after a low alcohol intake (Alcohol 1), and a session after a moderate to high alcohol intake (Alcohol 2). All visual functions were impaired by cannabis and alcohol use, particularly for the Cannabis and Alcohol 2 groups. The deterioration of all visual variables was higher for the Alcohol 2 than for the Alcohol 1 and Cannabis groups, except for retinal straylight, the deterioration of which was equal for the Cannabis group, and distant stereopsis, which was more impaired for the Cannabis group. The Alcohol 2 group experienced the most impairing conditions, although very similar to the cannabis group, and that factors other than the experimental conditions, such as sex and age, also influenced these visual changes. Alcohol and cannabis use clearly impair vision. The deterioration caused by cannabis is similar to, but slightly lower than, that produced by a moderate to high alcohol intake, with the experimental conditions, sex and age all having an impact on the variability of visual deterioration.

Man With Finger Ulcerations

A 49-year-old otherwise healthy man presented to the emergency department with blue discoloration and ulceration of his fingers. He described 6 weeks of waxing and waning painful skin breakdown on his fingertips with intermittent spontaneous drainage. Review of systems was otherwise unremarkable. He endorsed a history of heavy marijuana smoking but no tobacco use. Examination showed pitting of both hands with areas of ulceration on the fingertips (Figure 1). The Allen test for insufficient palmar arterial supply was positive.

Pathological Changes among Norvegicus Rattus Exposed on Novel Smoked Bambusa Vulgaris (Bamboo) Leaf: Cigarette Substitute during COVID-19 Lockdown in Nigeria

Background: This research titled; Pathology changes among Norvegicus Rattus exposed on novel smoked Bambusa vulgaris: Cigarette substitute during COVID 19 lockdown in Nigeria is stimulated following increase use of the aforementioned substances as a substitute to drugs during covid -19 lock down in Nigeria where a number of psychoactive substances were limited and restricted for months, both known addicts to cannabis and cigarette smoking and frustration induced initial smokers engaged massively on the use of bamboo leaf and that had continued after years of the lockdown.&#x0D; Methods: The experimental subjects were grouped into acute and chronic for both smoked and the control. Norvegicus rattus subjects were exposed to the 0.01g/g bamboo vulgaris dry leaf smoke twice daily for 21 and 42 days (acute and chronic) exposure respectively. The Animals were sacrificed and the organs harvested following ethical procedures for animal killing. The brain and lungs were divided and parts subjected into histopathological examination using formalin fixed paraffin processed methods stained with both routine and special stains, and the other parts were homogenized to investigate the oxidative stress biomarkers.&#x0D; Results: Histopathology results first revealed a severe cellular injury in both lungs and brain compare to the normal control; significance (p&lt;0.5) elevation found in MDA and reduced SOD, Gpx, GSH and catalase correlate the histology results with oxidative stress biomarkers.&#x0D; Conclusion: Smoking Bambusa vulgaris dry leaf is been found in this study to be more harmful to the respiratory system and brain in more rapid manner compared to conventional abused substances and should be discourage using state agency and enlightenment campaign

Fatal intoxication involving 2,5-dimethoxy-4-chloroamphetamine (DOC): A case report

2,5-dimethoxy-4-chloroamphetamine (DOC) is a substituted alpha-methylated phenethylamine, which was identified for the 1st time in 2009 in France, but is not classified as an illegal narcotic. This report presents a fatal intoxication involving consumption of DOC with analysis of multiple matrices. A 26-year-old man was found dead in his friend's apartment after a party. At place, numerous bottles of alcohol were discovered. The man was known as a cannabis smoker. Except the observation of a multi-visceral congestion and oedematous lungs, no obvious cause of death was identified at autopsy. Peripheral blood (PB), cardiac blood (CB), urine and bile were collected. Immunological screening for amphetamine, methamphetamine, opiates, cannabinoids, cocaine, buprenorphine, methadone and MDMA was performed on urine. Quantification of cannabinoids was performed on PB by GC-MS/MS. Analysis of ethanol and other volatile compounds was performed on PB and urine using HS-GC-MS. Ethylglucuronide (EtG) was quantified in PB and urine by GC-MS/MS. General unknown screening (GUS) was performed on PB by GC-MS and LC-PDA/MS. DOC was quantified in bloods, urine and bile by UHPLC-MS/MS after liquid-liquid extraction, using MBDB-d5 as internal standard. The assay was validated on whole blood for linearity (range: 2.0 to 500 ng/mL), selectivity, precision and accuracy at limit of quantification (LOQ: 2.0 ng/mL) and at high-level concentration (High QC: 400 ng/mL). The dilution process was validated in urine (dilution factor 1/10). Immunological screening was positive for cannabinoids. Confirmation in PB quantified THC, 11-OH-THC and THC-COOH at 3.40, 2.10 and 36.0 ng/mL, respectively. Ethanol analyses were negative but EtG was quantified at 0.48 μg/mL and 161 μg/mL in PB and urine, respectively. Mirtazapine was quantified at therapeutic concentration (20 ng/mL) in PB. DOC was detected on GUS by GC-MS and LC-PDA/MS. The method of DOC quantification was validated by measurement of accuracy and precision at the LOQ (104% and 12.6%) and at the High QC (97.4% and 8.5%). The 10-fold dilution process in urine was validated in term of accuracy (100%) and precision (4.1%). Selectivity was validated by analyzing 6 blank samples and no interference was observed at DOC retention time. In the present case, DOC was quantified at 104 ng/mL, 322 ng/mL, 648 ng/mL and 371 ng/mL in PB, CB, urine and bile respectively. Presence of cannabinoids and EtG in blood and urine suggest alcohol and cannabis consumption several hours preceding the death. Reports of use of DOC have mainly described non-fatal intoxications, with reported blood concentrations from < 10 to 18 ng/mL (Abbara. TOXAC 2017;29:82–89). At our best knowledge, only one fatal case has been reported in the literature (Barnett. JAT 2014;38:589–591), in which DOC blood and urine concentrations were 377 and 3193 ng/mL. Difference between PB and CB concentrations in the present case could be explain by postmortem redistribution. In the present case, the circumstances of death, autopsy findings and toxicological results were consistent with a toxic cause of death by DOC overdose in association with cannabis consumption.

Prenatal exposure to Cannabis smoke induces early and lasting damage to the brain

Cannabis is the most widely used illegal drug during pregnancy, however, the effects of gestational exposure to Cannabis smoke (CS) on the central nervous system development remain uncharacterised. This study investigates the effects of maternal CS inhalation on brain function in the offspring. Pregnant mice were exposed daily to 5 min of CS during gestational days (GD) 5.5–17.5. On GD 18.5 half of the dams were euthanized for foetus removal. The offspring from the remaining dams were euthanized on postnatal days (PND) 20 and 60 for evaluation. Brain volume, cortex cell number, SOX2, histone-H3, parvalbumin, NeuN, and BDNF immunoreactivity were assessed in all groups. In addition, levels of NeuN, CB1 receptor, and BDNF expression were assessed and cortical primary neurons from rats were treated with Cannabis smoke extract (CSE) for assessment of cell viability. We found that male foetuses from the CS exposed group had decreased brain volume, whereas mice at PND 60 from the exposed group presented with increased brain volume. Olfactory bulb and diencephalon volume were found lower in foetuses exposed to CS. Mice at PND 60 from the exposed group had a smaller volume in the thalamus and hypothalamus while the cerebellum presented with a greater volume. Also, there was an increase in cortical BDNF immunoreactivity in CS exposed mice at PND 60. Protein expression analysis showed an increase in pro-BDNF in foetus brains exposed to CS. Mice at PND 60 presented an increase in mature BDNF in the prefrontal cortex (PFC) in the exposed group and a higher CB1 receptor expression in the PFC. Moreover, hippocampal NeuN expression was higher in adult animals from the exposed group. Lastly, treatment of cortical primary neurons with doses of CSE resulted in decreased cell viability. These findings highlight the potential negative neurodevelopmental outcomes induced by gestational CS exposure.

EP-68 A Case of Spontaneous Pneumomediastinum due to Marijuana usage- A rare cause

Abstract Pneumomediastinum without trauma or clear secondary cause is called Spontaneous pneumomediastinum with an incidence between 0.001%-0.014% and most commonly seen in young males. Marijuana smoking has rarely been identified as a possible cause of spontaneous pneumomediastinum, which is likely caused by barotrauma during breathing manoeuvres. Fewer than 10 case reports have been reported in the literature on Marijuana causing Spontaneous pneumomediastinum. We present a 24year male who presented with dysphagia, swelling and crackling under the skin of his neck for the past 12hours, half an hour after blowing his nose. There was no chest pain or dyspnoea, and he was hemodynamically stable with normal blood investigations. He smokes cannabis regularly and occasionally does cocaine. On examination, surgical emphysema was felt on both sides of the neck; the systemic examination was unremarkable. CT thorax demonstrated extensive pneumomediastinum and surgical emphysema from the angle of the jaw throughout the neck and down to the right subcapsular region. No pneumothorax was seen, and lung parenchyma was unremarkable. However, to rule out the clinical suspicion of oesophageal rupture, he had a CT oesophagus with oral contrast, which showed no extravasation of contrast from the oesophagus. The patient was admitted for observation, and the Chest X-ray after 12hours dint show pneumothorax. He was clinically well, tolerating oral feeds, so he was discharged with oral antibiotics as a prophylactic cover as per UGI surgeons. The knowledge about this rare cause would help the physicians diagnose and educate the patients on the risk involved in using Marijuana.

Abstract P3005: Cannabinoid Receptor 1 Antagonist Genistein Attenuates Marijuana-Induced Vascular Inflammation

Epidemiological studies reveal that marijuana increases the risk of cardiovascular disease (CVD); however, little is known about the mechanism. Δ 9 -tetrahydrocannabinol (Δ 9 -THC), the psychoactive component of marijuana, binds cannabinoid receptor 1 (CB1/CNR1) in the vasculature and is implicated in CVD. A UK Biobank analysis found that cannabis is an independent risk factor for CVD. We found that marijuana smoking activated inflammatory cytokines implicated in CVD. In silico virtual screening identified genistein, a soybean isoflavone, as a putative CB1 antagonist. Human-induced pluripotent stem cell-derived endothelial cells (hiPSC-ECs) were used to model Δ 9 -THC induced inflammation and oxidative stress via NF-κB signaling. Knockdown of the CB1 receptor with siRNA, CRISPR interference (CRISPRi), and genistein attenuate the effects of Δ 9 -THC. In mice, genistein blocked Δ 9 -THC-induced endothelial dysfunction in wire myograph, reduced atherosclerotic plaque, and had minimal penetration of the central nervous system (CNS). Genistein is a peripherally restricted CB1 antagonist that attenuates Δ 9 -THC-induced atherosclerosis.

Differences in those who prefer smoking cannabis to other consumption forms for mental health: what can be learned to promote safer methods of consumption?

Smoking cannabis in medical users is associated with exposure to harmful toxins. It is important to characterize cannabis-use profiles and risk-factors for medical cannabis users who smoke cannabis. 100 members of a medical cannabis dispensary with mental health concerns were interviewed in detail about their cannabis use. Forty seven percent of participants preferred smoking only, 18% preferred vaporizing, 25% preferred both smoking and vaping, and 10% preferred oral ingestion methods. Smokers differed from other users in multiple ways, including a greater preference for THC-dominant chemovars, and more frequent and greater amount of cannabis consumption. Smoking was also associated with greater rates of alcohol use disorder. These results may inform harm-reduction approaches to decrease the number of individuals smoking cannabis and use less harmful methods of medical cannabis ingestion.

Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey

BackgroundLittle is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis. MethodsThis cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data. ResultsOverall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05). ConclusionsAlthough there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.

Increased Levels of the Acrolein Metabolite 3-Hydroxypropyl Mercapturic Acid in the Urine of e-Cigarette Users.

Carcinogen and toxicant uptake by e-cigarette users have not been fully evaluated. In the study reported here, we recruited 30 e-cigarette users, 63 nonsmokers, and 33 cigarette smokers who gave monthly urine samples over a period of 4-6 months. Their product use status was confirmed by measurements of exhaled CO, urinary total nicotine equivalents, cyanoethyl mercapturic acid (CEMA), and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. Urinary biomarkers of exposure to the carcinogens acrolein (3-hydroxypropyl mercapturic acid, 3-HPMA), benzene (S-phenyl mercapturic acid, SPMA), acrylonitrile (CEMA), and a combination of crotonaldehyde, methyl vinyl ketone, and methacrolein (3-hydroxy-1-methylpropyl mercapturic acid, HMPMA) were quantified at each visit. Data from subject visits with CEMA > 27 pmol/mL were excluded from the statistical analysis of the results because of possible unreported exposures to volatile combustion products such as secondhand cigarette smoke or marijuana smoke exposure; this left 22 e-cigarette users with 4 or more monthly visits and all 63 nonsmokers. Geometric mean levels of 3-HPMA (1249 versus 679.3 pmol/mL urine) were significantly higher (P = 0.003) in e-cigarette users than in nonsmokers, whereas levels of SPMA, CEMA, and HMPMA did not differ between these two groups. All analytes were significantly higher in cigarette smokers than in either e-cigarette users or nonsmokers. The results of this unique multimonth longitudinal study demonstrate consistent significantly higher uptake of the carcinogen acrolein in e-cigarette users versus nonsmokers, presenting a warning signal regarding e-cigarette use.