Online survey characterizing vaporizer use among cannabis users

Highlights

• Online survey assessed current patterns of vaping in large sample of cannabis users.

• The majority of users had tried vaping cannabis but frequent vaping was not common.

• Few preferred vaping cannabis to smoking.

• Those that prefer vaping consider it to be a safer, more positive experience.

• Using Facebook can facilitate rapid repeated assessments of cannabis vaping.

Abstract

Background

Along with changes in cannabis laws in the United States and other countries, new products for consuming cannabis are emerging, with unclear public health implications. Vaporizing or “vaping” cannabis is gaining popularity, but little is known about its prevalence or consequences.

Methods

This study characterized the prevalence and current patterns of vaping cannabis among a large national sample of cannabis users. An online survey was distributed through Facebook ads targeting individuals with interests related to cannabis use. The sample comprised 2910 cannabis users (age: 18–90, 84% male, 74% Caucasian).

Results

A majority (61%) endorsed lifetime prevalence of ever vaping, 37% reported vaping in the past 30 days, 20% reported vaping more than 100 lifetime days, and 12% endorsed vaping as their preferred method. Compared to those that had never vaped, vaporizer users were younger, more likely to be male, initiated cannabis at an earlier age, and were less likely to be African American. Those that preferred vaping reported it to be healthier, better tasting, produced better effects, and more satisfying. Only 14% reported a reduction in smoking cannabis since initiating vaping, and only 5% mixed cannabis with nicotine in a vaporizer. Many cannabis users report vaping cannabis, but currently only a small subset prefers vaping to smoking and reports frequent vaping.

Conclusion

Increases in availability and marketing of vaping devices, and the changing legal status of cannabis in the United States and other countries may influence patterns of use. Frequent monitoring is needed to assess the impact of changing cannabis laws and regulations.

Introduction

The prevalence of using electronic cigarettes (e-cigs) to vaporize nicotine is rapidly growing and generating debate and research on its potential benefit and harm (Arrazola et al., 2015, Gostin and Glasner, 2014, Hajek et al., 2014). Similarly, devices now use similar electronic technologies to vaporize cannabis, and this practice is gaining popularity as an alternative to smoking cannabis products. Vaporizing, or ‘vaping’ cannabis refers to the process of heating cannabis concentrates, liquid, or plant material to a temperature that releases an aerosolized mixture of water vapor and active cannabinoids, which is then consumed by inhalation. Vaping devices for cannabis vary widely, from large tabletop units to small pen-style devices that are similar to e-cigs, and depending on the device, additional substances such as flavoring agents can be added to enhance the vaping experience (Giroud et al., 2015). Few studies have examined the practice of vaping cannabis, and little is known about its prevalence, patterns, or consequences.

Two small survey studies suggest that cannabis users believe vaping to be less harmful to their health than typical combustible smoking methods (Etter, 2015, Malouff et al., 2014), which is similar to tobacco users perceptions of e-cigs (Zhu et al., 2013). This theoretical benefit relates to reduction in the ingestion of potentially harmful cannabis smoke, which contains tar (phenols and carcinogens such as benzopyrene and benzanthracene), ammonia, hydrogen cyanide, and nitrosamines in comparable amounts to tobacco smoke (Tashkin, 2013), a benefit that may extend to concerns about second-hand cannabis smoke. A laboratory study evaluating contents of cannabis smoke and vapor found that the vaporizer extracted more active cannabinoids with fewer carcinogenic byproducts than smoking at 230 °C, but lower temperatures extracted minimal amounts of cannabinoids, suggesting that temperature control is important (Pomahacova et al., 2009). A study directly comparing the impact of smoking vs. vaping cannabis reported fewer respiratory problems associated with vaping (Earleywine and Barnwell, 2007), supporting the contention that vaping affords a harm reduction effect on respiratory disorders caused by cannabis smoking.

Aside from this potential health advantage of vaping over smoking, initial surveys have identified a number of other appealing aspects of vaping (Etter, 2015, Malouff et al., 2014). First, some believe that vaping provides a more efficient way to use cannabis (more positive effect for less cost or effort). Objective evidence for differences in psychoactive effects between vaping and smoking is lacking, however; a laboratory study of three cannabis cigarette concentrations (1.7%, 3.4%, and 6.8% THC) did not show clear differences in ratings of “high” between vaping and smoking, but 14 of 18 participants reported preference for vaping and expired carbon monoxide levels were lower after vaping (Abrams et al., 2007). Survey respondents identified two other positive features of vaping: better taste and the ability to use it more discreetly with little or no smell (Etter, 2015, Malouff et al., 2014).

As with use of e-cigs, public health concerns related to vaping cannabis warrant attention (Budney et al., 2015). First, little is known about the potential negative effects of acute and long-term inhalation of aerosols emitted by vaping devices. While vaping eliminates many of the potentially harmful byproducts of cannabis smoke (Pomahacova et al., 2009), more information is needed to determine the overall safety profile of vaporization. Second, the perceived positive attributes of vaping cannabis mentioned above could result in increased prevalence or frequency of cannabis use. Perceptions that vaping is a safer, better tasting experience that provides a more efficient high and can be used discreetly in locations where smoking cannot occur could contribute to earlier initiation of use, more rapid escalation of use, more frequent use, and therefore more problematic use of cannabis. Last is the contribution of vaping cannabis to an emerging “vaping culture” (Gostin and Glasner, 2014), which includes marketing of vaping devices not just for nicotine or cannabis, but for inhaling non-psychoactive flavors, which could increase the prevalence and decrease age of onset of cannabis (or nicotine) use via vaping devices.

The primary goal of the present online survey was to characterize age of onset, prevalence, and current patterns of vaping among cannabis users. Facebook was utilized to facilitate rapid data collection in a large, national sample of cannabis users and to obtain initial benchmarks for vaping. Previous studies have begun to assess trends in vaporizer use (Etter, 2015, Malouff et al., 2014), however, sample sizes were small and only included individuals that reported vaping cannabis and/or nicotine, so prevalence among cannabis users, and differences between cannabis users that vaped vs. never vaped were not assessed. To address these gaps, this survey assessed: (1) lifetime and current prevalence of vaping, (2) demographic differences between those who vape and those who do not, (3) reasons for vaping, (4) comparisons between smoking and vaping, (5) within-person vaping and smoking patterns, and (6) the relationship between vaping and other substance use (e.g., tobacco use, vaping flavors).