Vaping: also harmful if cannabidiol replaces nicotine

Many erroneously assume that e-cigarettes are not as harmful as normal cigarettes. Unfortunately, this is not the case, according to a recent study.

Which is riskier: Vaping nicotine or cannabidiol?

A common assumption or hope among users is that vaping is not so bad if it at least does not involve nicotine. Unfortunately, this also proves to be untrue. On the one hand, many studies have been able to confirm harmful effects without nicotine or cannabis being vaped at all. Recently, a recent study using in vivo and in vitro models (mice and human immune and airway cells) investigated which option is more toxic for the lungs and immune cells: vaping nicotine or cannabidiol (CBD)? The results may surprise some.

The models were exposed to filtered air, nicotine and CBD aerosols for a fortnight. Harmful effects were evident for both CBD and nicotine after this short time. However, vaping CBD in this experiment triggered an even stronger inflammatory reaction and led to more pathological changes in the lungs than vaping nicotine.1 The CBD aerosols weakened the immune system even more significantly by killing more neutrophils. A lower number of pulmonary macrophages, which normally also protect against infections, was also detectable.2

However, a major methodological limitation of the study is that different solvents were used for vaping nicotine and CBD, and their harmfulness when heated was not addressed separately.

Further studies needed

The transferability of animal and in vitro exposure models to real human exposure is limited. For now, it can be concluded that heating hydrocarbons (such as THC/CBD) is simply not a good idea and that the effects of CBD vaping would be an urgent topic for further research. This is also illustrated by recent trends: a nationwide survey in the US over 20 years reported a 245% increase in cannabis use among minors with a simultaneous decrease in alcohol consumption.3 Similarly, an analysis of data from the PATH (Population Assessment of Tobacco and Health) study published in JAMA Pediatrics in 2022 found that most smoking adolescents and young adults currently use cannabis rather than nicotine.3

According to data from the CDC (US Centres for Disease Control and Prevention), the increased incidence of e-cigarette or vaping use-associated lung injury (EVALI) in the USA in 2019 was due to vitamin E acetate oil (also known as tocopheryl acetate), which was added en masse to illegal cannabis cartridges as a blending agent.4

Alarming trends

In the USA alone, more than 2.5 million young people consumed vaping products in 2022. Most (85%) use flavoured e-cigarettes. Fruit flavours were the most popular, followed by candy and dessert flavours, mint and menthol. "These numbers are simply unacceptable," says Lisa Lacasse, President of the American Cancer Society Cancer Action Network, in a press release. "We cannot accept that more than 2.5 million children are being lured into a lifelong addiction by e-cigarettes. "5

Another CDC report makes it clear that nicotine is no less of a problem. "Youth use of tobacco products in any form, including electronic cigarettes, is hazardous to health, and most e-cigarettes contain nicotine, which is highly addictive, can damage the developing adolescent brain, and can increase the risk of later addiction to other drugs,"5 

A 2023 study also shows that vaping causes more DNA damage in the mouth than conventional cigarettes. Those who used sweet-flavoured pods had the highest levels of DNA damage, followed by those who used fruit or mint flavours.6

References
  1. Bhat, T. A., Kalathil, S. G., Goniewicz, M. L., Hutson, A. & Thanavala, Y. Not all vaping is the same: differential pulmonary effects of vaping cannabidiol versus nicotine. Thorax 78, 922–932 (2023).
  2. Is Vaping CBD Really Better Than Nicotine? Research Shows CBD Can Be Harmful to Lungs | Immunology. Labroots https://www.labroots.com/trending/immunology/25208/vaping-cbd-worse-nicotine.
  3. Caruana, D. Emerging Patterns of Cannabis Consumption. Vaping Post https://www.vapingpost.com/2023/07/13/emerging-patterns-of-cannabis-consumption/ (2023).
  4. New York State Department of Health Announces Update on Investigation into Vaping-Associated Pulmonary Illnesses. https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm.
  5. CDC survey shows more than 2.5 million young people used electronic cigarettes in 2022, and most were flavored products – Kentucky Health News. https://cidev.uky.edu/kentuckyhealthnews/2022/10/10/cdc-survey-shows-more-than-2-5-million-young-people-used-electronic-cigarettes-in-2022-and-most-were-flavored-products/ (2022).
  6. Tommasi, S., Blumenfeld, H. & Besaratinia, A. Vaping Dose, Device Type, and E-Liquid Flavor are Determinants of DNA Damage in Electronic Cigarette Users. Nicotine Tob Res 25, 1145–1154 (2023).