Smoking vs vaping

Over the years, people have developed various ways of smoking cannabis. Most recently, using a vaporiser or vape has become especially popular among nicotine and cannabis consumers. Vapes come in many different forms and have been used as a safer alternative to smoking or to help quit smoking. Unfortunately, inadequate regulations, a lack of research and vaping’s increasing popularity have resulted in counterfeit goods on the market. These products, which do not fulfill their purpose as smoking cessation or harm reduction tools, have created a lot of negative press.¹

You’ve probably seen the reports about vaping-related illnesses and deaths in the USA over the past years. A lot of people are now asking about the dangers of vaping. Is vaping safe? What are the effects of smoking? Is it better to smoke or vape? These questions are especially important now that the Food and Drug Administration (FDA) has just authorized the first vape products for marketing in the USA, which is leading to a lot of discussion about the safety and benefits of vaping compared to traditional methods of smoking.

I’m writing this piece to help you understand the risks related to vaping and some other ways of smoking cannabis, and the actions you can take to minimize harm from these products.

Cannabis Cigarettes

Cannabis cigarettes, also known as joints or spliffs, contain cannabis in the form of a hand-rolled cigarette (see here for more information). The cannabis in joints is smoked by burning it at very high temperatures, a process called combustion. At these temperatures many toxic compounds are inhaled, like when you smoke tobacco. Many of these compounds, such as formaldehyde, acetaldehyde and tar are higher in tobacco than cannabis smoke but most are still present when smoking a joint. Some even in higher amounts, like nitrogen oxides and ammonia.² These are known as carcinogens or cancer-causing agents.

There’s definitely a link between smoking cannabis and lung disorders. Long-term cannabis use can lead to chronic bronchitis, shortness of breath on exertion and possibly lung cancer.^{3, 4} However, people commonly add tobacco to their joints to help cannabis burn better⁷, so it’s hard to separate the harmful effects of these drugs. Adding tobacco increases the temperature of the joint, ultimately increasing the toxic by-products and making cannabis and tobacco an unhealthy combination (5) that comes with risks for your health.

Vaping

Initially popularised in the nicotine market, cannabis vapes heat a liquid concentrate, also known as cannabis oil, or the cannabis flower at lower temperatures compared to traditional cigarettes. This generates a vapour with fewer harmful compounds. Some studies do show that people who switch to vaping, from smoking cannabis, have improved respiratory symptoms and lung function.^{5, 6, 12} So there certainly are potential benefits to vaping compared to traditional forms of smoking.

It is also important to recognise the difference between vaping oils and vaping cannabis flower, a distinction that even health officials fail to make.¹³ Using a dry herb vaporizer to vape cannabis flower may have several health advantages. For example, vaping using the oils requires a higher temperature compared to vaping flower which, as mentioned, tends to produce fewer harmful compounds.¹⁴

But over the past year, the U.S. has come across over 2,000 cases of vaping-related illnesses and at least 39 confirmed deaths, which is being described as a health crisis. These vaping-associated-lung-injuries, referred to as VALI, can come in different forms but typically present with the following symptoms:¹⁵

• Cough
• Shortness of breath (especially after using vaporiser)
• Chest pain
• Nausea, vomiting or diarrhoea
• Fatigue
• Fever
• Weight loss

So, what caused this “health crisis”? Since the vaping devices and associated illnesses are somewhat new, there is not enough research to fully understand the causes. Part of the issue is that ineffective government regulations and laws make it difficult to conduct studies with cannabis.¹. One thing that seems clear is that the majority of the illnesses are linked to vaping cannabis oils, and not cannabis flower. Beyond that, health officials and researchers have some good ideas based on the cases that have emerged.

One of the illnesses that may be caused by vaping oils, referred to as “popcorn lung”, is an inflammatory condition that results in blocked airways. Treatments used for other lung illnesses do not work with popcorn lung, so patients are sometimes left with no option other than a lung transplant.¹⁵

The condition was originally identified in workers of a microwave popcorn factory, and the culprit was inhalation of a chemical called diacetyl. It turns out that diacetyl and similar chemicals, such as 2,3-pentanedione and acetoin, are added to some cannabis liquids for flavouring.^{12, 15, 16, 17, 18} Research has shown that these compounds can cause damage to the lungs,¹⁷ and that the smoke from flavoured liquids especially has high levels of toxic by-products as a result.¹⁸ The U.S. Food and Drug Administration is, because of these findings and the appeal of flavours for young underage smokers, looking to ban all flavoured vaping products.

Investigations have also brought to light some other potential causes of the vaping illnesses. The cannabis oils contain thinning agents that dilute the product. When heated, such as during vaping, these compounds produce toxic by-products. Some of these agents seem to be more harmful than others, most notably polyethylene glycol 400 (PEG 400).⁸ Another chemical that can cause injury if inhaled is vitamin E acetate, which has been found in many black market devices, cartridges and liquids^{12, 15} and in fluid samples from the lungs of patients with vaping illnesses.²⁰

So, is vaping bad for you?

As with any drug, the safest action is to avoid vaping altogether, especially as the exact risks and benefits are currently unclear. But if you find yourself going back to smoking joints, vaping may still be a safer choice as long as you keep these pointers in mind:

• Use a dry herb vaporizer to vape cannabis flower. This may be a healthier alternative to the cannabis oils.¹⁴
• If possible, search the ingredients of the liquid products and avoid thinning agent PEG 400. Vegetable glycerine (VG) is a safer option.⁸
• Buy official products, and only cartridges and liquids meant for this device.⁹
• If possible, avoid vitamin E acetate, often found in black market products.^{12, 15}
• If you do shop on the black market, DO NOT buy “Dank Vapes” devices.¹⁹
• Keep the device voltage low (definitely below 3.8V) or, if it displays the temperature, maintain the temperature between 200-230℃ ²¹, as toxic by-products increase with higher power and temperature.⁸
• Take shorter puffs, as the temperature increases the longer you inhale.¹⁸
• Clean the coil</u> of the product regularly, or buy a new device. “Coil gunk” can increase toxic elements in the vape smoke.^{10, 11}
• Avoid flavoured products, as these contain higher levels of diacetyl, 2,3-pentanedione and acetoin.^{12, 15, 16, 17, 18}

I hope that this article was interesting and provided you with a bit more context around vaping, smoking and the recent illnesses that have appeared. It is important for everyone to have honest, evidence-based discussions about vaping, which, if used in a safe manner and with the right intentions, can be a less harmful alternative to smoking. There are risks involved with vaping, particularly since many younger adults and youths are drawn to the products even though they are not smokers to begin with. But ignoring how vaping can be useful is not the right direction. Keep reading about this and related topics so we can continue to learn together! You can start by looking at some other articles on Drugs & Me, such as our cannabis guide that provides other tips to manage the benefit and harm of cannabis use.

This post was created for informational purposes and is not a substitute for professional medical advice. All drugs pose risks, and the best way to avoid them is not to take any, but we understand that people still choose to do so. Drugs and Me exists to provide you with information about drugs, helping to manage the benefit and harm of drugs based on the best evidence available. Take a look at our various guides to find out how you can stay safe.

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References

¹ Richtel, M. (2019). Marijuana and Vaping: Shadowy Past, Dangerous Present. The New York Times [Internet]. The New York Times. Accessed: 8 Feb 2020.

² Moir D, Rickert WS, Levasseur G, Larose Y, Maertens R, White P, Desjardins S. (2007). A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chemical research in toxicology. Dec 7;21(2):494-502.

³ CNA (2018). Harm reduction for non-medical cannabis use. CNA-AIIC. Accessed: 8 Feb 2020.

⁴ Biehl JR, Burnham EL. (2015). Cannabis smoking in 2015: a concern for lung health?50637-5/fulltext) Chest. 2015 Sep 1;148(3):596-606.

⁵ Owen KP, Sutter ME, Albertson TE. (2014). Marijuana: respiratory tract effects. Clinical reviews in allergy & immunology;46(1):65-81.

⁶ Loflin M, Earleywine M. (2015). No smoke, no fire: What the initial literature suggests regarding vapourized cannabis and respiratory risk. Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR.51(1):7.

⁷ Van der Kooy F, Pomahacova B, Verpoorte R. (2009). Cannabis smoke condensate II: influence of tobacco on tetrahydrocannabinol levels. Inhalation Toxicology, 21(2):87-90.

⁸ Troutt WD, DiDonato MD. (2017). Carbonyl compounds produced by vaporizing cannabis oil thinning agents. The Journal of Alternative and Complementary Medicine, 23(11):879-84.

⁹ Belluz J. (2019). Vaping appears to be making hundreds of people sick. Doctors have no idea why.. Accessed: 8 Feb 2020.

¹⁰ Sleiman M, Logue JM, Montesinos VN, Russell ML, Litter MI, Gundel LA, Destaillats H. (2016). Emissions from electronic cigarettes: key parameters affecting the release of harmful chemicals. Environmental science & technology, 50(17):9644-51.

¹¹ Varlet V, Concha-Lozano N, Berthet A, Plateel G, Favrat B, De Cesare M, Lauer E, Augsburger M, Thomas A, Giroud C. (2016). Drug vaping applied to cannabis: Is “Cannavaping” a therapeutic alternative to marijuana? Scientific reports, 6:25599.

¹² Borodovsky JT, Cavazos‐Rehg PA, Bierut LJ, Grucza RA. (2019). Cannabis Vaping and Health: Regulatory Considerations. Addiction.

¹³ CDC (2020) Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Centers for Disease Control and Prevention. Department of Health and Human Services. Accessed: 8 Feb 2020.

¹⁶ DaVinci (2019). A Dry Herb Vaporizer vs. Other Smoking Methods. DaVinci. Accessed: 8 Feb 2020.

¹⁵ Astorino DM. (2019). How Bad Is Vaping, Really? Shape. Accessed: 8 Feb 2020.

¹⁶ Allen JG, Flanigan SS, LeBlanc M, Vallarino J, MacNaughton P, Stewart JH, Christiani DC. (2015). Flavoring chemicals in e-cigarettes: diacetyl, 2, 3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environmental health perspectives, 124(6):733-9.

¹⁷ Park HR, O’Sullivan M, Vallarino J, Shumyatcher M, Himes BE, Park JA, Christiani DC, Allen J, Lu Q. (2019). Transcriptomic response of primary human airway epithelial cells to flavoring chemicals in electronic cigarettes. Scientific reports. 2019 Feb 1;9(1):1400.

¹⁸ Qu Y, Kim KH, Szulejko JE. (2018). The effect of flavor content in e-liquids on e-cigarette emissions of carbonyl compounds. Environmental research, 166:324-33.

¹⁹ Associated Press (2019). Here are the e-cigarette brands linked to the vaping epidemic. New York. Accessed: 8 Feb 2020.

²⁰ King, B.A., Jones, C.M., Baldwin, G.T. and Briss, P.A., (2020). The EVALI and youth vaping epidemics—implications for public health. New England Journal of Medicine, 382(8), pp.689-691.