Marijuana e-cigarettes are believed to be a safer alternative to smoking. Users can still benefit from all the advantages of cannabinoids and terpenes without inhaling carbon monoxide, particulate matter from plants, or over 100 toxins released during combustion.
However, a few years ago, the outbreak of lung disease (mostly related to the use of illegal THC oil) challenged this sense of safety. Acetate vitamin E, a cheap thickening agent used for diluting oil, was identified as the culprit and quickly removed from products. However, it may still persist in illegal oils and e-cigarettes.
Despite a sharp decline in the incidence of lung disease related to electronic vapor products, or EVALI, since reaching its peak in September 2019, concerns about the safety of marijuana vaporization persist in peer-reviewed scientific reports and mainstream media sources. While numerous articles have been written comparing the pros and cons of vaping electronic cigarettes versus consuming marijuana, it is important to revisit this issue in the post-vitamin E acetate era for comparison.
Why cannabis?
According to reports, the popularity of vaping cannabis is increasing along with the legal availability. However, vaping is rarely the sole method of consuming cannabis, as only 13% exclusively vape it. People often opt to vape cannabis instead of smoking it because it is more convenient, discreet, and efficient. Sometimes, people simply do not want their space to smell like weed.
E-cigarettes are also considered a safer choice because heating the liquid rarely exceeds 400°F, whereas burning flowers can reach close to 500°F, thus reducing the amount of harmful gases and toxins inhaled.
In addition, for those seeking specific and replicable effects, cannabinoids such as tetrahydrocannabinol (THC) or cannabidiol (CBD) and terpenes found in vaping cartridges can provide consistent results.
Furthermore, by adding cannabinoids and terpenes to traditional cultivation methods and strain genetics, optimization can be tailored to specific therapeutic needs or recreational desires. It is important to note, however, that the scientific evidence behind the combinations for therapeutic optimization is still primarily theoretical.
Is vaping safer than smoking cigarettes?
Over the past few years, there has been no controlled and randomized study directly comparing the safety of smoking and using electronic cigarettes using a standard causal inference model.
However, the belief that e-cigarettes do not harm the lungs may be a misconception. A study conducted in 2020 among 2,553 young people found that using e-cigarettes for marijuana at any time increased the risk of developing bronchial symptoms, such as shortness of breath. This result persisted even after adjusting for nicotine e-cigarettes and using marijuana or tobacco.
Last month, it was reported that using an electronic cigarette at least three times can double the risk of wheezing. Wheezing occurs when a person's airways become partially obstructed and they make a short whistling or rattling sound while breathing. However, it is important to note that the potential impact of previous exposure to vitamin E on the lungs cannot be ruled out as we approach the era of vitamin E acetate.
Studies on electronic cigarettes clearly indicate that they are associated with adverse effects on the lungs and airways. Even without nicotine, inflammation in the airways may be caused by the vaping liquid itself, suggesting that some of these effects may also extend to the vaporization of cannabinoids.
The anti-inflammatory properties of tetrahydrocannabinol (THC) and cannabidiol (CBD), particularly when used together, may counteract some of the inflammatory effects of cannabis vaporization. However, respiratory irritation is typically reported with cannabis vaporization, indicating that some level of inflammation may still occur.
When consuming unregulated e-cigarette products, there may be additional health issues that arise. While vitamin E acetate has largely disappeared from vape products, heating it can release destructive gases that contributed to the 2019 EVALI epidemic, which can be produced by other compounds found in unregulated delta-8, CBN, and CBG e-cigarette products. It is crucial to understand the contents of one's e-cigarette shopping cart for safe use.
Is there a difference in the effects between vaping and smoking?
The results of studies comparing smoking and vaping cannabis highlight the challenges researchers face when examining these consumption methods. Differences in usage history, frequency, and natural physiological variances can affect the levels of cannabinoids that enter the body and how long they remain.
In a study, when inhalation amounts were strictly controlled, there was no significant difference in the levels of tetrahydrocannabinol or other cannabinoids collected in the blood using these two methods.
However, in a study on infrequent marijuana users (meaning no use in the past 30 days), vaporizing was found to cause an increase in tetrahydrocannabinol (THC) content in the blood compared to smoking, resulting in greater impairment on various cognitive, visual, and subjective measures.
Similarly, another study investigated how smoking and e-cigarette use affect appetite and metabolism-related hormones after consuming a standard breakfast. While both smoking and vaping marijuana lowered insulin levels, smoking marijuana resulted in a greater decrease in insulin levels 15 minutes after use.
The decrease of insulin can partially explain the low incidence of type II diabetes among regular cannabis users, a disease that originates from excessive release of insulin and ultimately leads to insulin resistance.
Which is better? Smoking or vaping?
The EVALI panic of 2019 tarnished the safety reputation of vape devices in the eyes of the public, media, and research community. Reports of harm caused by cannabis vaporization may lead to "white hat bias" - where people unintentionally distort information to fit societal expectations or personal views of the industry.
In this situation, the historical illegality and ingrained societal beliefs about the harmful effects of marijuana may lead to the idea that consuming marijuana, even if no more harmful than smoking tobacco, is equally harmful.
Some individuals may report that although there is a lack of evidence indicating an increase in the harm of electronic cigarettes, their subjective experiences align with these beliefs. However, although most devices no longer contain publicly harmful additives that caused hospitalization and death during the EVALI outbreak, illegal and unapproved devices and e-cigarette liquids continue to circulate.
Studies comparing the long-term safety and health effects of smoking and electronic cigarettes have typically captured the extended usage of these unregulated products, which are more easily accessible. However, it remains difficult to draw conclusions regarding the long-term safety of electronic cigarettes based on existing devices and e-liquids.
There is no significant difference in the impact of acute smoking and e-cigarette use on the concentration of cannabinoids in the body. However, the differences in puff patterns between smoking a bowl and using an e-cigarette may have varying effects on the brain and body. Ultimately, as with most cannabis products, understanding its contents, the reputation of its source, and regulating intake are the key factors for safe and effective use.
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