In-home cannabis smoking more prevalent than in-home tobacco smoking among 2019 global drug survey respondents

Background: Cannabis use has increased over the past several years as some countries have legalized its use for the treatment of certain medical conditions and/or for recreational use. Thus, concerns have risen about potential adverse health effects. Increasing number of reports have associated cannabis use with serious cardiovascular (CV) complications. Furthermore, there appears to be a likeness in the harmful health effects, especially on the CV and respiratory systems, of cannabis smoking to those of tobacco smoking. Objective: To review the CV effects of cannabis use and compare them with those of tobacco use. Methods: Articles were reviewed that were published in English literature reporting on cannabis and cannabinoid pharmacology and their effects on the CV system and their consequences. Emphasis was also placed on articles reporting on cannabis use in adolescents, exposure to secondhand smoke, its effect on exercise and finally its inter-relationship and similarities with tobacco use. Results: With growing cannabis use, an increasing number of reports have emerged associating marijuana use with serious and life-threatening CV complications, including acute coronary syndromes, potentially lethal cardiac arrhythmias and ischemic strokes. There are certain similarities of the deleterious CV and respiratory effects of cannabis smoking with those of tobacco smoking. Despite the difference in the active ingredients (tetrahydrocannabinol vs. nicotine), each substance produces a plethora of chemicals when smoked and these are largely identical; furthermore, due to different modes of smoking, cannabis chemicals are retained in the body for a longer time. Of course, concomitant tobacco and cannabis smoking is a perplexing factor in isolating damages specifically pertaining to cannabis use, while the health risk is additive. Although the mechanisms producing CV harm may be somewhat different between these two substances, the outcome appears similar, or even worse, as the effects may emerge at a younger age. Conclusion: There is an increasing concern that, apart from the mental health problem with cannabis smoking, societies may be facing another wave of a déjà vu/déjà vécu phenomenon similar to the tobacco smoking story.

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MP50: Vaping, tobacco and cannabis among patients presenting to the emergency department: a cross-sectional study

CJEM ◽

10.1017/cem.2020.198 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S60-S61

Author(s):

K. Zhou ◽

D. Junqueira ◽

S. Couperthwaite ◽

J. Meyer ◽

B. Rowe

Keyword(s):

Emergency Department ◽

Lung Injury ◽

Tobacco Smoking ◽

Respiratory Symptoms ◽

Cannabis Use ◽

Categorical Variables ◽

Continuous Variables ◽

Cannabis Smoking ◽

Lung Health ◽

Respiratory Conditions

Introduction: Inhaled toxins from tobacco smoking, cannabis leaf smoking as well as vaping/e-cigarette products use are known causes of cardio-respiratory injury. While tobacco smoking has decreased among Canadian adults, there are now several other forms of legal inhalant products. While legal, the evidence of benefit and safety of vaping is limited. Of concern, cases of e-cigarette or vaping products use associated lung injury (EVALI) have been accumulating in the U.S. and now in Canada. Despite this, very little is known about the inhalation exposure of emergency department (ED) patients; this study was designed to explore lung health in the ED. Methods: We investigated the prevalence of exposure to vaping, tobacco and cannabis among patients presenting to a Canadian ED from July to November 2019. Ambulatory (CTAS 2 to 5), stable, adult (≥ 17 years) patients were prospectively identified and invited to complete a survey addressing factors related to lung health (previous diagnosis of respiratory conditions and respiratory symptoms at the ED presentation) and information on current exposure to vaping, tobacco and cannabis smoking. Categorical variables are reported as frequencies and percentages; continuous variables are reported as medians with interquartile range (IQR). The study was approved by the Health Research Ethics Board. Results: Overall, 1024 (71%) of 1433 eligible patients completed the survey. The median age was 43.5 (IQR: 29, 60), and 51% were female. A total of 351 (31%) participants reported having been previously diagnosed with ≥1 respiratory conditions, and 177 (17%) were visiting the ED as a result of ≥1 respiratory symptoms (e.g., cough, shortness of breath, wheezing). Daily tobacco smoking was reported by 190 (19%), and 83 (8%) reported using vaping/e-cigarette products. Cannabis use within 30 days was described by 80 (15%) respondents. Exposure to tobacco and vaping products was reported by 39 (4%) participants, 63 (6%) reported using tobacco in combination with cannabis smoking, and 3% reported combining vaping and cannabis use. Conclusion: Patients seeking care in the ED are exposed to a large quantity of inhaled toxins. Vaping products, considered the cause of the most recent epidemic of severe lung injury, are used in isolation and in combination with other smoking products in Canada. These exposures should be documented and may increase the risk of lung health injuries and exacerbations of chronic respiratory conditions.

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Marijuana and the lung: hysteria or cause for concern?

Breathe ◽

10.1183/20734735.020418 ◽

2018 ◽

Vol 14 (3) ◽

pp. 196-205 ◽

Cited By ~ 8

Author(s):

Luis Ribeiro ◽

Philip W. Ind

Keyword(s):

Lung Cancer ◽

Chronic Bronchitis ◽

Tobacco Smoking ◽

Forced Vital Capacity ◽

Vital Capacity ◽

Marijuana Use ◽

List Type ◽

Shortness Of Breath ◽

Increased Risk ◽

Cannabis Smoking

Increasing cannabis use and legalisation highlights the paucity of data we have on the safety of cannabis smoking for respiratory health. Unfortunately, concurrent use of tobacco among marijuana smokers makes it difficult to untangle individual effect of marijuana smoking. Chronic cannabis only smoking has been shown in large cohort studies to reduce forced expiratory volume in 1 s/forced vital capacity via increasing forced vital capacity in chronic use contrary to the picture seen in tobacco smoking. The cause of this is unclear and there are various proposed mechanisms including respiratory muscle training secondary to method of inhalation and acute anti-inflammatory effect and bronchodilation of cannabis on the airways. While cannabis smoke has been shown to increase symptoms of chronic bronchitis, it has not been definitively shown to be associated with shortness of breath or irreversible airway changes. The evidence surrounding the development of lung cancer is less clear; however, preliminary evidence does not suggest association. Bullous lung disease associated with marijuana use has long been observed in clinical practice but published evidence is limited to a total of 57 published cases and only one cross-sectional study looking at radiological changes among chronic users which did not report any increase in macroscopic emphysema. More studies are required to elucidate these missing points to further guide risk stratification, clinical diagnosis and management.Key pointsCannabis smoking has increased and is likely to increase further with relaxation of legalisation and medicinal use of cannabinoids.Chronic marijuana smoking often produces symptoms similar to those of chronic tobacco smoking such as cough, sputum production, shortness of breath and wheeze.Cessation of marijuana smoking is associated with a reduction in respiratory symptoms and no increased risk of chronic bronchitis.Spirometry changes seen in chronic marijuana smokers appear to differ from those in chronic tobacco smokers. In chronic marijuana smokers there is an increase in FVC as opposed to a definite decrease in FEV1.Multiple case series have demonstrated peripheral bullae in marijuana smokers, but no observational studies have elucidated the risk.There is currently no clear association between cannabis smoking and lung cancer, although the research is currently limited.Educational aimsTo update readers on legalisation of recreational and medicinal cannabis.To summarise the evidence base surrounding the respiratory effects of inhaled marijuana use.To provide clinicians with an understanding of the main differences between cannabis and tobacco to be able to apply this to patient education.To highlight common respiratory problems among cannabis users and the need for recreational drug history taking.

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