Stealth-vaping: a new era of illicit substance misuse? a systematic review and meta-analysis of the prevalence of electronic nicotine delivery systems for the consumption of illicit substances

AimsTo estimate the prevalence of using Electronic Nicotine Delivery Systems (ENDS) for the consumption of illicit Substances (illegal under UK Law). We hypothesised that this is an increasingly common mode of delivery.BackgroundUsing ENDS to consume nicotine is increasing in popularity worldwide with a prevalence in the UK of 6% and in the USA 4%-6%. Existing studies have reported that people are switching to vaping because it is felt to be safer than smoking.However there is also emerging evidence that this mode of consumption is increasingly being used as it is discreet and much less easy to detect, hence sometimes referred to as stealth-vaping. This appears to be driving a switch to vaping to administer substances other than nicotine, notably, but not exclusively cannabis, including concentrated forms of Tetrahydrocannabinol (THC) and synthetic cannabinoids. Anecdotally this practice is known to be occurring in psychiatric inpatient settings.This is against a backdrop of the uncertain long-term effects of vaping and the emergence of case reports of the death of otherwise healthy young persons after using ENDS to consume cannabis.MethodSearch strategy: MEDLINE , EMBASE, Cochrane Database of Systematic Reviews, Grey Literature using Medical Subject Headings (MeSH), text words relating to vaping of drugs and hand searching journals.Statistical methods: Synthesis of data was performed using inverse variance with double arcsine transformation in MetaXL. Heterogeneity was assessed with the Cochran's Q and I2.ResultFrom 970 abstracts, 61 papers were selected for full text review, 18 met the inclusion criteria. The total study population for the outcome of ENDS nicotine users who also use ENDS for the consumption of illicit substances was 9098. There was significant heterogeneity with a random effects model prevalence of 17% (95%CI 7%-32%). The total study population for the outcome of cannabis users who use ENDS to consume cannabis was 52708. There was significant heterogeneity with a random effects model prevalence of 23% (95%CI 12%-37%).ConclusionThe use of ENDS to consume illicit substances is concerning as it appears to be relatively common practice. This was most notable in studies of existing cannabis users, younger people and medical marijuana users.Given the uncertainty of long term health consequences and poor understanding of sudden death in some users, this study highlights an emerging and substantial public health concern.Currently there is a paucity of primary studies to elucidate the impact on health.

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In vitro and in vivo cardiac toxicity of flavored electronic nicotine delivery systems

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00283.2020 ◽

2021 ◽

Vol 320 (1) ◽

pp. H133-H143

Author(s):

Obada Abouassali ◽

Mengmeng Chang ◽

Bojjibabu Chidipi ◽

Jose Luis Martinez ◽

Michelle Reiser ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Cardiac Electrophysiology ◽

Cardiac Toxicity ◽

Delivery Systems ◽

Cardiac Safety ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

The use of electronic nicotine delivery systems (ENDS) is not harm free. It is not known whether ENDS negatively affect cardiac electrophysiological function. Our study in cell lines and in mice shows that ENDS can compromise cardiac electrophysiology, leading to action potential instability and inducible ventricular arrhythmias. Further investigations are necessary to assess the long-term cardiac safety profile of ENDS products in humans and to better understand how individual components of ENDS affect cardiac toxicity.

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A scoping review of studies on the health impact of electronic nicotine delivery systems

Internal and Emergency Medicine ◽

10.1007/s11739-021-02835-4 ◽

2021 ◽

Author(s):

Cother Hajat ◽

Emma Stein ◽

Saran Shantikumar ◽

Raymond Niaura ◽

Pietro Ferrara ◽

...

Keyword(s):

Mental Health ◽

Scoping Review ◽

Controlled Trial ◽

Health Impact ◽

Delivery Systems ◽

Chronic Obstructive ◽

Cross Sectional ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

AbstractWe conducted a scoping review of studies on health outcomes from electronic nicotine delivery systems (ENDS). The objective was to identify, narratively synthesize, assess the strength and quality of evidence and critically appraise studies that have reported disease end points associated with the use of ENDS. We included published literature on the health impact of ENDS from 01/01/2015 until 01/02/2020 following the PRISMA guidelines using PubMed, Embase, Scopus and Google Scholar. The database search identified 755 studies, and other sources 265; 37 studies met final eligibility criteria. Levels of evidence included 24(65%) cross-sectional, one (2.7%) case–control and six (16%) case studies, four (11%) cohort studies, one (2.7%) randomized controlled trial (RCT) and one (2.7%) meta-analysis; 27(73%) studies reported only on harms, eight (22%) reported on benefits, two (2%) on benefits and harms. Quality ratings were poor in 20 (54%), fair in 9(24%) and good in 8(22%) of studies. In our review, ENDS was not shown to be causative for harmful cardiovascular disease (CVD) outcomes and shown to be beneficial for hypertensive patients. Switching from cigarettes to e-cigarettes resulted in reduced exacerbations of chronic obstructive pulmonary disease (COPD), with no evidence of long-term deterioration in lung function. Mental Health, cancer and mortality were not adequately studied to form any consensus. Our review has not demonstrated ENDS to be causative of harmful CVD outcomes; furthermore switching from cigarettes to e-cigarettes was associated with improved hypertensive control and reduced exacerbations of COPD, with no evidence of increased asthma risk or long-term respiratory harm. Mental health, cancer and mortality outcomes have not been adequately studied to form a conclusion. Overall, the findings of our review did not provide evidence to counter the consensus held by many that ENDS use is safer than the risks posed from smoking cigarettes.

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Electronic Nicotine Delivery Systems (ENDS) and Their Relevance in Oral Health

Toxics ◽

10.3390/toxics7040061 ◽

2019 ◽

Vol 7 (4) ◽

pp. 61 ◽

Cited By ~ 4

Author(s):

Gozde Isik Andrikopoulos ◽

Konstantinos Farsalinos ◽

Konstantinos Poulas

Keyword(s):

Oral Health ◽

Periodontal Diseases ◽

Delivery Systems ◽

Long Term Effects ◽

Periodontal Health ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

Gingival Cells ◽

Oral Cells

The number and popularity of electronic nicotine delivery systems (ENDS) and especially e-cigarettes (e-cigs) have been increasing in the last decade. Although ENDS owe their popularity to excluding the harmful chemicals that are present in tobacco smoke, there is a debate whether they are safe, regulated, and as harmless as they are assumed to be and have potential unknown long-term effects. Involvement of cigarette smoking to the progression of periodontal diseases, other adverse oral health outcomes, and its detrimental effects to oral health are well-described. ENDS producer companies claim that these products can improve oral health by providing alternatives to smoking. However, the effect of e-cigs on oral health is not fully understood and is still debated among many scientists and clinicians. The number of studies addressing the potential toxic effect of ENDS or e-cig aerosol on oral cells is limited along with the clinical studies which are still preliminary, and their sample size is limited. The long-term effects of inhaled aerosols and the potential synergistic effect of the e-cigs components are not known. It is essential and of utmost importance to determine whether exposure to ENDS aerosol contributes to the progression of periodontal diseases and how it affects periodontal ligament and gingival cells which are believed to be its first targets. This review briefly summarizes the available evidence about the effects of e-cigs on periodontal health including several pathophysiological events, such as oxidative stress, DNA damage, inflammation, cellular senescence, dysregulated repair, and periodontal diseases.

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Beliefs and Self-reported Practices of Health Care Professionals Regarding Electronic Nicotine Delivery Systems: A Mixed-Methods Systematic Review and Synthesis

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz046 ◽

2019 ◽

Vol 22 (5) ◽

pp. 619-629 ◽

Cited By ~ 6

Author(s):

Daniel A Erku ◽

Coral E Gartner ◽

Kylie Morphett ◽

Kathryn J Steadman

Keyword(s):

Health Care ◽

Mixed Methods ◽

Health Care Professionals ◽

Delivery Systems ◽

Potential Health ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

Patient Health ◽

Training And Support

Abstract Aims This review explores the (1) beliefs and attitudes of health care professionals (HCPs) toward electronic nicotine delivery systems (ENDS) including use as a smoking cessation aid and/or harm reduction, safety and regulation, and (2) the extent and content of patient–HCP communication about ENDS. Methods PubMed, Embase, CINAHL, and PsycINFO were searched to identify articles published since 2003. The Mixed Methods Appraisal Tool and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of studies. Thematic synthesis was used to analyze qualitative data. Results A total of 45 articles (32 quantitative, 12 qualitative, and 1 mixed) were included. There was wide variation regarding beliefs about the efficacy of ENDS as a cessation aid. Although the majority of HCPs believes that ENDS are safer than combustible cigarettes, they also have concern about the short and long-term safety of ENDS, uptake by adolescents, and the potential for ENDS to act as a “gateway” to smoking cigarettes. Beliefs about ENDS are influenced by media stories and experiences provided by patients. Although most HCPs do not proactively recommend ENDS, they are more likely to support ENDS use among patients with smoking related comorbidities, heavy smokers with previous unsuccessful quit attempts, or patients who express interest in trying them. Conclusions Overall, HCPs hold diverse views about the efficacy of ENDS and expressed wariness over their potential health effects. HCP endorsement of ENDS use seems to depend largely on patient health status, the presence of other competing risk factors and patient preferences. Implication Although evidence on safety and efficacy of ENDS is emerging, HCPs should be honest with their clients, stating that the long-term safety is not yet established but what is known is that they appear to be a lower risk alternative to cigarettes. Our review highlights a need for further training and support for HCPs regarding ENDS use, which would enable them to guide their clients in making evidence-based decisions.

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Electronic Nicotine Delivery Systems Rejection Measure

PsycTESTS Dataset ◽

10.1037/t77883-000 ◽

2020 ◽

Author(s):

Scott R. Weaver ◽

J. Wesley Heath ◽

David L. Ashley ◽

Jidong Huang ◽

Terry F. Pechacek ◽

...

Keyword(s):

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

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Injuries associated with electronic nicotine delivery systems

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002834 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Tom Vyncke ◽

Edward De Wolf ◽

Henk Hoeksema ◽

Jozef Verbelen ◽

Petra De Coninck ◽

...

Keyword(s):

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

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Guidance to Employers on Integrating E-Cigarettes/Electronic Nicotine Delivery Systems Into Tobacco Worksite Policy

Journal of Occupational and Environmental Medicine ◽

10.1097/jom.0000000000000420 ◽

2015 ◽

Vol 57 (3) ◽

pp. 334-343 ◽

Cited By ~ 5

Author(s):

Laurie P. Whitsel ◽

Neal Benowitz ◽

Aruni Bhatnagar ◽

Chris Bullen ◽

Fred Goldstein ◽

...

Keyword(s):

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

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Statewide vaping product excise tax policy and use of electronic nicotine delivery systems among US young adults, 2014–2019

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056653 ◽

2021 ◽

pp. tobaccocontrol-2021-056653

Author(s):

Dae-Hee Han ◽

Dong-Chul Seo ◽

Hsien-Chang Lin

Keyword(s):

Young Adults ◽

Tax Policy ◽

State Level ◽

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Us States ◽

Excise Tax ◽

Nicotine Delivery ◽

Logistic Regressions ◽

State Changes

ObjectivesAn increasing number of US states have required a tax on electronic nicotine delivery systems (ENDS) in the past few years. This study evaluated the effect of statewide vaping product excise tax policy on ENDS use among young adults.MethodsWe used the two recent waves (2014–2019) of the Tobacco Use Supplement to the Current Population Survey. A total of 17 896 US young adults were analysed. Difference-in-differences approach along with weighted multilevel logistic regressions were used to evaluate the association of vaping product excise tax policy adoption with current ENDS use, accounting for the clustering of respondents within the same states.ResultsThere was an increase in current ENDS use prevalence from 2014–2015 (3.4%) to 2018–2019 (5.4%). The presence of a tax on ENDS products was significantly associated with reduced current ENDS use (adjusted OR (AOR)=0.64, 95% CI=0.43 to 0.95). Importantly, respondents living in states with the policy showed significantly lower increase in ENDS use prevalence during the study period (interaction between within-state changes and between-state differences: AOR=0.57, 95% CI=0.35 to 0.91), controlling for other state-level policies and sociodemographic characteristics.ConclusionsOur findings suggest that adopting a vaping product excise tax policy may help reduce ENDS use and suppress the increase of ENDS use prevalence among young adults. Considering that there are still a number of US states that have not implemented vaping product excise tax policy, wider adoption of such policy across the nation would likely help mitigate ENDS use prevalence.

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