E-Cigarettes: are they being used to vape recreational drugs and new psychoactive substances (NPS)?

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1 E-Cigarettes: are they being used to vape recreational drugs and new psychoactive substances (NPS)? Dr David Wood Consultant Physician and Clinical Toxicologist Clinical Toxicology, Guy s and St Thomas NHS Foundation Trust and King s Health Partners and Faculty of Medicine and Life Sciences, King s College London, London, UK

2 Nothing to declare Conflicts of Interest

3 Objectives Hopefully by the end of this talk I ll have convinced you that there is.. 1. Increasing evidence of cannabis use by vaping / electronic nicotine delivery devices (ENDD/cigarettes) 2. Currently limited evidence that there is significant use of these routes for other drugs / NPS

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6 Survey of 621 adolescents 268 tried e-cigarette Not clear what without nicotine means Cannabis Other recreational drugs / NPS Flavoured e-cigarette liquid

7 Online questionnaire survey of 3,587 people in 2010 From USA (62%), UK, Canada, France and Switzerland (4%) 27 (0.9%) used e-cigarette to inhale other substances

8 Survey of five high schools in Connecticut, USA 3,847 respondents (approx. 1/3 rd used an e-cigarette) 5.4% vaped cannabis by e-cigarette Previous e-cigarette use Odds Ratio of vaping cannabis 5.27 ( )

9 Use amongst US Adolescents Asked about e-cigarette / vapouriser use from 2014 Overall use in last 30 days % % 2015 survey asked about contents of inhaled mist at last time used Flavours: 65-65% across all grades Marijuana / hash oil: 6-7%

10 Survey of 4,269 in 2014 Summer Styles national survey Life-time prevalence of cannabis use 34.5%

11 Survey of 2,910 adults recruited through Facebook Mean age of first cannabis use: 15.7 ± 4.4 years 61% (1,783) had ever vaped cannabis Mean age of first vaping use: 24.2 ± 12.2 years

12 Majority used by both smoking and vaping Smoking more frequent route in 76% Vaping more frequent route in 3% Only 7 (0.2%) exclusively use by vaping

13 Data from 2 national Australian monitoring studies 888 people who inject drug (PWID) 151 had used electronic cigarettes 793 regular psychostimulant users (RPU) 252 had used electronic cigarettes

14 >2,500 cannabis users had used butane hash oil 41% used by vape pen or vapouriser

15 Qualtrics and Facebook survey of 2,838 individuals Comparison between states based on presence or absence of medical marijuana laws (MML)

16 Mulling: process of adding tobacco to cannabis prior to smoking Typically most common route of use Greater exposure to tobacco smoke Reasons for not adding tobacco when vapourising Clogs / dirties the vapouriser Harsher on the throat Not needed to vapourise the cannabis Unpleasant taste

17 Short-term marijuana smoking (12 studies) Bronchodilation Increased FEV 1 post-smoking Longer-term marijuana smoking (21 studies) Reduced FEV 1 and FEV 1 /FVC ratio Increased sputum production Increased cough and wheeze

18 Survey of individuals on mailing lists of organisations committed to reforming drug laws 6,731 non-vaporizer users; 152 vaporizer users p<0.05

19 22 regular cannabis users with 2 (out of 9) respiratory symptoms at baseline Current smokers / inhalant users excluded Comparison of symptoms and lung function after cannabis use by vaporizer for 30 days instead of smoking

20 Online survey of 96 cannabis vaporizer users Predominately from USA (also Canada, UK, Australia) Four main benefits identified (each with >10 responses): 1. Perceived health benefits 2. Better taste 3. No smoke / smell / more discreet 4. More effect for same amount of marijuana Less likely to combine tobacco/marijuana for use Helped one individual to give up smoking

21 Comparison of products from cannabis plant material Vaporizer (3 diff temps)-vs- Cigarette

22 Survey of 2,002 university students in US Electronic cigarettes and marijuana Perceived to have least harm to health / addictiveness Overall most positive perception

23 Retrospective chart review in two burns unit in North California (Sept 2011 to Sept 2012)

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29 User Reports of Vaping First user report in July 2008 Reported used actually occurred in 2007 Use of Salvia divinorum To date 84 user reports on Erowid related to vaping

30 User Reports of Vaping Class Drug No. Cathinone α-php 2 α-pvp 1 Bk-MBDP 1 Phenylethylamine 25B/25I-NBOMe 2 2CE 1 DOC 1 Other Diphenhydramine 1 Deschloroketamine 1 Ephenidine 1 Ethylphenidate 1 Methoxetamine 1

31 36 year old male presented with opioid toxicity Reduced consciousness / respiratory effort Responded to naloxone Previously purchased synthetic opium on line Used with electronic cigarette Added to alcoholic beverages At least one other of episode of drowsiness related to e-cigarette use of synthetic opium

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33 The future of electronic cigarettes: impacts for recreational drug use?

34 Discussion Variety of different devices that can used for vaping Increasing evidence from population/sub-population surveys of cannabis use by vaping Unable to determine prevalence of use (<1%-60 + %) Potential respiratory benefits over use by mulling Limited evidence currently of other recreational drugs and/or NPS being used by vaping No data on risks associated with vaping drugs Some drugs maybe degraded by temperature of vaping Potential that increasing availability/use of devices may mean greater use of recreational drugs by this route