There has been a significant increase in the amount of self-reported marijuana e-cigarette use among middle school and high school students in the United States between 2017 and 2019, according to the results from 2 separate studies.1,2 These trends, as well as the outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI), has led the US Food and Drug Administration (FDA) to open a docket to gather additional information about the use of e-cigarette and vaping products.3

In the first study, researchers with the National Youth Tobacco Survey, an annual cross-sectional, school-based survey, investigated trends in e-cigarette use among middle- and high-school-aged adolescents.1 Of the 38,061 participants (49.1% girls; 55.9% high school age), 23.6% self-reported ever having used e-cigarettes and 10.9% reported current use of e-cigarettes. Between 2017 and 2018, the frequency of ever-use marijuana in e-cigarettes increased from 11.1% to 14.7% (3.6% difference). Observed increases were greatest among current users of 1 tobacco product (7.4% difference) and students who lived with a household member who used e-cigarettes (6.8% difference).1

An increase was seen in 2018 in the total number of individuals who reported ever using an e-cigarette product (42.7%), those currently using an e-cigarette (53.5%), and those who were poly tobacco users who ever used marijuana in an e-cigarette (71.6%). “The increase in marijuana use in e-cigarettes could be attributable to the increase of sales of pod-mod-style e-cigarette products, access to marijuana through informal sources (eg, friends, family members, illicit dealers), and reduced perception among adolescents of the harms of marijuana use,” the investigators said.

Beginning in 2019, “e-[c]igarette use has also been related to severe respiratory diseases,” the investigators noted. Of the vaping-related lung injury cases that were reported in November 2019 (n=2290), approximately 77% “were in people with a history of vaping tetrahydrocannabinol-containing products.”1

In the second study, investigators surveyed marijuana vaping trends among 8th, 10th, and 12th grade students between 2017 and 2019.2 Of the 28,346 students who completed the survey in 2019, 3.9% of 8th graders, 12.6% of 10th graders, and 14.0% of 12th graders reported marijuana vaping in the past 30 days. From 2018 to 2019, 30-day prevalence in marijuana vaping significantly increased, with 12th graders reporting a greater increase than from 2017 to 2018 (absolute difference, 4.0%). The investigators wrote that “[p]revalence increases in every year were statistically significant for all grades.”

“As the number of adolescents who vape marijuana increases, so too does the scope and effect of any associated health consequences, which may include lung injury,” they noted.2

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The FDA docket, which opened on February 14, 2020, and will stay open for formal comments until April 20, 2020, has been put in place by direction from Congress to pool publicly submitted information.3 This information will help the agency put steps into place to “address the recent lung injuries associated with the use of vaping products,” as well as to obtain “information on specific chemicals, compounds, ingredients or combinations of ingredients that when inhaled or aerosolized,  that when inhaled or aerosolized, may be associated with [e-cigarette, or vaping, product use-associated lung injury] symptoms.”

Please visit the FDA docket for more information, or if you have any unpublished data or information to contribute to their open docket.

References

1. Dai H. Self-reported marijuana use in electronic cigarettes among US youth, 2017 to 2018. JAMA. 2020;323(5):473-474.

2. Miech RA, Patrick ME, O’Malley PM, Johnston LD, Bachman JG. Trends in reported marijuana vaping among US adolescents, 2017-2019. JAMA. 2020;323(5):475-476.

3. FDA in brief: FDA seeks input from the public to help prevent future lung injuries associated with vaping. US Food and Drug Administration. https://www.fda.gov/news-events/fda-brief/fda-brief-fda-seeks-input-public-help-prevent-future-lung-injuries-associated-vaping. Published February 14, 2020. Accessed March 4, 2020.