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Vaping vs. Smoking – Which Is Safer?

Since cannabis is being increasingly recognized for its medicinal properties, a question that arises is what is the best way to use it.  Effectiveness and safety are governed by the route of administration 1 Maayah ZH et al. “The pharmacological effects of inhaled cannabis on pain in patients with multiple sclerosis: risks versus rewards.” Inflammation Research. 69(11)(2020):1073-6. . Cannabis is consumed mostly in three forms namely smoking, vaping, or orally. Due to a faster onset of action and higher bioavailability, smoking or vaping is preferred over oral consumption. Vaping vs. smoking, how do you decide which is safer? Is vaping safer than smoking?

What is the difference between vaping and smoking?

Vaping or smoking, though heat-induced, are different phenomena. . Hence, smoke contains pyrolytic products which might be toxic. Vaporization, commonly known as vaping on the other hand is a controlled process in which either cannabis concentrates; liquid, or plant material is heated to a temperature of 180°C-200°C 2 Abrams DI et al. “Vaporization as a smokeless cannabis delivery system: a pilot study.” Clinical Pharmacology & Therapeutics. 82(5)(2007):572-8. . Heating results in the formation of a mixture of water vapor and active cannabinoids which can be consumed by inhalation 3 Varlet V et al. “Drug vaping applied to cannabis: Is “Cannavaping” a therapeutic alternative to marijuana?.” Scientific reports. 6(1)(2016):1-3. . Vaping requires a vaping device. A variety of vaping devices are available which vary from large table-top units to small pen-style devices which are similar to e-cigarettes 4 Lee DC et al. “Online survey characterizing vaporizer use among cannabis users.” Drug and alcohol dependence. 159 (2016):227-33. .

Vaping vs. smoking: what does the research say?

Smoking is the traditional method for cannabis use. It is found to be the most commonly used method of cannabis use in the US. This could be due to the fact that the user can effectively self-titrate the dose 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. . In addition to its medicinal applications, cannabis is used frequently as a recreational drug globally 6 Lee MH et al. “Effects of smoking cannabis on lung function.” Expert review of respiratory medicine. 5(4) (2011):537-47. . Despite its popularity, smoking cannabis is associated with an array of ill effects 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. .

Smoking leads to the inhalation of toxic as well as carcinogenic materials produced during the combustion of cannabis. Frequent practice of smoking cannabis could adversely affect respiratory health 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. .

Many studies emphasize the link between smoking cannabis and the occurrence of respiratory symptoms including cough, increased sputum production, and wheezing. Other ill-effects of cannabis smoking include dyspnea, pharyngitis, and exacerbations of asthma 6 Lee MH et al. “Effects of smoking cannabis on lung function.” Expert review of respiratory medicine. 5(4) (2011):537-47. . The Institute of Medicine also highlights the harmful health effects of combustion products, which is a major concern in the use of cannabis cigarettes 2 Abrams DI et al. “Vaporization as a smokeless cannabis delivery system: a pilot study.” Clinical Pharmacology & Therapeutics. 82(5)(2007):572-8. . Additionally, various modes of smoking such as joints, pipes, or bongs creates room for problematic use 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. .

Is vaping safer than smoking? Vaping is considered a safer alternative to smoking 3 Varlet V et al. “Drug vaping applied to cannabis: Is “Cannavaping” a therapeutic alternative to marijuana?.” Scientific reports. 6(1)(2016):1-3. . A pilot study on vaporization of cannabis conducted by Abrams et al in 2007, investigated vaporization as an alternative means of delivery of inhaled cannabis 2 Abrams DI et al. “Vaporization as a smokeless cannabis delivery system: a pilot study.” Clinical Pharmacology & Therapeutics. 82(5)(2007):572-8. . The authors studied the pharmacokinetics and pharmacodynamics of vaporized cannabis and found that absorption of tetrahydrocannabinol (THC) was faster with the vaporizer compared to smoking. Smoking on the other hand increased carbon monoxide (CO) levels due to inhalation of combustion products but there was little increase in CO after inhalation of THC from the vaporizer 2 Abrams DI et al. “Vaporization as a smokeless cannabis delivery system: a pilot study.” Clinical Pharmacology & Therapeutics. 82(5)(2007):572-8. .

A new concept termed ‘cannavaping’ is getting introduced for the administration of therapeutic drugs and cannabis-based medicines with e-cigarettes 3 Varlet V et al. “Drug vaping applied to cannabis: Is “Cannavaping” a therapeutic alternative to marijuana?.” Scientific reports. 6(1)(2016):1-3. . Its popularity is increasing and it is being looked at as an alternative to cannabis smoking.

Amongst cannabis users as well, vaping is thought of as a less harmful option to smoking. This is evident from surveys done by Malouff et al (2014) and Etter (2015). According to these surveys vaping is chosen over smoking as it decreases health risk, avoids combustion, avoids tobacco and nicotine, avoids lingering smell, and also because vaping cannabis is cheaper 7 Etter JF. “Electronic cigarettes and cannabis: an exploratory study.” European Addiction Research. 21(3)(2015):124-30. .

Though vaping appears to be a safe option, there is a paucity of data regarding the long-term health consequences of regular vaping 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. . The perception of reduced respiratory distress could lead to an increase in the frequency of vaping, long-term effects of which are not known 5 Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7. .

Studies To Support The Use Of Vaping To Quit Smoking

Vaping is considered a better option for smoking. Vaping or the use of e-cigarettes is considered a novel aid for smoking cessation 8 Electronic Vaping Delivery Of Cannabis And Nicotine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545160/. Accessed on: 20th April 2021 .

In a study conducted by Caponnetto et al. in 2013, the effect of vaping on smoking cessation was studied. Smoking cessation was assessed in terms of reduction in the number of cigarettes smoked after vaping e-cigarette. It was observed that only 8.7% of smokers could completely restrain themselves from smoking after 52 weeks. However, vaping could significantly reduce the number of cigarettes smoked. Another study by Brose et al in 2015, has suggested that vaping e-cigarette if taken daily, helps reduce the number of cigarettes smoked 9 Kaisar MA et al. “A decade of e-cigarettes: limited research & unresolved safety concerns.” Toxicology. 365 (2016):67-75. .

Though e-cigarettes have not been approved by the FDA for smoking cessation to date, they are used more frequently than other FDA-approved pharmacotherapies for smoking cessation. Current evidence suggests that daily e-cigarette use is more likely associated with smoking cessation than non-daily use. A recent randomized trial by Hajek P et al in 2019 in the United Kingdom indicated the superiority of e-cigarettes over nicotine replacement therapy. .

What are the risks of vaping?

Though vaping is considered a healthier option for smoking and a novel aid for smoking cessation, there is little data to support this claim 8 Electronic Vaping Delivery Of Cannabis And Nicotine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545160/. Accessed on: 20th April 2021 . On the contrary vaping could have some concerns which include:

More intense and efficient effects along with better taste allow the use of vaping in more places. There could be an increase in the tendency of trying cannabis leading to an earlier age of onset and more frequent use.  All these factors could contribute to problematic use or addiction 12 12. Budney AJ et al. “Vaping cannabis (marijuana): parallel concerns to e‐cigs?.” Addiction. 110(11)(2015):1699-704. .

Benefits Of Vaping Instead Of Smoking

Cannavaping is a gentle, efficient, user-friendly, and safe alternative to smoking.

Inhalation of THC from the vaporizer brings about very little increase in CO levels. Thus the use of a vaporizer was found to be well-tolerated and did not have any adverse reactions. Vaporization could be used as a potential means of cannabis administration in medical therapy.

Vaping vs. smoking, are there differing benefits? Vaping has some obvious benefits over smoking. It can deliver desired cannabinoid compounds to the user without the risk of inhalation of smoke which contains toxins and carcinogens including carbon monoxide, tar, ammonia, and hydrogen cyanide. Vaping is considered a safer and less harmful option compared to combustible smoking methods. Vaping is found to be less associated with respiratory symptoms, but unfortunately, there are no clinical trials yet to support this claim.

Vaping can also limit exposure to second-hand cannabis smoke.

Vaping has non-health benefits as well which include better taste compared to smoking, better delivery efficiency in turn giving a more pleasurable experience. .

Cautions About Vaping That People Should Know

Vaping is safer than smoking only in case of dose consideration. This is because for first-time users or for those who don’t use cannabis regularly, vaping delivers greater amounts of THC. THC being the primary intoxicant in cannabis increases the likelihood of adverse reactions 13 13. Vaping Cannabis Produces Stronger Effects Than Smoking Cannabis For Infrequent Users. Available from: https://www.hopkinsmedicine.org/news/newsroom/news-releases/vaping-cannabis-produces-stronger-effects-than-smoking-cannabis-for-infrequent-users. Accessed on: April 22nd 2021 .

The available literature reflects a low risk of clinically significant interactions with cannabis products. However, right now there are no human studies that describe drug-drug interactions with cannabis products. On the contrary, it has been observed that chronic exposure to cannabis products may reduce the efficacy of cannabinoids as well as health products 14 14. Foster BC et al. “Cannabis and cannabinoids: kinetics and interactions.” The American journal of medicine. 132(11)(2019):1266-70. .

Thus, the use of cannabis, even if as vaping should be done cautiously.

Conclusion

Although vaping appears safer than smoking, it is also associated with negative effects on the body. Being a relatively new method, literature on vaping of cannabis is sparse. Currently, there is no data supporting the long-term use of vaping. Vaping should be used with caution and dose consideration is very important. The other important aspect of vaping is its use in smoking cessation. Though vaping to quit smoking is being used routinely, it is not an FDA-approved method.

In conclusion, smoking and vaping, both are associated with some health hazards. However, as far as ingestion of toxic byproducts is concerned vaping is considered a better alternative to smoking. The faster onset of action, better taste, and affordability of vaping make it an attractive yet risky option for cannabis use.

Sources
  1. Maayah ZH et al. “The pharmacological effects of inhaled cannabis on pain in patients with multiple sclerosis: risks versus rewards.” Inflammation Research. 69(11)(2020):1073-6.
  2. Abrams DI et al. “Vaporization as a smokeless cannabis delivery system: a pilot study.” Clinical Pharmacology & Therapeutics. 82(5)(2007):572-8.
  3. Varlet V et al. “Drug vaping applied to cannabis: Is “Cannavaping” a therapeutic alternative to marijuana?.” Scientific reports. 6(1)(2016):1-3.
  4. Lee DC et al. “Online survey characterizing vaporizer use among cannabis users.” Drug and alcohol dependence. 159 (2016):227-33.
  5. Borodovsky JT et al. “Smoking, vaping, eating: is legalization impacting the way people use cannabis?.” International Journal of Drug Policy. 36 (2016):141-7.
  6. Lee MH et al. “Effects of smoking cannabis on lung function.” Expert review of respiratory medicine. 5(4) (2011):537-47.
  7. Etter JF. “Electronic cigarettes and cannabis: an exploratory study.” European Addiction Research. 21(3)(2015):124-30.
  8. Electronic Vaping Delivery Of Cannabis And Nicotine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545160/. Accessed on: 20th April 2021
  9. Kaisar MA et al. “A decade of e-cigarettes: limited research & unresolved safety concerns.” Toxicology. 365 (2016):67-75.
  10. Pierce JP et al. “Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16.” PloS one. 15(9)(2020):e0237938.
  11. Chadi N et al. “Cannabis vaping: Understanding the health risks of a rapidly emerging trend.” Paediatrics & child health. 25(Supplement_1)(2020):S16-20.
  12. 12. Budney AJ et al. “Vaping cannabis (marijuana): parallel concerns to e‐cigs?.” Addiction. 110(11)(2015):1699-704.
  13. 13. Vaping Cannabis Produces Stronger Effects Than Smoking Cannabis For Infrequent Users. Available from: https://www.hopkinsmedicine.org/news/newsroom/news-releases/vaping-cannabis-produces-stronger-effects-than-smoking-cannabis-for-infrequent-users. Accessed on: April 22nd 2021
  14. 14. Foster BC et al. “Cannabis and cannabinoids: kinetics and interactions.” The American journal of medicine. 132(11)(2019):1266-70.

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