For as long as e-cigarettes have existed, though, people -- many of them younger individuals -- have experimented with using these devices to ingest substances other than nicotine. Frequently, the substance of choice has been cannabis.
To better understand the degree to which American youth use marijuana in e-cigarettes, two teams of investigators analyzed data from a pair of surveys on tobacco use and behavioral trends. The teams' findings, presented in research letters published in the Feb. 4 issue of JAMA, revealed that marijuana use in e-cigarettes has increased significantly since 2017.
In the first research letter, researchers sampled data from the 2017 and 2018 National Youth Tobacco Surveys. In the surveys, middle and high school students were asked if they had ever used marijuana, marijuana concentrates or waxes, tetrahydrocannabinol, or hash oils in an e-cigarette. More than 38,000 children and adolescents completed the surveys.
Overall marijuana use in e-cigarettes among American youth increased from 11.1% in 2017 to 14.7% in 2018, a statistically significant uptick. Among ever users of e-cigarettes, prevalence rose from 37.2% to 42.7% during that period, and for current e-cigarette users, the increase was from 51.7% to 53.5%.
The highest year-to-year increases were seen in adolescents ages 16-17 and in high school students. In 16- and 17-year-olds, marijuana use in e-cigarettes jumped from 18% in 2017 to 24.1% in 2018, while in the broader category of high school students, use grew from 16.1% in 2017 to 21.7% in 2018.
In the second research letter, researchers analyzed data from the 2017, 2018 and 2019 Monitoring the Future surveys. These surveys examine various behaviors among eighth-, 10th- and 12th-grade students throughout the United States.
Students were randomly selected and asked on how many occasions, if any, they had vaped marijuana during the past 30 days, the past 12 months and throughout their lifetime. Altogether, more than 57,000 students were asked about marijuana vaping.
The researchers reported that statistically significant marijuana vaping increases occurred each year in students at every grade level. In 2017, 1.6% of eighth-grade students, 4.3% of 10th-grade students and 5% of 12th-grade students reported having vaped marijuana in the previous 30 days. By 2019, past-30-day marijuana vaping prevalence among the groups had increased to 3.9%, 12.6% and 14%, respectively.
"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 when using black market formulations," the authors wrote. "The rapid rise of marijuana vaping indicates the need for new prevention and intervention efforts aimed specifically at adolescents."
Marijuana use has been associated with a host of adverse health effects such as short-term memory loss and impaired motor skills. Long-term marijuana use can negatively affect brain development, leading to cognitive impairment and poor academic performance.
The negative effects of vaping, meanwhile, are becoming increasingly clear, and the Academy has joined forces with other organizations to warn the administration and Congress about the harms associated with e-cigarette use.
Susan Chiarito, M.D., who practices in Vicksburg, Miss., and is a member of the Academy's Commission on Health of the Public and Science, told AAFP News that FPs are ideally positioned to educate young patients on the health effects of vaping.
"Family physicians have so many opportunities to warn our patients and their families about e-cigarettes," said Chiarito, citing wellness checks and immunization visits as examples of when FPs can have prevention-related discussions with children, teens and parents. "Millennials are keen on not having any chemical exposures, so it is an easy sell," she added.
Fellow commission member Beth Anne Fox, M.D., M.P.H., of Kingsport, Tenn., who spearheaded development of the AAFP's position paper on marijuana and cannabinoids, told AAFP News that similar opportunities exist for FPs to discuss marijuana use. She suggested educating young patients about the health effects of marijuana use during preventive care visits starting in middle school and continuing through subsequent preventive care and other office visits.
"Family physicians can educate patients and parents on the negative effects of marijuana use, including changes in attention, memory, decision-making and motivation," Fox said. She also noted that FPs can educate parents on role-modeling behaviors and advise them to personally avoid using illicit substances, which could increase access to marijuana within the home.
Fox further suggested that FPs obtain a detailed history to understand the reasons behind a patient's decision to use marijuana, as some underlying conditions (such as insomnia or depression) could be addressed by other treatment methods.
Regarding AAFP resources on these topics, the previously mentioned position paper on marijuana and cannabinoids includes information on use of these substances, their health effects, and research and regulatory considerations. It also links directly to the Academy's policy on marijuana possession for personal use.
In addition, FPs may want to review the Academy's policy on electronic nicotine delivery systems, which encourages members to start screening children for ENDS use when they enter school. The ENDS policy page also links to the AAFP position paper on preventing and treating nicotine dependence and tobacco use, along with additional resources.