Are Cannabis Pens Dangerous?

As cannabis legalization continues to spread, the same thing is happening to cannabis smokers. Cannabis disposable vape pens provide a lot of advantages over traditional smoking. They are compact, discrete, concentrated, and convenient, but are they safe? Vaping is still a relatively new phenomenon, and the data being collected tells a surprising story.

Smoking, especially in North America, has been on the decline for decades. Thanks to anti-smoking campaigns, associated health risks, and negative stigmatization of tobacco. [1] That trend began to change with the rise of vaping in 2007. [2] Vaping introduced a new generation to tobacco use with gimmicks like sweet flavors. It became the healthy alternative to smoking.

What’s in Your Vape Pen?

Vaporizers work on the concept of heating without burning. With cannabis, it is the heat that converts tetrahydrocannabinolic acid (THCA) to tetrahydrocannabinol (THC) to give the user a psychoactive experience. The same thing happens when smoking, but the heat that is applied creates smoke to be inhaled instead of vapor.

Cannabis smoke, like tobacco smoke, can be harmful to the lungs over extended periods of time. [3] The logic then follows: if users aren’t inhaling smoke, vaporizers must be safer. The idea is that the mixture within a vape is actually less harmful than the smoke being inhaled.

When using a vape pen, individuals inhale an aerosol mixture instead of smoke. [4] This mixture consists of multiple components, and the ingredients will vary from one manufacturer to another. Of course, they do tend to share some commonalities. 

Pens Compound

Most vape pens include some kind of flavoring agent, propylene glycol, and THC at a minimum. The risks start with propylene glycol, which is the thickening agent in the juice. [5] Still this chemical can cause nausea, vomiting, and possible kidney damage when consumed in large amounts. In reality, most vaporizer users don’t come close to this threshold. This may be the least of a vape user’s worries. 

More concerning is the fact that some cannabis pens contain heavy metals in their mixtures. [6] Heavy metal consumption is dangerous in any amount and can lead to brain, liver, or kidney damage. Moreover, they increase the risk of heart concerns and anemia. Finally, these metals represent a significant risk, but there is another danger that is even more common in vaping. 

Some vape pens contains vitamin E acetate. The using leads to numerous vaping related lung injuries. [7] In 2019, vitamin E acetate contributed to 2400 cases of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) resulting in hospitalizations and deaths across the country. [8]

Even the flavor additives in vape pens may be harmful. In fact, they increase the risk of inflammation and could possibly damage white blood cells. [9]  Arguably, the safest part of a the mixture for vaping may be the THC. Nonetheless, psychological and addiction risks are huge. [10][11] These associated THC concerns are also amplified by the high concentration of THC in cannabis pens. 

Vaping Compared to Smoking

Based on all the added components to cannabis in a vaping pen, it may seem like smoking is the safer alternative because it avoids all the additional additives. Thus, this is not true. The tenet that vapes provide safety is not quite a true. 

To clarify, cannabis smoking also contributes additional intoxicants in the form of naphthalene, acrylamide, and acrylonitrile. These components are not present in non-smokers. [12] These byproducts can all contribute to cardiovascular, liver, and neurological disorders later in life. Additionally, smoking may increase anxiety, paranoia, and short term memory loss in cannabis users. [13][14][15] 

Substitute for Smoking?

It would be incorrect to assume that smoking is by default a safer alternative because it lacks additional additives or side effects. In fact, cannabis pens give users control over various aspects of their consumption, allowing them to better manage the dosage when compared to smoking.

This may take the form of a single inhalation, control over the temperature, or choosing a vape pen with more transparency on THC potency. These elements of control also mean that vape pens provide more efficient cannabis consumption. 

This efficiency translates to less stress on the lungs, because a vape pen may provide a comparable experience from a single puff as from smoking an entire joint. By avoiding increased excessive inhalation of contaminants, the lungs will ultimately be better off in the long run. 

How to Vape Safely

When it comes to both smoking and vaping, the THC is not the problem, it’s all the other constituents that present health risks. That being said, the advantages of controlled dosage and efficiency from vape pens seems to be viable as a safer alternative to smoking. 

The major concern with cannabis pens is additives like vitamin E acetate or heavy metals within the solution. Any other additives have an acceptable threshold that is not likely to cause significant damage. The primary concern then becomes minimizing the risk of exposure to these harmful elements, and there are a few easy ways to do this.

First, avoid any underground sources for THC vape products, and only purchase vape pens from licensed dispensaries. While cannabis is not regulated by the FDA, individual states do regulate all cannabis products, and warn consumers when any of them may be unsafe. [16][17] 
If it is unclear where the vape material is sourced from, it is best to avoid it to mitigate any risk.

Additional Advice

For any vaporizers where temperature control is possible, setting the temperature lower will provide two additional benefits. The first is that THC tends to break down more at higher temperatures, which can increase the psychoactivity but also amplify the anxiety and paranoia associated with cannabis. [18] Lower vape temperatures can help prevent any negative short-term side effects.

This leads to the second reason for keeping vaporizer temperatures low. If vitamin E acetate is present in the vape pen, higher temperatures also cause it to break down more. [19] This increased breakdown leads to higher absorption rate, resulting in a higher possibility for E-cigarette or Vaping Use-Associated Lung Injury (EVALI) to occur.

References:

1. Smith, Derek R. “The historical decline of tobacco smoking among United States physicians: 1949–1984.” Tobacco induced diseases 4 (2008): 1-9.
2. Dinardo, Perry, and Ellen S. Rome. “Vaping: The new wave of nicotine addiction.” Cleveland Clinic journal of medicine 86.12 (2019): 789-798.
3. Lee, Marcus HS, and Robert J. Hancox. “Effects of smoking cannabis on lung function.” Expert review of respiratory medicine 5.4 (2011): 537-547.
4. Meehan-Atrash, Jiries, et al. “Aerosol gas-phase components from cannabis e-cigarettes and dabbing: mechanistic insight and quantitative risk analysis.” ACS omega 4.14 (2019): 16111-16120.
5. Zar, Tausif, Charles Graeber, and Mark A. Perazella. “Reviews: recognition, treatment, and prevention of propylene glycol toxicity.” Seminars in dialysis. Vol. 20. No. 3. Oxford, UK: Blackwell Publishing Ltd, 2007.
6. Mallampati, Srinivasa Reddy, Charles McDaniel, and Amber R. Wise. “Strategies for Nonpolar Aerosol Collection and Heavy Metals Analysis of Inhaled Cannabis Products.” ACS omega 6.26 (2021): 17126-17135.
7. Boudi, F. Brian, et al. “Vitamin E acetate as a plausible cause of acute vaping-related illness.” Cureus 11.12 (2019).
8. CDC Newsroom. (2016, January 1). CDC.
9. Guo, Weihong, et al. “Major constituents of cannabis vape oil liquid, vapor and aerosol in California vape oil cartridge samples.” Frontiers in Chemistry 9 (2021): 694905.
10. Englund, Amir, et al. “The effect of five day dosing with THCV on THC-induced cognitive, psychological and physiological effects in healthy male human volunteers: a placebo-controlled, double-blind, crossover pilot trial.” Journal of Psychopharmacology 30.2 (2016): 140-151.
11. Stuyt, Elizabeth. “The problem with the current high potency THC marijuana from the perspective of an addiction psychiatrist.” Missouri medicine 115.6 (2018): 482.
12. Lorenz, David R., et al. “Acrolein and other toxicant exposures in relation to cardiovascular disease among marijuana and tobacco smokers in a longitudinal cohort of HIV-positive and negative adults.” EClinicalMedicine 31 (2021): 100697.
13. Crippa, José Alexandre, et al. “Cannabis and anxiety: a critical review of the evidence.” Human Psychopharmacology: Clinical and Experimental 24.7 (2009): 515-523.
14. Freeman, Daniel, et al. “How cannabis causes paranoia: using the intravenous administration of∆ 9-tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia.” Schizophrenia bulletin 41.2 (2015): 391-399.
15. Kroon, Emese, Lauren Kuhns, and Janna Cousijn. “The short-term and long-term effects of cannabis on cognition: recent advances in the field.” Current Opinion in Psychology 38 (2021): 49-55.
16. Department of Cannabis Control – State of California. (n.d.). Requirements for cannabis goods. Department of Cannabis Control.
17. Department of Public Health. (n.d.). Vaping Health Advisory.
18. Jaidee, Wuttichai, et al. “Kinetics of CBD, Δ9-THC degradation and cannabinol formation in cannabis resin at various temperature and pH conditions.” Cannabis and cannabinoid research 7.4 (2022): 537-547.
19. Canchola, Alexa, et al. “Temperature dependence of emission product distribution from vaping of vitamin E acetate.” Plos one 17.3 (2022): e0265365.

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