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September 7th, 2015:

Teens find a new use for e-cigarettes: Vaping marijuana

Teenagers have discovered a new way to inhale marijuana — e-cigarette vaporizers, according to a study released Monday.

About 27% of high school students who have used both marijuana and e-cigarettes reported using the devices to vaporize cannabis. Those most likely to vaporize pot with e-cigarettes included males and younger students.

E-cigarettes are designed to vaporize solutions containing nicotine, said co-author Meghan Rabbitt Morean. But, she noted, “teenagers are resourceful, and it was only a matter of time.”

Vaporizers give kids a better way to hide what they’re inhaling.

“It’s so much easier to conceal e-cigarette pot use,” said Morean, an assistant professor at Oberlin College. “Everybody knows that characteristic smell of marijuana, but this vapor is different. It’s possible that teenagers are using pot in a much less detectable way.”

Researchers at Yale University based their findings on answers from a survey sent to nearly 4,000 Connecticut students. The study was published Monday in Pediatrics.

About 28% of students in the study had tried e-cigarettes.

Morean said people should remember to be cautious when interpreting her findings. There haven’t been any other studies showing teens are using e-cigs to vaporize marijuana. She noted that scientists don’t fully understand the health effects of e-cig-vaporized cannabis.

Marijuana use in other forms can cause several health problems such as short-term memory loss, slow learning, decreased sperm count and lung damage, according to the Centers for Disease Control and Prevention.

“We now know it’s happening, but there are more questions about who is using and how damaging it is,” Morean said.

E-cigarette use among youth increased more than 200% from 2011 to 2013, according to a report in the journal Nicotine and Tobacco Research. Those surveyed had not tried regular cigarettes.

“Unfortunately, there is really no end for what can be vaporized in these devices,” said Erika Sward, a spokeswoman for the American Lung Association.

Supporters of e-cigarettes, who describe them as a healthier alternative to regular cigarettes, found fault with the new survey. The study may not accurately reflect what teens across the country are doing because it surveyed students in only one state, said Phil Daman, president of the Smoke-Free Alternatives Trade Association and attorney for Daman & Associates.

His group strongly discourages underage use of vapor products.

“While some teens experiment, it’s vital that parents and guardians talk to their children about not using any age-restricted products including vapor products,” Daman said.
Morean said she and her colleagues plan to conduct additional studies.

She hopes researchers in other states will provide additional data, to provide a clearer picture of national trends.

“This research is so new,” Morean said.

Electronic Cigarettes – An Overview

Download (PDF, 2.7MB)

Vaporizer pens increase drug abuse and filling ER rooms

DEERFIELD BEACH, Florida — Emergency rooms in South Florida are filling up with patients suffering from synthetic drug overdoses, and the problem is getting worse due to a device that’s ostensibly supposed to help people quit smoking.

Vaporizer pens are becoming the new way for drug users to not only get high, but do it discreetly — at times right under the noses of police, parents and teachers.

And it is no local phenomenon. From big cities like St. Louis to small villages in upstate New York, these vape pens are popping up more frequently in drug busts, and the steady rise of abuse is alarming communities across the country. E-cigarettes, or vape pens, have been around for more than a decade but have boomed in popularity recently because of marketing to nicotine users looking for a safer alternative to smoking cigarettes. Also fueling the trend is the accessibility of oil concentrates. A vape pen creates an inhalable vapor with a small inner coil that slowly heats, creating a vapor that is inhaled.

Water-soluble synthetics are easily converted into liquid concentrate that can go into the device cartridges and be vaped just like nicotine and other legal substances. It makes it nearly impossible to tell what is inside someone’s vape. It could be nicotine, marijuana concentrate, or fruit-flavored, nicotine-free “e-liquid,” popular among kids. Or worst of all, it could be a deadly concoction of chemicals, often a product of China, known as synthetic drugs.

“It’s the concealment method; we don’t know what is in a vape pen until we actually have it tested by a forensic laboratory,” said Supervisory Special Agent John Scherbenske of the U.S. Drug Enforcement Administration.

Vaping in the ER

Just a few weeks ago in Deerfield Beach, Florida, Lt. Ozzy Tianga of the Broward Sheriff’s Office arrested a man high getting on “flakka” with a vaporizer pen. Flakka is a deadly and cheap synthetic drug also known as “$5 insanity,” and it’s causing huge problems for law enforcement.

Days later, a man who’d been high on flakka was discharged from Fort Lauderdale’s Holy Cross Hospital, only to go into the bathroom, vape more drugs and overdose again, said Dr. John Cunha, an emergency room physician there.

“I have had patients in my practice in the emergency room that I have walked in on that are actually vaping at the bedside,” Cunha said. “…Someone could be sitting in their room in the emergency room and they could be vaping in between being seen by medical professionals, and we would have no idea what they are taking.”

The scariest part is the rate at which it’s trending.

Spending an afternoon in Deerfield Beach with Tianga, driving down a few miles of the main drag, Federal Highway, we passed at least a half-dozen vape shops and most of them still had temporary signs — an indication they were brand new.

“Every time I drive, I see another store,” Tianga said.

There are currently no federal minimum age or youth restrictions for e-cigarettes, according to the DEA, although most states and cities have passed laws banning the sale to minors.

One small town in upstate New York, Victor, even put a six-month moratorium on any new vaporizer stores after community outcry over the difference in federal laws regulating vape pens in comparison to cigarettes.

But the discretion of the device is the most common complaint among law enforcement, city officials, parents, teachers, and medical personnel.

Tianga said he often encounters people with vape pens, and he’s left to wonder what’s inside them, or what the user might be high on.

“These individuals can smoke it right in front of you. And many of times these vapes have no scent, or because they are a chemical substance the scent can be changed. It could be a fruit smell. It could be no smell at all,” Tianga said. “An e-cigarette is not your traditional drug paraphernalia. So it’s much more difficult for a law enforcement officer to establish probable cause to determine this is actually a device intended for the consumption of narcotics.”

Hard to know who’s vaping drugs

It only takes a quick search to find examples on social media of students bragging about getting high in class, in their bedrooms, discreetly with the help of vapes.

“Look on Instagram,” said Barbara Carreno, spokeswoman for the DEA national headquarters in Washington. “You’ll see many thousands of posts by young people, snickering about smoking it in class.”

Gone are the days of getting caught smoking pot in school because you smelled like a skunk.

Among the most popular vaped synthetics, Scherbenske said, are the so-called “legal weeds” — K2 and Spice, synthetic drugs that mimic other drugs in many ways, but can have severe side-effects, too.

“They sit in the back of the room, and they think it’s funny,” Tianga said. “They are vaping, and what they are vaping — again — I cannot determine. From the smell I cannot determine. I actually have to get the pen out of their hand and there is very few field test kits that will tell you exactly what they are vaping.”

Tianga now travels around Broward County educating teachers, parents, residents, doctors and emergency response personnel about the dangers.

At a Deerfield Beach community forum, Tianga gave a chilling presentation that got audible reactions. Thirty-three people have died so far this year in Broward County from synthetic drug overdoses, with two more suspected deaths under investigation.

The mayor of Victor, the upstate New York town that temporarily banned them, said many of the concerns were about the number of teens using the devices.

“It’s kind of like the Wild West of vaporing,” Mayor Jason Ashton said. “There was no zoning or code laws in place to prevent or to say where that kind of store could go,” “When the outcry started and I was getting phone calls daily, one idea floated out was the put a hold on it. Find out what we can and can’t do. What this product really is. Does the outcry really demand this attention? It gives us time to mitigate the problem and do research. We’ve found that science hasn’t kept up with the trend.”

‘The future of pot’

It’s a frightening combination — both synthetics and vaporizers’ gaining popularity — each presenting new challenges to law enforcement used to dealing with the set rules of traditional drugs.

Rising usage of synthetics are being blamed for major spikes in murders in Washington, D.C.

But vape shop owners, several who tell us they never sell to anyone under 18, say the devices are helping people, not hurting them.

Carly Cromer, who manages Save on Vape in Deerfield Beach, said the goal isn’t to attract people to start using nicotine.

“As an industry, it’s to get people to quit smoking,” Cromer said, noting that it’s unfair to label the industry based on people who are abusing a product.

In Denver, where marijuana is legal, vape pen manufacturers say the ability to regulate intake with a concentrate inside a vape pen is essential for users who want to have more control over what they smoke.

Steve Berg, chief financial officer of O.Pen Vape, calls it “the future of pot.”

The trend is too new for there to be data to crunch, to back up what police officers and emergency room doctors are seeing.

Jim Hall, a drug abuse epidemiologist at Nova Southeastern University, said there are methods of tracking almost every other type of ingestion, from smoking to shooting, to oral consumption.

“But not vaping,” he said.

That’s going to start changing, because it’s trending upward, Hall said.

“We know that synthetics are being vaped. We know that kids are using synthetics,” he said.

Some findings from studies touching on the subject are disturbing.

The Centers for Disease Control and Prevention said in April that e-cigarette usage among middle- and high-schoolers tripled between 2013 and 2014. Usage among high-schoolers was 13.4% last year.

Most telling, Hall said, is that some kids had never smoked before. They are new users.

Cunha predicts that by the time the research catches up, the problem will be too big to control.

“I think that these devices do have a role in helping people get off of actual cigarettes and that they may be proven safer in that case, but in the hands of teenagers and drug abusers, they are definitely a very dangerous thing to have,” he said.

High School Students’ Use of Electronic Cigarettes to Vaporize Cannabis


BACKGROUND AND OBJECTIVES: Electronic cigarette (e-cigarette) use is increasing rapidly among high school (HS) students. Of concern, e-cigarettes can be used to vaporize cannabis, although use rates among adolescents are unknown. We evaluated lifetime rates of using e-cigarettes to vaporize cannabis among all lifetime e-cigarette users (27.9%), all lifetime cannabis users (29.2%), and lifetime users of both e-cigarettes and cannabis (18.8%); common means of vaporizing cannabis including hash oil, wax infused with Δ-9-tetrahydrocannabinol (THC), and dried cannabis; and demographic predictors of using e-cigarettes to vaporize cannabis.

METHODS: In the spring of 2014, 3847 Connecticut HS students completed an anonymous survey assessing e-cigarette and cannabis use.

RESULTS: Vaporizing cannabis using e-cigarettes was common among lifetime e-cigarette users, lifetime cannabis users, and lifetime dual users (e-cigarette 18.0%, cannabis 18.4%, dual users 26.5%). Students reported using e-cigarettes to vaporize hash oil (e-cigarette 15.4%, cannabis 15.5%, dual users 22.9%) and wax infused with THC (e-cigarette 10.0%, cannabis 10.2%, dual users 14.8%) and using portable electronic vaporizers to vaporize dried cannabis leaves (e-cigarette 19.6%, lifetime cannabis 23.1%, lifetime dual users 29.1%). Binary logistic regression indicated that male students (odds ratio [OR] = 2.05), younger students (OR = 0.64), lifetime e-cigarette users (OR = 5.27), and lifetime cannabis users (OR = 40.89) were most likely to vaporize cannabis using e-cigarettes. Rates also differed by HS attended.

CONCLUSIONS: Rates of vaporizing cannabis using e-cigarettes were high. These findings raise concerns about the lack of e-cigarette regulations and the potential use of e-cigarettes for purposes other than vaping nicotine

Has the traditional cigarette burned out?

The chief executive of Philip Morris told CNBC he wants their lines of e-cigarettes eventually to outsell traditional smokes.

Speaking on the sidelines of the European House-Ambrosetti Forum in Italy, CEO Andre Calantzopoulos told CNBC that he was very optimistic about the take-up of iQOS — a Marlboro-branded device that electronically heats, rather than burns, tobacco and differs from the broader range of “e-cigarette” that use nicotine and water vapor to simulate the smoking experience.

“Our objective and my personal ambition is that these reduced-risk products will overtake combustible cigarettes as soon as possible. And that’s clearly what we’re pursuing,” Calantzopoulos told CNBC.

He hopes cigarette alternatives will account for at least 15 percent of the company’s portfolio in five to 10 years, adding that was his conservative estimate.

But reaching those levels will require regulatory help, Calantzopoulos explained.

“These products have to be regulated — in their way of being developed, risk assessed and marketed — because we need to provide consumers with very clear, and not misleading, information about the benefits of the product, but also [to communicate] that they’re not zero risk products,” Calantzopoulos told CNBC.

Philip Morris has started clinical trials similar to those deployed by the pharmaceutical industry, to assess the risk profiles of alternatives like iQos, and these trials will be essential to combat a recent backlash against e-cigarettes, Calantzopoulos said.

“Voices say these products are more dangerous than cigarettes. Personally, I think this is rather irresponsible,” he explained.

The latest World Health Organization (WHO) report on e-cigarettes explains that most products haven’t been tested by independent scientists, and that the limited amount of testing that has taken place so far shows “wide variations” around toxicity levels.

However, the WHO said it is “very likely” that there is a lower toxic exposure from e-cigarettes than traditional combustible smokes.

For the time being, Calantzopolous said he was excited about the technology that was providing an industry-wide transformation.

“It’ s a very exciting moment actually

Tobacco use kills over 1.3 million every year in Southeast Asia

Dili (Timor-Leste), Sep 7: Over 1.3 million people die of tobacco consumption in Southeast Asia every year, with the region consisting of 250 million smokers and nearly the same number of smokeless tobacco users, according to a senior official of World Health Organization Dr Poonam Khetrapal Singh, regional director for South-East Asia, said: “We know that tobacco use is the leading cause of preventable deaths.” She was speaking at the inauguration of the WHO’s South-East Asia regional committee meeting here where health ministers and officials of 11 countries are meeting to set health priorities and discuss the health agenda for the region. (Also Read: World Health Organisation calls for higher taxes on tobacco)

“Worldwide, tobacco use kills nearly six million people annually with over 600,000 deaths due to exposure to second hand smoke,” she said at the inauguration, attended by Timor-Leste Prime Minister Rui Maria de Araújo, who was earlier the country’s health minister. Timor-Leste became the first new state of the 21st century when it achieved sovereignty on May 20, 2002.WHO has reiterated several times the number of deaths occuring because of tobacco use in Southeast Asia and other regions. Singh said the region was one of the largest producers and users of tobacco products in the world. “Many types of smoking and smokeless tobacco products are used in the region, which poses difficulties to harmonise taxation and regulations for controlling tobacco use,” she added.

But, she said, she was encouraged by the fact that the member state in the region had intensified their tobacco control activities. When asked later at a press conference on steps taken by India on tobacco control as compared to its regional partners, she said, India had “expressed an intention” to increase the size of pictorial warning on one side of the tobacco pack from 40 percent to 80 percent of the packet.She, however, declined to comment whether India would go ahead with its earlier commitment on pictorial warning.

Singh said WHO would continue to give advisory to India on tobacco control. She said that the best thing about the regional meeting was that the countries got to know the best practices of other countries to adopt. Thailand, she said, had graphic pictorial warning on both sides of the pack covering 85 per cent of the area, while Sri Lanka had 85 percent and Nepal 83 percent.

The latter intended to go up to 90 percent of the packet, she said adding that more countries were in the process of adopting larger warnings. Many countries had established smoke-free public places and banned advertisement of tobacco products, Singh said.Indonesia, she said, was not a signatory to the WHO convention on tobacco control, but on its own it had required 40 percent coverage of the cigarette packet with pictorial warning about the dangerous effects of smoking cigarettes. Although India is signatory to the WHO convention on tobacco control. India was not represented at the ministerial level at the regional meeting. J.P. Nadda is the minister of health. The meeting is from September 7 to September 11 at the state capital of the country which lies between Indonesia and Australia and occupies a land area of 14,874 km.

UK Health Officials: Smokers should vape instead

Hong Kong’s many British trained health practitioners will be shocked to find their counterparts in the UK are suggesting smokers should switch to e-cigarettes. Meanwhile, the former colony’s Food and Health Bureau looks to ban the product completely.

An expert independent evidence review published August 19 by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than conventional tobacco and have the potential to help smokers quit smoking. PHE is an operationally autonomous executive agency under, and sponsored by, the UK Department of Health.

The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), concluded that the current best estimate is that e-cigarettes are around 95% less harmful than smoking.

The review also suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people in the UK, and that there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.

Not in our backyard

Earlier in May, the Food and Health Bureau (FHB) proposed to the Panel on Health Services a number of measures to strengthen tobacco control in Hong Kong that included a complete ban on e-cigarettes.

A subsequent special hearing was held in LegCo on July 6th. Many health experts, including Professor Lam Tai-hing ( 林大慶), Director of HKU’s School of Public Health, and Professor Louis Shih Tai-cho ( 史泰祖), president of the Hong Kong Medical Association, strongly supported the Government’s efforts for a complete ban on e-cigarettes.

Professor Sophia Chan Shiu-chee ( 陳肇始), Under Secretary for Food and Health, has cited the WHO’s warning that research that suggesting e-cigarettes are a better alternative to conventional cigarettes were “inconclusive”.

Detractors of the invention have suggested the product could become a “gateway” for teenagers to cigarette smoking and renormalise the behaviour, undermining Hong Kong’s efforts to lower the smoking population.

Not risk-free, but less harmful

While the UK government-backed report admits e-cigarettes are not risk free, it has found it is a much less harmful alternative to smoking.

“E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm,” said Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England. “The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting.”

“The evidence consistently finds that e-cigarettes are another tool for stopping smoking and in my view smokers should try vaping and vapers should stop smoking entirely.” said Professor Ann McNeill, King’s College London and independent author of the review.

Professor Linda Bauld, Cancer Research UK’s expert in cancer prevention said, “Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realised based on the evidence assessed by this important independent review. In fact, the overall evidence points to e-cigarettes actually helping people to give up smoking tobacco.”

Her claims contradict suggestions made by Hong Kong’s British trained elite health practitioners that e-cigarettes may renormalise smoking.

British connection

After graduating from HKU’s Faculty of Medicine, Professor Lam Tai-hing received an MSc degree in medical sociology and an MSc degree in occupational medicine in 1980 and ‘81, respectively, both from The University of London. Professor Sophia Chan holds a Master of Education degree from the University of Manchester, a Masters degree in Public Health from Harvard University and a Doctor of Philosophy degree from HKU. Dr. Louis Shih is a Fellow of the Royal College of Physicians of Edinburgh and received a Masters degree in Clinical Dermatology from the University of London.

FHB unconvinced

Despite claims from its British counterpart, FHB remains unconvinced. In an official response to HT’s inquiries, a representative replied, “PHE’s report is among the many reviews conducted by various organizations to look into the effects of e-cigarettes. There are other studies showing the harm of e-cigarettes.”

Instead, the FHB has reiterated its confidence in the recommendations made from the 6th Meeting of Conference of Parties to the WHO Framework Convention on Tobacco Control (CoP6) held in Oct 2014. “We understand that there will be an updated report on e-cigarettes for CoP7 to be held some time in 2016. We will keep in view of the latest development and views and recommendations of WHO,” said the representative.

The representative did state that it would be willing to take the PHE report’s suggestion to make e-cigarettes available as a cessation device “in the event that certain e-cigarettes products are found to be suitable for use in smoking cessation purposes”.

PHE has stated, given the potential benefits as quitting aids, the body looks forward to e-cigarettes being regulated on the market and made available to smokers by UK’s National Health Service on prescription.

Liberal Party Survey

Meanwhile, the Liberal Par ty announced results to its survey on e-cigarettes in Hong Kong on August 29. Less than 7% of respondents indicated they have used e-cigarettes at least once in the past. In this group, more than 40% either thought e-cigarettes were a healthier alternative to conventional cigarettes or believed it would help them quit smoking.

(From L) Mr Fun Cheung, Mr Harris Yeung, and Mr Danny Ma present Liberal Party’s survey results.

(From L) Mr Fun Cheung, Mr Harris Yeung, and Mr Danny Ma present Liberal Party’s survey results.

Harris Yeung (楊浩泉), Vice Chairperson of the party’s Youth Committee, believes the Government should regulate e-cigarettes, and not ban it. “We support regulating e-cigarettes over banning them outright. If e-cigarettes are less harmful compared to conventional cigarettes, then why should we ban the less harmful alternative and not cigarettes? This is something the Government really needs to consider.”

“They need to first define e-cigarettes. Is it a food or a drug? Then they need to regulate the product, which includes the device and the e-liquid. They should ensure the safety of the ingredients in the e-liquid and the electronics of the device.”

Fun Cheung ( 張景勛), a member of the Youth Committee, expressed the need to make selling e-cigarettes to the underaged illegal, sharing that he once saw a primary school student purchase a vaping device from a newspaper stand in Tsim Sha Tsui.

Mr Cheung and his fellow Liberal Party youth member Danny Ma ( 馬家駿), are currently in the process of setting up the Hong Kong Vape Association. “We hope to harness the strength of non-governmental groups to bring forth positive dialogue,” said Mr Yeung.

Hong Kong currently has a known smoking population of 10.7%.

Portugal adds public vaping ban to new TPD law

Portugal has become the latest European Union member state to implement the EU’s Tobacco Products Directive (TPD), hewing closely to its requirements but also introducing a public vaping ban with limited exceptions.

The country’s new amendment to its tobacco law, which will come into force on 1st January, defines e-cigarettes using exactly the same wording as the TPD and adheres to it in key areas such as product and packaging restrictions.

But it also imposes a vaping ban in effectively all public enclosed spaces, notably including restaurants, bars and clubs; workplaces; and public-transportation locations.

Although this measure goes beyond the TPD, which sets no requirements on public usage, its tolerance of dedicated smoking and vaping areas in some smoke-free premises does appear to represent a watering-down of the Portuguese government’s position. An earlier draft of the amended tobacco law would have eliminated these exceptions entirely.

E-cigarette use will continue to be permitted, as will tobacco smoking, in physically separated smoking/vaping areas of bars and restaurants – as well as distinct areas of other locations such as psychiatric hospitals, rehabilitation centres, and nursing homes – as long as clearly identified rooms for the purpose have extraction ventilation systems meeting precise specifications.

A new report from ECigIntelligence, published this week, explores every aspect of the law in detail.

The government of prime minister Pedro Passos Coelho is also taking the now-standard step of prohibiting under-18s from using and buying e-cigarettes, again not required by the TPD but becoming a de facto pan-European policy; and the Portuguese law imposes slightly more stringent limitations on e-cig advertising and marketing than the TPD itself.

Portugal has taxed e-liquid at taxed at a rate of €0.60 ($0.70) per millilitre since the beginning of this year. The tax is unaffected by the new legislation.

What This Means: With only eight months to go before the May 2016 deadline for TPD implementation, the rush is on. Fewer than half of the 28 member states have officially begun their transposition process, so it is too early to tot up the final numbers, but preliminary indications from ECigIntelligence analysis are that it is mostly smaller countries which are opting for tobacco-style public-place restrictions, one of three important policy areas unaddressed by the TPD (the others being tax and sale to minors).

In this respect, Portugal complies with an emerging norm. Where it differed markedly even before introducing the new amendment to its tobacco law was in the imposition of an excise tax on e-cigs, thus far favoured by only a tiny minority of EU nations.

We do, however, expect many more of them to begin taxing e-cigarettes in due course, perhaps once the EU has completed its current consultation on the issue. That will not force any country to tax (or refrain from taxing), but it will set some guidelines