The surge in e-cigarettes and the legalization of cannabis products are providing teens with new alternatives.

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About a third of teens who use e-cigarettes say they have put non-nicotine substances in the devices. Getty Images

Legal or illegal, cannabis consumption has been commonplace among young Americans for decades.

In 2018, the trend continues — and the advent of new technology, such as electronic cigarettes, has given younger people more ways to consume marijuana-related products.

A team from the Office on Smoking and Health from the Centers for Disease Control and Prevention (CDC) shed more light on the trend in research published last month in JAMA Pediatrics.

The researchers reported that nearly 1 in 11 middle and high school students in the United States said they’d consumed cannabis using e-cigarettes as the delivery device.

According to prior research, among those students who already used e-cigarettes for nicotine use, about a third reported using e-cigarettes for non-nicotine substances.

Katrina Trivers, PhD, a lead epidemiologist in the CDC’s Office on Smoking and Health and the study’s lead author, told Healthline in an email that it’s a trend worth keeping an eye on.

“As marijuana use continues to be legalized in various states across the country, and as the tobacco product landscape continues to change, it will be important to continue to monitor the extent to which tobacco product and marijuana use patterns change,” explained Trivers.

Two phenomena

E-cigarettes — devices that produce an aerosol “vapor” by heating a liquid and often containing flavors, nicotine, and cannabis extracts — were virtually unheard of a decade ago.

Today, they’re a multibillion-dollar business.

Often used by smokers trying to kick the habit, they’ve supplanted conventional cigarettes as the most commonly used tobacco product among U.S. youths.

Cannabis — which was illegal apart from medical use until Colorado passed Amendment 64 in 2012 — is now legal for recreational or medical use in a majority of states.

Given the versatility of the active cannabinoid ingredients found in cannabis, it isn’t surprising that e-cigarettes often incorporate cannabis.

Trivers notes that while vaping is generally less harmful to one’s health than smoking, it’s still not exactly safe.

“E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes,” she wrote. “However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.”

The cannabis frontier

As cannabis moves into the mainstream, those wishing to consume it have a number of choices.

Erik Altieri, executive director of the National Organization for the Reform of Marijuana Laws, told Healthline that there’s a wide variety of options in legal states.

“If you look through the currently regulated market in a number of states, you’ll see that what the regulation has brought about is a more diverse array of options for individuals to consume their cannabis,” he said.

“That includes a whole selection of different types of edibles. It involves topical lotions, tinctures that are taken orally, vaporizer pens, patches, all sorts of things that are not related to the stereotypical smoking of a joint,” he noted. “They’re very popular. In places like Colorado, sales of those products have begun to make up a plurality to majority of their sales.”

The legal market also provides options for people who want the therapeutic benefit of cannabis without the psychoactive high.

Healthline spoke to Dr. Andrew Kerklaan, a Canadian chiropractor who launched a line of therapeutic creams and lotions that contain cannabidiol (CBD) — a non-psychoactive component of cannabis.

He told Healthline that, in his research, cannabis offers a range of benefits beyond simply getting high.

“I had many patients coming in asking questions about how they can benefit from cannabinoids,” he said. “As a clinician, I’d never done any research, I knew nothing about the endocannabinoid system. I felt it was my duty to learn and study, so I attended conferences and did as much research as I could, and it became very clear than cannabinoids certainly offer huge potential for human health and human benefit. There’s quite a fascinating historical restriction around its use, which is at odds with its potential. Restrictions add to a lack of research, and a lack of research causes the restrictions to stay in place.”

Now that those restrictions are being lifted in many areas — Canada is set to fully legalize cannabis this month — more research, such as Trivers’ study, is starting to come in.

Trivers acknowledges that there are still plenty of unknowns, but also some known facts, especially as cannabis use pertains to teens.

“At present, there is limited evidence on the specific health effects of using cannabis in e-cigarettes versus other forms, and more research would be beneficial on this topic,” she said. “However, because marijuana contains tetrahydrocannabinol, or THC, there are health risks associated with using marijuana regardless of how it is used. Therefore, any use of e-cigarettes by youth is not safe, including if it’s used to deliver cannabis. Cannabis use among youth can adversely affect learning and memory, and may impair later academic achievement.”

Staying safe

When it comes to cannabis policy, Americans have largely spoken.

About 6 in 10 Americans support legalization, a marked change from the attitudes of prior generations.

So with the advent of legalization, and the relative lack of research for now, what’s the best course forward for consumers?

Where cannabis is still illegal, says Altieri, consumers are limited to what a black market dealer can offer on a given day — and typically have no information on where the product is sourced from.

But with legalization comes regulations that give consumers the power to better understand the products on offer.

But with that power comes responsibility.

“Part of the onus is on the consumer to do the research and know where their products are being sourced from,” he explained. “Part of that also does fall to state regulators, where they’re making sure that there are responsible regulations in place governing what products are sold, and keeping businesses responsible for the products that they’re putting on their shelves.”

He notes that some states — Colorado and California in particular — impose testing requirements for cannabis products, ensuring that the listed potency is accurate.

He also points out that this oversight could also help ensure that delivery devices like e-cigarettes are meeting certain standards.

At the end of the day, both Altieri and Trivers agree that it’s best to keep cannabis, cigarettes, and e-cigarettes away from young minds.

“Everyone can play a role in helping youth to recognize and avoid the dangers of e-cigarette use,” wrote Trivers. “Parents in particular can set a positive example by being tobacco-free and ensuring that their kids aren’t exposed to the secondhand emissions from any tobacco products, including e-cigarettes.”

“We know e-cigarettes are now the most commonly used tobacco product among youth and that many aren’t aware of the dangers of these products, including the negative impacts of nicotine exposure on the developing adolescent brain, as well as the negative impacts of marijuana on learning, memory, and later academic achievement. Therefore, ensuring that youth are aware of the risks of using all forms of tobacco products, including e-cigarettes, is critical.”