Cloud-chasing and Gummi Bears: A vaping and cannabis edibles update for primary care Monica Hau Associate Medical Officer of Health Region of Peel – Public Health
NotAnExperiment.ca
Learning Objectives 1. Describe various vaping and dabbing delivery systems and the health outcomes of vaping and dabbing 2. Describe the safety and effectiveness of vaping products as a smoking cessation aid 3. Identify current regulations on cannabis edibles and their health impacts
Dr. Monica Hau, Associate Medical Officer of Health Dr. Peter Selby, MBBS, CCFP, FCFP, Dip A Agenda Case Studies Question & Answer Period
• Faculty: Dr. Monica Hau • Relationships with financial sponsors: – Grants/research support: Not applicable – Speakers Faculty/Presenter bureau/honoraria: Not Disclosure applicable – Consulting fees: Not applicable – Patents: Not applicable – Other: Associate Medical Officer of Health, Peel Public Health
Disclosure of Commercial Support • This program has received financial support from Peel Public Health in the form of program promotion and education dollars. • This program has not received in-kind support. • Potential for conflict(s) of interest: – None
Mitigating Potential Bias • Any recommendations made are those of Health Canada, Public Health Agency of Canada (PHAC), and the Centre for Addiction and Mental Health (CAMH).
Login to polling website Go to Sli.do #PeelCME
Warm-up polling question • How many times in the past month have you seen a patient for vaping- related concerns? A) None B) 1-10 times C) 11-20 times D) Over 20 times
https://media.giphy.com/media/B1lDT0KdplG What is Vaping? HC/giphy.gif The act of inhaling and exhaling an aerosol produced by a vaping Devices are usually battery- device, such as an e-cigarette powered and may come with removable parts The aerosol may contain: - nicotine/cannabis The device heats a liquid into an -carrier solvent (propylene aerosol glycol, glycerol) - Flavourings -heavy metals (contaminant)
Types of E-cigarettes First Generation Second Generation Third Generation • Mimic cigarettes • Resembles pen • Mods and Customizables • Disposable • Battery lasts longer • Customize power & • One power setting • Refillable and larger airflow • Refillable and larger cartridge cartridge Chun et al. 2017
4 th Generation • Sleek high-tech design • High nicotine delivery • Use of nicotine salt e-liquid formulations https://truthinitiative.org/research-resources/emerging- tobacco-products/e-cigarettes-facts-stats-and-regulations
History of Vaping in Canada E-cigarettes with nicotine are legalized for adults. Health Canada recommends vaping over smoking as a harm reduction method May 2007 2019 2018 E-cigarettes enter Vaping in the last 30 days increased amongst 16-19 y/o by North American 74% (8.4%-14.6%) from 2017-18 in a national repeat cross- marketplace sectional survey* Smoking cigarettes in this age group also increased. *Hammond et. al, 2019: https://www.bmj.com/content/365/bmj.l2219
Severe pulmonary illness associated with vaping, 2019 Canada 11 cases CDC Mandatory Canada’s confirmed hospital 1st death in reporting to 1 st US the US the Ontario confirmed Ministry of >2200 case in Health cases Montreal 47 deaths August 30 September September Present 18 27 Day
Polling question: Which of the following are NOT symptoms of Severe Pulmonary Disease Associated with Vaping/Dabbing? Symptoms of Vaping-related a) Cough, shortness of breath, chest pain Severe b) Nausea, vomiting, abdominal pain, Pulmonary diarrhea Disease c) Headache, nasal congestion, constipation d) Fatigue, Fever, weight loss https://www.canada.ca/en/public-health/services/diseases/vaping- https://www.nejm.org/doi/full/10.1056/NEJM pulmonary-illness/health-professionals/national-case-definition.html oa1911614
Severe Pulmonary Disease Associated with Vaping or Dabbing-National Case Definition The case definition includes: ✓ History of vaping or dabbing in the 90 days prior ✓ Pulmonary infiltrate ✓ Absence of pulmonary infection ✓ No evidence of alternative plausible diagnoses And evidence of severity (e.g. hospitalization, ventilation) Full definition: https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness/health- professionals/national-case-definition.html
▪ Majority of cases in the U.S. have vaped tetrahydrocannabinol (THC) ▪ Many report acquiring vapes from informal sources (e.g. Friends, online) ▪ Recent bronchoalveolar lavage samples of 29 patients identified vitamin E acetate, an additive in some (THC) containing products ▪ Evidence is not yet Current U.S. Investigation on sufficient to rule out contribution of other Vaping-related Severe Pulmonary chemicals of concern Disease https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung- disease.html https://interactives.nejm.org/ile/cdc_vaping/index.html
Tackling Youth Vaping - Role of Public Health • Policy advocacy- regulate vaping similar to tobacco • Supporting Schools • Enforcing Smoke-Free Ontario Act and the new Peel Regional No Outdoor Smoking and Vaping By- Law – Test shopping – Inspecting ~550 e-cigarette vendors in Peel • Conducting Surveillance
Social Media Campaign: notanexperiment.ca
Newly legalized: Cannabis Edibles, Extracts and Topicals https://www.youtube.com/watch?v=NATQjIWfGp8
https://www.cpha.ca/cannabasics
What Do We Know About Cannabis Use in Peel? • 16% of students have used cannabis at least once in the past 12 months (Ontario = 19%) – highest among grades 11 and 12 • Past year cannabis use is higher among males (11%) compared to females (5%) • As grade increases, perceived risk of harm from cannabis decreases – 69% of Grade 7 students believe that there is a “great risk” of harm associated with using cannabis regularly vs. 21% of grade 12 students (Ontario Student Drug Use and Health Survey, 2017)
Pre-legalization trends for cannabis-related harms in Peel region, 2017 • Peel’s rate of ED visit for cannabis -related harms is relatively low but increasing rapidly • Males > females • ED visits and hospitalizations for cannabis-related mental health disorders more common than cannabis poisonings • Youth (13-24 y/o) have the highest rates of ED visits and hospitalizations than any other age groups
Polling Question: National Trends in Cannabis Use Post-Legalization What is the fastest growing age group of legal recreational cannabis users in Canada A) 14-17 years B) 18-24 years C) 25-34 years D) 65+ years Cannabis Stats Hub: https://www150.statcan.gc.ca/n1/pub/13-610-x/13-610-x2018001-eng.htm
National Cannabis Survey, 3 rd quarter, 2019 https://www150.statcan.gc.ca/n1/pub/13-610-x/cannabis-eng.htm
New Cannabis Products - Regulations
What are Cannabis Edibles? • Products you eat or drink containing cannabinoids (THC and CBD) • Onset of effects- 30 minutes to 4 hours • Effects can last up to 6 to 24 hours • Effects can be more intense than inhaling cannabis • Health Canada recommends starting with 2.5 mg of THC or less
• Generally contain higher levels of cannabinoids than are found in the cannabis plant • Vary widely in their THC and CBD content • Can be solid in form, such as hash and kief, or a liquid, such as an oil intended for vaping • Typically smoked and vaped, and some can be added to dried cannabis • Tinctures are placed under the tongue using a spray or What are Cannabis Extracts? dropper
Cannabis Topicals
Cannabis- Role of Public Health • Policy advocacy and development • Support schools • Enforce Smoke-Free Ontario Act and Peel Regional No Outdoor Smoking and Vaping Bylaw • Conduct surveillance
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