Clearing The Air Vaping , Nicotine and Cannabis Presented by: [PDF]

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Clearing The Air Vaping , Nicotine and Cannabis

Presented by: David Fialko, BS, NCTTS, ICPS

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Risk Factors Associated With ATOD Use

Access:

▪ Illicit Drugs are easier to obtain then ever before ▪ Zip Code does not matter!

Purity:

▪ Drugs today are more potent than prior generations

▪ Can be either very pure or something even more dangerous

Perceived Level of Harm

▪ Social norms and media have influenced an all time acceptance of drug

use by the US population.

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Reoccurring themes that promote ATOD use amongst adolescents

Lack of family support & ineffective communication
Not feeling safe in home setting and/or school setting
Unclear or complete lack of boundaries & expectations
Antisocial / unhealthy adult, peer and parent role models

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Nicotine

▪80 percent of smokers do it primarily to self-medicate emotional problems.

▪ They are using cigarettes as a form of antidepressant or tranquillizer, a drug of solace for negative emotions.

▪Three-quarters of people with a history of depression become depressed after quitting, compared with 30 per cent of people with no such history. ▪Months or years after giving up, we still crave nicotine because, as with Prozac or Valium, it improves

ur mood.

▪Nicotine has a profound beneficial effect on the emotional state of people who could benefit from psychotropic medication. ▪Nicotine also improves concentration and performance on tasks that demand these.

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▪Nicotine is a highly addictive substance, distributed quickly through the blood stream ▪Provides an increase in dopamine (Bodies “natural happy drug”) also acts as a stimulant

Nicotine

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Motivational Salience

The Limbic System aka Emotional Brain

Prefrontal cortex helps us select the right behavior in a given situation Hippocampus moves short term memories to long term storage Amygdala ads relevance to memories and perceived rewards / consequences Site of Dopamine Target of Dopamine Motivates us

Excitatory

Brakes

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Nicotine & Cannabis

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PA Medical Cannabis (Marijuana)

Under Act 16 of 2016 (the Pennsylvania Medical Marijuana Act or the Act), the term “medical marijuana” refers to marijuana obtained for a certified medical use by a Pennsylvania resident with a serious medical condition and is limited by statute in Pennsylvania to the following forms:

Pill
Oil
Topical forms, including gel, creams, or ointments
A form medically appropriate for administration by vaporization or nebulization, excluding dry leaf or plant form
Tincture
Liquid
Plant material (for vaporization only)
Entourage effect (Terpenes, CBD’s and THC’s)
Carbonization destroys many of the terpenes, just like it destroys many of the cannabinoids. (above 365 degrees f)

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Effects of Cannabis on Body

Endocannabinoid System (ECS) Previously known as the Anandamide System “Endocannabinoids” are endogenous neurotransmitters that are produced by our bodies. They regulate neurotransmission and allow for feedback loops. ▪Anandamide

▪ Mood enhancer ▪ Modulates and regulates Dopamine transmission

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Effects of Cannabis on Body

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Down Regulation & Up Regualtion

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Effects of Cannabis on Body

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▪Increased risk of cardiovascular, respiratory, gastrointestinal disorders. ▪Decreased immune response and it also poses ill impacts on the reproductive health. ▪Epigenetics! ▪Nicotine affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. ▪Affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents.

Effect of Nicotine on Body

Indian J Med Paediatr Oncol. 2015 Jan-Mar; 36(1): 24–31. doi: 10.4103/0971-5851.151771

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Up Regulation & Down Regulation

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Effects of Nicotine on Body

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Nicotine Vs. Exercise?

What's the difference?

The healthy heart only has to work under pressure for brief intervals, several hours of strength / cardio

training per week.

Heart becomes stronger with a lower resting heart rate
Nicotine results in high blood pressure for extended periods throughout the day, seven days a week.
Dependency increases frequency
Heart becomes weaker with a higher resting heart rate
Exercise stimulates the production of new blood vessels!
Improving blood delivery
Nicotine also promotes the growth of new blood vessels BUT also stimulates tumor growth and the

build up of plaque inside arteries.

Tumor enhancer qualities of Nicotine allowing tumors to grow much more quickly which are more densely packed with blood

vessels feeding the tumor.

Nicotine Stimulates New Blood Vessel Formation; Also Promotes Tumor Growth And Atherosclerosis July 31, 2001 Source: Stanford University School of Medicine

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Nicotine Vrs Caffeine

Juul co-founder James Monsees stated in 2018:

“Chemically, nicotine is very similar to caffeine, and coffee is one of the most widely traded products in the world. While people of all ages around the world enjoy coffee, nicotine has been heavily stigmatized.”

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▪ Nicotine raises pulse & heart rate. Brain EEG becomes same as when people are agitated. ▪ Nicotine has a half life of 2 hours. Students who smoke may have more challenges learning and trouble concentrating due to withdrawal symptoms. ▪ Youth report withdrawal symptoms with lower amount of consumption than adults, even as low as 5 cigarettes per week. ▪ Smoking actually contributes to problems; withdrawal causes stress, anxiety.

Effect of Nicotine on Learning

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Caffeine: A stimulant that works by blocking the receptor for adenosine, a

neurotransmitter that causes relaxation!

Does Not increase dopamine, does not increase risks of heart disease or cancer, does not effect

epigenetics

Is Not: A tumor enhancer a cardio-toxic chemical,

Nicotine: A stimulant which increases the release of multiple different

neurotransmitters.

Increases the release of Dopamine, Norepinephrine, Acetylcholine
Nicotine (Acetylcholine) receptors change into a state that is more easily activated, thereby providing a

memory for nicotine exposure.

Nicotine Vrs Caffeine

J Neurosci. 2005 Jun 8; 25(23): 5563–5572. doi: 10.1523/JNEUROSCI.5240-04.2005

Caffeine increases striatal dopamine D2/D3 receptor availability in the human brainN D Volkow,1,* G-J Wang,1 J Logan,2 D Alexoff,2 J S Fowler,2 P K Thanos,2 C Wong,1 V Casado,3 S Ferre,4 and D Tomasi1

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Transition From E-cigs (ENDS) to Tobacco Products

A study by the University of Pittsburgh Schools of the Health Sciences found that young adults who use e-cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape.

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“ENDS” Electronic Nicotine Delivery Systems

▪According to the FDA, ENDS are devices that allow users to inhale an aerosol (vapor) containing nicotine or other substances. (Electronic Nicotine Delivery System) ▪The main component of ENDS is the e-liquid contained in cartridges combined with nicotine.

▪ Juul: contains nicotine salts & benzoic acid

▪ Benzoic acid: Is an irritant to the nose, throat and lungs if inhaled, which may cause coughing, wheezing and/or shortness of breath.

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5 Ideas about ENDS

1. ENDS are “less harmful” than traditional smoking 2. ENDS are harmful 3. ENDS are equally addictive to cigarettes 4. ENDS are NOT the best smoking cessation aid 5. ENDS are getting a new generation hooked on nicotine!!

How…….?

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Vaping is not in fact “vapor”

It is aerosol:

In physics, a vapor is a substance in the gas phase whereas an aerosol is a suspension of tiny particles of

liquid, solid or both within a gas.

Vapor from an electronic cigarette simulates tobacco smoke, but the process of burning tobacco does not
ccur.
The aerosol of electronic cigarettes is generated when the e-liquid reaches a temperature of roughly 200–

500 °F within the coil chamber.

The aerosol is made-up of liquid sub-micron particles of condensed vapor, which mostly consist of

propylene glycol, glycerol, water, flavorings, nicotine, and other chemicals.

THE COUNCIL OF SOUTHEAST PENNSYLVANIA, INC. (C)

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VG vrs PG ?

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Anatomy of an E-Cigerette

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Anatomy of an E- Hookah

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Marketing

Cigarette ads have been banned from TV since 1971 ENDS now marketed on TV & mainstream media channels

Themes such as rebellion, glamour & sex
Celebrity endorsements

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Marketing

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Trends- Recognizing

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Offers extra power to personal vaporizers
Bigger battery
Power and voltage customizable for a

cooler vape, warmer vape or more vape volume

Generally used by advanced users

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Trends – Recognizing Items

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Suorin Air Ultra Portable

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UWELL CALIBURN POD SYSTEM

“Uwell presents the Caliburn Pod System, a low profile refillable pod device that is made for salt nic juice vaping. This dual method firing device is pocket sized and ready for adventure.”

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JUUL

Discreet
Easily concealable
Trendy
Viewed as “harmful” as coffee
Cost: Around $50.00 for a starter kit
Refill pods are $20.00 for 4 pack
1 pod = nicotine equivalent of 1 pack of cigarettes

NPR Article on JUUL: https://www.npr.org/sections/health- shots/2017/12/04/568273801/teenagers-embrace-juul-saying- its-discreet-enough-to-vape-in-class

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JUUL

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Cannabis & Cross Utilization of ENDS

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Vaping Cannabis

Hash Oil : Several types

BHO: Butane extraction
Heavy metals & pesticide concentrates.
Brain lesions
NHO: Naphtha extraction
benzene, hexane
Cancer hazards
CDHO: Cannabinoids are drawn out by pressure and

carbon dioxide to separate plant material. (expensive)

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Heating BHO

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At 978°F terpenes degrade into methacrolein and benzene.

Methacrolein is structurally similar to acrolein, a pulmonary

irritant, which causes acute lung injury and pulmonary edema in laboratory animals.

We hypothesize a mechanism of lung injury and acute respiratory

failure secondary to inhalation of high levels of methacrolein and benzene related to relatively novel phenomena of BHO use.

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Concerns Regarding Cannabis

Adulterants in cannabis products able to be “vaped”

Vitamin E acetate
Made from petroleum: trimethylhydroquinone (carcinogenic)
Thickening agent
Thickness of oil usually equals quality
Vaping-related” illness have spread throughout 36 states in the past two months,

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Lung Injury Cases

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Identified Products

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Phytocannabinoids

Plant derivative compounds Phytocannabinoids mimic the characteristics of the endocannabinoids.

Two most people have heard of:
THC: mimics Anandimide
Delta-8-tetrahydrocannabinols (less psycho active)
Delta-9-tetrahydrocannabinols (more psycho active)
Cannabidiol (CBD): mimics 2-Arachidonoylglycerol (2-AG)

Potential to interfere with natural feed back loop

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Cannabis Potency (Flowering Material)

National average of marijuana's THC content:
1978 was 1.37%
1988 it was 3.59%
1998 4.43%
2008 8.49% University of Mississippi's Potency Monitoring Project (UMPMC)
Colorado average of marijuana’s THC content:
2016 17.1% Colorado Health Research Council (CHRC)

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3 Most Popular Strains

Sundae Driver:

20% THC
1% CBD

Banana Punch:

25% THC
1% CBD

Ice Cream Cake:

25% THC
2% CBD

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Smokable

Thai Stick: Then Moon Rocks : Now

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Hash

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Bubble Hash:
The powdery kief that coats your cannabis

flowers can be collected and pressed together to form hash

Tinctures:
Liquid concentrate procured through

alcohol extraction, which pulls out many of the plant’s cannabinoids.

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“Dabs”: How are they utilized?

Oil Rigs!

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Trends in “Methods Of Use”

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Trends in “Methods Of Use”

Bongs

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https://www.youtube.com/watch?v=ZytwYX06AzU

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Ability to Address

Catch My Breath- https://www.catch.org/bundles/23725

Program Details Cost: Free to Schools Ages: 10 to 18 / Grades 5 to 12 Evidence-Base Duration: 4 lessons / 30 to 40 minutes per lesson Shown to significantly reduce the likelihood of vaping in the year following program implementation (Kelder, S. H. et al. 2020)

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Cessation Options

Should only use FDA approved products

Why?
Longitudinal Studies
Control / Study groups
Risk vrs Benefit
Risk cannot be determined if there is no data from long term studies.
The claims by the vaping industry are currently unfounded
One study grossly misinforms the public:
Peter Hajek, PHD – Randomized Trial of E-Cigerettes versus NRT
https://www.nejm.org/doi/full/10.1056/nejmoa1808779

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Cessation Options

NRT is designed as step down

Goal is to be nicotine free in 3 to 4 months.

Approved forms

Gum – short acting
Lozenges- short acting
Patches – long acting

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PA Free Quitline 1-800-QUIT-NOW (784-8669) 1-855-DEJELO-YA (335-3569) Text2Quit.com Nicotine Anonymous 1-877-879-6422 DeterminedToQuit.com

Resources

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Questions & Answers

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Name: David Fialko Title: Certified Prevention Specialist – ICPS, NCTTS The Council of Southeast Pennsylvania, Inc. 4459 W. Swamp Road Doylestown, Pennsylvania 18902 Phone: (215) 230-8218 ext. 3162 Dfialko@councilsepa.org www.councilsepa.org