Cloud-chasing and Gummi Bears: A vaping and cannabis edibles update - - PowerPoint PPT Presentation

A vaping and cannabis edibles update for primary care

Monica Hau Associate Medical Officer of Health Region of Peel – Public Health

Cloud-chasing and Gummi Bears:

NotAnExperiment.ca

Learning Objectives

• 1. Describe various vaping and dabbing

delivery systems and the health outcomes

• f 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

Agenda

• Dr. Monica Hau, Associate

Medical Officer of Health

• Dr. Peter Selby, MBBS,

CCFP, FCFP, Dip A Case Studies Question & Answer Period

Faculty/Presenter Disclosure

• Faculty: Dr. Monica Hau
• Relationships with financial

sponsors: – Grants/research support: Not applicable – Speakers bureau/honoraria: Not 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

What is Vaping?

The act of inhaling and exhaling an aerosol produced by a vaping device, such as an e-cigarette Devices are usually battery- powered and may come with removable parts The device heats a liquid into an aerosol The aerosol may contain:

• nicotine/cannabis
• carrier solvent (propylene

glycol, glycerol)

• Flavourings
• heavy metals (contaminant)

https://media.giphy.com/media/B1lDT0KdplG HC/giphy.gif

Types of E-cigarettes

First Generation

• Mimic cigarettes
• Disposable
• One power setting

Second Generation

• Resembles pen
• Battery lasts longer
• Refillable and larger

cartridge

Third Generation

• Mods and Customizables
• Customize power &

airflow

• Refillable and larger

cartridge

Chun et al. 2017

• Sleek high-tech

design

• High nicotine

delivery

• Use of nicotine salt

e-liquid formulations

4th Generation

https://truthinitiative.org/research-resources/emerging- tobacco-products/e-cigarettes-facts-stats-and-regulations

2007 E-cigarettes enter North American marketplace May 2018 E-cigarettes with nicotine are legalized for adults. Health Canada recommends vaping over smoking as a harm reduction method

History of Vaping in Canada

2019 Vaping in the last 30 days increased amongst 16-19 y/o by 74% (8.4%-14.6%) from 2017-18 in a national repeat cross- sectional survey* Smoking cigarettes in this age group also increased.

*Hammond et. al, 2019: https://www.bmj.com/content/365/bmj.l2219

Canada 11 cases US >2200 cases 47 deaths Canada’s 1st confirmed case in Montreal

Severe pulmonary illness associated with vaping, 2019

August 30 September 18 September 27 Present Day

CDC confirmed 1st death in the US Mandatory hospital reporting to the Ontario Ministry of Health

Symptoms of Vaping-related Severe Pulmonary Disease

Polling question:

Which of the following are NOT symptoms of Severe Pulmonary Disease Associated with Vaping/Dabbing?

a) Cough, shortness of breath, chest pain b) Nausea, vomiting, abdominal pain, diarrhea c) Headache, nasal congestion, constipation d) Fatigue, Fever, weight loss

https://www.canada.ca/en/public-health/services/diseases/vaping- pulmonary-illness/health-professionals/national-case-definition.html https://www.nejm.org/doi/full/10.1056/NEJM

• a1911614

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

Current U.S. Investigation on Vaping-related Severe Pulmonary Disease

▪ Majority of cases in the U.S. have vaped tetrahydrocannabinol (THC) ▪ Many report acquiring vapes from informal sources (e.g. Friends,

• nline)

▪ Recent bronchoalveolar lavage samples of 29 patients identified vitamin E acetate, an additive in some (THC) containing products ▪ Evidence is not yet sufficient to rule out contribution of other chemicals of concern

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, 3rd 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

What are Cannabis Extracts?

• 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,

• r a liquid, such as an
• il 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 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