A recent study has found that vaping cannabidiol (CBD) leads to more severe lung damage than vaping nicotine.
Research into CBD’s benefits and risks has yielded mixed findings, but its use is still growing in popularity.
Physicians need to ask patients about their vaping history.
People who vape cannabidiol (CBD), a non-impairing compound found in cannabis, may be at higher risk for more serious lung damage than those who vape nicotine, according to a new study conducted by Roswell Park Comprehensive Cancer Center and published in Thorax.
Vape devices—sometimes referred to as electronic cigarettes, e-cigarettes, or vape pens—allow the user to inhale vapors made within the device, where liquid is heated up in a cartridge.
The study, which compared the pulmonary effects of acute inhalation of CBD vapor against nicotine vapor, used both mice and in vitro cytotoxicity experiments with human cells. To compare the CBD vape and the nicotine vape, the study utilized products containing 50 mg/mL of CBD and 5.0% nicotine, respectively.
Findings showed that inhaling CBD aerosoles led to an increase in the number and severity of focal lesions, as well as increased inflammation, increased myeloperoxidase (MPO) activity, and heightened oxidative stress. Additionally, inhalation of CBD aerosoles killed lung neutrophils at a higher rate than nicotine, while also causing more damage to human small airway epithelial cells. It also led to a reduction in protective pulmonary interstitial macrophages.
The authors concluded, “Vaping of CBD induces a potent inflammatory response and leads to more pathological changes associated with lung injury than vaping of nicotine.” They also called for additional research on the long-term effects of regular vaping of both CBD and nicotine and on the effects of vaping other kinds of cannabinoids, like THC.
The majority of research around vaping to date has examined nicotine, not CBD. In Roswell Park’s news report about the study, Yasmin Thanavala, Ph.D., who led the study, commented on the study’s importance: “We believe this is the first-ever report on what happens to various immune cell types and markers of damage and inflammation measured in the lung following in vivo inhalation exposure.”
Previous studies have shown that vaping can expose users to a whole spectrum of chemicals, including propylene glycol, flavorants, and vegetable glycerin. When heated, these substances can become dangerous. These chemicals can be found in vape pens even without the added CBD or nicotine.
Why does this study matter?
The study’s findings are key, especially as CBD vapes are growing in popularity. This recent CBD sales boom is potentially linked to people—particularly younger people—hoping to manage their psychological distress through the inhalation of CBD, according to BMC Psychology.
CBD has garnered a reputation for being a safe, natural option to support health—and it can be found in everything from coffee to body oils. The science on CBD is mixed and research is needed.
Arguably, CBD may provide some meaningful health benefits. A study in the Journal of Cannabis Research showed that patients who used CBD-rich products (containing 0.5–1 mg of THC/mL and 20–25 mg of CBD/mL) saw improvements in pain, depression, and anxiety. Certainly, CBD enthusiasts report that it helps them in a variety of ways.
But despite the abundance of potential therapeutic benefits of CBD, it’s also not without certain risks. The Food and Drug Administration (FDA) has taken the stance that there are risks around CBD, including liver injury, male reproductive system harm, and cognitive side effects. It may also interfere with other medications and should not be used when pregnant.
Though this study clearly looked at vaping CBD and did not examine topical use or other uses of CBD.
CBD is not FDA-approved for any of the above uses. The only FDA-approved product containing CBD is Epidiolex (cannabidiol), which treats seizure disorders.
Who is at greatest risk?
According to Abraham Benavides, M.D., a medical advisor at Nature Bloom (a cannabis resource) with a background in cannabis research, “Teenagers are particularly vulnerable to the harmful effects of CBD vapes, since these products are easily accessible to them, and their developing lungs are more susceptible to the damaging chemicals that can cause permanent harm to their bodies.”
This issue isn’t anything new, either—and the problem is worsening. A 2018 survey of more than 44,000 students found that 37 percent of 12th graders reported vaping, vs 28 percent in 2017. This included nicotine and cannabis products.
Benavides says that patients with respiratory or cardiovascular problems such as asthma or heart disease should also be especially warned against vapes. Patients who manage chronic pain may be tempted to turn to CBD vaping, as many do—but researchers are calling for further investigation.
It’s important to ask your patients about their potential vape usage, and if it includes CBD or nicotine, Thanavala advised, speaking for the Roswell Park news release. You should also remind patients that smoking also includes vaping. Patients should understand the real-life implications of vaping CBD. Thanavalal’s study found that vaping CBD can lead to suppression of adaptive immunity in the lungs, increased susceptibility to respiratory infections, and poorer outcomes to prophylactic vaccination.
"It is important [for physicians] to convey that while decades of science-based evidence has established that smoking traditional combustible tobacco cigarettes is harmful for health and the cause for multiple diseases, vaping is also harmful," Thanavala tells MDLinx.
In the end, as Benavides summed it up: "Vaping poses significant health risks that include lung and organ damage, respiratory issues, addiction, and more. Despite being marketed as a ‘safer’ alternative to smoking, vaping is not a safe practice.”