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Clinical Encounters: Vaping

Build Key Clinical Skills Related to Vaping

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Helping Patients Who Vape Cannabis Recreationally (V2)

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Helping Patients Who Vape Cannabis Recreationally (V2)

Cannabis vaping interventions

1 hr CME/CE

Goal: The clinician learner will be able to screen for and assess their patients for cannabis vaping as part of their substance use evaluation. The clinician will be able to provide brief interventions for patients who are not ready to stop vaping cannabis through those who are ready to quit and need a plan.

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NASW Credit Approved!  See Other Credit Options

This activity is designed to change: Competence, Performance, Patient Outcome.   1 hr

Educational Objectives:

After completing this activity participants will be able to:

  • Use a non-judgmental approach and encourage open dialogue with patients about cannabis vaping as part of substance use screening.
  • Evaluate patient’s recreational cannabis vaping, including level of dependence.
  • Educate patients using recreational cannabis regarding addictive potential and other harmful health effects.
  • Use motivational interviewing to facilitate patients quitting cannabis vaping.
  • Guide patients in harm reduction if they are not currently willing to quit recreational cannabis vaping.

Audience and Accreditation

Audience: Primary care providers, counselors, and social workers

TypeEst. TimeReleasedExpires
AMA PRA Category 1 Credit(s)™1 hr3/23/223/22/25
DCBN1 hr3/23/223/22/25
NBCC1 hr3/23/223/22/25
NASW1 hr*12/1/2111/30/22
NYSOASAS1 hr6/1/204/1/23

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit™ Designation Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942.

NBCC Credit Statement:Clinical Tools, Inc. designates this enduring material for a maximum of 1 clock hour(s) of NBCC credit. Clinical Tools, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6161. Activities that do not qualify for NBCC credit are clearly identified. Clinical Tools is solely responsible for all aspects of the activity.

NASW Credit Statement: This program is Approved by the National Association of Social Workers (Approval # 886426346-7674) for 2.5 continuing education contact hours.

*Helping Patients Who Vape Cannabis Recreationally (1hr) is part of a specific NASW activity called Vaping Interventions (Total 2.5 hours). All 3 activities within Vaping Interventions must be completed to be awarded NASW credit.

NYS OASAS Credit Statement: This activity is pending approval from the New York State Office of Addiction Services and Supports.

Florida Board Of Medicine: Clinical Tools, Inc. is recognized by the Florida Board Of Medicine
as an accredited provider of continuing medical education for physicians.

Florida Physician Assistants: Clinical Tools, Inc. is recognized by the Florida Physician Assistants
as an accredited provider of continuing medical education for physician assistants.

Florida Board Of Nursing – Certified Nursing Assistants: Clinical Tools, Inc. is recognized by the Florida Board Of Nursing – Certified Nursing Assistants as an accredited provider of continuing medical education for nurses.

Florida Board Of Nursing: Clinical Tools, Inc. is recognized by the Florida Board Of Nursing as an accredited provider of continuing medical education for nurses.

Florida Board Of Clinical Social Work, Marriage And Family Therapy And Mental Health Counseling: Clinical Tools, Inc. is recognized by the Florida Board Of Clinical Social Work, Marriage And Family Therapy And Mental Health Counseling as an accredited provider of continuing medical education for counselors.

Florida Board Of Respiratory Care: Clinical Tools, Inc. is recognized by the Florida Board Of Respiratory Care as an accredited provider of continuing medical education for respiratory therapists.

Arkansas State Board of Nursing Accreditation Statement: Clinical Tools, Inc. is recognized by the Arkansas State Board of Nursing as an accredited provider of continuing medical education for nurses.

Georgia Board of Nursing: Clinical Tools, Inc. is recognized by the Georgia Board of Nursing as an accredited provider of continuing medical education for nurses.

New Mexico Board of Nursing: Clinical Tools, Inc. is recognized by the New Mexico Board of Nursing as an accredited provider of continuing medical education for nurses.

South Carolina Board of Nursing: Clinical Tools, Inc. is recognized by the South Carolina Board of Nursing as an accredited provider of continuing medical education for nurses.

A letter of completion for 1 hour is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Professional Practice Gaps

Training Activity References

Participation Requirements     

Funding

Development of this activity was supported by grant #R43DA050401 from the National Institutes of Health.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc. requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Christy Kollath-Cattano, PhD (Assistant Professor, College of Charleston )
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Carla Berg, PhD (Assistant Professor, Emory University)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Lisa Graves, MD,MclSc (Associate Dean Faculty Affairs Western Michigan University Homer, Stryker M.D. School of Medicine)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Dana Anne Cavallo, PhD (Assistant Professor, Yale University School of Medicine)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Michael J. Zvolensky, PhD (Hugh Roy and Lillie Cranz Cullen Distinguished Professor at University of Vermont)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Steve Applegate, MEd, MEd (President, Applegate Consulting)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Most Recent Reviews

CTI Content Review:  3/18/2022
CTI Editorial Review: 3/23/2022

View Reviews


Reviews for this activity

Good learning experience

This was overall a good learning experience . It covered both breath and depth and can be useful to anyone who is either working directly or indirectly with clients.

— Mental health practitioner from CT, 12/30/2020

Helping Patients Who Vape Cannabis Recreationally
5
2021-02-17T15:12:26-05:00

— Mental health practitioner from CT, 12/30/2020

This was overall a good learning experience . It covered both breath and depth and can be useful to anyone who is either working directly or indirectly with clients.
https://vaping.clinicalencounters.com/blog/testimonials/good-learning-experience/

Very informative and educational.

Very informative and educational. Thank You.

— Nurse from NM, 07/29/2020

Helping Patients Who Vape Cannabis Recreationally
5
2021-02-17T15:12:54-05:00

— Nurse from NM, 07/29/2020

Very informative and educational. Thank You.
https://vaping.clinicalencounters.com/blog/testimonials/very-informative-and-educational/
5
2
Helping Patients Who Vape Cannabis Recreationally

Activity Content

Pre-Assessments
Course not enrolled
Learn More! Help Patients Who Vape Cannabis
Course not enrolled
Test Your Knowledge
Course not enrolled
Post-Assessments
Course not enrolled
Introduction
Course not enrolled
Case Simulation – Jacob Carter
Course not enrolled
Resources
Sample Lesson

Primary Sidebar

Activity Home Expand All
Pre-Assessments
1 Topic | 1 Test
Pre-Survey
Vaping Cannabis Knowledge Pre-Test
Introduction
Case Simulation – Jacob Carter
Learn More! Help Patients Who Vape Cannabis
Resources
Test Your Knowledge
1 Test
Vaping Cannabis Knowledge Post-Test
Post-Assessments
2 Topics
Post-Survey
Request Certificate
Funding Information Development of this website was funded entirely by grant #R43DA050401 from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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A member of The Clinical Encounters Training Group: SBIRT Training | BupPractice | PainTx Challenge | CE:Vaping | CE:Alcohol | CE:Obesity | OpioidCME

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Unless otherwise noted, individuals pictured are models and are used for illustrative purposes only.
This site is for educational purposes only and medical decisions should not be based solely on its content. This site, its authors, and its consultants do not assume liability for errors or omissions.
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Professional Practice Gaps

Around 10% of adolescents in the U.S. have vaped cannabis1,2. However, many healthcare providers are not screening their patients for it and are not prepared to help patients who vape cannabis due to a lack of understanding of vaping in general3,4 and vaping of cannabis, in particular 5. Healthcare providers have a limited understanding of vaping and minimal training, practice, or experience negotiating the fine art of engaging youth in discussions that productively detect and discuss substance use or can lead to intervention3,4. Unfortunately, few providers ask patients about vaping5 or cannabis use6 explicitly. Although the medical professional societies, APA and AAFP, recommend screening for substance use at well-child visits7 including screening for electronic nicotine delivery systems8,9, health care providers still use ineffective screening approaches10.

Providers have moderately low levels of knowledge about e-cigarettes and moderately low comfort discussing e-cigarettes with parents and adolescent patients3. In a survey of 4th-year medical students, more than 2/3 (68.7%) regarded their training on vaping as inadequate 11It is important for providers to understand how their patients use cannabis, because vaping cannabis may lead to different patterns of use and different blood levels of ingredients than smoking it12–14, which may lead to differences in risks from intoxication, dependency, and effects on daily living.

Practice Gap References

  1. Kowitt Sarah D, Osman Amira, Meernik Clare, et al. Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA. BMJ Open. May 1, 2019;9(6). doi:10.1136/bmjopen-2018-028535. PMID: 31196904.
  2. Trivers Katrina F, Phillips Elyse, Gentzke Andrea S, Tynan Michael A, Neff Linda J. Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth. JAMA Pediatr. November 1, 2018;172(11):1097-1099. doi:10.1001/jamapediatrics.2018.1920.
  3. Pepper Jessica K, McRee Annie-Laurie, Gilkey Melissa B. Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. J Adolesc Health Off Publ Soc Adolesc Med. June 2014;54(6):678-683. doi:10.1016/j.jadohealth.2013.10.001. PMCID: PMC4111908. PMID: 24332394.
  4. Al-Abed Amber, Chung Tara, Lin Elizabeth, Ismail Intesar. Knowledge, Perceptions, and Awareness of Electronic Cigarettes Among Healthcare Providers and In-Patients. 19th Denman Undergrad Res Forum 2014. March 26, 2014.
  5. Bascombe Ta Misha S, Scott Kimberly N, Ballard Denise, Smith Samantha A, Thompson Winifred, Berg Carla J. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study. Health Educ Res. June 2016;31(3):375-383. doi:10.1093/her/cyv103. PMCID: PMC4872592. PMID: 26802106.
  6. Lapham Gwen T, Lee Amy K, Caldeiro Ryan M, et al. Frequency of Cannabis Use among Primary Care Patients in Washington State. J Am Board Fam Med JABFM. 2017;30(6):795-805. doi:10.3122/jabfm.2017.06.170062. PMCID: PMC5769869. PMID: 29180554.
  7. Levy Sharon JL, Kokotailo Patricia K. Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics. November 1, 2011;128(5):e1330-e1340. doi:10.1542/peds.2011-1754. PMID: 22042818.
  8. Walley S, Jenssen B. Electronic Nicotine Delivery Systems. Pediatrics. November 1, 2015;136(5):1018-1026. doi:10.1542/peds.2015-3222. PMID: 26504128.
  9. Devitt Michael. Research Shows Perceptions of E-cigarettes Are Changing. AAFP News. April 15, 2019.
  10. Harris Sion Kim, Herr-Zaya Kathleen, Weinstein Zohar, et al. Results of a statewide survey of adolescent substance use screening rates and practices in primary care. Subst Abuse. 2012;33(4):321-326. doi:10.1080/08897077.2011.645950. PMID: 22989275.
  11. Ruppel T, Alexander B, Mayrovitz HN. Assessing Vaping Views, Usage, and Vaping-Related Education Among Medical Students: A Pilot Study. Cureus. February 28, 2021;13(2):e13614. doi:10.7759/cureus.13614. PMCID: PMC8011463. PMID: 33816013.
  12. Spindle Tory R, Cone Edward J, Schlienz Nicolas J, et al. Acute Effects of Smoked and Vaporized Cannabis in Healthy Adults Who Infrequently Use Cannabis. JAMA Netw Open. November 30, 2018;1(7). doi:10.1001/jamanetworkopen.2018.4841. PMCID: PMC6324384. PMID: 30646391.
  13. Spindle Tory R, Cone Edward J, Schlienz Nicolas J, et al. Acute Pharmacokinetic Profile of Smoked and Vaporized Cannabis in Human Blood and Oral Fluid. J Anal Toxicol. May 1, 2019;43(4):233-258. doi:10.1093/jat/bky104. PMCID: PMC6676961. PMID: 30615181.
  14. Meehan-Atrash Jiries, Luo Wentai, McWhirter Kevin J, Strongin Robert M. Aerosol Gas-Phase Components from Cannabis E-Cigarettes and Dabbing: Mechanistic Insight and Quantitative Risk Analysis. ACS Omega. September 16, 2019;4(14):16111-16120. doi:10.1021/acsomega.9b02301. PMCID: PMC6777088. PMID: 31592479.
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Training Activity References
  1. Kowitt Sarah D, Osman Amira, Meernik Clare, et al. Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA. BMJ Open. May 1, 2019;9(6). doi:10.1136/bmjopen-2018-028535. PMID: 31196904.
  2. Trivers Katrina F, Phillips Elyse, Gentzke Andrea S, Tynan Michael A, Neff Linda J. Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth. JAMA Pediatr. November 1, 2018;172(11):1097-1099. doi:10.1001/jamapediatrics.2018.1920.
  3. Pepper Jessica K, McRee Annie-Laurie, Gilkey Melissa B. Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. J Adolesc Health Off Publ Soc Adolesc Med. June 2014;54(6):678-683. doi:10.1016/j.jadohealth.2013.10.001. PMCID: PMC4111908. PMID: 24332394.
  4. Al-Abed Amber, Chung Tara, Lin Elizabeth, Ismail Intesar. Knowledge, Perceptions, and Awareness of Electronic Cigarettes Among Healthcare Providers and In-Patients. 19th Denman Undergrad Res Forum 2014. March 26, 2014.
  5. Bascombe Ta Misha S, Scott Kimberly N, Ballard Denise, Smith Samantha A, Thompson Winifred, Berg Carla J. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study. Health Educ Res. June 2016;31(3):375-383. doi:10.1093/her/cyv103. PMCID: PMC4872592. PMID: 26802106.
  6. Lapham Gwen T, Lee Amy K, Caldeiro Ryan M, et al. Frequency of Cannabis Use among Primary Care Patients in Washington State. J Am Board Fam Med JABFM. 2017;30(6):795-805. doi:10.3122/jabfm.2017.06.170062. PMCID: PMC5769869. PMID: 29180554.
  7. Levy Sharon JL, Kokotailo Patricia K. Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics. November 1, 2011;128(5):e1330-e1340. doi:10.1542/peds.2011-1754. PMID: 22042818.
  8. Walley S, Jenssen B. Electronic Nicotine Delivery Systems. Pediatrics. November 1, 2015;136(5):1018-1026. doi:10.1542/peds.2015-3222. PMID: 26504128.
  9. Devitt Michael. Research Shows Perceptions of E-cigarettes Are Changing. AAFP News. April 15, 2019.
  10. Harris Sion Kim, Herr-Zaya Kathleen, Weinstein Zohar, et al. Results of a statewide survey of adolescent substance use screening rates and practices in primary care. Subst Abuse. 2012;33(4):321-326. doi:10.1080/08897077.2011.645950. PMID: 22989275.
  11. Spindle Tory R, Cone Edward J, Schlienz Nicolas J, et al. Acute Effects of Smoked and Vaporized Cannabis in Healthy Adults Who Infrequently Use Cannabis. JAMA Netw Open. November 30, 2018;1(7). doi:10.1001/jamanetworkopen.2018.4841. PMCID: PMC6324384. PMID: 30646391.
  12. Spindle Tory R, Cone Edward J, Schlienz Nicolas J, et al. Acute Pharmacokinetic Profile of Smoked and Vaporized Cannabis in Human Blood and Oral Fluid. J Anal Toxicol. May 1, 2019;43(4):233-258. doi:10.1093/jat/bky104. PMCID: PMC6676961. PMID: 30615181.
  13. Meehan-Atrash Jiries, Luo Wentai, McWhirter Kevin J, Strongin Robert M. Aerosol Gas-Phase Components from Cannabis E-Cigarettes and Dabbing: Mechanistic Insight and Quantitative Risk Analysis. ACS Omega. September 16, 2019;4(14):16111-16120. doi:10.1021/acsomega.9b02301. PMCID: PMC6777088. PMID: 31592479.
  14. CDC. Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping. Cent Dis Control Prev. February 18, 2020.
  15. CDC. Quick Facts on the Risks of E-cigarettes for Young People. Cent Dis Control Prev. August 12, 2019.
  16. Madison Matthew C, Landers Cameron T, Gu Bon-Hee, et al. Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine. J Clin Invest. October 1, 2019;129(10):4290-4304. doi:10.1172/JCI128531. PMCID: PMC6763255. PMID: 31483291.
  17. Kosmider Leon, Sobczak Andrzej, Fik Maciej, et al. Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res Off J Soc Res Nicotine Tob. October 2014;16(10):1319-1326. doi:10.1093/ntr/ntu078. PMCID: PMC4838028. PMID: 24832759.
  18. Choi Hyunok, Schmidbauer Norbert, Spengler John, Bornehag Carl-Gustaf. Sources of Propylene Glycol and Glycol Ethers in Air at Home. Int J Environ Res Public Health. December 2010;7(12):4213-4237. doi:10.3390/ijerph7124213. PMCID: PMC3037050. PMID: 21318004.
  19. Jensen R Paul, Luo Wentai, Pankow James F, Strongin Robert M, Peyton David H. Hidden Formaldehyde in E-Cigarette Aerosols. N Engl J Med. January 22, 2015;372(4):392-394. doi:10.1056/NEJMc1413069. PMID: 25607446.
  20. Morean Meghan E, Kong Grace, Camenga Deepa R, Cavallo Dana A, Krishnan-Sarin Suchitra. High School Students’ Use of Electronic Cigarettes to Vaporize Cannabis. Pediatrics. October 2015;136(4):611-616. doi:10.1542/peds.2015-1727. PMCID: PMC4586732. PMID: 26347431.
  21. Fataar Fathima, Hammond David. The Prevalence of Vaping and Smoking as Modes of Delivery for Nicotine and Cannabis among Youth in Canada, England and the United States. Int J Environ Res Public Health. November 2019;16(21). doi:10.3390/ijerph16214111. PMCID: PMC6862259. PMID: 31731420.
  22. Richtel Matt. Marijuana and Vaping: Shadowy Past, Dangerous Present. The New York Times. https://www.nytimes.com/2019/10/21/health/marijuana-and-vaping-shadowy-past-dangerous-present.html. Published October 21, 2019. Accessed February 10, 2020.
  23. Hädener Marianne, Vieten Sina, Weinmann Wolfgang, Mahler Hellmut. A Preliminary Investigation of Lung Availability of Cannabinoids by Smoking Marijuana or Dabbing BHO and Decarboxylation Rate of THC- and CBD-Acids. Forensic Sci Int. February 2019;295:207-212. doi:10.1016/j.forsciint.2018.12.021. PMID: 30638755.
  24. Smart Rosanna, Caulkins Jonathan P, Kilmer Beau, Davenport Steven, Midgette Greg. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addict Abingdon Engl. December 2017;112(12):2167-2177. doi:10.1111/add.13886. PMCID: PMC5673542. PMID: 28556310.
  25. Penny Brian. What “Oils” Can and Can’t Be Put in a Vape Pen?. Thought Your Penny. July 16, 2015.
  26. WM. Marijuana Vape Pens: What They Are & How To Consume. weedmaps. December 20, 2017.
  27. Song Min-Ae, Reisinger Sarah A, Freudenheim Jo L, et al. Effects of Electronic Cigarette Constituents on the Human Lung: A Pilot Clinical Trial. Cancer Prev Res (Phila Pa). October 16, 2019:canprevres.0400.2019. doi:10.1158/1940-6207.CAPR-19-0400. PMID: 31619441.
  28. Penny Brian. Portable Vape Pens Are a Discrete Way to Vape Anything. Thought Your Penny. April 21, 2019.
  29. Abrams DI, Vizoso HP, Shade SB, Jay C, Kelly ME, Benowitz NL. Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study. Clin Pharmacol Ther. November 2007;82(5):572-578. doi:10.1038/sj.clpt.6100200. PMID: 17429350.
  30. Krishnan-Sarin Suchitra, Morean Meghan, Kong Grace, et al. E-Cigarettes and “Dripping” Among High-School Youth. Pediatrics. March 2017;139(3). doi:10.1542/peds.2016-3224. PMCID: PMC5330405. PMID: 28167512.
  31. Talih Soha, Balhas Zainab, Salman Rola, Karaoghlanian Nareg, Shihadeh Alan. “Direct Dripping”: A High-Temperature, High-Formaldehyde Emission Electronic Cigarette Use Method. Nicotine Tob Res Off J Soc Res Nicotine Tob. April 2016;18(4):453-459. doi:10.1093/ntr/ntv080. PMCID: PMC6220833. PMID: 25863521.
  32. Heaney K. The Stoner’s Guide to Vaping Illness. The Cut. November 21, 2019.
  33. Wall Street Journal Editorial Board. Opinion | The Vaping-Marijuana Nexus. Wall Street Journal. https://www.wsj.com/articles/the-vaping-marijuana-nexus-11577299411. Published December 25, 2019. Accessed February 7, 2020.
  34. Frost Adam. How Much THC is in CBD Oil? | NuLeaf Naturals Blog. NuLeaf Nat. October 28, 2019.
  35. Ducharme J. Is Vaping Marijuana Safe? Deaths and Lung Disease Linked to E-Cigs Call That Into Question. Time. September 6, 2019.
  36. CDC. Electronic Cigarettes. What’s the Bottom Line?. 2019.
  37. NIDA. Vaping of marijuana on the rise among teens. NIDA. December 18, 2019.
  38. Cassidy Rachel N, Meisel Matthew K, DiGuiseppi Graham, Balestrieri Sara, Barnett Nancy P. Initiation of vaporizing cannabis: Individual and social network predictors in a longitudinal study of young adults. Drug Alcohol Depend. July 1, 2018;188:334-340. doi:10.1016/j.drugalcdep.2018.04.014. PMCID: PMC5999573. PMID: 29857317.
  39. Jones Connor B, Hill Melanie L, Pardini Dustin A, Meier Madeline H. Prevalence and Correlates of Vaping Cannabis in a Sample of Young Adults. Psychol Addict Behav J Soc Psychol Addict Behav. December 2016;30(8):915-921. doi:10.1037/adb0000217. PMID: 27631612.
  40. Knapp Ashley A, Lee Dustin C, Borodovsky Jacob T, Auty Samantha G, Gabrielli Joy, Budney Alan J. Emerging Trends in Cannabis Administration Among Adolescent Cannabis Users. J Adolesc Health Off Publ Soc Adolesc Med. April 2019;64(4):487-493. doi:10.1016/j.jadohealth.2018.07.012. PMCID: PMC6408312. PMID: 30205931.
  41. NIDA. Monitoring the Future Survey: High School and Youth Trends. DrugAbuse.gov. December 18, 2019.
  42. Peters Jeramy, Chien Joseph. Contemporary Routes of Cannabis Consumption: A Primer for Clinicians. J Am Osteopath Assoc. February 1, 2018;118(2):67-70. doi:10.7556/jaoa.2018.020.
  43. Aston Elizabeth R, Farris Samantha G, Metrik Jane, Rosen Rochelle K. Vaporization of Marijuana Among Recreational Users: A Qualitative Study. J Stud Alcohol Drugs. January 2019;80(1):56-62. doi:10.15288/jsad.2019.80.56. PMCID: PMC6396515. PMID: 30807275.
  44. Earleywine Mitch, Barnwell Sara Smucker. Decreased respiratory symptoms in cannabis users who vaporize. Harm Reduct J. April 16, 2007;4:11. doi:10.1186/1477-7517-4-11. PMCID: PMC1853086. PMID: 17437626.
  45. Jones Connor B, Meier Madeline H, Pardini Dustin A. Comparison of the locations where young adults smoke, vape, and eat/drink cannabis: Implications for harm reduction. Addict Behav Rep. September 12, 2018;8:140-146. doi:10.1016/j.abrep.2018.09.002. PMCID: PMC6174524. PMID: 30302367.
  46. Merianos Ashley L, Jandarov Roman A, Klein Jonathan D, Mahabee-Gittens E Melinda. Characteristics of Daily E-Cigarette Use and Acquisition Means Among a National Sample of Adolescents. Am J Health Promot AJHP. November 2019;33(8):1115-1122. doi:10.1177/0890117119854051. PMCID: PMC6824948. PMID: 31159556.
  47. Tucker Joan S, Pedersen Eric R, Seelam Rachana, Dunbar Michael S, Shih Regina A, D’Amico Elizabeth J. Types of cannabis and tobacco/nicotine co-use and associated outcomes in young adulthood.. Psychol Addict Behav. June 2019;33(4):401-411. doi:10.1037/adb0000464.
  48. National Conference of State Legislatures. State Medical Marijuana Laws. June 25, 2019.
  49. LaVito Angelica. Doctors treating deadly lung disease face a problem: Some patients lie about vaping. CNBC. November 20, 2019.
  50. Loflin Mallory, Earleywine Mitch. A new method of cannabis ingestion: the dangers of dabs?. Addict Behav. October 2014;39(10):1430-1433. doi:10.1016/j.addbeh.2014.05.013. PMID: 24930049.
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