10 JanuaryHealth + Wellness
Marijuana edibles like these gummy bears may come with a higher risk than previously thought. Jamie Grill / Getty Images
Consuming marijuana edibles may not be as risk-free as some like to believe, Canadian doctors argue.
<p>There is still much left to be discovered about marijuana and its effects. Cannabis edibles take an average of around four hours longer to produce noticeable effects when compared to inhaled cannabis, which the authors of a commentary titled <em><a href="https://www.cmaj.ca/content/192/1/E1" rel="noopener noreferrer" target="_blank">Health considerations of the legalization of cannabis edibles</a></em> argue can lead to its overconsumption. Furthermore, the effects of cannabis consumption can last up to eight hours, leading to a much longer period of impairment. These factors create a heightened risk in "cannabis-naïve individuals" like children, older people or pets who may mistake edibles for candy or other food.</p><p><em>Cannabis sativa </em>is a plant that contains more than 80 different naturally occurring compounds called "cannabinoids," most well-known are cannabidiol (CBD) and tetrahydrocannabinol (THC), according to the <a href="https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process" target="_blank">U.S. Federal Drug Administration</a>. Marijuana edibles are products containing CBD or THC made for ingestion, which produce a variety of effects depending on the dosage, chemical makeup and individual response to the product. </p><p><br/></p>
<p>"Although edibles are commonly viewed as a safer and more desirable alternative to smoked or vaped cannabis, physicians and the public should be aware of several risks related to the use of cannabis edibles," <a href="https://www.eurekalert.org/pub_releases/2020-01/cmaj-cep123019.php" target="_blank">wrote</a> by physicians <a href="https://doctors.cpso.on.ca/DoctorDetails/Grewal-Jasleen/0328544-119051" target="_blank">Jasleen Grewal</a> and <a href="http://www.dlsph.utoronto.ca/faculty-profile/loh-lawrence-c/" target="_blank">Lawrence Loh</a> in the commentary published in the <a href="https://www.cmaj.ca/content/192/1/E1" target="_blank">Canadian Medical Association Journal</a>. </p><p>In 2018, the northern nation became the first major world economy to legalize recreational marijuana in what that was likened to the ending of alcohol prohibition in the U.S, reported <a href="https://www.nytimes.com/2018/10/17/world/canada/marijuana-pot-cannabis-legalization.html" target="_blank" rel="noreferrer noopener">The New York Times</a>. In October of last year, Canada amended its cannabis regulations to authorize the legal production and sale of cannabis edibles.</p><p>In light of these new regulations, the use of marijuana is prevalent. A <a href="http://www150.statcan.gc.ca/n1/daily-quotidien/190815/t005a-eng.htm" target="_blank">2019 National Cannabis Survey</a> found that more than one-in-four respondents in Canada had used cannabis in the previous three months and consumed edibles. By comparison, <a href="https://www.reuters.com/article/us-health-marijuna-us-adults/one-in-seven-us-adults-used-marijuana-in-2017-idUSKCN1LC2B7" target="_blank">Reuters</a> reports that one-in-seven American adults reported using marijuana in 2017. However, that proportion went up dramatically for respondents who lived in states where marijuana was completely legal.</p>
<p>As of the beginning of this year, <a href="https://www.businessinsider.com/legal-marijuana-states-2018-1" target="_blank">Business Insider</a> reports there are 11 states with both legalized recreational and medical marijuana for adults over the age of 21, and 33 states that allow marijuana for medicinal purposes. However, legislation regarding the distribution, sale, use and growing largely vary between state governments and federal prohibition is still in effect, which means that in the U.S. there little regulatory oversight when it comes to safety regulations and consumer cautions. (Though <a href="https://www.forbes.com/sites/sarabrittanysomerset/2019/11/18/us-lawmakers-to-vote-on-more-act-to-end-federal-cannabis-prohibition/#1c9c990e423c" target="_blank">Forbes</a> reports that there have been congressional moves in recent months to legalize marijuana at a federal level.)</p><p>"After legalization of cannabis edibles in Colorado, the state poison control center saw a 70 percent increase in calls for accidental cannabis exposure in children from 2013 to 2017, and studies of health care usage reported more children than adults being treated for ingestion incidents," write the authors. </p><p>The authors argue that information available on edibles can be misleading and may run counter to what evidence suggests. A recent survey by the <a href="https://www.ccsa.ca/canadian-youth-perceptions-cannabis-report" target="_blank">Canadian Center on Substance Use and Addiction</a> found that younger consumers believe that cannabis edibles have a positive effect on mood, anxiety and sleep. Though the controversial plant has been linked to <a href="https://www.health.harvard.edu/blog/medical-marijuana-2018011513085" target="_blank">health benefits</a> for many conditions, long-term consumption is also associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/28127591" target="_blank">adverse effects</a> like panic attacks and psychosis. </p>
<p>The authors do not suggest banning marijuana, but instead argue that doctors and consumers should be aware of the effects of marijuana and should follow federal regulations regarding its use.</p><p>"Physicians should routinely question patients who ask about cannabis about their use or intended use of edible cannabis products so that they can counsel these patients regarding child safety, potential for accidental overconsumption and delayed effects, and potential for interactions with other substances such as alcohol, benzodiazepines, sleeping aids and opioids," caution the authors.</p><p>Additionally, the authors note that state efforts should continue to monitor cannabis use and continue evaluating the effects of legalized edibles to ensure that regulations are met and the most vulnerable groups are protected. </p>
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14 October 2019Health + Wellness
- Mice exposed to nicotine-containing e-cigarette vapor developed lung cancer within a year.
- More research is needed to know what this means for people who vape.
- Other research has shown that vaping can cause damage to lung tissue.
A new study found that long-term exposure to nicotine-containing e-cigarette vapor increases the risk of cancer in mice.
<p>This study adds to a growing body of research highlighting the potential negative health effects of vaping.</p><p>The researchers caution in a <a href="https://nyulangone.org/news/e-cigarette-smoke-causes-lung-cancer-mice" target="_blank">statement</a> that, because this is a mouse study, the results are not meant to show directly what happens in people who vape.</p><p>But they argue that the results are concerning enough that, "E-cigarette smoke must be more thoroughly studied before it is deemed safe or marketed that way."</p><p>And it comes as the number of <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html" target="_blank">vaping-related lung injuries</a> in the U.S. has grown to 1,299 cases, with 26 confirmed deaths. In those cases, federal officials believe cartridges containing THC may be to blame.</p>
E-Liquid Vapor Linked to Cancer in Mice<p>In the new <a href="https://www.pnas.org/content/early/2019/10/01/1911321116" target="_blank">study</a>, one group of mice were exposed to nicotine-containing e-cigarette vapor for 20 hours per week for 54 weeks.</p><p>After this time, 22.5 percent of the mice developed a type of lung cancer called an adenocarcinoma.</p><p>Also, 57.5 percent of these mice developed a rapid growth of cells in the bladder, known as urothelial hyperplasia. This is a type of abnormal tissue growth seen in cancer.</p><p>Another group of mice breathed nicotine-free e-cigarette vapor for the same duration. None of these mice developed lung cancer, while 6.3 percent (one mouse) developed bladder hyperplasia.</p><p>The researchers also had a control group of mice who breathed only filtered air. One of these mice (5.6 percent of the total) developed a lung tumor after 54 weeks. None showed signs of abnormal cell growth in the bladder.</p><p>Their findings were published this month in the journal Proceedings of the National Academy of Sciences of the United States of America.</p><p>The researchers think that nicotine is responsible for the increased risk of cancer in the mice.</p><p>They published <a href="https://www.pnas.org/content/115/7/E1560.long" target="_blank">research</a> last year in the same journal showing that nicotine in human lung and bladder cells can form other chemicals called nitrosamines. These chemicals are <a href="https://ntp.niehs.nih.gov/ntp/roc/content/profiles/nitrosamines.pdf" target="_blank">potential carcinogens</a>, or cancer-causing agents, in people.</p><p>Dr. Margarita Oks, a pulmonologist at <a href="https://www.northwell.edu/find-care/find-a-doctor/pulmonary-disease/dr-margarita-oks-md-11363448" target="_blank">Lenox Hill Hospital</a> in New York City, said this study shows that e-cigarettes may also carry some of the same health risks as combustible cigarettes.</p><p>"The reason that the vaping industry has been so successful is because of the claim that vaping is safer than smoking cigarettes," said Oks, who was not involved in the new research. "This study is showing otherwise, albeit in a mouse model."</p><p>While this is a mouse study, and it's unclear what will happen in humans with long-term e-cigarette use, the devices are so new that researchers will have to wait decades to get a long-term study on humans using e-cigarettes at this point.</p>
Nicotine Suspected in Mice Cancers<p>Dr. Nima Majlesi, director of toxicology at <a href="https://www.northwell.edu/find-care/find-a-doctor/emergency-medicine/dr-nima-majlesi-do-11317913" target="_blank">Staten Island University Hospital</a> in Staten Island, New York, who was not involved in the new study, said it's difficult to apply the new results to people because potentially carcinogenic chemicals may affect mice and people differently.<br></p><p>But Oks said this research still warrants attention even though it was done in mice.</p><p>"All mouse research is done with the purpose of eventually being translated to clinical research as it pertains to humans," she said.</p><p>Majlesi said the new study also raises questions because, "Nicotine itself is not considered a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020336/" target="_blank">carcinogen</a>. It is the other components in tobacco that cause cancer."</p><p>Nicotine-replacement gums and patches have not been linked to an increased risk of cancer, he said.</p><p>The authors of the paper point out that chemicals added during the curing of combustible tobacco are known to cause carcinogenic nitrosamines to form.</p><p>Scientists believe that inhaling nitrosamines in tobacco smoke is partially responsible for how cigarettes cause cancer.</p><p>However, the <a href="https://www.pnas.org/content/115/7/E1560.long" target="_blank">2018 study</a> found that human cells contain chemicals that can react with nicotine to form nitrosamines and other harmful compounds.</p><p>The authors point out that more research is needed to determine whether nicotine-containing e-cigarette vapor poses a cancer risk in people, and how frequently someone would need to vape to increase their risk.</p>
Harmful Effects of Vaping<p>A recent <a href="https://www.bmj.com/content/366/bmj.l5275.full" target="_blank">review</a> in The BMJ of previous research shows that vaping has a number of harmful effects in people, even if it isn't cancer. These effects include respiratory symptoms such as difficulty breathing, increased asthma and bronchitis-like symptoms — especially in adolescents.<br></p><p>Studies also show that vaping can damage lung tissue, increase the risk of bacterial or viral infections in the lungs, and cause the type of lipoid pneumonia seen in some of the recent vaping-related illnesses.</p><p>Research has also found that the components of e-liquids — including nicotine, propylene glycol and vegetable glycerin, and flavors — may have negative health effects.</p><p>One of the challenges in studying vaping is that e-liquids and e-cigarette devices vary from product to product.</p><p>"I am not sure we can re-create all the components of vaping liquid and say that it is universal to all brands," said Majlesi.</p><p>What's missing from all this research are long-term studies in people on the safety and toxicity of vaping.</p><p>Without those, "Saying with certainty that e-cigarettes are safer than combustible cigarettes is impossible," write the authors of The BMJ review.</p>
<p class=""><em>Reposted with permission from our media associate <a href="https://www.healthline.com/health-news/e-cig-vaping-led-to-lung-cancer-in-mice-what-does-this-mean-for-humans#Experts-caution-against-vaping" rel="noopener noreferrer">Healthline</a>.</em></p>
Experts Caution Against Vaping<p>However, there's enough evidence that vaping isn't completely safe to raise concerns among health professionals. The recent outbreak of severe lung disease linked to vaping has highlighted how little researchers know about the long term effects of e-cigarettes.<br></p><p>In the outbreak of lung disease linked to vaping, which has sickened over <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html" target="_blank">1,299 and led to 26 deaths</a>, the Centers for Disease Control and Prevention (CDC) believes much of the damage may be from people who were vaping products with THC. But researchers are still investigating.</p><p>"Vaping is a major public health issue at this time, and we should discourage vaping of any kind," said Majlesi. "Although it appears that THC-containing products are most responsible for the recent issues with lung injury."</p><p>Last week, the Food and Drug Administration warned consumers to <a href="https://www.fda.gov/news-events/press-announcements/statement-consumer-warning-stop-using-thc-vaping-products-amid-ongoing-investigation-lung-illnesses" target="_blank">stop using THC vaping products</a>. The CDC, though, <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/need-to-know/index.html" target="_blank">recommends against</a> the use of any vaping product.</p><p>Oks said people who currently vape should stop, and those who are considering it should not start.</p><p>"There have been so many severe respiratory illnesses — and now deaths — related to vaping that it is not worth the risk," said Oks, "whether or not this new link to possible cancer is validated in the future."</p>
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