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Outcome measures included selfreported severity of nine respiratory symptoms as well as spirometry measures. Participants agreed to record a quantity in grams – a common unit for purchas- ∗ Corresponding author at: Department of Psychology. Procedure Potential participants responded to an advertisement requesting regular cannabis users. Mitch Earleywine ∗ Department of Psychology. Conclusions: These preliminary data reveal meaningful improvements in respiratory function. Participants consumed a legal herb in the laboratory to ensure proper technique.g. Social Sciences 399. & Currow. p = 0. 2000). Laruent. The present study investigated vaporization’s impact in cannabis smokers who reported respiratory irritation. All rights reserved. To our knowledge. Tetrault et al. E-mail address: email@example.com .: +1 518 442 4836. One major concern about medical cannabis is a safe delivery method. in press). a machine that heats the plant to release cannabinoids in a mist without smoke and other respiratory irritants. Saraﬁan. included minimum age of 18 years. NY 12222. Baldwin. Vaporized cannabis creates subjective effects and plasma concentrations of 9 -tetrahydrocannabinol (THC) comparable to that of smoked cannabis (Abrams et al.2010. 1996). drug policy has attenuated experimental evaluation (Hall... suggesting that a randomized clinical trial of the cannabis vaporizer is warranted. SUNY.007. determined via phone. including the maximum amount of air exhaled in 1 s (forced expiratory volume. Christie. 2005). regular cannabis consumption (≥4 days/week).drugpo.75) and FVC. Results: The 12 participants who did not develop a respiratory illness during the trial signiﬁcantly improved respiratory symptoms (t(11) = 6.Author's personal copy International Journal of Drug Policy 21 (2010) 511–513 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.07. University at Albany. 2005).com/locate/drugpo Short report Pulmonary function in cannabis users: Support for a clinical trial of the vaporizer Nicholas T. & O’Neil. Tashkin. d = 1. The cannabis vaporizer. Dubinett. United States. no largescale exploration of vaporization in lieu of smoked cannabis exists. © 2010 Elsevier B. Article history: Received 24 February 2010 Received in revised form 25 March 2010 Accepted 4 April 2010 Keywords: Cannabis Pulmonary function Medical cannabis Harm reduction Although studies examining the efﬁcacy of cannabis as an alternative therapeutic have increased recently.90. Vaporbrothers Inc.053. it is associated with increased respiratory symptoms and aerodigestive cancers (Hall et al. 2009. Inclusion criteria. One alternative to smoking cannabis requires the vaporizer. United States a r t i c l e i n f o a b s t r a c t Background: Debates about cannabis policy often mention respiratory symptoms as a negative consequence of use. Methods: Twenty frequent cannabis users (uninterested in treatment) reporting at least two respiratory symptoms completed subjective ratings of respiratory symptoms and spirometry measures prior to and following 1 month’s use of a cannabis vaporizer in a pre/post-design. Tel. 2007). St. Participants then received a vaporizer (Vaporbrothers standard vaporizer. eligible participants provided informed consent. Tennen. and four cases of users with respiratory irrita- tion improved pulmonary function after 1 month of vaporization (Earleywine & Van Dam. & Roth.V. FVC).. Afﬂeck. All agreed to use the vaporizer exclusively until follow-up.1016/j. 2007). Torrance. Miller. d = 1. CA) and training in use. Earleywine). Vaporizer users report less respiratory irritation than cannabis smokers (Earleywine & Smucker Barnwell. appears to have the potential to minimize respiratory complaints. 2007) but minimizes smoke and associated byproducts that cause respiratory irritation (Gieringer. d = 3. On an initial laboratory visit. The vaporizer has potential for the administration of medical cannabis and as a harm reduction technique. 2005. All rights reserved. Hall. FEV1) and maximum total lung volume (forced vital capacity. in press).75. 1400 Washington Ave. completed a cannabis use interview.. Carney. & Anderson.77. Although cannabis smoke lacks the carcinogenic effects of tobacco smoke (Melamede.V. Albany. 0955-3959/$ – see front matter © 2010 Elsevier B.000065. p = 0. p = 0.22. and spirometry measures of pulmonary function. a 9-item respiratory distress questionnaire (detailed below).04. fax: +1 518 442 4867.. Participants also received training using a calendar to record cannabis use (e. an effect likely magniﬁed by the common mixing of cannabis with tobacco (Robertson.elsevier. Van Dam. Current (within the last year) tobacco smokers and inhalant users were excluded (see Earleywine & Van Dam. FEV1 improved but not signiﬁcantly t(11) = 1. doi:10. Armeli. 2004). & Goodrich.edu (M. t(11) = 2. 2002. and at least 2 of 9 respiratory symptoms (detailed below). University at Albany.
92 (4. & Peterson.6 28.63).5.2) 14.05. Following 1 month of vaporizer use.4). Pre-M (SD) Respiratory distress FEV1 FVC 26.8 9. Cannabis use Participants completed an interview assessment of cannabis use in the previous 30 days at the initial laboratory visit (Timeline Followback. t(18) = 1.07.1 (14.007. Hilario.0) 11. M.80 for FEV1/FVC (cf. Rappaport.83 (11) 2. and tightness in the chest at night (cf. coughing up phlegm in the morning.T.0) 3.71) intervention. Participants repeated the initial assessments and an exit interview. SD = 0. Linn. A large change on FEV1 did not quite reach statistical signiﬁcance.5 N. use of inhalants.25.97 (11) p 0. FVC improved signiﬁcantly t(11) = 2. Participants were then debriefed. Tetrault et al.5 (1. Easton. Munyaradzi. Results Attrition was low and adherence high. Pre-intervention. d = 1.7 (2. coughing up phlegm regularly.0. Measures Pulmonary function Participants performed spirometry to American Thoracic Society (ATS) standards using the Astra 100 Spirometer (SDI Diagnostics.. cystic ﬁbrosis.54 (1.34. Tetrault et al. a problem relevant to smokers (Blake. all p’s > 0.46.74)). 2008).80 (M = 76. df = degrees of freedom.77) 4.and post-intervention meeting a cut-score of 0. t(11) = 1. wheezy or whistling chest sounds. and respiratory illness (RI) during the intervention. Participants rated severity from 0 “not present” to 8 “very severe” (internal consistency at time 1 (Cronbach’s ˛ = 0. the proportion of participants below the cut-score decreased to 30% (M = 78. 2000).1 (1. Van Dam. p = 0.36.053.9 (1. SD = 17. the sample showed changes comparable to those in long-term tobacco cessation (Anthonisen et al.27) 4.6 9. Connett.2) 63. Wang. RI and nonRI groups did not differ on any pre-intervention or demographic variables. M = 30.12) Post-M (SD) 6.6 85. 1979. 2002.22.2) were recorded in litres. Participants reported an average of 3.0) of consumption at their current rate.75. informed they could keep the vaporizer and paid US $40. may actually underestimate the effect the vaporizer could have with cannabis users who also smoke tobacco.4 to 23.Author's personal copy 512 Table 1 Demographic characteristics.4) 16.90. Kodani.5 19 47. 1988).2) 6. 10 times: n = 1). Statistical analyses Naturally acquired respiratory illness (RI) signiﬁcantly decreases pulmonary function (O’Connor et al. Gilliland. a drop that failed to reach statistical signiﬁcance (p > 0.6 28. SD = 1.8 23. a Statistically signiﬁcant. d = 1. 2007).2) 3. SD = 0.047a 0. We also examined the percentage of individuals pre. & Ware. This change was larger in participants reporting an RI (M = −0..77. cannabis consumption ranged from 2. 2008).10).7 (2. Discussion ing cannabis.11 vs.2 years (SD = 2. Earleywine / International Journal of Drug Policy 21 (2010) 511–513 Table 2 Pre.7 (6.22 (11) 1. approximately 64% of the sample had ratios below the FEV1/FVC cut-score of 0. Shapiro. 2002). These preliminary results suggest that the vaporizer might improve pulmonary function in cannabis users who experience respiratory symptoms. including: asthma. SD = 5.66) 3.76 (1. Given the potential interactions between tobacco and cannabis on lung function. & Stanley. FEV1 = forced expiratory volume (L) in 1 s. Individuals who did not acquire an RI (n = 12) signiﬁcantly decreased respiratory symptoms (t(11) = 6. 2 participants failed to follow-up and 4 participants reported smoking cannabis (instead of vaporizing) more than 3 days (5 times: n = 3. We hypothesized that 1 month of vaporizer use would (1) decrease respiratory symptoms and (2) increase pulmonary function. Demographic M (SD) Age in years Education in years Age ﬁrst cannabis use Age regular cannabis use Cannabis use per week (days) Cannabis use per week (g) Average “High” (range = 0–6) % of sample Male Current alcohol use History of tobacco use History of cocaine use History of ecstasy use History of LSD use History of mushroom use History of opiate use History of prescription Stimulant use History of sedative use N = 22 20. Subjective respiratory distress Participants responded “yes” or “no” to nine questions on respiratory distress. 2007. reporting cannabis use methods other than vaporization. They also tracked their use during the intervention using a calendar approach (described above).and post-intervention outcomes for individuals without respiratory illness (n = 12). Participants returned approximately 30 days later (range = 26–46 days. FEV1 and FVC are two common measures of pulmonary functioning (Anthonisen. usual cough. breathlessness related to walking. Grams per day dropped marginally from pre. & Murray. SD = 14. p = 0. M = −0. Individuals reporting an RI during the study (n = 8) showed no changes across time.85) and time 2 (Cronbach’s ˛ = 0.. Individuals who consume both tobacco and cannabis separately might decrease tobacco .4 (1.6.5) 14.23) t(df) 6. Sobell & Sobell. the ﬁndings reported here. The best forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from three reproducible attempts (within 0. 2009). Procedures were approved by the local institutional review board. SD = 0.007a t = one-way paired samples t-test.(M = 1.75) and improved pulmonary function.90) to post(M = 1.7 23.10. d = 3. This estimation approach of cannabis consumption correlates with other estimates of use and associated negative consequences (Walden & Earleywine. Volkova.22 (0.. Collet. Participants Twenty-two (22) participants took part in the study. Postintervention. Separate analyses were conducted for individuals with and without RI during the intervention. Details appear in Table 2.75. p = 0. Prior to intervention.3).7). 2002).000a 0. shortness of breath related to walking.4 g/week.60 (1. which focused only on those who do not use tobacco. Other demographics appear in Table 1. FVC = forced vital capacity (L). & Gauderman. p = 0. Abell. MA).000065.
As habitual cannabis smokers seem to exhibit the most marked respiratory impairment (Tashkin et al. W. M.. Spirometry measures are less susceptible to bias. D. 4. 458–466. I. it may have advantages over synthetic THC (dronabinol. 2002. smoked cannabis with a pre-. 11.. Impact of respiratory illness on expiratory ﬂow rates in normal. Collet. & Gauderman... Collins. E. 1669–1678. Changes in pulmonary function after naturally acquired respiratory infection in normal persons..-P. Harm Reduction Journal. Journal of Cannabis Therapeutics. J. Spirometry utilization after hospitalization for patients with chronic obstructive pulmonary disease exacerbations.. G... histopathological examination of lung and immune cells over the course of the trial may also prove informative (cf. 17. H. (2008). British Journal of General Practice. & Ware. Harm Reduction Journal. (2007). 71S–81S. the staff at Vapor Brothers. 78.. & Benowitz. The adverse effects of cannabinoids: Implications for use of medical marijuana. 477–479). though potential attrition should also be considered (see Anthonisen et al. D. 1087–1093. in press). American Journal of Respiratory and Critical Care Medicine. B. P. Melamede. One approach may be random assignment to vaporizer use vs. E.. Cannabis use in the community. though this may be difﬁcult to achieve (cf. R. (2008).Author's personal copy N.. a sample of approximately 80 would provide adequate power to detect a within–between interaction. . Carney. (2009).. Sobell. R. Additionally. S. Concato. 1996). M.. 2002) and the commonality of RI in smokers (Blake et al. Author N. The adverse health effects of cannabis use: What are they. Larger scale controlled clinical trials are necessary to explore the potential of the vaporizer to minimize respiratory complications. (1979). G. Tashkin et al. 178. Tetrault. Heath. 20. 21. G. 2008).. O’Connor et al. L. Laruent. & Anderson.. These data suggest a randomized controlled trial is warranted. J. 572–578.. Abell. The American Review of Respiratory Disease. B. E. Munyaradzi. D. M. Stress and alcohol use: A daily process examination of the stressor-vulnerability model. The impact of the vaporizer was limited to individuals not reporting a respiratory illness (RI). M. remediation. asthmatic. (2005).T. A. S. & Smucker Barnwell.. W. J. M. 2002). R. Kodani. D. American Journal of Medical Quality. & Currow. J. & Fiellin. Crothers. (2007). A. Based on medium effects. Journal of Personality and Social Psychology. W. & Murray.. Wang. Pediatric Pulmonology.. The limits of any pre/post-experimental design also apply.. or decision to submit for publication. a clinical trial of the vaporizer should control for other smoked substances and inhalant use (Tetrault et al. M.C: American Psychiatric Association. S. 2009). B. M.75) may be partially due to participant bias. Journal of Clinical Pharmacology. Earleywine. V. M. (2000). R. Minimally. 1685–1686..g. the present results suggest a safer means of exploring the utility of medical cannabis and an important harm reduction technique. G. D. Gilliland. (2002). Washington D. 24. & Sobell. Given that cannabis plants contain components that can counteract adverse effects of THC (e. Outcome variables might follow those utilized here (cf. & Goodrich. D. O’Connor. and post-assessment period over 6–12 months. middle-. declares no conﬂict of interest. P. The relationship of RI to cannabis use needs further exploration. 979–994. Jones. 82.. L. W. N. 2. Canadian Medical Association Journal. 4. D. (2004).. & Leighton. & Peterson. A.. J. Hall. M. 42. (2005). Shapiro. Miller. Volkova et al. (2007). Jay. in press). Earleywine / International Journal of Drug Policy 21 (2010) 511–513 513 consumption congruent with efforts to minimize respiratory ailments associated with cannabis consumption (Earleywine & Van Dam. Cannabis vaporizer combines efﬁcient delivery of THC with effective suppression of pyrolytic compounds. Acknowledgements This work was supported by a grant from the Marijuana Policy Project. Walden. J. P. (2002). Robertson et al. Lancet Oncology... D. Hilario.V. declares involvement with a number of cannabis law reform groups. N.. Tennen. While many factors will continue to inﬂuence cannabisrelated drug policy (Hall.. 198–202. Hall et al. S. Author M. & Roth. Cannabinoids and cancer: Causation. Degenhardt & Hall.. and the participants. Baldwin. Tashkin.g. Given the direct impact of RI on pulmonary function (e. Gieringer. Kelly. 20.. 112–121. 2005).... & Hall. 120. T.. How high? Quantity as a predictor of cannabisrelated problems. F. Van Dam. Non-tobacco smokers would provide the ideal sample (Earleywine & Van Dam. M. Mehra. Connett. Addiction Research and Theory. 6. Cannabis and tobacco smoke are not equally carcinogenic. The authors thank Jon Rosen for helpful advice. 2009). a high rate of RI could be characteristic of studies with heavy cannabis smokers. Rappaport et al. Handbook of psychiatric measures (pp. Rappaport. D. T. W. Clinical Pharmacology & Therapeutics. Afﬂeck..T.. D.. D. Effects of marijuana smoking on pulmonary function and respiratory complications. 2007).D.. & O’Neil.. & Earleywine. C. S. Volkova. S. T. and what are their implications for policy? International Journal of Drug Policy. 5. T. M.. P... Robertson. individuals who have used regularly for several years might be the optimal population. Several caveats are appropriate for the interpretation of these data. M. K. H. B. Anthonisen et al. & Van Dam. Saraﬁan. C. Shade. 675–679... & Stanley.. M. (2000).. J. 7–27. W. H. A. Harm Reduction Journal.. H. C.. Campbell. 1988). (2009). A. J. 2002). Christie. B. Vaporization as a smokeless cannabis delivery system: A pilot study. J.. B. W.. R. 61– 66. S.. Vizoso. 671–674. 166. In American Psychiatric Association (Ed. 2002). Alcohol timeline followback. M.. References Abrams. N.. Annals of Internal Medicine. 35–42. cannabidiol).. Dubinett. written manuscript. (1996). R. Linn. Anthonisen. and palliation. and allergic children. Archives of Internal Medicine.. M. Blake. Given increased risk for aerodigestive cancers in cannabis smokers (e.. Degenhardt. 221–228.. Decreased respiratory symptoms in cannabis users who vaporize. (in press). 109. Hall. 167. Smoking and lung function of lung health study participants after 11 years. N. R. Moore. S. Cigarette smoking and upper respiratory infection among recruits in basic combat training. Respiratory and immunologic consequences of marijuana smoking. (1988). St. Case studies in cannabis vaporization. 46.. N. Earleywine. Armeli. S..E. analysis. Marijuana Policy Project had no input on the design.g. Canadian Medical Association Journal. offering more compelling evidence of vaporizer-associated improvements. (2002). 34. and a repeated measures design.. 1979. the huge effect of the vaporizer on self-reported respiratory irritation (d = 3.). R. Adverse effects of medical cannabinoids: A systematic review. L. (2008)..
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