Are Your Patients Vaping 58 Joints/Day?

​David A. Perna, PhD
Licensed Psychologist
Lecturer in Psychology
Department of Psychiatry
Harvard Medical School

The Clinical Assessment of Vaping Exposure

For: Parents/Therapists/College Counselors

My close friend and professional colleague, David Smelson, PhD, UMASS Medical Center, and his co-researchers from Children's Hospital, Harvard Medical  School in Boston, offer an excellent article/quick read to help clarify terminology and evaluation of vaping both cannabis and nicotine. Please be sure to read their article. I have listed the reference below. 

I was impressed with the following two usage/statistical points that I had not picked up on in my clinical work with patients in our group practice or in speaking with students in our College Transition Program: 

"The amount of THC that some users vape can be dramatic, reaching up 50 mg THC inhaled in a single session, with a total consumption of up to 700 mg per day; in comparison, a typical ‘‘joint’’ of marijuana delivers approximately 12 mg inhaled THC" (Boyer, et al, 2020, p. 4).

That means that a teen/college student using a vape can inhale the equivalent of 58 joints per day. That's right, according to this article, by doing the math, that is what you come up with-think about that. That is why I am seeing so many patients suffering from the impact of severe cannabis intoxication, referred to as Cannabinoid Hyperemesis Syndrome (CHS).

At low levels of use, cannabis causes increased appetite and stimulates eating, which brings about the commonly known term as the "munchies" following use. That is why it was first medically used to help people who struggled with cancer. These medical patients who were being given chemotherapy to treat their illness commonly experienced gastrointestinal distress. Small doses of cannabis allowed them to eat so they would be able to maintain their weight while they proceeded through treatment. However, at the opposite end of the continuum,  in extremely high doses, cannabis  will commonly cause:

• Severe nausea
• Vomiting or Cyclical Vomiting (Repeated bouts of vomiting) 
• Abdominal pain

I have never witnessed patients struggle with the negative effects of such high doses of cannabis until the onset of the vaping boom in the Boston area. I have now had several patients who have struggled with the above-mentioned issues. I have also had several students in our College Transition Program who have decided to stop using cannabis completely since they felt that vaping the higher amounts started to  make them feel increasingly anxious and on edge. 

​The second point that was made in Dr. Smelson's article on vaping  that I found was quite helpful was as follows: 

"...over 60% of adolescents do not understand that JUUL devices are nicotine delivery devices." (Boyer, et al, 2020, p. 2).

I found this fact to be quite amazing. I never focus on educating kids/teens on the reality that vaping devices deliver either nicotine or cannabis. I assumed that all kids were completely aware of this fact. They know that cigarettes contain nicotine. Why would they inhale the vaping vapor? This issue will allow me to explore their awareness of this fact more closely in our initial sessions when vaping is discussed as a standard part of our intake evaluation  process or when vaping is specifically presented as a treatment concern by parents.

Thanks again to Dr. Smelson and his colleagues for such a powerful, information-packed,  yet concise article. 

​Resources for Parents:

• Vaping Toolkit
• Vaping and Marijuana: What You Need to Know
• Talk with Your Teen About E-Cigarettes: A Tip Sheet for Parents

Resources for Professionals:

• Cannabinoid Hyperemesis Syndrome 
• Cannabinoid Hyperemesis: A Case Series of 98 Patients

​
APA Citation For This Article:
Boyer, Edward, MD, PhD, Levy, Sharon, MD, MPH, Smelson, David, Vargas, Sara, et al. (2020). The Clinical Assessment of Vaping Exposure. Journal of Addiction Medicine, Advance on-line publication. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovftw&NEWS=N&AN=01271255-900000000-99270. https://doi.org/10.1097/ADM.0000000000000634

Additional References:
Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. (2011). Cannabinoid hyperemesis syndrome. Current drug abuse reviews, 4(4),
241–249. https://doi.org/10.2174/1874473711104040241

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