E-liquid marketing is focused on promoting flavors , and is known to enhance appeal, and intentions to use more than advertisements for non-flavored products . Youth also believe that advertisements for flavored e-liquids target individuals similar to their own age . Findings from this study highlight that flavors are one of the key topics of discussions related to e-liquids on Twitter, which supports FDA’s recent announcement about the need to regulate sale of flavored e-liquids, and e-cigarette products . Person Tagging, or one Twitter user directly communicating to another about e-liquids, was also a common topic in this study, consistent with prior research . This finding demonstrates that Twitter users communicate their experiences with e-liquids with their friends and followers on Twitter. In other words, posts classified under ‘person tagging’ consistently used ‘@Person’ tags to involve others in conversations about e-liquids. Cannabis was a common topic in the present study. Compared to smoking cannabis, motivations for vaping cannabis, in general, include better taste, lower perceived health risks, and stronger drug impact in the form of higher concentrations of cannabinoids . Mixing nicotine and cannabis in vaporizers, is also an emerging trend, although additional research is warranted to examine the prevalence of this behavior . The present study contextualizes discussions of cannabis grow system use within the larger discourse about e-liquids given limited evidence about the prevalence or health effects of vaping cannabis . Future work should explore topics of conversation at the intersection of nicotine and cannabis. The composition of e-liquids was discussed on Twitter in 2018. Awareness of e-liquid composition requires a nuanced understanding of the proportions of its constituents. Varying proportions of e-liquid VG/ PG content in combination with puff topography , and device architecture, determine e-cigarette users’ experiences and nicotine delivery .
E-liquid composition has direct implications for appeal, and user experience, and potentially for the maintenance of longer-term use. For instance, producing bigger vape clouds is known to drive e-cigarette product appeal . Older, regular smokers typically desire a throat hit that is similar to their regular combustible cigarettes . In this evolving e-liquid product landscape, it is possible that knowledge of e-liquid composition allows users to adapt to and choose from the wide variety of these products. Conversations at the intersection of flavors and e-liquid composition, may potentially enhance the appeal of e-cigarettes. Such knowledge may be transmitted to Twitter influencing product preference, and may educate new users about ways to initiate, and maintain, product use. The health risks of nicotine were also discussed suggesting Twitter users are concerned about the health consequences of nicotine. These types of messages may be amplified by public health practitioners to clarify the consequences of nicotine on adolescent development or other consequences. While health risks of nicotine were a common topic in the present study, the use of e-liquids to quit smoking combustible cigarettes was rarely mentioned. Similar to prior research utilizing Twitter , conversations about e-cigarette use and related products seldom mention cessation.The committee graded the strength of the evidence of the effectiveness of cannabis and cannabinoids in several therapeutic areas. We also explained in Chapter 151 the barriers to conducting research with cannabis, which are particularly relevant to a discussion of therapeutic effects. In truth, most of the literature we reviewed was not actually assessing the cannabis plant, but pharmaceutically derived compounds, especially tetrahydrocannabinol alone as dronabinol or nabilone. There are an increasing number of trials investigating nabiximols, which is a whole plant extract. Some studies looked at cannabidiol alone, but none of the studies on the pharmaceutical cannabidiol preparation, Epidiolex, was yet published in the literature we reviewed. This agent has shown promise in epilepsy patients.
Studies of the whole plant, usually smoked or vaporized, were few. So, when you ask what conclusions we drew regarding the therapeutic uses of cannabis, it would probably be more correct to ask about the therapeutic uses of cannabinoids; and then recall the strength of the evidence that qualified our confidence in the validity of the conclusion. I can say that the committee concluded there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults, nausea and vomiting related to cancer chemotherapy, and symptoms of spasticity associated with multiple sclerosis. Again, this means that we found strong evidence in good-quality systematic reviews or meta analyses to support these conclusions. Interestingly, these were quite similar to the results reported in the IOM 1999 report.2 We found moderate evidence that cannabinoids may be beneficial in sleep disorders associated with several chronic illnesses. Evidence supporting the use of cannabis or cannabinoids for appetite stimulation, improving anxiety, and symptoms of Tourette syndrome was felt to be limited by our review of existing literature. For all the other conditions or symptoms included in the analysis, we found only limited or no evidence to support or refute that cannabis or cannabinoids have benefit. Included in our list were conditions or diseases for which states allow patients to access cannabis. As mentioned, we also found no evidence of benefit in epilepsy, although recently completed and ongoing clinical trials are supporting the benefit of pharmaceutical grade cannabidiol for refractory seizures. One of my mantras on the committee was that the absence of evidence of effectiveness does not equate to evidence of the absence of effectiveness! We were quite selective and stringent in reviewing only the highest quality clinical trials and restricted our grading of evidence by using the careful criteria that the committee agreed upon. This coupled with the significant barriers that exist to conducting clinical trials of the potential therapeutic benefit of the plant material leave us with a handful of strong conclusions on therapeutic benefits of cannabis.
Most of the conclusions are based on studies of approved pharmaceutical products or those under current clinical investigation. Hopefully, the future will allow for larger, longer, high-quality studies of plant-based medicine preparations to be conducted and provide us with much needed information. As an oncologist, I am faced daily with patients asking me if they can forego conventional cancer therapies and treat their malignancy with cannabis. There is absolutely no data in the published literature to support the use of cannabis or any cannabinoid as a treatment for cancer. The committee decided to veer from the mandate to only include clinical trials in the report to be able to say something about cannabinoids and cancer. So, a review of 34 preclinical studies of cannabinoids in brain tumors was included. Although there is an increasing and impressive body of evidence that cannabinoids may have some anticancer activity in cell culture and animal studies,hydroponics rack system the only clinical trial in cancer patients reported to date involved infusion of tetrahydrocannabinol by a catheter into brain tumor recurrences in nine patients. Hence, we concluded there was insufficient evidence to support or refute the conclusion that cannabinoids are an effective treatment for cancers.There are some specific areas that might have benefitted from more precision in the summary conclusions. For example, the substantial statistical association between cannabis use and schizophrenia might suggest a causal link association. In fact, there has been no increase in diagnosis of schizophrenia in western societies during the five decades since recreational cannabis use became prevalent. A more cautious interpretation of the cannabis–schizophrenia association may be that different elements of psychopathology travel together, perhaps reflflecting influence of some common vulnerability factor or factors, with problematic substance use being one of those indicators. Regarding cannabis and persisting brain injury, my view as someone who has looked at neurocognitive consequences of several substances of abuse, leads me to the conclusion that the evidence for lasting effect of cannabis on the brain is very inconclusive. The meta analyses on neurocognitive performance in adult cannabis users that adjusted for recency of use basically found no associations, and similarly, the brain imaging reports have been contradictory. Even data on human neuro developmental consequences are quite fragmented. So, in that sense the report might have hewed closer to data by interpreting the strength of the associations more cautiously or explaining the pitfalls better.Regarding schizophrenia, the report concluded that there was substantial evidence to support an association between cannabis use and development of psychotic disorders. This was one of the strongest conclusions in the report. The strength of this conclusion arose from the large number of studies examining this issue as well as evidence for a dose–response relationship in which more frequent cannabis use was associated with higher risk of developing a psychotic disorder. All of the studies reviewed found some degree of increased risk with no significant findings to the contrary. It is still not clear whether cannabis use causes schizophrenia and, as pointed out by Dr. Grant, alternate hypotheses could explain this strong and consistent association.
Regarding anxiety disorders, the report concluded that there was moderate evidence for an association between cannabis use and an increased incidence of social anxiety disorder.Also, the report concluded with moderate evidence that cannabis use is associated with a small increase in the risk of developing depressive disorders, but no evidence to support or refute an association between cannabis use and symptoms of depression. It is not clear whether cannabis use is causally linked to the development of social anxiety or depression.Several studies have investigated the possible association with cannabis and lung and upper aerodigestive malignancies over the years. It makes sense that an inhaled plant material that many equate with tobacco should raise a concern for the possibility of an increased risk of tobacco-related malignancies. We reviewed two publications each comprised of analysis of six studies that both failed to show a statistical association between the use of cannabis and the development of lung cancer. One could question how this could be so when there is such a clear link between tobacco smoking and pulmonary neoplasia. First, no one smokes 20 to 40 cannabis cigarettes a day. Second, cannabis has anti-inflammatory, antioxidant, and some believe antitumor qualities which tobacco does not. Many of the older studies suggesting a link between cannabis smoking and lung cancers did not control for tobacco use. We also reviewed another analysis of nine case–control studies of head and neck cancers that also was suggestive of no increased association of cannabis use with those malignancies either. The only possible link that we noted was limited evidence of a statistical association between current, chronic, or frequent cannabis use and nonseminomatous germ cell testicular tumors. As an oncologist, I am not sure I see biologic plausibility in that association other than the fact that cannabis use and testicular cancer are two things common to young men.The committee concluded that there is substantial evidence for an association between cannabis use and increased risk of motor vehicle accidents. This conclusion was based primarily on a 2016 meta analysis of 21 case–control or culpability studies across 12 countries and included an impressive sample of nearly 240,000 participants. The findings demonstrated that cannabis use, as assessed by self-report and the presence of tetrahydrocannabinol metabolites in blood, saliva, or urine, was associated with a 20% to 30% higher odds of a motor vehicle crash. In addition, the magnitude of the association was in the low to moderate range. An important aspect of the study was the magnitude of effect was weakened when accounting for alcohol intoxication. A limitation of these findings is the difficulty in determining the proximity of cannabis use relative to motor vehicle crashes based on the presence of tetrahydrocannabinol and its metabolites in biological samples, like urine or plasma, since they can be detected long after use in heavy cannabis users. However, studies by the Huestis laboratory investigating the effects of acute cannabis exposure on performance in a driving simulator agree with these findings.These controlled studies demonstrate that smoking cannabis significantly impairs psychomotor skills needed for safe driving.Four recommendations were put forth to support and improve a cannabis research agenda. The first recommendation was to address research gaps. These gaps included prioritized research areas to assess the short- and long-term effects of cannabis and cannabinoids specifically related to clinical and observation research, health policy and economic research, and public health and public safety research. The second recommendation included suggestions to improve research quality by developing a set of research standards and benchmarks that can yield high-quality cannabis research.