Acute Effects of Smoked and Vaporized Cannabis in Healthy Adults Who Infrequently Use Cannabis: A Crossover Trial | Adolescent Medicine | JAMA Network Open | JAMA Network
[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.108.182. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Cyrenne  P, Shanahan  M.  Toward a regulatory framework for the legalization of cannabis: how do we get to there from here?  Can Public Policy. 2018;44(1):54-76. doi:10.3138/cpp.2017-026Google ScholarCrossref
2.
Berg  CJ, Stratton  E, Schauer  GL,  et al.  Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win.  Subst Use Misuse. 2015;50(1):79-89. doi:10.3109/10826084.2014.958857PubMedGoogle ScholarCrossref
3.
Compton  WM, Han  B, Jones  CM, Blanco  C, Hughes  A.  Marijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys.  Lancet Psychiatry. 2016;3(10):954-964. doi:10.1016/S2215-0366(16)30208-5PubMedGoogle ScholarCrossref
4.
Russell  C, Rueda  S, Room  R, Tyndall  M, Fischer  B.  Routes of administration for cannabis use—basic prevalence and related health outcomes: a scoping review and synthesis.  Int J Drug Policy. 2018;52:87-96. doi:10.1016/j.drugpo.2017.11.008PubMedGoogle ScholarCrossref
5.
Etter  JF.  Electronic cigarettes and cannabis: an exploratory study.  Eur Addict Res. 2015;21(3):124-130. doi:10.1159/000369791PubMedGoogle ScholarCrossref
6.
Lee  DC, Crosier  BS, Borodovsky  JT, Sargent  JD, Budney  AJ.  Online survey characterizing vaporizer use among cannabis users.  Drug Alcohol Depend. 2016;159:227-233. doi:10.1016/j.drugalcdep.2015.12.020PubMedGoogle ScholarCrossref
7.
Morean  ME, Kong  G, Camenga  DR, Cavallo  DA, Krishnan-Sarin  S.  High school students’ use of electronic cigarettes to vaporize cannabis.  Pediatrics. 2015;136(4):611-616. doi:10.1542/peds.2015-1727PubMedGoogle ScholarCrossref
8.
Brown  D.  California sales ignite in February, as vapes, edibles keep on burning. https://www.cannabisbusinessexecutive.com/2018/04/california-sales-ignite-february-vapes-edibles-keep-burning/. Accessed April 5, 2018.
9.
Budney  AJ, Sargent  JD, Lee  DC.  Vaping cannabis (marijuana): parallel concerns to e-cigs?  Addiction. 2015;110(11):1699-1704. doi:10.1111/add.13036PubMedGoogle ScholarCrossref
10.
Gieringer  D, St Laurent  J, Goodrich  S.  Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds.  J Cannabis Ther. 2004;4(1):7-27. doi:10.1300/J175v04n01_02Google ScholarCrossref
11.
Pomahacova  B, Van der Kooy  F, Verpoorte  R.  Cannabis smoke condensate III: the cannabinoid content of vaporised cannabis sativa.  Inhal Toxicol. 2009;21(13):1108-1112. doi:10.3109/08958370902748559PubMedGoogle ScholarCrossref
12.
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. 2007;82(5):572-578. doi:10.1038/sj.clpt.6100200PubMedGoogle ScholarCrossref
13.
Newmeyer  MN, Swortwood  MJ, Barnes  AJ, Abulseoud  OA, Scheidweiler  KB, Huestis  MA.  Free and glucuronide whole blood cannabinoids’ pharmacokinetics after controlled smoked, vaporized, and oral cannabis administration in frequent and occasional cannabis users: identification of recent cannabis intake.  Clin Chem. 2016;62(12):1579-1592. doi:10.1373/clinchem.2016.263475PubMedGoogle ScholarCrossref
14.
Newmeyer  MN, Swortwood  MJ, Abulseoud  OA, Huestis  MA.  Subjective and physiological effects, and expired carbon monoxide concentrations in frequent and occasional cannabis smokers following smoked, vaporized, and oral cannabis administration.  Drug Alcohol Depend. 2017;175:67-76. doi:10.1016/j.drugalcdep.2017.02.003PubMedGoogle ScholarCrossref
15.
Sobell  LC, Sobell  MB. Timeline follow-back. In:  Measuring Alcohol Consumption. Totowa, NJ: Humana Press; 1992:41-72. doi:10.1007/978-1-4612-0357-5_3
16.
Vandrey  R, Herrmann  ES, Mitchell  JM,  et al.  Pharmacokinetic profile of oral cannabis in humans: blood and oral fluid disposition and relation to pharmacodynamic outcomes.  J Anal Toxicol. 2017;41(2):83-99. doi:10.1093/jat/bkx012PubMedGoogle ScholarCrossref
17.
Hooker  WD, Jones  RT.  Increased susceptibility to memory intrusions and the Stroop interference effect during acute marijuana intoxication.  Psychopharmacology (Berl). 1987;91(1):20-24. doi:10.1007/BF00690920PubMedGoogle ScholarCrossref
18.
Vandrey  RG, Mintzer  MZ. Performance and cognitive alterations. In: Cohen  L,  et al.  Pharmacology and Treatment of Substance Abuse Using Evidence and Outcomes Based Perspectives. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 2009.
19.
Wilson  WH, Ellinwood  EH, Mathew  RJ, Johnson  K.  Effects of marijuana on performance of a computerized cognitive-neuromotor test battery.  Psychiatry Res. 1994;51(2):115-125. doi:10.1016/0165-1781(94)90031-0PubMedGoogle ScholarCrossref
20.
McLeod  DR, Griffiths  RR, Bigelow  GE, Yingling  J.  An automated version of the digit symbol substitution test (DSST).  Behav Res Meth Instrum. 1982;14(5):463-466. doi:10.3758/BF03203313Google ScholarCrossref
21.
Kleykamp  BA, Griffiths  RR, Mintzer  MZ.  Dose effects of triazolam and alcohol on cognitive performance in healthy volunteers.  Exp Clin Psychopharmacol. 2010;18(1):1-16. doi:10.1037/a0018407PubMedGoogle ScholarCrossref
22.
Herrmann  ES, Cone  EJ, Mitchell  JM,  et al.  Non-smoker exposure to secondhand cannabis smoke II: effect of room ventilation on the physiological, subjective, and behavioral/cognitive effects.  Drug Alcohol Depend. 2015;151:194-202. doi:10.1016/j.drugalcdep.2015.03.019PubMedGoogle ScholarCrossref
23.
Coulter  C, Miller  E, Crompton  K, Moore  C.  Tetrahydrocannabinol and two of its metabolites in whole blood using liquid chromatography-tandem mass spectrometry.  J Anal Toxicol. 2008;32(8):653-658. doi:10.1093/jat/32.8.653PubMedGoogle ScholarCrossref
24.
Felch  LJ, Di Marino  ME, Griffiths  RR. A meta-analysis of psychomotor, subject- and observer-rated effects in abuse liability studies of anxiolytics. In: Harris  ILS, ed.  Problems of Drug Dependence. Washington, DC: Government Printing Office; 1996.
25.
Holm  S.  A simple sequentially rejective multiple test procedure.  Scand J Stat. 1979;6(2):65-70.Google Scholar
26.
Keppel  G.  Design and Analysis: A Researcher Handbook. Englewood Cliffs, NJ: Prentice Hall; 1991.
27.
Barrett  FS, Schlienz  NJ, Lembeck  N, Waqas  M, Vandrey  R.  “Hallucinations” following acute cannabis dosing: a case report and comparison to other hallucinogenic drugs.  Cannabis Cannabinoid Res. 2018;3(1):85-93. doi:10.1089/can.2017.0052PubMedGoogle ScholarCrossref
28.
Steigerwald  S, Wong  PO, Khorasani  A, Keyhani  S.  The form and content of cannabis products in the United States.  J Gen Intern Med. 2018:33(9):1426-1428. doi:10.1007/s11606-018-4480-0PubMedGoogle ScholarCrossref
29.
Chiang  CW, Barnett  G.  Marijuana effect and delta-9-tetrahydrocannabinol plasma level.  Clin Pharmacol Ther. 1984;36(2):234-238. doi:10.1038/clpt.1984.168PubMedGoogle ScholarCrossref
30.
Cone  EJ, Huestis  MA.  Relating blood concentrations of tetrahydrocannabinol and metabolites to pharmacologic effects and time of marijuana usage.  Ther Drug Monit. 1993;15(6):527-532. doi:10.1097/00007691-199312000-00013PubMedGoogle ScholarCrossref
31.
Cosker  E, Schwitzer  T, Ramoz  N,  et al.  The effect of interactions between genetics and cannabis use on neurocognition: a review.  Prog Neuropsychopharmacol Biol Psychiatry. 2018;82:95-106. doi:10.1016/j.pnpbp.2017.11.024PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    3 Comments for this article
    Another hazard of vaping
    Frederick Rivara, MD, MPH | University of Washington
    Vaping has changed the tobacco smoking landscape and now may do the same with cannabis. Vaping intensified the drug effects of cannabis in this small crossover study. Will the FDA which has become more aggressive in limiting vaping of tobacco also do so for cannabis. Will large states like California inaction restrictions?
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Have you seen what happened to this?
    Adam Gordon, BS | Euphoric Cannabis Marketing
    Have you seen what has happened to this paper in the cannabis press? Look at this: https://www.marijuanamoment.net/vaporized-marijuana-produces-a-stronger-high-than-smoking-it-study-finds/

    I am interested in tracking how we got from one to the other. Would you guys have any idea who initially picked this up?

    The story of this story is quite fascinating, I think.

    Thanks
    Adam
    CONFLICT OF INTEREST: None Reported
    Differential CNS effects of cannabis vs "medical" cannabis
    Gerald Pope, M.D. | W Beaumont Hospital
    Was the trial conducted with "medical" or commercial cannabis? Most of the effects observed appear to be related to central nervous system, cannabis induced, malfunctioning. Does "medical" cannabis differ in its physiological CNS effects? Does it produce therapeutic effects rather-than psychopathology-or is it a misnomer?
    CONFLICT OF INTEREST: None Reported
    Original Investigation
    Substance Use and Addiction
    November 30, 2018

    Acute Effects of Smoked and Vaporized Cannabis in Healthy Adults Who Infrequently Use Cannabis: A Crossover Trial

    Author Affiliations
    • 1Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 2RTI International, Research Triangle Park, North Carolina
    • 3Division of Workplace Programs, Substance Abuse and Mental Health Services Administration, Rockville, Maryland
    JAMA Netw Open. 2018;1(7):e184841. doi:10.1001/jamanetworkopen.2018.4841
    Key Points español 中文 (chinese)

    Question  How does smoked and vaporized cannabis acutely influence subjective drug effects, cognitive and psychomotor performance, and cardiovascular measures in healthy adults who infrequently use cannabis (>30 days since last use)?

    Findings  In a crossover trial of 17 healthy adults, inhalation of smoked and vaporized cannabis containing 10 mg of Δ9-tetrahydrocannabinol (THC) produced discriminative drug effects and modest impairment of cognitive functioning, while inhalation of a 25-mg dose of THC was associated with pronounced drug effects, increased incidence of adverse effects, and significant impairment of cognitive and psychomotor ability. Vaporized cannabis produced greater pharmacodynamic effects and higher concentrations of THC in blood compared with equal doses of smoked cannabis.

    Meaning  Significant, sometimes adverse, drug effects can occur at relatively low THC doses in infrequent cannabis users, and accordingly these data should be considered with regard to regulation of retail cannabis products and education for individuals initiating cannabis use.

    Abstract

    Importance  Vaporization is an increasingly popular method for cannabis administration, and policy changes have increased adult access to cannabis drastically. Controlled examinations of cannabis vaporization among adults with infrequent current cannabis use patterns (>30 days since last use) are needed.

    Objective  To evaluate the acute dose effects of smoked and vaporized cannabis using controlled administration methods.

    Design, Setting, and Participants  This within-participant, double-blind, crossover study was conducted from June 2016 to January 2017 at the Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, and included 17 healthy adults. Six smoked and vaporized outpatient experimental sessions (1-week washout between sessions) were completed in clusters (order counterbalanced across participants); dose order was randomized within each cluster.

    Interventions  Cannabis containing Δ9-tetrahydrocannabinol (THC) doses of 0 mg, 10 mg, and 25 mg was vaporized and smoked by each participant.

    Main Outcomes and Measures  Change from baseline scores for subjective drug effects, cognitive and psychomotor performance, vital signs, and blood THC concentration.

    Results  The sample included 17 healthy adults (mean [SD] age, 27.3 [5.7] years; 9 men and 8 women) with no cannabis use in the prior month (mean [SD] days since last cannabis use, 398 [437] days). Inhalation of cannabis containing 10 mg of THC produced discriminative drug effects (mean [SD] ratings on a 100-point visual analog scale, smoked: 46 [26]; vaporized: 69 [26]) and modest impairment of cognitive functioning. The 25-mg dose produced significant drug effects (mean [SD] ratings, smoked: 66 [29]; vaporized: 78 [24]), increased incidence of adverse effects, and pronounced impairment of cognitive and psychomotor ability (eg, significant decreased task performance compared with placebo in vaporized conditions). Vaporized cannabis resulted in qualitatively stronger drug effects for most pharmacodynamic outcomes and higher peak concentrations of THC in blood, compared with equal doses of smoked cannabis (25-mg dose: smoked, 10.2 ng/mL; vaporized, 14.4 ng/mL). Blood THC concentrations and heart rate peaked within 30 minutes after cannabis administration and returned to baseline within 3 to 4 hours. Several subjective drug effects and observed cognitive and psychomotor impairments persisted for up to 6 hours on average.

    Conclusions and Relevance  Vaporized and smoked cannabis produced dose-orderly drug effects, which were stronger when vaporized. These data can inform regulatory and clinical decisions surrounding the use of cannabis among adults with little or no prior cannabis exposure.

    Trial Registration  ClinicalTrials.gov Identifier: NCT03676166.

    ×