Medical Examiner

Teens Who Vape Might Also Smoke Weed. Could That Be a Good Thing?

If they’re going to smoke marijuana, at least vaping it is healthier.

A teen vaping.
Photo illustration by Slate. Photo by Thinkstock.

Another week, another study providing ammunition for the irrational war against e-cigarettes. This time, it was the University of Missouri–Kansas City (UMKC) that delighted sensationalists with a longitudinal survey study asserting that adolescent kids are almost twice as likely to dabble with weed one year after their first puff on an e-cigarette. As lead author Hongying Dai of Children’s Mercy Hospital and UMKC put it, “the widespread use of e-cigarettes among youth may have implications for the uptake of other drugs of abuse beyond nicotine and tobacco products.”

The thing is, all of this talk about kids and vaping and marijuana smells a bit funky. Finding a correlation between teens who’ve used e-cigarettes and teens who later try weed doesn’t mean that one certainly causes the other—another entirely possible, and perhaps more likely, option is that the same things that compel someone to use an e-cig might compel them to smoke weed, such as having a sensation-seeking personality. But I’m not even sure the findings would be much to worry about if they do hold up. We know that vaping weed entails fewer toxins and decreased respiratory symptoms compared to smoking it. The researchers didn’t track how the students were consuming their marijuana, but I certainly wish they had. Because to me, the study raises an altogether different question: Could using e-cigarettes propel kids to vape their marijuana? And if so, could this actually be a good thing?

Before we tackle this burning question, let’s take a quick recap. Two years ago, the surgeon general released a report on e-cigarette use among youth and young adults and cited the headline-grabbing figure of a 900 percent increase in high school vaping between 2011 and 2015. If Dai’s study revealed something other than a correlation, we’d also expect to see an increase in cannabis use across this period.

We haven’t. The Monitoring the Future (MTF) study surveys a nationally representative sample of eighth-, 10th-, and 12th-graders across the U.S. every year. The 2017 survey indicated low, mostly unchanged levels of marijuana use, with a slight decline in the number of 10th graders trying weed at least once across the past year. Fluctuations in trying cannabis and smoking it daily have been inconsequential across the past five years. This is in spite of the aforementioned spike in teen vaping and against a backdrop of increasingly liberalized marijuana laws. So the MTF study provides little evidence that vaping is significantly exacerbating cannabis use.

Nonetheless, the MTF study does tell us that marijuana is U.S. adolescents’ illicit drug of choice. The study suggests that this may result from teenagers perceiving cannabis as a low-harm, low-disapproval narcotic. Sensation seeking also provides a solid explanation for why teens might experiment with cigarettes, alcohol, and marijuana. In recent years, researchers have established an additional relationship between high sensation-seeking levels and trying out vapes.

Interestingly, the UMKC study itself indicates that higher sensation seeking is associated with both marijuana experimentation and regular use. The analysis also suggests that smoking a single cigarette or having a sip of alcohol could be better predictors of any future marijuana use than puffing on an e-cigarette. With our understanding of sensation-seeking personalities and polysubstance use, these results are hardly surprising. Yet the authors of the study opted to merely describe these findings, rather than give them any sustained discussion. The longitudinal correlation between e-cigs and weed was hypothesized by the research team and is a novel discovery, so it makes sense to highlight it. But read in conjunction with these other findings, it seems vaping may play a diminished role in teenage uptake of marijuana.

The problem might be that there already is an overwhelming media narrative that e-cigarettes are the new scourge of contemporary society. Coverage of the UKMC study cited psychiatrist Scott Krakower deploying classic rhetorical scaremongering: “If you go to marijuana, is that going to lead to pills? Is that going to lead to something else?” Even media outlets like Vice and Michardly known for moralizing over drug-taking behaviors—have run articles claiming that vaping is just as bad for your health as cigarettes and can disinhibit smoking cessation. But if we examine the two largest and most in-depth scientific reviews on vaping, it soon becomes clear that e-cigarettes can help smokers to quit and could be up to 95 percent less harmful than tobacco. As Jeremy Samuel Faust argued in Slate, e-cigs might not be good for us, but they might be the best addiction to have.

The perils of vaping nicotine are worth investigating further, of course. But the subject at hand is whether vaping an e-cig has a causational relationship with smoking weed. Again, I suspect that if there is a connection, it could be a good thing. Marijuana users often smoke tobacco—a review by Aprana Agrawal and colleagues proposed that one main factor here is that cigarettes and spliffs involve inhaling smoke in the same way, making it relatively effortless to switch between the two. Similarly, with certain kinds of e-cigarettes, it’s possible to swap out the e-liquid for hash oil. One recent U.S. study examined the medium through which high schoolers are consuming their weed: It found that about 18 percent of Connecticut high school vapers are also using their e-cigs to vape marijuana derivatives.

This at least opens the possibility that e-cigarettes may encourage some teens to vape their weed.

There isn’t much data available to assess this theory. We still need more information on what adolescents use to vape and what they use to consume weed. The UMKC research team drew their data from the Population Assessment of Tobacco and Health study, whichabsurdly enoughdoesn’t survey respondents on what’s inside their vapes. But we do have good evidence to suggest that vaping weed is a healthier method than smoking it, so in the end, this potential moral panic may actually be a small health win.