Since the introduction of e-cigarettes in the United States in 2007, these devices rapidly gained popularity, especially amongst U.S. Additionally, special interchangeable coil head adapters have enabled the use of e-cigarettes to aerosolize cannabis as dried plant material or a concentrated extract, either by itself or dissolved in an e-liquid. Electronic devices intended for cannabis such as personal vaporizers are used to heat the dried plant material or its extracts to deliver aerosolized cannabinoids in a form that can be inhaled without combustion. Some e-cigarette users inhale this aerosol to mimic tobacco smoking without tobacco combustion. The heated e-liquids forms an aerosol (mixture of liquid droplets and gas phase substances) that is inhaled by the user. More research is needed, particularly with regard to e-cigarettes (generation, power settings, etc.), e-liquids (composition, bulk or vaped form), modeled systems (cell type, culture type, and dosimetry metrics), biological monitoring, secondhand exposures and contact with residues that contain nicotine and flavorings, and causative agents and mechanisms of EVALI toxicity.Įlectronic nicotine delivery systems such as electronic cigarettes (e-cigarettes) are used to heat an e-liquid composed of humectants and sometimes flavorings and nicotine. Vitamin E acetate, a diluent and thickening agent in cannabis-based products, was strongly linked to the EVALI outbreak in epidemiologic and laboratory studies however, e-liquid chemistry is highly complex, and more than one mechanism of lung injury, ingredient, or thermal breakdown product may be responsible for toxicity. Our literature search identified 33 articles related to EVALI.

experienced an outbreak of lung injuries, termed e-cigarette, or vaping, product use-associated lung injury (EVALI) that began in 2019 among 2,022 hospitalized patients who had data on substance use (as of January 14, 2020), 82% reported using a delta-9-tetrahydrocannabinol (main psychoactive component in cannabis) containing e-cigarette, or vaping, product. Additionally, modern e-cigarettes can be modified to aerosolize cannabis as dried plant material or a concentrated extract. Cinnamaldehyde was most frequently reported to be cytotoxic, followed by vanillin, menthol, ethyl maltol, ethyl vanillin, benzaldehyde and linalool. At least 65 individual flavoring ingredients in e-liquids or aerosols from e-cigarettes induced toxicity in the respiratory tract, cardiovascular and circulatory systems, skeletal system, and skin. In this review, 67 original articles (primarily cellular in vitro) on the toxicity of flavored e-liquids were identified in the PubMed and Scopus databases and evaluated critically. Evidence is growing in the scientific literature that inhalation of some flavorings is not without risk of harm. Flavorings in e-liquids is a primary reason for youth to initiate use of e-cigarettes. E-cigarettes are used to aerosolize a liquid (e-liquid) that the user inhales. Electronic cigarettes (e-cigarettes) were introduced in the United States in 2007 and by 2014 they were the most popular tobacco product amongst youth and had overtaken use of regular tobacco cigarettes.

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