Toxicology of Flavoring- and Cannabis-Containing E-Liquids Used in Electronic Delivery Systems

Details

• Personal Author:
  LeBouf, Ryan F. ; Leonard, Stephen S. ; Ranpara, Anand ; Stefaniak, Aleksandr B.
• Description:
  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. E-cigarettes are used to aerosolize a liquid (e-liquid) that the user inhales. Flavorings in e-liquids is a primary reason for youth to initiate use of e-cigarettes. Evidence is growing in the scientific literature that inhalation of some flavorings is not without risk of harm. 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. 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. Cinnamaldehyde was most frequently reported to be cytotoxic, followed by vanillin, menthol, ethyl maltol, ethyl vanillin, benzaldehyde and linalool. Additionally, modern e-cigarettes can be modified to aerosolize cannabis as dried plant material or a concentrated extract. The U.S. 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. Our literature search identified 33 articles related to EVALI. 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. 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. [Description provided by NIOSH]
• Subjects:
  Aerosols Cannabis Electrical Equipment And Supplies Flavoring Agents Hazardous Substances Nicotine Occupational Health Respiratory Tract Diseases Safety Smokers Solvents Tobacco Products Volatile Organic Compounds

  More +
• Keywords:
  Author Keywords: E-cigarettes Cigarette Smoking Circulatory System Delta-9-tetrahydrocannabinol Delta9-THC E-liquids Electronic Devices Flavorings In Vitro Studies Respiratory System Disorders Toxicity Vaporizers Vapors VOCs Volatile Organic Compounds

  More +
• ISSN:
  0163-7258
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division ; HELD - Health Effects Laboratory Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  224
• NIOSHTIC Number:
  nn:20062372
• Citation:
  Pharmacol Ther 2021 Aug; 224:107838
• Contact Point Address:
  Aleksandr B. Stefaniak, Respiratory Health Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, USA
• Email:
  AStefaniak@cdc.gov
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Services
• Peer Reviewed:
  True
• Source Full Name:
  Pharmacology & Therapeutics
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2c93440f779a60e0e0d1b881ea64e763187b84219bebc9bd6e47c92cc3ba6fb84edd7c29273b9362c8b49f7101f354f209943cba99179aafefa70cfd31e2f2f2
• Download URL:
  https://stacks.cdc.gov/view/cdc/225635/cdc_225635_DS1.pdf
• File Type:
  [PDF - 1.78 MB ]