Vaping has gained incredible pop- ularity in the United States1 and in the United Kingdom2 over the last decade. Likely, this is due to the confluence of certain conditions that, together, bolstered an environment conducive for explosive growth. These conditions include the long existence of vaporizer technology, the growth of the legal cannabis industry, the continued marketing efforts of the tobacco industry, intense marketing campaigns of alternative and safer nicotine delivery systems, and youth culture in a hyper-connected broadband/Internet era. Tangentially, emerging “gray market” industries that are largely unregulated or underregulated have also contributed to a broader vape culture. This includes the manufacture of alternative cannabis products, such as cannabidiol (CBD), that have expanded wildly since the passage of the Agriculture Improvement Act of 2018.3 While the U.S. Food & Drug Administration and the U.K. Home Office continue to create clear and comprehensive guidelines, a regulatory vacuum continues to exist in both countries allowing products to flourish in stores and online. Facets of the legal/illegal cannabis4 and CBD markets continue to exploit the broadening vape culture. In all, the following products are available in vape form: cannabis oil and other concentrates (e.g., wax, butter, “shatter,” or butane-extracted compounds—all containing THC), CBD and “cannabis alternatives,” nicotine and nicotine/tobacco alternatives, and essential oils (or “herbal vape” products that can include “flavor” combinations such as jasmine, lime, and patchouli; orange, frankincense, and ylang ylang; fennel, thyme, and vanilla). The following sections describe this emerging vaping trend in these ways: its history, the known and unknown pharmacology (including toxicity), legal considerations, and regulatory concerns. It does so while focusing on both the products of consumption (e.g., the vape “juice,” salts, or organic matter) as well as the devices used to produce the aerosol for their consumption.
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