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Cannabis vaping skyrockets among high school students in the US

As reports in the United States of severe lung illnesses related to vaping began to make headlines in 2019, rates of cannabis vaping among high school students were soaring, according to high quality survey data analysed by New York University, writes John Gever for MedPage Today.

Results from the long-running Monitoring the Future study showed that 4.9% (95% CI 4.3% to 5.5%) of high school students reported ‘frequent’ vaping of cannabis products – 10 or more times in the previous month – up from 2.1% in 2018 (95% CI 1.7%-2.6%), reported Dr Joseph J Palamar of New York University.

Rates of any cannabis vaping in the previous month also increased dramatically, from 7.5% in 2018 (95% CI 6.7% to 8.4%) to 14.0% in 2019 (95% CI 13.1% to 14.9%), Palamar wrote in the Journal of Adolescent Health.

Cannabis vaping involves inhalation of evaporated oils or from heated concentrates known as dabs, according to the MedPage Today story published on 6 May 2021.

These increases accompanied what was the most frightening, and still somewhat mysterious, respiratory disease outbreak in recent years, until it was eclipsed by the COVID-19 pandemic. Nearly 3,000 Americans, mostly young adults, fell ill with EVALI – e-cigarette or vaping-associated lung injury – and 68 died, Palamar noted.

Epidemiological and lab research eventually settled on vitamin E acetate, a common component of illicit cannabis vaping products, as the likely cause, even though a substantial minority of victims denied use of such products.

Palamar's analysis drew on Monitoring the Future data on 4,072 students in 10th and 12th grades in 2018 and 8,314 in 2019, writes MedPage Today. Other highlights from the analysis include:

  • Past-month cannabis vaping nearly tripled among female students from 2018 to 2019.
  • Rates for students age 18 and older rose 2.5-fold.
  • Social activity, as indicated by reports of ‘going out’ four to seven times a week, was associated with above-average rates of cannabis vaping.
  • Small increases from 2018 to 2019 in cannabis vaping were seen among students reporting other psychoactive drug use including opioids, cocaine, ‘tranquilisers’ and non-LSD hallucinogens.

An open question, not addressed in Palamar's study, is the extent to which school closures and social restrictions resulting from the COVID-19 pandemic affected these trends, and Monitoring the Future data won't shed light on that for some time. That's because the survey was stopped in March 2020, as school closures took hold, writes John Gever in MedPage Today.

Still, the survey’s truncated 2020 data showed that the number of 10th graders saying cannabis was ‘fairly easy’ or ‘very easy’ to obtain declined sharply, accelerating a trend underway for more than 20 years, and despite the spread of legal marijuana.

Palamar noted several limitations to his analysis and to Monitoring the Future in general. Drug use data came from unverified self-reporting, and the survey is conducted at participating schools, meaning that students “chronically absent or who dropped out are underrepresented”, he wrote. Also, some sub-groups were too small to permit detailed examination, such as students reporting daily cannabis vaping.


Study details

Increases in Frequent Vaping of Cannabis Among High School Seniors in the United States, 2018-2019

Joseph J Palamar

Affiliation: Department of Population Health, New York University Grossman School of Medicine, United States.

Published in the Journal of Adolescent Health on 7 May 2021.



Studies have examined trends in cannabis vaping, but research is needed to examine trends in more frequent use as this may increase risk for adverse health outcomes.


Data were from 12,561 high school seniors participating in the Monitoring the Future national study. Prevalence of self-reported frequent vaping of cannabis (defined as using ≥10 times in the past month) was compared between 2018 and 2019 cohorts.


Frequent vaping of cannabis significantly increased from 2.1% to 4.9%, a 131.4% increase. This increase was larger than the increase for any vaping of cannabis (which increased 85.9%).

Notable significant increases occurred among students aged ≥18 years (a 154.9% increase), female students (a183.5% increase), those who go out 4 to 7 evenings per week (a 163.0% increase), and those reporting past-year non-medical prescription opioid use (a 184.7% increase).


Frequent vaping of cannabis is increasing among adolescents in the United States, particularly among selected subgroups.


MedPage Today story – Cannabis Vaping Skyrockets in High School Students (Open access)

Journal of Adolescent Health article – Increases in Frequent Vaping of Cannabis Among High School Seniors in the United States, 2018–2019 (Restricted access)




Early cannabis use linked to heart disease – Canadian research

Vaping cannabis tied to more lung damage symptoms than cigarettes, nicotine

Legal cannabis stores linked to fewer opioid deaths in the United States – BMJ

Frequent adolescent cannabis use linked to IQ decline — Irish Royal College



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