Electronic Cigarettes to Vaporize Cannabis: Prevalence of Use and Associated Factors among Current Electronic Cigarette Users in Germany (DEBRA Study)

Abstract

Background: In Germany, cannabis is the most widely used illicit drug, and inhalation together with tobacco is most popular. However, it has been described that electronic cigarettes (ECs) are being used to vaporize cannabis (extract). No current data on EC cannabis use in the German population are yet available. Objectives: This study examines the prevalence of EC cannabis consumption for mood changing effects among current EC users, and associated consumer characteristics in Germany. Methods: We used data from the German Study on Tobacco Use (period: 8/2016–01/2019, DEBRA, www.debra-study.info), a nationally representative household survey. EC cannabis use for mood-changing effects was assessed in 504 current EC users (aged ≥ 18 years) of the total sample (N = 32,678). Ever use was defined by: (1) occasional or regular use, or (2) experimental consumption. Associations with socio-demographic consumer characteristics and tobacco smoking were analyzed using multivariable regression analyses. Results: Amongst current EC users, 7.2% had ever vaporized cannabis: 2.3% (95%CI = 1.2–3.9) reported occasional or regular use (1) and 4.8% (95%CI = 3.2–7.1) reported experimental use (2). Age was associated with ever EC cannabis use: highest prevalence rates were found among 18–24-year-olds: 6.5% (95%CI = 2.3–13.1) (1) and 8.0% (95%CI = 3.7–15.8) (2), respectively. The majority (90.2%) of ever EC cannabis users were current tobacco smokers. Conclusions: One in 14 current EC users in Germany has ever vaporized cannabis for mood-changing reasons, and almost all EC cannabis consumers also smoke tobacco. Highest usage rates can be observed among young adults. Hence, trends of EC drug misuse need to be monitored consequently, particularly in young people.

Keywords:

• Electronic cigarettes
• vaporizing
• cannabis
• hashish
• tetrahydrocannabinol
• German Study on Tobacco Use
• household survey
• DEBRA

Acknowledgments

We would like to thank Kantar Health (Constanze Cholmakow-Bodechtel and Linda Scharf) for the data collection and data management.

Author Contributions

SK coordinates the DEBRA study, analyzed and interpreted the data, and drafted the manuscript. JH co-analyzed and interpreted the data, and contributed to the writing of the manuscript. DK conceived the DEBRA study, acquired funding, contributed to the study design for the present analysis, and contributed to the writing of the manuscript. All named authors contributed substantially to the manuscript and agreed on its final version.

Disclosure statement

All authors have no conflict of interest to declare. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

Data availability statement

All relevant data are within the paper. The data underlying this study are third-party data and are available to all researchers on reasonable request from the corresponding author [SK].

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional Ethics Committee at the Heinrich-Heine-University Duesseldorf, Germany (ID 5386/R) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The DEBRA study has been also registered at the German Clinical Trials Register (DRKS00011322).

Funding

The DEBRA study was funded by the Ministry for Culture and Science of the German Federal State of North Rhine-Westphalia (“NRW-Rückkehrprogramm”).

Informed consent

The fieldwork is conducted by the market research institute Kantar Health Munich, Germany. The interviewers from Kantar Health make sure that all participants give oral informed consent. This method of consent has been also approved by the ethics committee.