The
outbreak of e-cigarette or vaping product use-associated lung
injury (EVALI) has been cause for concern to the medical community,
particularly given that this novel illness has coincided with the
COVID-19 pandemic, another cause of severe pulmonary illness. Though
cannabis e-cigarettes tainted with vitamin E acetate were primarily
associated with EVALI, acute lung injuries stemming from cannabis
inhalation were reported in the literature prior to 2019, and it has
been suggested that cannabis components or additives other than vitamin
E acetate may be responsible. Despite these concerning issues, novel
cannabis vaporizer ingredients continue to arise, such as Δ8-tetrahydrocannabinol, Δ10-tetrahydrocannabinol,
hexahydrocannabinol, and cannabichromene. In order to address cannabis
e-cigarette safety and vaping in an effective manner, we provide a
comprehensive knowledge of the latest products, delivery modes, and
ingredients. This perspective highlights the types of cannabis vaping
modalities common to the United States cannabis market, with special
attention to cartridge-type cannabis e-cigarette toxicology and their
involvement in the EVALI outbreak, in particular, acute lung injurious
responses. Novel ingredient chemistry, origins, and legal statuses
are reviewed, as well as the toxicology of known cannabis e-cigarette
aerosol components.