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Just as reports 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.

Results from the long-running showed that 4.9% (95% CI 4.3%-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 Joseph J. Palamar, PhD, 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%-8.4%) to 14.0% in 2019 (95% CI 13.1%-14.9%), he wrote in the .

Cannabis vaping involves inhalation of evaporated oils or from heated concentrates known as dabs.

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.

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, "tranquilizers," 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.

Sill, 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-report, and the survey is conducted at participating schools, meaning that students "chronically absent or who dropped out are underrepresented," he wrote. Also, some subgroups were too small to permit detailed examination, such as students reporting daily cannabis vaping.

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