Tobacco use in the United States has been a major public health topic for decades, ever since early research showed its correlation with various forms of cancer. Over the years, campaigns have urged individuals to give up smoking, and they’ve largely been successful. Today, fewer adults smoke than they did a decade ago.
Unfortunately, the introduction of electronic cigarettes and vape devices has led to many people picking up vaping as a habit instead. This means that nicotine use nationwide is still relatively common, especially among increasingly younger demographics. In light of the opioid epidemic, it’s worth examining the relationship between vaping and opioid use to determine likely health outcomes for individuals with a polysubstance misuse habit.
How are vaping + opioids related?
Vaping among opioid users
General tobacco use among individuals with opioid use disorder (OUD) is stunningly high. Some sources estimate that 80% of opioid users use tobacco in one form or another. On some level, this isn’t too surprising: Both opioids and tobacco impact similar and related areas of the brain, and individuals who experience an addiction to one substance are far more likely to develop an addiction to the other.
Being addicted to multiple substances is known as polysubstance use disorder, and it’s linked to higher rates of fatal overdose. Tobacco is also easily obtainable since it’s not as heavily controlled as other substances and is also much less expensive.
One study examining the prevalence of e-cigarette use among opioid users found that 6% of patients voluntarily reported using their vape on a daily basis, while 18% had used a vape or other e-cigarette within the previous 30 days, and 62% had a history of vape use. About 85% of the patients reported that they had an active habit of smoking cigarettes, and 46% of patients claimed to use vapes as a method of cutting back on smoking.
This study shows that cigarettes are still far and away the preferred form of tobacco delivery, but it’s also clear that e-cigarette use is becoming more common among patients with opioid use disorder. This alone makes the phenomenon worth further study.
Vaping demographics
While people of all ages and demographics use vapes in the United States, there’s one group that is particularly likely to vape. According to the United States Centers for Disease Control and Prevention (CDC), e-cigarettes are the most common tobacco product used among children and youths.
The numbers are telling. The CDC found that, in 2023, one in every 22 middle school students and one in every 10 high school students had used a vape within the 30 days prior to their interviews. Meanwhile, only one in every 100 middle schoolers and two in every 100 high schoolers had smoked a cigarette. Another study from the CDC found that the percentage of 12th graders who had used a vape increased from 11% in 2017 to as much as 25% in 2019.
These numbers are concerning for many reasons, but they’re especially worrisome when taken in the context of the ongoing opioid crisis. Some research now suggests that e-cigarettes may be a gateway drug among youths, meaning that as we see an increase in the number of children vaping, opioid use among youths is also likely to rise.
Can you vape during opioid treatment?
Tobacco + opioid interactions
Theoretically, vaping and opioid use can be done together without a major risk of complications. Unlike using opioids with alcohol or other depressants, concurrent vaping and opioid use does not have immediately life-threatening side effects. However, this doesn’t mean polysubstance use is actually safe. In fact, smoking and vaping may make opioid use more likely and more difficult to manage. Studies suggest that tobacco use increases an individual’s sensitivity to pain, which could lead a person to seek stronger painkillers, including opioids.
As vaping has become more popular, the risk of contaminated vape fluids has increased due to a lack of industry regulation and oversight. This is being done with fentanyl in particular, which is an incredibly potent and difficult-to-identify synthetic opioid that has been involved in tens of thousands of overdose deaths.
The U.S. Drug Enforcement Agency (DEA) has been aware of the availability of fentanyl-laced vape cartridges since a 2019 fentanyl overdose death that triggered a home search and seizure of fentanyl-laced vape equipment. In the years since, tainted vape cartridges have turned up in schools in states ranging from New York to Iowa to Colorado, with local law enforcement and health officials highlighting the risks of underage users buying vape fluids from unlicensed vendors.
The side effects of vaping opioids—even accidentally—have not yet been well studied and documented, and there may be more risk than normal when vaping nicotine and opioids together.
How vaping hinders OUD treatment
Numerous studies show that individuals who use tobacco or vapes during opioid treatment have worse long-term recovery outcomes than those who abstain from habitual nicotine use. Smoking and vaping during treatment are correlated with significantly higher cravings for opioids and far lower rates of treatment completion. Opioid treatment is designed to help curb cravings, so vaping counteracts one of the main benefits of treatment.
Additionally, new research even suggests that stopping smoking and vaping during opioid treatment leads to less intense smoking after treatment and a higher likelihood of pursuing the goal of permanently quitting.
Further risks of vaping
In addition to being a health concern and complicating OUD treatment due to the way that tobacco and opioids interact, vaping can also pose another concerning risk. Within the last few years, fentanyl-laced vapes have been discovered across the country. This poses a major risk of overdose, especially for people who are seeking treatment to end their opioid use.
Patients who stop using opioids recreationally without a medication for addiction treatment (MAT) are more likely to experience a fatal overdose from fentanyl due to their decreased tolerance for opioids and fentanyl’s potency. Fentanyl can stay in a person’s system for around 24 hours, which means that individuals who encounter fentanyl-laced vapes are at greater risk if they use the vape multiple times in a day.
Real-world help based on research
As new forms of drugs and ways of using them emerge, healthcare providers need to be aware and responsive. Ophelia’s clinicians participate in ongoing research that informs and demonstrates the value of our OUD treatment methods, starting with an effective telehealth model designed to fit into your schedule.
Our intake team will determine whether Suboxone® or another buprenorphine-naloxone medication is right for you (important safety information) and ensure you’re able to fill the prescription at a local pharmacy. From there, you’ll meet with a dedicated clinical team to receive comprehensive care tailored to your physical and behavioral health needs.
Sources
