Most of the THC-containing products used by the patients were obtained from friends, family, school, dealers, or off the street. Interestingly, most of the patients used universal “vape pens” for which prefilled THC cartridges can be used, as opposed to the closed pod devices sold for proprietary nicotine containing products . Use of devices with a tank designed to be filled with nicotine-containing liquid or THC oil was reported by 18 patients, and 14 reported aerosolizing THC concentrates by “dabbing,” a process involving vaporizing extracts of a concentrate that has been placed on a hot surface.Although the CDC investigation suggests that a clue to the vaping lung injury epidemic lies in the Dank Vapes products, the causative agent remains unknown. Public health investigators in New York State suggested that vitamin E acetate added as a thickening agent to THC-containing extracts, including Dank Vapes , may be responsible for lung injury, after 34 samples of extracts used by injured patients all contained it . However, other extracts tested used by cases in other states have not confirmed the universal presence of vitamin E acetate . Because virtually all THC containing extracts are oily, lipoid pneumonia also has been suggested as the responsible pathophysiology , and some but not all BAL fluid from patients has shown the presence of lipidladen macrophages . It is important to note that some patients with lung injury only used nicotine-containing products . Triantafyllou and colleagues describe several possible mechanisms by which vaping can lead to acute lung injury . The common vehicles of the nicotine-containing extracts are propylene glycol and glycerin, which have been shown to induce airway remodeling . Nicotine vapor itself has been shown to induce macrophage activation , and flavoring additives, including the known respiratory toxin diacetyl, lead to the generation of byproducts that directly injure the airway epithelium . It is really no surprise to anyone with a background in in halational toxicology that when chemically complex extracts are heated to the point of aerosolization and vaporization,cannabis grow facility toxic agents will be generated . A recent paper from the Mayo Clinic that described the pathological examination of lung biopsies from 17 patients with vaping associated lung injury reported findings more consistent with airway-centered chemical pneumonitis from one or more inhaled toxic substances, rather than lipoid pneumonia .

Although the CDC, in concert with state public health officials, feverishly works to find the “bad actor or actors” in vaping extracts, it has also taken steps to warn the public of the dangers of vaping, especially of THC-containing extracts. The CDC recommends that current users consider refraining from using e-cigarette, or vaping, products, particularly those containing THC . The agency also recommends that youth and young adults not use e-cigarettes or vaping products and that these products not be bought off the street or modified in any way. The negative publicity surrounding e-cigarettes has caused the company with the largest share of the market, JUUL, to stop all advertising, end internet sales of flavored e-cigarettes, and drop its well-funded political campaign to skirt San Francisco’s legislative ban on sales of e-cigarettes. JUUL’s CEO recently resigned, to be replaced by an executive from Altria, the tobacco company that owns 35% of JUUL. The tragic epidemic of lung injury due to vaping was preventable. If the U.S. Food and Drug Administration had taken a more proactive approach to regulation of e-cigarettes as electronic nicotine delivery devices similar to nicotine patches or gum, there would likely have been much less use by America’s youth. Data from the 2019 Monitoring the Future Survey conducted annually by the National Institute on Drug Abuse showed a doubling of the percentage of teens who reported vaping, with 25% of high school seniors reporting use in the last month. Rather than take regulatory action that could have protected the nation’s youth, the FDA abdicated its responsibility and let corporate profits come before public health. A cardinal tenet of environmental health is the precautionary principle that holds when a new product is developed that may have the potential for harm, it should be tested carefully for toxicity before being widely marketed. The FDA was made aware of the potential harm of inhaling vapors of nicotine-containing aerosols but allowed tobacco company–funded companies like JUUL to market flavored e-cigarette pods, which has led to the nicotine addiction of thousands of children.

There is a powerful lesson here. Ignore the precautionary principle at society’s peril. Lives have been lost through this ignorance.HIV infection is a global pandemic and the population is growing due to successful treatment with highly active antiretroviral therapy. Although rates of HIV have been reduced in the United States among most groups as a result of successful public health efforts , sexual risk behavior and subsequent acquisition and/or spread of HIV and other sexually transmitted infections are still of concern among men who have sex with men as well as drug using populations. Thus, it is evident that, despite research and efforts to understand and curb sexual risk behavior within these vulnerable populations, additional work employing novel approaches are needed. Sexual risk behaviors can be viewed as a composite of numerous behaviors that collectively make-up a complex behavioral phenotype. As with most complex phenotypes, sexual risk behavior is heterogeneous and several factors contribute to the variance that can be observed from one individual to another. To date, a majority of work examining risk factors for sexual risk behavior phenotypes have primarily focused on psychosocial factors and/or other complex/heterogeneous behavioral phenotypes such as substance use behaviors as indicators for current or future sexual risk behavior. Ultimately these indicators, upon sufficient replication, become candidates for public health interventions that aim to prevent and reduce sexual risk behaviors. However, the trouble with many of these candidates is that they are too proximal to sexual risk behaviors and often cooccur, making it difficult to disentangle temporal precedence and ultimately limit prevention efforts. One relatively novel approach is to examine intermediate phenotypes or endophenotypes such as neurocognitive factors as well as biological factors. These factors are more distal to the onset of sexual risk behavior and thus are potentially more advantageous candidates for identifying vulnerable individuals and informing prevention efforts for sexual risk behavior. Studies in literature examining neurocognitive and biological factors as indicators for sexual risk behaviors are limited. In fact, only two studies to date have examined neurocognitive factors and none to our knowledge have examined biological factors as potential indicators. Although this paucity of research is surprising given previous work linking both neurocognitive and genetic indicators to other health related behaviors, research has established the dopminergic system as a common link between neurocognitive functioning and sexual behavior.

The dopminergic system has been shown to be involved in sexual arousal, motivation and the subsequent rewarding effect of sexual behavior . Furthermore, DA in the human brain, specifically in the prefrontal cortex , has been shown to be necessary for proper cognitive functioning to occur and high or low levels of DA in this brain region are known to contribute to individual cognitive differences in humans. The PFC is of particular importance when examining risk behavior in that executive functions such as decision-making, planning, self-monitoring as well as behavior initiation, organization, and inhibition are largely dependent on PFC integrity. Impairment in executive functioning may result in difficulties in assessing relationships between a person’s current behavior and future outcomes; thereby resulting in choices and/or responses on the premise of immediate rewards versus long term consequences and an ultimate potential increase in the likelihood for participation in sexual risk behaviors. Thus,cannabis grow system mechanisms responsible for maintaining a dopamine balance within the brain and in particular the PFC would appear to be good biological candidates for further exploration of an association between executive dysfunction and sexual risk behavior. One such candidate is catechol-O-methyltransferease which is a mammalian enzyme involved in the metabolic degradation of released dopamine, particularly in the PFC. Of particular interest to this study is a common polymorphism involving a Val to Met substitution at codon 158. The Val allele of the COMT Val158Met polymorphism is 40% more enzymatically active than the Met allele. Thus, carriers of the Met allele metabolize dopamine at a less efficient rate, resulting in higher levels of dopamine in the synapse and ultimately an escalation in dopamine receptor activation. This differentiation of dopamine receptor activity dependent on COMT genotype has led to several investigations into the relationship between COMT and executive dysfunction in which the Val allele has been putatively linked to poor performance on executive functioning tasks. However, to our knowledge no work has examined the relationship between COMT and sexual risk behavior; albeit studies of similar behaviors such as novelty seeking, reward dependence, as well as affective arousal and regulation have demonstrated significant relationships. Given the aforementioned paucity of research in the current literature addressing the contribution of genetic and neurocognitive factors on sexual risk behavior, the primary aim of this study was to examine the main effects of executive functioning as well as the main effects of the COMT Val158Met polymorphism on sexual risk behavior among a ethnically diverse population of men with and without METH dependence and/or HIV infection. Within this aim, we hypothesized that the highly active COMT Val/Val genotype and its putatively associated deficits in executive functioning would be independently associated with sexual risk behaviors. In addition, as a result of previously mentioned research that has demonstrated an association between COMT genotype and executive functioning we also explored the potential interaction effects of COMT and executive dysfunction on sexual risk behavior.Participants were volunteers evaluated at the HIV Neurobehavioral Research Center at the University of California in San Diego as part of a cohort study focused on central nervous system effects of HIV and methamphetamine.

The current study comprised 192 sexually active non-monogamous men with and without methamphetamine dependence and/or HIV infection . Men were classified as non-monogamous if they stated they had “no current partner” at time of assessment. Monogamous men were excluded because unsafe sexual behavior within a monogamous relationship is less risky than in non-monogamous relationships. All participants underwent a comprehensive characterization procedure that included collection of demographic, neuromedical, psychiatric as well as neuropsychiatric information. HIV serological status was determined by enzyme linked immunosorbent assays plus a confirmatory test. Lifetime METH dependence was determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Version IV . However, participants were not actively using other substances, with the exception of cannabis and alcohol. Potential participants were excluded if they met lifetime dependence criteria for other drugs, unless the dependence was judged to be remote and episodic in nature by a doctoral level clinician. Alcohol dependence within the last year was also an exclusion criterion. All participants were seronegative for hepatitis C infection. Additional information for each participant was collected as it relates to current depressed mood as well as lifetime diagnosis of Major Depression Disorder and/or Bipolar Disorder I or II. Current depressed mood was assessed utilizing the Beck Depression Inventory-I and MDD and Bipolar Disorder were ascertained using the SCID-IV. Information was also collected to determine lifetime dependence on sedatives, cannabis, opioids, cocaine,hallucinogens, and alcohol, using the SCID-IV. For METH+ participants, additional information was collected regarding age at first use, years of use, and days since last use of METH; whereas for HIV+ participants, HIV RNA plasma copies was ascertained as part of a larger neuromedical evaluation. All participants gave written consent prior to enrollment and all procedures were approved by the Human Research Protection Program of the University of California, San Diego and San Diego State University.Executive functioning was determined as part of a larger comprehensive battery of tests covering seven ability domains . The executive functioning domain deficit score, of particular focus in this study, was made up of perseverative responses on the Wisconsin Card Sorting Test; errors on the Halstead Category Test, which measures abstraction and cognitive flexibility; and time to complete the Trail Making Test part B, reflecting ability to switch and maintain attention between ongoing sequences.