If you’ve been following the news over the last nine months, you have undoubtably heard about the health crisis involving the use of vaping devices (commonly referred to as e-cigarettes or e-cigs). As of early February 2020, more than 2,700 people had been hospitalized across the U.S., and 60 had died, from what authorities are calling “e-cigarette or vaping-associated lung injury” (EVALI). Those affected have been mostly young males (under age 35), though the cases have ranged from teens to people in their 70s. Most of them reported using vaping devices that contained tetrahydrocannabinol (THC), the psychoactive chemical in marijuana, largely sold illicitly.
I’ve read the CDC’s weekly updates on this outbreak with dismay. While e-cigarettes were initially hailed by some as “safer” than traditional cigarettes—and possibly a tool for helping long-time smokers quit—many health experts, myself included, have been wary of these devices from the start.
E-cigarettes are battery operated devices that heat a liquid solution of nicotine (or THC). The user inhales the vapor, which includes not only the nicotine or THC but also any chemicals used to create or flavor the vapor. Many of the added substances are known carcinogens or otherwise harmful to the lungs, such as hydrocarbons and volatile organic compounds. Some devices, like the popular Juul, fit easily in the palm of the hand and can be used discreetly (say, when a teacher’s back is turned). That unobtrusiveness, combined with the enticing flavors of vaping liquids available (such as mango and chocolate), have helped make vaping remarkably popular—especially among young people.
In a 2019 CDC survey, more than one-quarter of high school students, and one in 10 middle school students, reported using e-cigarettes in the previous month, a major increase since the CDC started tracking youth e-cigarette use in 2011. And in a government survey released in December 2019, 14 percent of high school seniors said they had vaped marijuana in the previous 30 days—almost double the percentage of the year before.
That children are among the biggest consumers of vaping products isn’t surprising; that’s where the marketing is directed, regardless of what company websites say about having to be 21 or older to buy the products. The vaping industry knows what the tobacco industry learned a long time ago: If you want to attract long-term users, the most effective time to get someone addicted to nicotine is by age 18.
Yet despite all this, until very recently e-cigs have had no government oversight. In January 2020, the FDA finally stated that it would ban vaping cartridges with fruit, dessert, or other sweet flavors. The vaping industry successfully lobbied to have menthol flavors exempted from the ban. And the ban doesn’t apply to disposable e-cigs, which can still be sold in tempting flavors. It remains to be seen whether the FDA’s action will help blunt the youth vaping epidemic, or if young people who are now nicotine-addicted from e-cigs will simply switch to tobacco- or menthol-flavored vaping liquids—or, perhaps more likely, to single-use e-cigs.
As for the EVALI outbreak, CDC testing of lung-fluid samples from patients has revealed vitamin E acetate as a likely culprit. This chemical acts as a thickening agent and is commonly added to THC-containing products. While safe to use on skin or swallow in capsules, vitamin E acetate is dangerous to the lungs when inhaled. The investigation is not over, though. Many different substances are used in vaping liquids. Fully understanding the causes and effects of this outbreak will take time.
In a warning issued in January 2020, the World Health Organization stated that “there is no doubt” that e-cigarettes are “harmful to health and are not safe.” I agree. Anyone who vapes should quit, just as anyone who uses tobacco should quit. At the very least those who vape should avoid products containing THC. Vapers experiencing symptoms of EVALI (including shortness of breath, coughing, chest pain, vomiting, or chills) should seek immediate medical attention. And smokers of regular cigarettes should not switch to e-cigs as a way to quit but instead talk to their doctor about methods that have been proven safe and effective.