Crisis Situation

An alarming 2.5 percent of high school students are using electronic cigarettes today.  That is a 135% increase over the past two years. At the same time, more than 1,600 people have suffered from a vaping related lung injury, and several dozens have died. The United States Surgeon General Jerome Adams has issued an advisory regarding the dangers of e-cigarette use stating, “I am officially declaring e-cigarette use among youth an epidemic in the United States.”

Nicotine is a dangerously addictive substance that harms adolescent brain development.  According to the Centers for Disease Control and Prevention (CDC), the brain develops until age 25, and nicotine exposure harms the part of the brain that controls attention, learning, mood and impulse control.  It also increases the likelihood of future addiction to other drugs.

Even Congress has been investigating the youth vaping epidemic and how it happened.  They found that more than 81% of people 12 to 17 who start smoking a tobacco product start with a flavor.  While we now know that the flavors of the e-cigs hooks kids, it is the nicotine that reels them in. 

In the midst of the CDC investigation into the vaping-related health crisis which has claimed 23 lives as of October 11, and 1,100 cases of vaping-related illness have been reported nationwide.  Patients in more than two dozen states have been presenting at hospitals throughout the country with symptoms such as:

  •         Coughing
  •         Chest pain
  •         Shortness of breath
  •         Nausea and vomiting
  •         Fever 

Dr. Anne Schuchat, principal deputy director of the CDC, said that the epidemic shows few signs of slowing down and is “continuing at a brisk pace.”

It is difficult for state health departments to collect and test all of the relevant samples, or even collect them due to misdiagnosis when the patient first presented.  But the larger issue is that this is a complex and multi-pronged public issue.

“Safer” or “Safe”

While there is evidence to suggest that using e-cigarettes is safer than smoking traditional cigarettes, there is a difference between “safer” and “safe.”  E-cigarettes arrived in the U.S. market in 2007 and have been investigated by addiction researchers as a method to help adults quit smoking regular cigarettes. E-cigarettes contain fewer chemicals than regular cigarettes and were presented as a safer alternative. However, Yale health researchers who study the health effects of vaping have found that vape devices have not been proven to help adult smokers quit smoking.

A study of 70,000 users found that vaping nicotine still doubles the risk of a heart attack.  Most people who vape are not even trying to stop smoking at all. They are vaping in places where smoking of regular cigarettes is not permitted and continuing to smoke traditional cigarettes where allowed. Those who both vape and smoke multiply their chance of a heart attack by five.

The American Lung Association has issued a definitive statement. “E-cigarettes are not safe and can cause irreversible lung damage and lung disease.  No one should use e-cigarettes or any other tobacco product.”

Because of this information, the FDA issued a statement strongly urging people to stop using all vaping products containing THC (the psychoactive compound in marijuana),  particularly those purchased off the black market. However, the CDC has pointed out that not all of the cases reported have involved THC. Lung injuries have been reported in patients that used nicotine vaping products exclusively.  This led to the CDC recommends that you not use any vaping products, particularly pregnant women and teens.

Key Facts about Use of E-cigarettes

  •   Electronic cigarettes—or e-cigarettes are also called vapes, e-hookahs, vape pens, and electronic delivery systems (ENDS) among others.
  •  Using an e-cigarette product is commonly called vaping.
  •   E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
  •   The liquid can contain nicotine, THC, and cannabinoid  (CBD) oils, and other substances and additives.

What Is Causing the Crisis?

With respect to the recent reports of acute vaping-related lung injuries—there are a few theories.  Lung ailments are being caused by the ingredients present in cartridges containing THC. Most of these were purchased off the black market.

The CDC reported that 78% of the 514 cases it has analyzed so far involved patients using products containing THC. A separate study reported that 66% of patients had specifically used “Dank Vapes,” a black-market manufacturer of uncertain origin that claims to contain 90% THC.

A lot of focus is centered on vitamin E acetate, a compound that has traditionally been used in skin creams and supplements but is increasingly being used by black-market producers as a thickening agent.  Vitamin E acetate is harmless if ingested or used topically but can be toxic if inhaled.

 According to Dr. Melodi Pirzada, chief of pediatric pulmonology at NYU Winthrop Hospital in Long Island, the inhalation of vitamin E acetate in oil can cause lipoid pneumonitis.  Lipid pneumonitis is a rare condition that results from fat particles being inhaled into the lungs. Symptoms are similar to those presented by the vaping lung injury patients, including chest pain and shortness of breath.

Many of the vaping ingredients are not listed on the products.  Some “e-juice,” a common name for the vaping liquid used in the e-cigarettes, contains diacetyl.  Diacetyl is a food additive that was used to make popcorn taste buttery without butter. A condition is known as “popcorn lung” was diagnosed first in the workers of a popcorn factory that used diacetyl.  It is used in vape cigarettes to enhance the flavors. 

Most high-end vape producers don’t use diacetyl, but in 2015, more than half the mass-marketed e-cigarettes were found to contain the chemical.  Since it is found primarily in flavored liquids, it is more appealing to teenagers. The more appealing it is, the more they use and the more exposure to the chemicals and a growing addiction.

Mayo Clinic researchers conducted a biopsy review of 17 subjects with vaping related lung injury.  They found that though the majority of samples (71%) came from patients who had used THC cartridges, the damage appeared to have not been caused by oil inhalation, but by “direct toxicity or tissue damage from noxious chemical fumes.”

Recently, a Juul employee sued the vaping company, claiming it fired him in retaliation for blowing the whistle on the marketing of at least a million contaminated mint-flavored e-cigarette cartridges.  Juul is the most popular among high schoolers due to a marketing strategy that targets teens with sleek vaping pens and different flavors.

However, the CDC has pointed out that not all of the cases reported have involved THC.  Lung injuries have been reported in patients that used nicotine vaping products exclusively.  This led to the CDC recommends that you not use any vaping products, particularly pregnant women and teens.

Long-term effects

Ultimately, there’s very little known about what happens to the chemicals in e-cigarettes when you heat and inhale them.  In a briefing, Anne Schuchat said that the CDC is conducting studies to try to analyze both the product and potentially the vapor or aerosol released by the heating of such chemicals. Due to this being a relatively new crisis it’s still a question as to what the long-term health effects may be.

We all know nicotine is not good for you.  Many e-cig products contain higher levels of nicotine than advertised.  We also know that e-cigarettes contain chemicals like propylene glycol and glycerine which can release volatile organic compounds that may be harmful when inhaled.

 A mouse study in the Journal of Clinical Investigation found that the inhalation of such chemicals, even without nicotine or THC, led to the mice’s lungs developing lipid-laden immune cells, an effect mimicking that of lipoid pneumonitis. With smoking-related diseases, you don’t know the effects until 20 years or more. So it’s possible we won’t know the long-term effects of e-cigarettes for 20 years or more. 

The vaping industry is moving so quickly that by the time studies come out, they might not be applicable to what’s popular now which makes long-term effects really difficult to judge.

Short-term Effects

Short-term risks of vaping—particularly vaping related illness—are very real.  John Carl, MD, a pulmonologist at the Cleveland Clinic said, “We know a lot of the short-term effects [on the lungs],” explaining that vaping increases inflammation in the lungs.  It paralyzes the cilia, the hair-like projections in the airways that remove microbes and debris. 

When those cilia become paralyzed, they are unable to do their job protecting the lungs, which increases your risk of infection, like pneumonia.  Both lipoid pneumonia, a lung infection caused by lipids or fats in the lungs; and chemical pneumonia, a lung infection caused by inhalation of chemicals, have been linked to vaping.

The cardiovascular effects of smoking are well known.  Nicotine causes high blood pressure and cholesterol abnormalities. Research published in 2017 in Nature Reviews Cardiology explains that “to date, most of the cardiovascular effects of [electronic cigarettes] demonstrated in humans are consistent with the known effects of nicotine.”

The Youth Vaping Crisis

Before the first cases of lung injuries were reported, kids vaping was a big health concern across the country.  Last year’s data showed a spike in youth vaping with 3.6 million young people have used e-cigarettes. Preliminary numbers show a similar rise in the 2019 data.  And the dangers are heightened by unsafe black market vaping devices and THC cartridges.

Since 2014, e-cigarettes have been the most commonly used tobacco product among American youth.  In fact, more high school students use “vapes” than adults. Use among middle and high school students increased by 900% from 2011-2015.

 So why are 1 in 3 high schoolers vaping?

  •         They are unaware or don’t care about the dangers.
  •         Manufacturers are targeting youth with clever marketing campaigns and sweet flavors.
  •         It is more acceptable in public places.
  •         It can be used as a coping mechanism to deal with uncomfortable feelings like depression or loneliness.

 The Surgeon General specifically mentioned Juul e-cigarette products. The Juul e-cigarettes contain a high level of nicotine. One cartridge contains the same nicotine as a pack of 20 cigarettes. Juul uses nicotine salts in its products, which gives a more pleasant feeling than freebase nicotine and helps account for its popularity.

 Young people who tried products with high concentrations of nicotine were more likely to keep smoking and vaping later. A 2015 study showed that for 2000 adults who stopped smoking by using e-cigarettes, over 160,000 teens and young adults made the transition in the opposite direction.

Physicians across the country are treating patients with mysterious life-threatening illnesses.  Otherwise healthy patients in their late teens and 20s are showing up with severe shortness of breath.  Some wind up in intensive care or on a ventilator for weeks.

The latest data from the CDC says that among 1,364 patients, the median age is 24 years old.  Forty percent of the patients were 18 to 24 years old.

What Can Be Done?

The delay in implementing comprehensive regulations for e-cigarettes has contributed to a growing crisis of vaping related illnesses and deaths across the U.S. and is a particular risk to young adults.

Bans on Vaping

Americans strongly support making vaping companies list all ingredients and health risks on product labels and barring teens from buying them.  But 59% surveyed agree a ban on vaping will drive more consumers to the unregulated black market.

Vaping is being regulated across the U.S.  Some state and regional governments have extended their indoor smoking bans to include e-cigarettes.

The federal administration announced that only tobacco flavored e-cigarettes will be allowed on the market.  The FDA specifically plans to crack down on the sale of vaping products in flavors like fruit, candy, and mint.

When the state of Massachusetts announced a 4-month ban on vaping products, vapers across the state reported a jittery alarm and anger at being cut off from their preferred source of nicotine, while tobacco cigarettes remained legal.  Vaping stores saw a last-minute rush of buying from panicky vapers. Others planned quick trips to vape shops in more lenient neighboring states.

Officials at K-12 schools where e-cigarette and vaping have soared are struggling with how to balance discipline for using tobacco products on school property with treatment and counseling. In Fort Myers, Florida, the Lee County School District saw tobacco and drug offenses increase almost five-fold while drug offenses more than doubled. Much of that was due to kids being caught vaping at school. 

In August, the district opened a new center where students suspended for such offenses are set for 20 days. At the center, the students complete their studies online, under the supervision of staff, for the four weeks, but they also receive mentoring and drug-treatment counseling. Very similar to an outpatient program.

 What if My Child is Vaping? 

Whether it’s nicotine, THC oil, or both, teens need to quit.  But that is easier said than done. Deepa Camenga, MD, a pediatrician board certified in addiction medicine says it’s never too early to begin talking about e-cigarettes in age-appropriate language.

But what do you do when your teenager or any loved one is already addicted to e-cigarettes? You could cross your fingers and hope it stops. Or you could talk in a non-confrontational manner about the dangers of vaping.  Ask about why he/she feels the need to use it. Often, young people use vaping and other drugs as a method to cope with an underlying problem. Parents need to remain calm and supportive and avoid punishing what has oftentimes become an addictive behavior. Nicotine replacement therapy or prescription drugs, counseling, and other support is what is needed.

Sana Lake Recovery Center has treatment programs for addictions of varying degrees. We have addiction specialists ready to guide you and your loved one on a path to recovery. Our specialists are available around the clock to answer any of your questions.