Addiction Policy Forum Blog

8 min read

What you should know about the multistate outbreak of severe lung problems linked to e-cigarettes and vaping

By Mark Gold, MD on September 12, 2019

The Centers for Disease Control (CDC) recently issued a warning about vaping following a multistate outbreak of severe lung problems linked to the use of electronic cigarettes.1 According to the CDC, there are, as of September 6, 450 reported cases of possible vaping-linked lung problems across 33 states and 1 territory, resulting in 6 deaths.2 Officials have not identified a specific e-cigarette product as a cause of the illnesses, meaning that various devices on the market could be contributing to this alarming pattern. Patients admitted for lung problems report difficulty breathing, fatigue, fever, nausea, and vomiting. Somehow, to proponents and purveyors of e-cigarettes, the very idea that vaping could be dangerous seems to have come as a surprise.3 

The CDC updated its warning to suggest that e-cigarette and vaping device users refrain from using the products at all during the course of its investigation. It has also warned against buying counterfeit or street vaping products, including those with THC or other cannabinoids, and against modifying e-cigarette products. Moreover, the CDC urges youth, pregnant women, and adults who do not currently use tobacco products to refrain from using e-cigarette products, and encourages individuals who smoke and want to quit to use FDA-approved medications instead of e-cigarettes. Some health officials and experts believe that street vaping products with illicit or tainted substances may be behind the outbreak of lung problems, but no one can be certain at this point. Some patients have reported using vaping cartridges with THC or cannabinoids, but others have reported using different vaping cartridges without such substances. Most contain ingredients not generally tested for chronic inhalation in humans, and, to make matters worse, they can become contaminated in ways detrimental to respiratory and heart health.4 It is unlikely that any substance you inhale has been tested for safety for weeks, months, or over the long haul. But inhalation from vaping has effects on the lungs that are dramatic, can be easily seen on imaging5, and do not seem easy to reverse. Tobacco smoking in the English colonies of North America started early and peaked in the U.S. in the 1960s and 1970s, credible evidence proving its causal links to cancer, emphysema, and bronchitis emerging only over a century after its explosive growth and wild popularity.6 Why would boosters and defenders of today’s e-cigarettes, looking back at this history, believe that research would come to indicate the product’s benefits for the lungs, or for the respiratory health of those they may expose to vaping?

While experts and officials will continue to study this outbreak and may identify particular illicit substances as the culprit, the headlines have naturally raised questions for individuals who vape about long term consequences. What we know about cigarette smoking is bad enough, but there are few surprises. Here, we’re in uncharted territory. Yes, the FDA and other agencies will look at the broader health and safety of e-cigarette products and devices, but in the meantime, users will need to be evaluated and hope that their own lungs are not compromised in ways that only become clearly understood after they stop, or years down the line. While receiving considerably less media coverage, journalists recently found that the FDA began investigating vaping-associated seizures after some users of JUUL, the top-selling vaping product in the U.S., submitted claims of seizures to the administration’s safety portal.7

It is important to note that Research You Can Use previously observed that there is not yet enough evidence to conclude whether e-cigarettes are suitable for smoking cessation. Some researchers now suggest that vaping nicotine may not be safer than smoking tobacco cigarettes.8 More recently, the FDA has agreed that JUUL’s claims of comparative safety are unproven.9 Other new studies have looked at the relative health of ingredients in some e-cigarette products, and the effects of vaping on the vascular system. The truth is that it’s risky and scientifically invalid to start from the premise that drugs are safe until proven dangerous. It reminds me of cocaine being touted as safe, or non-addicting, or even as “the champagne of drugs” until the aftermath of widespread use in the 1970s and 80s demonstrated that it was highly addictive and led to heart problems, brain damage, and other diseases.10

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4 min read

Are e-cigs helpful or harmful? Science says “it’s complicated.”

By Mark Gold, MD on July 11, 2019

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3 min read

Cannabis use via E-cigarette on the Rise Among Adolescents

By Mark Gold, MD on April 2, 2019

Electronic cigarettes (e-cigarettes) are the most commonly used nicotine-delivery product among US youth and their popularity is rising - 1 in 5 high school students currently use them. Until recently, there were few regulations on how companies that sell e-cigarettes can market and sell them - although companies claim that the product was made for and is marketed to adults, there has been a major uptick in use. Aggressive marketing campaigns that position e-cigarettes as a safe alternative to smoking have worked, convincing adults and youth that e-cigarettes are harmless. Because they are new to market, E-cigarette companies can also employ types of marketing strategies that are forbidden to traditional cigarette companies due to their efficacy among adolescents, such as sponsoring film and music festivals. E-cigarettes, also called vapes, vape-pens, and e-hookahs, can be filled with tobacco products that are far more addictive than cigarettes due to their much higher nicotine concentration. Instead of being packed with tobacco, e-cigarettes use cartridges that are filled with liquid that can deliver a much higher dosage of nicotine. These cartridges can also be can also be filled with cannabis.

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