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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5 min read

Smoking will kill you, but first, it will accelerate the aging process

By Mark Gold, MD on September 5, 2019

Scientists and the general public have been aware of the harmful effects of tobacco for years now, recognizing its links to cardiovascular problems, cancer, and an array of other serious health problems. The Centers for Disease Control states that cigarette smoking accounts for over 480,000 deaths every year in the United States, and seven million deaths worldwide annually, which makes smoking the leading cause of preventable death in the world.1 Of those 480,000 deaths per year in the United States, the CDC includes more than 41,000 deaths resulting from secondhand smoke exposure. Secondhand smoke can cause or worsen a wide range of damaging health effects in children and adults, including lung cancer, respiratory infections and asthma. Scientists have concluded that the only real difference between first and secondhand smoke is consent. Children and others exposed to secondhand smoke suffer the same consequences but did not intend to smoke at all.2 In toto, cigarette smoking results in one in five deaths annually, or 1,300 deaths every day. On average, smokers die 10 years earlier than nonsmokers. 

Unfortunately for individuals who are smoking or exposed to cigarettes, new research indicates that tobacco use contributes to yet another health problem: biological aging. Previously, studies on the effects of tobacco use on aging have been fairly limited in their conclusions, but in recent years researchers have focused more on the question, applying new scientific tools in their work. One recent study, by Mamoshina et. al., used artificial intelligence to analyze blood and cell counts of smokers and non-smokers and to measure how much tobacco use aged smokers.

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6 min read

Now What? THC Exposure and the Adolescent Brain

By Mark Gold, MD on August 29, 2019

As more states move to decriminalize or legalize marijuana and THC-related products, researching potential harms associated with cannabis use is an even more important field of study. In certain cases, such as marijuana-related medications, there is sound evidence. Usually, the manufacturer of a drug has to do clinical trials, called FDA trials, to demonstrate dose, safety, and efficacy for a particular problem or illness. The FDA did approve the first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. This was a well-conceived and logical trial and process. It resulted in the approval of Epidiolex (cannabidiol, or CBD) oral solution for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older. This was the first FDA-approved drug that contains a purified drug substance derived from marijuana. It was also the first FDA approval of a drug for the treatment of patients with Dravet syndrome. Notably, however, the FDA did not approve a crude plant or marijuana, but CBD. CBD does not cause intoxication or euphoria, the “high” that comes from marijuana’s tetrahydrocannabinol (THC). In this case, we know that the medication is safe, we know its formulation and composition, and we know the dose. We also know that before this treatment, there were no good alternatives.

According to pediatricians and research scientists, there’s no scientific evidence supporting the acceptability of adolescent marijuana use, and products sold in dispensaries pose considerable risks to children and teens.1 The situation with cannabis, vaping THC, and other preparations is considerably different from that of an FDA-approved medication. In these cases, sadly, we are doing the research after the fact. We know that laws are meant to prevent children from using and smoking marijuana, but the public appears confused about safety warnings when children and adolescents seem like they are safely given cannabis for seizures. Recent data shows that use is increasing among young people. A SAMHSA report found that marijuana is teens’ most widely used illicit drug.2 Frequent marijuana use, in both youth (aged 12-17 years) and young adults, appears to be associated with risk for opioid use, heavy alcohol use, and major depressive episodes. Youth have access to the legal cannabis and related product markets, as well as the thriving illicit marketplace for drugs. Health problems linked to vaping may be in the headlines, as many of those with reported lung damage have vaped THC, but it is not the only problem facing teen users.3 

What does the latest research tell us about the effects of cannabis on the adolescent brain, and do we know enough to make recommendations? 

Science has not shown that cannabis is performance-enhancing like amphetamines, psychostimulants, or medications like methylphenidate given to people with learning problems. Research has clearly shown that adult cannabis use can affect a person’s memory, performance and ability to learn. Recently, Gorey et. al. conducted a systematic review of 21 human and animal studies to investigate whether age influenced the effects of cannabis on the brain, and found preliminary evidence that suggested it does. Further understanding the differences between how cannabis affects the adult brain versus the adolescent one could help us create better messaging and education for youth about how cannabis could affect them.  

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