After years of turning a blind eye, people are starting to question the arguments in favor of vaping nicotine rather than smoking it. A number of mysterious illnesses, some resulting in death, have drawn intense scrutiny over what was for years marketed as a safer alternative to smoking.
Federal regulators, local governments, and even the White House have all picked up the cause. They want to better control the market, limit access to teenagers, and find out exactly what is causing people to get sick.
The Latest Vaping News
Reports of strange and deadly vaping-related illnesses have come as a wake-up call for the medical community. For years, doctors and public health advocates reveled at the sight of nicotine e-cigarettes chewing up shares of a market that once belonged to traditional, combustible cigarettes. To many, it meant progress in the fight against smoking, which they perceived as far more dangerous.
Looks, however, can be deceiving.
The truth is vaping poses a very new and unique threat. Like smoking, it’s often seen as “cool” among teens and young adults. But unlike cigarettes, vape products come in many different flavors, strengths, and designs. Combined with the perception that vaping is somehow safer and less addictive than smoking, anti-vaping advocates have been forced to work from a completely different playbook than the one used in the fight against cigarettes.
New Products, New Problems
In an article for the Boston Globe, Dr. Alicia Casey, a pediatric pulmonologist at Boston Children’s Hospital, expressed her frustration with these new challenges:
“I never thought in my lifetime that we would be going downhill like this with nicotine, which is why people didn’t realize this was going on. The medical community had kind of been celebrating our accomplishments with burned cigarettes and then this came out of nowhere.”
And it’s not just nicotine. Many of the recent illnesses linked to vaping were found in patients who had only vaped oils containing THC — the active ingredient in cannabis. Over the past year, hundreds of patients have been admitted to hospitals with severe respiratory problems. But finding out which products patients were using — and how — is as much a psychological challenge as it is medical.
In many ways, cannabis is still a taboo subject to discuss with authorities, especially in states where it remains illegal. The abundance of black-market vape pens and cartridges may also be discouraging patients from telling doctors the truth about their vaping habits.
For that reason, many doctors, including Dr. Casey, believe the illness is severely underreported. Whether through fear of the law or mere misdiagnosis, cases of what’s been called “vape lung” have gone undetected by doctors and health officials.
This creates an even greater challenge for investigators trying to figure out if the disease stems from a bad batch of oil cartridges, a mystery chemical unique to vape oil, or some fundamental biological reaction to inhaling vapor.
After all, doctors will point out, the lungs are not meant to breathe liquid, and vapor is simply an air-diffused liquid. That most patients suffering from the illness were shown to have very low oxygen levels suggests some impairment of normal respiratory functions.
Tracking the Problem to Its Source
Finding the source of the problem is a little like finding a needle in a haystack. Vaping oils are so new, so inconsistently manufactured, and so minimally regulated that authorities have little understanding of their chemical composition. Moreover, substances change when combusted, so even if a chemical is known to be safe in one form, the same cannot be said once it’s vaporized or inhaled.
Last week, the Washington Post reported the U.S. Food and Drug Administration (FDA) is working alongside the Centers for Disease Control and Prevention (CDC) to investigate criminal activity associated with the outbreak, which has sickened more than 500 people in 38 states and killed at least seven.
However, FDA officials were quick to point out that they will not be prosecuting people for the personal use of any controlled substance.
“The focus is on the supply chain,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, told the Washington Post.
Some experts believe black-market vaping products are to blame. One substance that appears to be common in most cases is vitamin E acetate. Black market dealers often use the chemical to thicken or fill out vape oil cartridges. It’s a common thread among cases, but it hasn’t been shown to be in every case, which is what you’d like to see if you’re trying to find a single cause.
The Post reports that some 150 samples have been collected from patients across the country. The FDA plans to analyze each of them, but without knowing what chemical to look for, investigators have an uphill battle ahead of them — a battle that will take time.
That's why officials were clear to point out that no conclusion has been drawn. The investigation is still in its infancy, but that hasn’t stopped regulators and health officials from acting. In addition to recommending people stop vaping until the source of the disease has been identified, officials at both the state and federal level have moved to pass bans on some vaping products.
Trump Administration Seeks Nationwide Ban on Flavored E-Cigarettes
Earlier this month, the Trump administration announced it will seek a full, nationwide ban on all flavored e-cigarettes. That rule aims to curb vaping among kids and teens while controlling how electronic nicotine products are marketed. Representatives from the administration said vape companies like Juul and Blu were responsible for getting young people hooked on their products through fruity- or mint-flavored vape oils.
Acting FDA Commissioner Ned Sharpless explained how the proposed ban is connected to the black-market investigation, saying both aim “to clear the market of unauthorized, non-tobacco-flavored e-cigarette products.”
In a statement last week, Sharpless said the new regulatory actions are critical for public health, and for “protecting kids from the dangers of nicotine addiction and tobacco-related disease and death.”
With an outbreak of illness, a wave of new regulations, and a public health campaign designed to curb use among teenagers, it seems the vape trend is history repeating itself.