September 9, 2019
Most of us are rapidly getting an education on the severe risks of the new E cigarette/vaping epidemic that has taken the country by storm over the past few years. With 5 deaths as of this writing and more than 450 hospitalized by severe lung disease this year related to vaping, the whole country is awoken to a sad reality that the epidemic may start claiming more lives and cost billions in healthcare costs.
The vaping concerns are primarily affecting our teenagers and young adults bringing the scrutiny of the FDA to bear down on the main company, JUUL, for perceived deceptive marketing to minors with rechargeable flavored devices and illegal health claims. For years there was a serious lack of credible data to give us clear direction as to risk and avoidance necessity. This is no longer a reality. Serious problems are here and death, the ultimate side effect, has claimed a human life five times.
Like regular cigarettes but in lower volumes, E cigarettes contain heavy metals and toxic particles that are emitted in the vapor after a mechanical heating process occurs:
• Nicotine
• Ultrafine particles that can be inhaled deep into the lungs
• Flavoring such as diacetyl, a chemical linked to a serious lung disease
• Volatile organic compounds
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead (US Surgeon General Report 2016)
From a nicotine perspective: "The long-term consequences of nicotine exposure, including susceptibility to nicotine addiction and potentially reduced impulse control, deficits in attention and cognition, and mood disorders." (US Surgeon General Report 2016) Nicotine is exceedingly addicting and may lead to over use of the device and a shift to cigarettes.
Nicotine levels can be very high in the vapor and are exceptionally high in the refillable concentrated vial. These devices can hold more nicotine than the average pack of cigarettes increasing the risk of overdose.
Nicotine addiction can also lead to chronic exposure to the above chemicals which are thought to be linked to chronic disease over time. From a public health perspective, we know that chemicals are an antecedent trigger to many types of cancer with increasing volumes of exposure coupled with time producing the highest risk. Tobacco is the poster child for this reality and it looks like we may have replaced one problem with another by thinking that E-cigarettes are a better alternative.
In the current lung disease issue, the trigger for the respiratory decompensation is unknown. When the CDC analyzed the lung disease patient data through interviews they found that, "in many cases, patients have acknowledged recent use of tetrahydrocannabinol (THC)-containing products while speaking to healthcare personnel or in follow-up interviews by health department staff; however, no specific product has been identified in all cases, nor has any product been conclusively linked to illnesses." (CDC 8/21 statement)
A recent analysis from the investigators at the FDA points to a vitamin E oil derivative being a possible culprit. When we think about the lungs as a tissue, we have to acknowledge that there is a very large surface area of sensitive tissue not used to or supposed to be exposed to oils and chemicals. The vitamin E oil that is present in the marijuana based products can vaporize only to reform in the lungs and cause a chemical reaction in the lungs leading to bad outcomes.
Vaping's chronic concerns are yet unknown, however, the answers to this question and many more vaping questions to come will continue to evolve over the coming years. However, to wait and disregard the current risk data is to take a small but serious roulette spin with your life acutely and most likely chronically.
Educate anyone that will listen to the seriousness of this issue.
Another concern right now is the toxicity of the refillable liquid nicotine that could be ingested by a small child thinking that it is a drink. They often have a sweet smell and taste. Fortunately, they are now stored in child proof containers.
Bottom line: If you still choose to use these devices, store them appropriately and keep them away from children.
Not a fan of vaping,
Dr. M
CNN JUUL/FDA Article
CDC 8/21 Statement
CDC 8/23 Statement on the First Vaping Death
CDC Quick facts about E-cigarettes
US 2016 Surgeon General Report
Washington Post Article
