Vaping: an emerging 21st Century crisis

Shutterstock Vaping is the inhalation of the vapor created by an e-cigarette or another vaping device.

Earlier this month, a 40-year-old man in California died from vaping-related lung disease. He was the seventh person to die as a direct result of vaping. The previous six deaths included a man from Minnesota.

So far this year, nearly 400 people in the U.S. from 36 states and the U.S. Virgin Islands have suffered from vaping-related lung injuries. Most victims have been hospitalized; many have ended up in the intensive care unit and required placement on breathing machines.

According to the Centers for Disease Control and Prevention (CDC), patients’ initial symptoms include cough, chest pain, or difficulty breathing. Other reported symptoms include nausea, vomiting, diarrhea, fatigue, fever and weight loss.

The CDC, the Food and Drug Administration (FDA), and state departments of health are investigating this outbreak. There is no definitive cause or well-defined connection between cases. E-cigarettes containing cannabis-like products, such as THC are linked to many of the cases. In New York, health officials also found extremely high levels of the chemical vitamin E acetate in almost all cannabis-containing vaping products they analyzed.

What is vaping?

Vaping is the inhalation of the vapor created by an electronic cigarette (e-cigarette) or another vaping device. According to the CDC, e-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems.”

Some look like regular cigarettes, cigars or pipes. Others resemble pens, USB drives, or other everyday items. The classic e-cigarette consists of a compact lithium-ion battery, a vaporization chamber, and a solvent mixture cartridge.

The e-cigarettes produce vapor by heating the liquid that usually contains nicotine, flavorings, and other chemicals that help to make the vapor. Users inhale this vapor into their lungs. Bystanders can also be exposed to the vapor when the user exhales into the air.

Courtesy of CDC Different types of e-cigarettes

E-cigarettes are most commonly used to inhale nicotine. They can also be used to deliver substances like tetrahydrocannabinol (THC), cannabidiol (CBD), butane hash oils (dabs), and other drugs.

Some of the most popular types of e-cigarettes are USB-shaped devices. The most popular of these devices is called the JUUL. All JUUL e-cigarettes have significant levels of nicotine. A single JUUL “pod” has as much nicotine as a pack of 20 regular cigarettes!

E-cigarettes have traditionally been used by smokers as a substitute for regular cigarettes. They have been marketed as a smoking cessation aid. However, there is no really clear evidence that they will help you stop smoking.

While the e-cigarette vapor usually contains fewer toxic chemicals than regular cigarettes, it still contains harmful substances. These include heavy metals like lead, volatile organic compounds, and other cancer-causing agents.

Most e-cigarettes contain nicotine, which is very addictive. It is also detrimental to the developing adolescent brain and dangerous to pregnant women and their developing fetuses.

Courtesy of CDC USB-type-E-cigarettes

E-cigarettes can also cause unintended injuries. Defective e-cigarette batteries have caused fires and explosions. Children and adults have also been poisoned by swallowing, breathing or absorbing e-cigarette liquid.

In the U.S., young people are much more likely than adults to vape. According to the CDC, in 2018 more than 3.6 million U.S. middle and high school students had used e-cigarettes in the previous 30 days, including 4.9 percent of middle-schoolers and 20.8 percent of high school students.

 From 2017 to 2018, e-cigarette use increased 78 percent among high school students and 48 percent among middle school students. There is a considerable concern that the makers of e-cigarettes are explicitly targeting youth. Vaping products that are flavored to taste like menthol, fruit, different types of dessert, and other flavors that are attractive to young people is evidence of this marketing ploy.

What should we do?

E-cigarettes should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products. While the vaping-related lung illness outbreak is ongoing, people should consider not using e-cigarette products, and those who do should be aware of and monitor themselves for symptoms.

Courtesy of CDC Toxic substances contained in the exhaled vapor

More also needs to be done by the FDA and our various state and federal legislative bodies to decrease the epidemic use of e-cigarettes by our youth. Unfortunately, it might be too late. Lax laws and a flourishing underground market for vaping products means that getting this outbreak under control will be difficult.

Across the U.S., public health officials are becoming aware of a massive underground market for illegal vaping products, for nicotine and for marijuana. Sales happen online, on the streets, in pop-up stores, and in individual transactions via social media.

A recent drug bust in Kenosha, Wisconsin illustrates the scope of the problem. Police seized about $1.5 million worth of drugs and 31,000 vape cartridges filled with liquid THC, almost 100,000 empty cartridges, and 57 mason jars filled with THC oil, each worth about $6,000.

It is essential that parents learn as much as possible about e-cigarettes to better protect their children and educate them about the dangers posed by these devices.

Dr. Kiragu is the medical director of the Pediatric Intensive Care Unit at Hennepin Healthcare and an associate of the Children’s Respiratory and Critical Care Specialists Group. The group provides ICU coverage at Children’s Hospital and Gillette Children’s Hospital. He is an assistant professor of pediatrics at the University of Minnesota. He is past president of the MN Association of Black Physicians and the MN Chapter of the American Academy of Pediatrics.

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