Sep 19, 2019
by Gary Pace M.D.
With the recent spate of hundreds of hospitalizations (and 5 deaths at the time of this writing) associated with vaping nicotine and THC in healthy young people, the public health community is sending out significant warnings to medical practitioners to be on the lookout for pulmonary complications and for the public to avoid getting vape products from unlicensed sources.
E-cigarettes and vaping of nicotine and THC/CBD has exploded on the scene over the last few years, in many ways being presented as a ‘healthier’ alternative to smoking the substances. While there have been suspicions of longer term negative effects, nothing has really come up until this flurry of pulmonary problems that began in June. It is not clear what is causing the illness now, but most of the problems are associated with cannabis products and possible connection to vitamin E oil additives.
An electronic cigarette (e-cig) is a battery powered vaporizer thatheats up a liquid substance that contains nicotine or THC along with propylene glycol, glycerin, flavorings, and likely a variety of other substances (including solvents and oils that may persist from manufacturing). The production is not well regulated at this point and there seems to be a lot of variation in what is contained in products from different manufacturers. Research on health effects is still in its infancy. Studies comparing e-cigs vs. regular cigarettes are very limited, but the general thinking has been that e-cigs are safer since there is less inhalation of carbon monoxide, carcinogens, and other by products from combustion.
There has been interest in using e-cigs for cessation of tobacco use. A few studies have been done on this issue with conflicting results. Thereare tobacco smokers who have switched to e-cigs, which is potentially less risky, but a big concern is that the industry is attracting people who havenever smoked and hooking them on nicotine. Increasing concern has emerged about the efforts of e-cigmanufacturers, especially Juul, in targeting young people with the new technology and enticing flavors of e-cigs, thus bringing a whole new generation into the nicotine-consuming demographic. Recently, the FDA said that Juul (which has 70% of the e-cig market) had been marketing their products illegally, by claiming they are safer than cigarettes without adequate proof.
While culpability is not well-defined at this point, it is clear that majorinroads are being made by these companies in attracting young people totheir products. For example, over 3.6 million middle and high schoolstudent used e cigs last year, more than double the number from the yearbefore. Certainly the fact that kids can hide its use more easily, the widevariety of flavors, the higher nicotine content (up from 2.4 % in cigarettes to 5% in e-cigs), and ease of use (up to 200 doses in one cartridge) make it very appealing for teens who are in school and living with parents. The marketing techniques of these companies look very similar to those used by tobacco companies in the past, and some of the legal and regulatory obstruction tactics will probably come from the same bag of tricks. As demonstrated in previous decades, tremendous market potential can be found in the highly addictive nicotine.
The Press Democrat on September 4 noted: “ Investigators from the federal Centers for Disease Control and Prevention are scrutinizing more than 200 cases of severe lung illness associated with e-cigarettes in 25 states, including 36 in California, reported over the past three months. Most of the victims are teenagers or young adults…Symptoms include trouble breathing, a painful cough, vomiting, nausea, fever, fatigue and diarrhea. Doctors have been unable to find a bacterial or viral source for the disease. There is one commonality: Victims reported vaping nicotine products, cannabis or chemicals derived from cannabis.”
While Sonoma County has not had a reported case, Dr.Celeste Philip, the county’s public health officer wisely cautioned in the Press Democrat: “As we learn more about the cause of these injuries, I urge individuals to limit their use of vaping products or quit using them all together.”
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