The news about vaping from the Centers for Disease Control and Prevention (CDC) keeps getting more ominous.
Today, the CDC
CDC officials added that there are 26 confirmed deaths from these illnesses. Those deaths include a 17-year-old Bronx youth who last week became the youngest vaping victim in this current epidemic.
Federal officials are also saying users shouldn’t modify what they vape. That includes using outside oils or store-bought products.
The Mayo Clinic recently blamed the illnesses on “toxic inhalation” and compared the damage to that of chemical spills or World War I mustard gas.
But, wait… isn’t vaping less harmful than smoking?
It still may be. But there’s also something deadly about the products besides nicotine and researchers are scrambling to figure it out.
“There are no known specific risk factors for the development of lung injury,” said Dr. Daniel Parenti, FCCP, FACOI, a professor in the department of internal medicine at Philadelphia College of Osteopathic Medicine. “However, the disease has been reported more in males, who make up 70 percent of the affected patients. A New England Journal of Medicine article described 53 cases of lung injury in which 30 percent had underlying asthma."
“The only conclusive predisposing risk for vaping-associated lung injury is vaping," Parenti told Healthline.
Vaping has become the most popular form of tobacco among U.S. teens since it became commercially available more than a decade ago.
Its use rose 900 percent among high school students between 2011 and 2015.
In addition, researchers
And it wasn't just to get off traditional cigarettes. A 2015 report estimated that 40 percent of users between the ages of 18 and 24 didn’t smoke before vaping.
And those are just the ones researchers know about.
“I travel to middle and high school to talk to students about the dangers of vaping and nicotine addiction,” Dr. Shelley L. Schmidt, a pulmonologist in Grand Rapids, Michigan, told Healthline. “The questions being asked clearly point to a large number of teenagers who have symptoms but are not reporting because they do not want to disclose that they are vaping.”
"The lung is very fragile. The lung is not designed for heated chemical vapor," Schmidt said.
E-cigarettes use a battery to heat and vaporize a combination of nicotine extracted from tobacco, flavorings, and other chemicals the user inhales.
According to the Johns Hopkins Medicine website, regular tobacco cigarettes contain 7,000 chemicals, many of which are considered toxic. However, it’s not generally known exactly what chemicals are in e-cigarettes.
But “there’s almost no doubt that they expose you to fewer toxic chemicals than traditional cigarettes,” Dr. Michael Blaha, MPH, a professor of medicine at Johns Hopkins, wrote on the site.
Part of the problem is a lack of knowledge around exactly what people are vaping, even beyond added nicotine or THC.
“The lack of clarity on what is causing the vaping illnesses is not a huge surprise because vaping products are not standardized across brands, so every product a patient reports using needs to be fully examined by the team responding to the current outbreak,” Megan Arendt, communications manager of Action on Smoking and Health (ASH), a Washington D.C.-based advocacy group, told Healthline. “No vaping products have been proven safe. We’ve known that since they hit the market years ago.”
Which makes sense, since smokers and vapers ingest many of the same chemicals, said Dr. Lawrence Weinstein, the chief medical officer of American Addiction Centers.
Multiple factors likely contribute to illness, he said.
“Cadmium, nickel, manganese, lead, and chromium are all metals found in both e-cigarettes and cigarettes,” Weinstein told Healthline. “One metal in particular — chromium — specifically targets the respiratory tract. It also induces asthma, decreases lung function, and can cause cancer of the respiratory system, prostate, and stomach.”
Weinstein said an e-cigarette’s metal concentration can vary, depending on the heating element (refill concentrations are lower). He also said studies have shown product labels can be misleading.
“It has been discovered that the amounts of nicotine contained within the cartridges are often incorrect, the amount of manganese generated in electronic nicotine devices are potentially unsafe, and e-cigarettes containing nicotine present marked health risks,” Weinstein said. “With so much evidence pointing at the dangers of nicotine, it would not be a safe assumption that substances infused with THC are the main culprits of the recent rash of vaping-related illnesses.”
One Northern California cannabis dispensary agrees that THC is not behind the illnesses.
“We have not seen any reports that show evidence that THC is the problem,” said Caity Maple, vice president of government affairs & compliance at Perfect Union, a Sacramento-based dispensary with four locations. “Our understanding is that they have identified that vape products containing THC are associated with the problem, but that they don’t know if THC has anything to do with the issue.”
Maple told Healthline that while she believes the government is motivated by genuine concern, banning vaping products would make the market more dangerous.
“By eliminating the only way for consumers of vape products to access tested and regulated products, this could drive more people to turn to illicit products that are the culprits of recent illnesses and deaths,” Maple said. “It will essentially take all legal and lab-tested vape products off the market, leaving consumers no option but to move to the less safe alternatives.”
Maple said while the FDA gathers information about the illnesses, they should also concentrate on cracking down on illegal trade and educate the public about the legal cannabis trade.
“We agree black market vape cartridges are an enormous public safety risk,” she said.
William MacLean is the chief executive officer of Wildflower, a wellness brand that uses cannabidiol in all its products, including vaping devices. He said lack of regulation contributes to lack of understanding.
“There are many problems that can contribute to vape safety issues. However, they are all being lumped together into a single issue,” MacLean told Healthline. “The lack of regulations in this industry means there are many low-cost producers that do not have an eye for safety, introducing poor quality at any and all stages of production. From contaminated raw materials for the vaping fluid, to delivery devices that burn too hot and create smoke instead of vapor, these are all factors.”
He said when his company got started, the market was flooded by low-quality products that contaminated the vapor with chromium heating elements and plastic.
“There are also many vape devices that focus on creating a big cloud of smoke,” he said. “Smoke is created when burning occurs and particulate matter is created. Younger consumers, who are price conscious, are more vulnerable because the cheapest products are likely the least concerned with quality and safety.”
The illnesses are likely due to a combination of factors, added Prue Talbot, PhD, a professor of cell biology at University of California Riverside who has researched the health impacts of vaping and concluded that concentration of metals in vaping aerosols have increased since tank-style e-cigarettes were introduced in 2013.
“The majority of reports have involved cannabis, suggesting aerosolized oils, including vitamin E acetate, may be involved," Talbot told Healthline. "But some reports involve electronic cigarettes that aerosolize nicotine but not oils. It’s also possible that the problems currently being reported have existed previously but were only recently recognized as being linked to vaping."
Whatever the cause, people are looking at vaping in a new light, which Arendt says can only help public safety.
“Generally, the public isn’t fond of using products that injure and kill, so hopefully awareness that e-cigarettes are not harmless will be enough of a deterrent,” she said.