US health officials have recommended that people refrain from using e-cigarettes as they investigate a severe lung illness that has killed eight people. Here are some things to consider.
Allegations of illegal marketing tactics. More than 500 cases of severe lung illness in 38 US states. Seven deaths. A proposed federal ban of most flavoured e-cigarettes and new efforts in many states to counter an epidemic of youth vaping.
There's been an avalanche of vaping news this month, which leaves many users facing a crucial question: Is it time to quit? Here's a look at the issues.
First, how big is vaping?
E-cigarettes swept onto the market about a decade ago. They're now a US$2.6 billion industry in the United States, and roughly 20,000 vape and smoke shops have sprung up across the country in the past few years. There is also a thriving black market for vape pods. A survey last year found that 10.8 million American adults used e-cigarettes — and that more than half were also smoking cigarettes.
E-cigarettes have become especially popular among teenagers. Preliminary results from an annual survey sponsored by the National Institute on Drug Abuse and released Wednesday found that 1 in 4 12th graders said they had vaped in the previous month, a sharp rise from the previous year.
Young people are especially susceptible to nicotine addiction and may be more likely to take up regular cigarettes once they are hooked.
Is vaping safer than smoking?
There was an idea for a while that e-cigarettes, because they don't generate smoke and tar, were safer than smoking cigarettes or at least that they could help a smoker shift to a less dangerous alternative. But the mysterious spate of illnesses thrust concerns about vaping's health effects into the spotlight. Many of the people who got sick were vaping THC, and authorities are investigating what else black-market pods contain.
Dr. Albert Rizzo, chief medical officer for the American Lung Association, noted that the organisation's opposition to vaping predated the outbreak. He disputed the perception that e-cigarettes are a safer alternative and pointed to the lack of information about what chemicals they contain and the paucity of research about the effects of vaping.
"To say that something is safer than a product like cigarettes that kills 7 million people in the world each year because of tobacco-related disease, and half a million people in this country, is not saying a lot," Rizzo said. "We have no evidence of whether it's safe at all. There's just no scientific basis for that."
A new generation of young people addicted
The rise of vaping comes after at least two decades of great success in decreasing smoking rates across the country and has health experts concerned that those gains could be reversed.
Most e-cigarettes contain nicotine, which is highly addictive and especially harmful to young people, whose brains are still developing. (The human brain is still developing until you turn 25 or so.) Nicotine can harm the parts of the brain that handle memory, attention and learning.
It's also illegal for minors to vape. (A growing number of states have even raised the vaping age to 21.) And using e-cigarettes may make teenagers more likely to smoke real cigarettes in the future. Rizzo noted that the vast majority of current smokers became addicted before they were 18.
Some people may not realize how much nicotine they're ingesting as they puff away. A typical pod made by Juul can contain as much nicotine as a pack of cigarettes and is designed to last for about 200 puffs.
"We have a whole new generation of young people in high school and middle school that are now nicotine-addicted," Rizzo said. "We don't know what the dangers of e-cigarettes are."
What about THC?
While many people use e-cigarettes to inhale nicotine, some use it for THC, the high-inducing chemical found in marijuana. A large portion of the recent cases of lung illness were in patients who vaped THC.
The Food and Drug Administration said that a significant subset of samples of vaping fluid used by sick patients also contained a compound called vitamin E acetate, which has been a subject of further investigation. The FDA has warned people to avoid vaping THC.
A minority of the people who got sick said they had used e-cigarettes containing only nicotine — but there were also concerns that some young people were not being entirely forthcoming about their vaping habits.
Public officials are warning people not to vape
Public health officials at the Centers for Disease Control and Prevention have recommended that people refrain from vaping as the agency investigates the illnesses. They stressed that young people, pregnant women and non smokers should never vape. They also cautioned people who do use e-cigarettes to monitor themselves for symptoms of lung illness, like coughing and chest pain.
An editorial in The New England Journal of Medicine this month stated bluntly that doctors should discourage people from vaping and reiterated that e-cigarettes should never be used by non smokers.
The acting commissioner of the FDA, Dr. Ned Sharpless, has said that the issue of tobacco control in the e-cigarette era keeps him up at night. The agency got authority over what it calls "electronic nicotine delivery systems" only in 2016 and is now working on new research and regulations.
In a statement, Sharpless noted the inherent paradox of e-cigarettes: While they were pitched as a way to get smokers to stop lighting up, they hooked a new generation that may end up smoking traditional cigarettes to get that fix.
Written by: Karen Zraick and Jacey Fortin
Photographs by: Jeenah Moon
© 2019 THE NEW YORK TIMES