The Dangers of Vaping

When the CDC reports romaine lettuce may be contaminated with salmonella or E. coli – you can’t find it, you can’t buy it. It gets pulled from the shelves immediately. Yet when dozens of people have died from lung illnesses tied to vaping, with over 1,300 hospitalized in intensive care, and the CDC tells people to stop vaping immediately, responses are anything but immediate. One big box store did announce it will not sell any more vaping products, but only after it sells out its current inventory!

Make no mistake – vaping is dangerous for many reasons. We need to address this public health issue with greater urgency.

Vaping may cause permanent damage to your lungs

While the CDC has yet to determine the exact cause of these lung illnesses, it is serious enough that health officials have called for people to stop vaping right away. There is real concern that the damage seen in these patients may be long-lasting and perhaps even permanent. It is too soon to tell if people will be able to recover their full lung function.

Health professionals have long anticipated that vaping would, eventually, be shown to cause permanent lung damage. For example, one of the flavorings used in vape juice is associated with a condition called “popcorn lung,” so-called because workers in a plant processing microwave popcorn started to show signs of significant lung disease caused by the flavoring that made microwave popcorn taste buttery. The flavoring is not meant to be heated at high temperatures, and certainly not inhaled. Although it has been largely banned from popcorn products, it is still incorporated in flavored vape juices.

So far, the current crisis does not show signs of being “popcorn lung,” but there are a whole number of other substances in vape juice that have not been tested for use as an inhalant. You can swallow vitamin E, coconut oil, hemp oil, and many other ingredients just fine. The body will digest them and, in some cases, even derive a health benefit from them. However, they are not meant to be vaporized and inhaled. In fact, such inhaled lipids and oils clog the lung’s alveoli, the tiny areas of the lung where oxygen and carbon dioxide are exchanged. This results in making the lungs inefficient and ineffective, leading to breathing difficulties and, possibly, lung failure.

Vaping products are not safe – they’re highly addictive

People are under the misconception that vaping is safe, and it’s not. This is troubling, especially since kids and teens have picked up the idea as well. JUUL even had an outreach program that went to schools across the country and told the students that vaping was safe. The FDA rightly put a stop to that, because there is absolutely no proof that vaping is safe, that it is safer than cigarettes, or that vaping can help people quit their smoking habit. Far from it. I suspect we will find that it is likely to have profound long-term health effects and has led to a dramatic increase in the number of people addicted to nicotine.

While the act of vaping itself is not addicting, almost all vaping products contain nicotine or THC, the active ingredients in tobacco and marijuana, respectively. For example, there is not a single pod sold by JUUL that does not contain nicotine, and nicotine is known to be highly addictive.

Vaping is different than smoking. A cigarette has a concrete beginning and end; it takes six or seven minutes to smoke a cigarette, and then you’re done for a while. But with vaping, you take a quick hit, and you can take another hit shortly thereafter. Because of this, people who vape get a continuous infusion of nicotine, and, as a result, will take in more nicotine. To make matters worse, many vapers also like to use what’s called “high-octane juice” which contains an amount of nicotine equivalent to four packs of cigarettes.

Nicotine is a poison. It is naturally produced by the tobacco plant as an insecticide to help protect it from insects that would cause it harm. Therefore, it is not surprising that the plant, and its nicotine, is poisonous to humans. In small amounts, nicotine can act as a stimulant, but at high levels (or with long-term use) it causes damage to the heart and blood vessels.

We have known for decades that nicotine is highly addictive. It is, perhaps, one of the most difficult addictive substances to quit, and, importantly, it is also one of the most deadly. We know that 50% of the people addicted to tobacco products will ultimately die of a tobacco-related illness. Why are we foolish enough to think that vaping will somehow be different?

There is no regulation of vaping devices or vaping fluids

In the United Kingdom, the amount of nicotine in the vaping material and the e-cigarettes themselves are highly regulated. Vapers in the U.K. have a product with a consistent amount of nicotine.

In the U.S., we are living in the wild, wild west of vaping. There is no regulatory control of how much nicotine (or THC) is allowed in vaping pods, nor are manufacturers required to label their products with the contents. Even if there were labels, there is no agency or entity to establish independent certification that the labels are accurate. Users in the U.S. have no idea as to the concentration of nicotine or THC in the product they are using, and that makes a significant difference.

The FDA has given manufacturers until 2020 to prove their products are safe before they will be allowed to sell them. Initially, the FDA was going to ban all sales until the safety was proven, but there was concern about the economic impact this would have on the small businesses – the vape shops, the mom and pop manufacturing companies. It is unfortunate that the FDA did not take a stronger stance in 2015, as now we are seeing not only a significant increase in the use of nicotine vaping products by children, adolescents, and adults, but also serious health consequences.

Vaping leads to cigarette use

I know from experience that a heavy vape user will turn to cigarettes if they run out of vape juice – such as when the store is closed or they cannot afford the juice, or the supply is cut off for whatever reason. Nicotine is very addictive and vape users will have to find other sources, such as cigarettes, to avoid withdrawal.

The ugly truth is that people who vape are far more likely to start smoking, and it often takes a lot of cigarettes to replace the amount of nicotine delivered by a vaping device. For those who have turned to vaping to replace cigarettes with what they think is a “healthier option,” they will find themselves smoking many more cigarettes if they ever switch back.

Massachusetts just banned sales of vaping devices for four months. While I applaud the move, we cannot make these sorts of prohibitions in isolation. Many of the current vapers will now be driven to use cigarettes to satisfy their nicotine cravings. For those of us who fought the battle to get teenage smoking under control, this emergence of vaping is a nightmare. We now have kids addicted to high levels of nicotine, which means that when they lose access to the vaping products, they are going to get their fix by switching to cigarettes. They will not be able to walk away. We are likely going to see an increased number of people smoking cigarettes or using other tobacco-related products.

We know what happened when doctors suddenly stopped prescribing opioid pain relievers – many people turned to illicit means to fill their opioid addiction. Overdoses from heroin and fentanyl have climbed as a result. Once the cycle of addiction has started, we cannot solve the problem simply by limiting the supply. Instead, we must devote time and resources to screening, early intervention and treatment.

It is incredibly important to raise awareness about this issue. Since 2011, I have been the Chair of the American Society of Addiction Medicine’s (ASAM) Work Group on tobacco and nicotine. The number of young people using tobacco products had moved to an all-time low. There was not a kid who we met, or an adult who used cigarettes, who did not know that smoking and using tobacco products was harmful. Then, when e-cigarettes came on the market, with no regulation and easy availability for young people, everything changed. We had diminished the choke hold of smoking on society, and I believe we can do that again with vaping, if we continue to raise the alarm and take the necessary actions.