CDC, health practitioners advise everyone to stop vaping
In recent months, an “outbreak” has been established by the Centers for Disease Control (CDC) in cases of vaping-related lung injury, especially in the state of California. By the most recent count — updated every Thursday on the CDC website — on Oct. 29, there were 1,888 reported cases and 37 deaths by vaping-related illness across the country. And these numbers only continue to climb following CDC investigations.
The lung illnesses — which the CDC has started collectively calling EVALI, which stands for “e-cigarette, or vaping, product use associated lung injury” — are overrepresented in male and younger populations. Seventy percent of 1,378 patients affected by the illness identify as male and 79% of 1,364 patients reported being under 35 years old. As of now, the median age for deceased patients is 53 years old.
It is understood that products containing THC and obtained informally off the street — through dealers, friends or family — are the root of most EVALI cases, especially when combined with frequent and extended use. Although cigarette use ties all patients together, research is still needed to determine what is actually causing lung injury and what chemicals, or mix of chemicals, are causing the most damage.
Heat is needed to turn the oil or liquid compositions in a pod or cartridge into gas for inhalation. But this process might be making chemicals more dangerous, according to Dr. Nicholas Kenyon, the division chief of pulmonary, critical care and sleep medicine in the UC Davis Health department of internal medicine.
The plethora of products with unknown chemical makeups make it much harder for health providers to give advice beyond not using any e-cigarette or vaping products, whether or not they contain nicotine or THC.
“I think we have to say that you should be worried simply because we don’t have a good handle on the situation right now,” Kenyon said. “It is true that some people have really just used nicotine products and ended up with vaping lung injury. It is certainly safest not to vape. We understand that this is a problem, that millions of young people are using these. It really doesn’t take very long for somebody to start to develop lung injury. Certainly the dose and the frequency of use does correspond with the development of lung injury, but even [with] infrequent use for some time, if you get an adverse reaction to some of the chemicals in these products, it is possible to get fairly severe lung injury.”
As of now, it is critical for health practitioners to be attuned to identifying EVALI cases in California and report all such cases to the local state health department and the CDC, according to Kenyon.
“It’s not very easy to recognize,” Kenyon said. “When these cases come in, they look like other forms of pneumonia just that they tend to be in young people so that’s a little bit unusual.”
Many students assume that the retail establishment prevalence and popularity of Juul, a major e-cigarette producer, make their products safer to consume. Despite the health community and the CDC being more concerned about black market and THC-containing products, even Juul products are now being called into question. In a lawsuit filed on Oct. 29, Siddharth Breja, a former executive of Juul, alleges that Juul knowingly “sold at least one million contaminated mint-flavored nicotine pods,” according to a New York Times article.
“Mr. Breja detailed a culture of indifference to safety and quality-control issues among top executives at the company and quoted the then-chief executive Kevin Burns saying at a meeting in February: ‘Half our customers are drunk and vaping’ and wouldn’t ‘notice the quality of our pods,’” The Times reported.
But a fourth-year pre-med student, who agreed to speak on the condition of anonymity, is not moved enough by all this news to quit just yet; she said she goes through a Juul pod about every two days.
“I just read it and I think it’s just more media stuff,” she said. “Juul was a hype and now anti-Juul is another hype. Anti-Juul culture.”
For her, a consensus merely telling her to stop vaping does not warrant quitting. The extremity of the cases she reads about also reassures her, because in comparison to those EVALI patients, her consumption is not that extreme.
“Sometimes it’ll burn the back of my throat if my pod is burnt, but that doesn’t worry me just because I’m like, ‘That’s just a pod being burnt,’” she said. “It’s not anything.”
She started vaping five months ago with a Suorin but moved to Juuling, because the Suorin was “more powerful.” Sometimes she will feel “kind of weasy” from vaping because of her asthma, so she stops “hitting [the Juul] so much” until she’s fine. She said if she started noticing any adverse health effects, it would prompt her to stop sooner.
“My usage sometimes does worry me just because I’m like, ‘I don’t want to do this everyday, all the time,’” she said. “I do believe I will stop in the future, but I don’t have a desire to right now. I don’t desire to be Juuling all my life.”
Another fourth-year student who has been vaping for about two years started off by slowly incorporating nicotine-containing juices into his Orion vape device.
“Before I started using e-nicotine devices, I was quite into vaping and learning tricks,” he said via email. “However, gradually I started to experiment with using 3mg juices and then 6mg juices, and I somehow ended up on the e-nicotine trend. I now use 50mg juices which is quite an upgrade from 3mg juice.”
He would puff his Orion “around 20 times per day” as he went about his “daily activities” like after eating, going to the gym, showering or waking up. The news has started to concern him though.
“As a e-cig smoker I am concerned of what this adverse habit will lead to,” he said. “At first I believed that vaping was relatively safe, due to the lack of research done with it. However after articles and news sources began releasing ‘vaping dangers’ and ‘vaping deaths’ reports, I am beginning to become quite worried of what I am putting in my body.”
For Kenyon, there is promise in young adults offering to help doctors and investigators with research efforts.
“People who are using these products would have to agree to have some of their breath or maybe some blood work sampled so that we can get a sense of what’s in these products,” Kenyon said. “It would require researchers as well as really many young people to help engage in understanding this.”
On a last but consequential note, the fourth-year pre-med student sighed as she tried to address how people around her have approached her nicotine addiction. As she stumbled for the right words, she expressed how people have snatched her Juul from her hands or chastised her when they see it, which she says hurts her more than it motivates her to quit.
“[I’ve] been experiencing a lot of judgment and shame behind using the Juul, and I think it’s very discouraging,” she said. “People taking it out of my hands and doing those things low key hurt[s] even though I know what I’m doing may not be good for my body and I know that they care, it’s still like actions speak louder. For people who do that, it can be kind of hurtful and it […] makes me feel more shameful than it does for me to encourage to be stopped.”
Kenyon admitted that the many methods of combating nicotine addiction — such as gums, patches, nasal sprays and addiction programs — have not been “overly successful.” He emphasized, however, that several attempts at quitting are often needed to overcome nicotine addiction. E-cigarettes are no different.
“The average number of times it takes to quit nicotine cigarettes is about three to four [serious] quits,” Kenyon said. “When we talk to our patients, we always recommend, ‘Don’t get down on yourself. If you failed once keep trying.’ People can succeed on their third or fourth try.”
Two student sources were kept anonymous on account of them speaking to their drug use.
Written by: Cecilia Morales — science@theaggie.org
