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To Vape Or Not To Vape?

As of this date, nine people have died from vaping. Another 530 vaping-related illnesses have been confirmed. This month, the Food and Drug Administration (FDA) moved to ban flavored e-cigarettes, citing their appeal to young people. A few days earlier, New York’s health commissioner warned the state’s residents to stop vaping until the Center’s for Disease Control and Prevention (CDC) could determine what’s behind the sudden epidemic.

Our family practice doctors at Cohen Medical Associates in Delray Beach have received a number of questions from our patients regarding the safety of e-cigarettes, so we wanted to explore this issue further.

The background

Vaping is a term for an electronic device that contains liquid nicotine, along with other substances. Some vaping pens are self-contained; that is, users can take them out of the package and immediately begin inhaling the nicotine vapor (thus, the term “vaping”).

Others, like the popular Juul system, are powered by a rechargeable battery, and use “pods,” or cartridges, containing the liquid nicotine, flavoring, and—with some users—THC, the active ingredient in marijuana that produces the “high.” A single pod carries the same amount of nicotine as a pack of cigarettes.

A 2016 survey found that about 10 million Americans vaped regularly. Nearly half of those were under the age of 35, with 18-24-year-olds the most frequent users.

In 2018, over three million high school students and 570,000 middle school students reported they were using e-cigarettes, according to the CDC.

Why here, why now?

Vaping was introduced nearly a decade ago as a way for smokers to quit smoking cigarettes. In the interim, millions have used these products without the type of lung illnesses we’ve been seeing in recent months. In addition, the illness appears to be confined to the U.S. In the U.K., for example, the BBC recently reported that health experts there say they are not aware of any similar incidents with UK-regulated vaping products. Approximately three million people in the U.K. vape, the BBC says.

Logic would seem to suggest, then, that some sort of recently introduced contaminant is to blame.
Martin Dockrell, Head of Tobacco Control at Public Health England, told the BBC, “A full investigation is not yet available but we’ve heard reports that most of these cases were linked to people using illicit vaping fluid bought on the streets or homemade, some containing cannabis products, like THC, or synthetic cannabinoids, like Spice.
“Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare Products Regulatory Agency, and they operate the Yellow Card Scheme, encouraging vapers to report any bad experiences,” Dockrell said.

Prior concerns

Health officials in this country were raising concerns about the proliferation of vaping, especially among young people, long before this recent spate of serious illnesses. A study in lab mice at Houston’s Baylor College of Medicine found the solvents used in vaping liquid damaged lungs.

While vaping has been touted as safer than smoking so-called “analog” cigarettes, experts have cautioned that a lack of long-term studies means that no one knows the eventual effects of what people are inhaling.

But, again, the first serious respiratory illnesses didn’t surface until July of this year, with the first vaping-related death reported August 23rd in Illinois. By then, federal and state health officials were investigating nearly 200 cases in 22 states.

Investigators are currently focusing on vitamin E acetate, a thickening agent used to adjust THC levels in black-market pods. But some of the victims reported vaping only nicotine products, though they may have been reluctant to admit to marijuana use.

The new illness

Symptoms seem to arise suddenly and include:

  • shortness of breath
  • coughing
  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • fever
  • fatigue
  • weight loss
  • pneumonia
  • complete respiratory failure.

Many of those hospitalized developed acute respiratory distress syndrome. Victims end up on ventilators, and some are even placed into medically induced comas, to keep them alive.

Even if treatment is able to prevent death, many survivors have been left with long-term, possibly permanent, lung damage.

Should you quit vaping?

While the possibility of respiratory damage and even death seems remote given the number of users vs. the number of vaping-related illnesses, we would suggest that anyone who is vaping consider stopping, at least until investigators can determine the source of this mysterious new illness. If you don’t choose to stop vaping, at least be sure to buy pre-packaged pods/cartridges from recognized manufacturers and avoid homemade or illicit “street” liquids.

If you’re using vaping to stop smoking, we can offer numerous other avenues to help wean you away from nicotine. If you’re using it as a marijuana delivery device (which is still illegal in Florida, except for medical marijuana), there are other, less-risky methods to ingest the drug.

We strongly recommend that young people refrain from vaping. Even without the added danger of this new illness, studies have shown that nicotine use among adolescents can impair brain development, memory, and learning, and may permanently alter brain chemistry, as well as damage lungs.

Reported vaping-related illness and deaths have risen alarmingly in the past few weeks. Why take the chance?

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