This week, the Centers for Disease Control and Prevention reported a fifth death linked to vaping and ENDS (electronic nicotine delivery systems) products. To date, there are a reported 450 pulmonary illness cases linked to vaping. The symptoms tied to the severe pulmonary disease include a cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, fatigue, fever or weight loss. Some patients reported the symptoms developing over a few days while others reported it happening over a few weeks, according to the CDC. The number of reported cases is expected to rise as people seek evaluation for concerns that they may have previously assumed were related to other causes.
The exact cause of the pulmonary illness is still under investigation. The e-cigarette industry has only recently come under regulation by the FDA, making the search for the root cause of the recent illnesses difficult in an industry that is still being untangled by the FDA. It wasn’t until the summer of 2016 that the FDA extended its authority over all tobacco products, including ENDS products, all cigars, hookah (also called waterpipe tobacco), pipe tobacco, nicotine gels, and dissolvables that did not previously fall under the FDA’s authority. But, that the regulation went into effect does not mean that the products currently on the market are safe. The FDA allowed a two year window for manufacturers to continue selling their products while submitting them for review- and an additional year to allow for the review to be complete. During these time frames, no adjustments to the products are required, essentially leaving consumers vulnerable to any ill effects they may cause.
These guidelines of course assume that manufacturers are adhering to the new requirements to submit their products for review. The sudden surge of pulmonary illness related to vaping is highlighting exactly how large the e-cigarette black market really is. Growing concern lies in the fact that many of the vaping products are readily available outside of normal avenues where tobacco products are typically purchased, like a smoke shop. Black market products can be bought through street vendors, online, etc., making tracing the product back to manufacturers for further investigation and accountability incredibly difficult.
Different products contain a wide array of ingredients, and some of those ingredients haven’t been tested for consumption by means of inhalation, putting users at risk. As researchers try to narrow down the cause of the pulmonary illness, part of the confusion is that one substance isn’t linked to all of the cases. Vitamin E acetate (an oil derived from Vitamin E) has been found to be a common ingredient, but is not present in all the products linked to the pulmonary illnesses. Although ingredients like Vitamin E acetate may seem harmless (after all, doesn’t the word “vitamin” seem healthy?), as we have shared before, supplements, regardless of their name, are unregulated. In the case of Vitamin E acetate, typical use is as a topical or ingested as a vitamin supplement- and it has not been tested for inhaled consumption.
The usage of ENDS products has grown to epidemic proportions. I’d previously posted about the CDC and FDA raising significant concerns over the dramatic rise in use of e-cigarettes. Their concerns surrounded that some e-cigarette users may consume more nicotine than they realize and consequently experience heightened addictive drug effects. The elevated exposure could lead to seizures, convulsions, vomiting, and brain injury. Manufacturers of ENDS products claim their merchandise is safe, but a study published this year showed many popular products are contaminated with bacterial and fungal toxins that cause lung disease, in addition to the negative effects of nicotine.
These concerns have led many healthcare providers and government leaders to seek methods to regulate the sale of ENDS products and restrict marketing from avenues that could influence youth. Some steps, like prohibiting certain advertisement methods and placement are now being applied to ENDS products as they have been to other tobacco products since the late 1960s and 1970s.
Even as distribution of “traditional” tobacco products (cigarettes and cigars) remains legal, the number of smokers in the United States has declined from 42 percent in 1965 to less than 17 percent today, a trend that surveys show has been driven by both health warnings and high excise taxes. On the other hand, usage of ENDS products has surged- the CDC reports that nearly 9 million adults report using ENDS products at average, three times a day. Estimates for the number of youth using ENDS products vary, mainly due to many youngsters hiding their usage. But one thing is clear- the number of youth that use the products has surged and raises serious concerns about the long-term damage that is occurring.
One survey in 2018 shared a glimpse of how extensive the prevalence of usage among youth may be. The survey included responses from more than 44,000 students from 392 public and private schools. Students were asked about their drug, alcohol and cigarette use, as well as related attitudes. High school seniors had the sharpest one-year increase, with more than 37% reporting vaping within the past 12 months – a jump from nearly 28% in 2017. The upswing among high school sophomores (32.3 % from 23.9 %) was nearly as great, while eighth-graders (17.6 % from 13.3 %) had a smaller increase. Additionally, the percentage of 12th-graders who reported vaping in their lifetime rose to 42.5 percent from 35.8 percent in 2017. The health repercussions for all the children that have been exposed to ENDS products may prove to be vast and irreversible, if not deadly.
For years, medical providers and community leaders have warned about the dangers of these unregulated products and slowly the FDA has started to regulate the products to maintain health and safety. But, the reality of the situation is coming to light as users may have now been exposed for years to ingredients that can cause severe damage. ENDS products had been marketed as a means to quit smoking, leading people to believe that it was a healthy alternative. But the continued exposure to the nicotine in the products as well as the variety of other unregulated ingredients has proven no healthier, or safe at all.
The CDC has issued a strong recommendation that people stop using ENDS products in light of the recent health concerns. You can seek help quitting using tobacco products by calling 1-800-QUIT-NOW (1-800-784-8669), or visiting the CDC’s “How to Quit Smoking” help page here.
-main image provided by :thehill.com