Tip/Thought of the Day

Vaping Injuries Continue To Rise; FDA Exerts Its Authority In An Effort To Protect Public Health

For years, medical providers and community leaders have warned about the dangers of electronic nicotine delivery systems (ENDS) that include e- cigarettes and other vaping products. Finally, the FDA has started to regulate these products to maintain health and safety. But, only now is the stark reality of the situation coming to light- users have been exposed for years to ingredients that can cause severe damage. ENDS products had been marketed as a means to quit smoking, falsely leading people to believe that it was a healthy alternative. But continued exposure to the nicotine in these products as well as the variety of other unregulated ingredients has proven no healthier, or safe at all. 

As of January 14, 2020, ENDS products have resulted in a total of 2,668 hospitalizations associated with lung injury (now named EVALI). Sixty deaths have been verified in 27 states, with others currently under investigation. Coinciding with the increased concerns about the effects of ENDS products, the legal purchase age for all tobacco products, including ENDS products, was raised to 21 year old on December 20th, 2019. This is part of the effort to curb usage by our youth, and limit overall exposure to tobacco.

This is an additional layer of action, following restrictions that were applied in June 2009 and October 2016, extending FDA regulation over all tobacco products, including e-cigarettes, cigars, and hookah and pipe tobacco. The FDA now has authority to regulate the manufacturing, distribution, and marketing of all tobacco products (including ENDS products). In January 2020, the FDA asserted its authority further and placed a strict restriction surrounding flavored e-cigarette cartridges that appeal to children; companies that do not end the manufacture, distributions, and sale of flavored ENDS products within 30 days will face FDA enforcement actions.

CDC updates EVALI case count and data on product usage from patients

The symptoms tied to the severe pulmonary disease, EVALI, 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 CDC provided detailed information on the findings as of January 14, 2020: 

– The median age of patients that were admitted to hospitals due to EVALI symptoms was 24 years and ranged from 13–85 years.

– 2,022 hospitalized patients had data on substance use, of whom:

-82% reported using THC-containing products; 33% reported exclusive use of THC-containing products.

-57% reported using nicotine-containing products; 14% reported exclusive use of nicotine-containing products.

What causes EVALI?

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. 

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.

ENDS usage surpasses that of “traditional” tobacco products

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. The health repercussions for all the children that have been exposed to ENDS products may prove to be vast and irreversible, if not deadly. 

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. 



Sources:

-cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information

-usatoday.com/story/money/2019/12/26/tobacco-minimum-age-fda-raises-age-buy-tobacco-18-21/2753807001/

-fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children

-safetyandhealthmagazine.com/articles/print/17921-number-of-teens-vaping-hits-record-high-survey-shows

-https://www.phillyvoice.com/cdc-confirms-fifth-fourth-death-vaping-lung-disease-illness-california-minnesota-illinois/

-fda.gov/consumers/consumer-updates/facts-fdas-new-tobacco-rule

-beta.washingtonpost.com/health/2019/09/05/contaminant-found-vaping-products-linked-deadly-lung-illnesses-state-federal-labs-show/?noredirect=on

-politico.com/story/2018/04/01/congress-bans-airing-cigarette-ads-april-1-1970-489882

-main image provided by :thehill.com

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