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. Recent studies have added to concerns surrounding the harm caused by vaping, with results showing that users have been exposed to ingredients that can cause severe damage. A new study, conducted by researchers at Johns Hopkins University, found that vaping exposes users to roughly 2,000 chemicals, including harmful industrial compounds. ENDS products had been marketed as a means to quit smoking, falsely leading people to believe that it was a healthy alternative, but new information continues to reveal the harms of vaping, even once.
The study conducted by Johns Hopkins looked at products form four popular companies: Juul labs, British American Tobacco, ITG Brands, and Mi-One Brands. The study, which the FDA is reviewing, looked at only tobacco-flavored liquids. Recent decisions from the FDA have determined that thousands of flavored products will need to be removed from the market. Confirming previous studies that revealed the presence of other harmful components like bacterial and fungal toxins researchers found that items often contained components not listed on the labels at all, or are known to cause harm:
- Researchers found caffeine in BAT’s Vuse and Mi-One’s Mi-Salt vaping products. The FDA allows caffeine to be added to beverages and food as long as it’s listed in the ingredients panel.
- Juul’s devices contained a chemical commonly used as a flame retardant for polymers, which the study speculated might be a contaminant from the device itself.
- Hazardous chemicals highlighted in the study include isophorone, detected in Mi-Salt and Vuse products, which can cause effects ranging from nose and throat irritation to fatigue and depression, according to the Environmental Protection Agency.
- Vanillin, a synthetic form of vanilla flavoring that has been reported to cause allergic reactions and other ailments, was detected in Mi-Salt, Vuse and Blu.
Another study, released August 2021 in Jama Pediatrics shared the alarming findings that young, healthy adults that use vaping products even once can trigger immediate damage to cells that lays the groundwork for future illness. It was found that even half an hour of vaping leads to oxidative stress within the body, where there is an imbalance of free radicals (molecules which damage cells) and the antioxidants that can fight them.
This is especially concerning as the popularity of vaping continues to grow among teens and young adults. Nearly 30% of high school students in a 2020 study said they had used an e-cigarette during the previous month. That even one-time use of vaping products can wreak havoc on young bodies raises serious alarm as the long term effects are still not known.
“Just like there is no safe level of tobacco cigarette smoking, there is no safe level of electronic cigarette vaping — vapes are not harmless, and nonsmokers should not use them,” said lead researcher of the study exploring the damage from oxidative stress related to vaping, Dr. Holly Middlekauff, a professor of cardiology and physiology at the University of California, Los Angeles David Geffen School of Medicine.
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.
FDA oversight not enough to limit consumer exposure
Restrictions 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.
But, that the regulation went into effect does not mean that the products currently on the market are safe, as continually comes to light as studies such as the recent one out of Johns Hopkins reveals. 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.
October 12th, 2021, the FDA announced it approved Vuse’s solo e-cig and its tobacco flavored nicotine cartridges based on data from the company that it significantly reduced exposure to harmful chemicals compared to traditional cigarettes, in people who already smoke. Even though the FDA was aware of Vuse’s popularity among young smokers, they still agreed to their authorization because of the potential adult benefit. The argument was that the 2018 ruling limiting flavors to nicotine and menthol and setting the legal purchase age to 21 for all nicotine products, inclusive of ENDS products, was sufficient. The FDA stressed while this product alone is now legal, just like cigarettes, people who don’t smoke should not use them. Sadly, I, along with many of my colleagues, have seen them used as much as, or more than, traditional cigarettes because they don’t create smoke vapors and can be used inside and out. Changing one harmful addiction for another is not the answer.
New studies add to concerns surrounding EVALI cases
Over the past few years, cases of vaping related lung damage, what is referred to as EVALI, rose significantly– resulting in nearly 3,000 hospitalizations and deaths as of mid-2020. Symptoms include cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, weight loss, and in some cases, death. Of those that sought medical help due to EVALI symptoms:
-82% reported using THC-containing products and 33% reported exclusive use of THC-containing products.
-57% reported using nicotine-containing products; 14% reported exclusive use of nicotine-containing products.
The exact cause of the pulmonary illness is still under investigation, but is linked to using vaping products. 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.
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 in 2020 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
-https://consumer.healthday.com/8-11-vaping-just-once-triggers-dangerous-oxidative-stress-2654597660.html
-safetyandhealthmagazine.com/articles/print/17921-number-of-teens-vaping-hits-record-high-survey-shows
-https://www.washingtonpost.com/business/fda-authorizes-first-e-cigarettes-cites-benefit-for-smokers/2021/10/12/51617568-2b97-11ec-b17d-985c186de338_story.html
-https://www.bloomberg.com/news/articles/2021-10-12/british-american-tobacco-gets-fda-approval-to-market-e-cigarette
-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
-https://www.bloomberg.com/news/articles/2021-10-06/vape-products-contain-potentially-harmful-chemicals-caffeine
-https://jamanetwork.com/journals/jamapediatrics/article-abstract/2782800