By: Sarah Johnson
What a year 2019 has been, especially when you take a closer look at the rise vaping, the massive amount of attention it has received, and trends in legislation and policy around the US government! This blog post is an update to our post from March, 2019, 2019 Vaping Legislation, discussing what vaping is, health concerns, the rise of vaping with children, what actions the FDA was looking into, and some legislation. If you want to find out more about vaping in general, take a look at this awesome infographic (attached at the bottom of this piece) discussing the serious health risks associated with vaping.
Update on Concerns Surrounding Vaping in the United States.
The CDC has been hard at work this year, attempting to pinpoint the cause of the elevated numbers in deaths and illnesses linked to vaping we have seen throughout the year. Earlier this month, the US Centers for Disease Control and Prevention announced that there have been 47 deaths and 2,290 illnesses linked to vaping. According to the chief data scientist for the investigation, Macarena Garcia, the agency reportedly first attempted to use a scaled-down version of a system used to track food-borne outbreaks, but quickly realized it could not be scaled up to address the rate at which the outbreak spread across the nation.
What is important to remember when looking at the serious health issues that have arisen the last year, is no single product or substance has been linked to all cases. Medical and scientific professionals need to gather more information to know whether a single product, substance, brand, or method of use is responsible for the outbreak. Of the people who got sick, 573 patients filled out reports showing:
- 76% reported using tetrahydrocannabinol (THC)-containing products (the psychoactive ingredient in cannabis), with or without nicotine-containing products.
- 58% reported using nicotine-containing products.
- 32% reported exclusive use of THC-containing products.
- 13% cent reported exclusive use of nicotine-containing products.
These illnesses have been named EVALI, or E-cigarette, or Vaping, product use Associated Lung Injury. The CDC, with the help of New York’s Wadsworth Center laboratory, were able to identify vitamin E acetate as a cause of some EVALI cases, many of which were linked to illicit cartridges, not supplied by any major vaping company, but instead on the “black market”. The process of identifying vitamin E as a culprit was incredibly labor intensive, requiring more than 1,000 measurements to rule many plant oils and rule out the other chemicals and compounds on the list of possible suspects. Vitamin E acetate has a similar consistency to honey that clings to the inner lining of lungs when it is inhaled, disrupting normal lung function.
When examining why the vitamin E acetate was even showing up in vaping cartridges, the deputy director of the New York lab said, “We are under the impression that the vitamin E acetate is being used to dilute cannabis oil and stretch it and make it go further so that you can sell more products and make more money.” Many states have already started tackling the issues with vitamin E acetate, like Colorado and Ohio, who have been working to address it being used as a thickening agent or to dilute THC oil in vape cartridges. Colorado’s Marijuana Enforcement Division decided to ban additives including polyethylene glycol, vitamin E acetate, and medium chain triglycerides (MCT Oil) beginning January 1, 2020 and outlined many guidelines and new regulations. In July this year, California launched CApotcheck.com, a tool for people to look up licensees in an attempt to discourage illegal purchases.
Many people believe that vaping could also lead to a serious medical condition called bronchiolitis obliterates, or “popcorn lung”. This year a youth in Canada presented with what is thought to be the first case of popcorn lung due to vaping. He was put on life support (ECMO) to survive his illness and spent 47 days at the hospital. Popcorn lung is linked to a chemical, diacetyl, often found in vaping liquid that provides a buttery or caramel-like flavor. Diacetyl is safe to eat, but very dangerous to inhale.
As you can see from the numbers listed above, the CDC has also found a small population of sick patients who insist they used only nicotine-containing products, which don’t contain vitamin E acetate. The CDC maintains this page on their website with all developments as they come. In their What We Don’t Know section they state:
“While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI. Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.”
Legislation Update
As we have seen with many other legislative trends this year, national legislation is hard to pass, but localities are moving forward. Although not much vaping legislation has been passed on the state and national level, city councils all over the US are regulating vaping. In June 2018, San Francisco voters passed a referendum that banned flavored vaping products. In October 2018, Chicago City Council passed an e-cigarette tax hike citing public health concerns. Earlier this week, the New York City Council passed a bill to ban flavored e-cigarettes in a vote of 42 to 2. The ordinance bans all flavored e-cigarette and vaping liquid flavors except for tobacco.
Eighteen states – Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, New Jersey, New York, Ohio, Oregon, Texas, Utah, Vermont, Virginia, Washington and Washington, D.C.– have raised the tobacco age to 21. This seems to be one way states are working to address the issue at the heart of the vaping debate, the incredibly high numbers of people under 18 reporting to vape. US HR 3942, or the Preventing Online Sales of E-Cigarettes to Children Act, was passed by the House of Representatives in October. The bill would require online age verification for the purchase of e-cigarettes, hookahs, cigars and related devices, require age verification at delivery of the listed products, and comply with all state and local tobacco tax requirements.
Michigan became the first state to ban flavored e-cigarettes in September of 2019 when their Governor, Gretchen Whitmer, used her and state department’s emergency authority to order the ban. The bill also restricts marketing, preventing companies from advertising vaping products as “clean,” “safe,” “healthy” and other terms that portray the products as “harmless.” The ban would have been imposed by the Michigan Department of Health and Human Services (MDHHS) and prohibited online and retail sales of flavored nicotine vaping products. Steven Johnson, introduced HB 5019 that aimed to ban the Michigan Department of Health and Human Services from banning the sale of flavored vapes that have a nicotine level of 2% or less in response to Gov. Whitmer’s emergency action. The ban took effect on October 2nd, but was temporarily blocked by a judge claiming the ban may force adults to return to smoking more harmful tobacco products and has irreparably hurt vaping businesses. Beau LaFave introduced HB 4996 that would prohibit the Michigan from implementing rules that limit the production, sale or use of vaping products.
Massachusetts Governor, Charlie Baker, declared a public health emergency and ordered a four-month ban on the sale of all vaping devices in the state, not just flavored products. Just last week, Massachusetts became the first state to ban flavored tobacco. The bill, H 4196, will outlaw any flavored tobacco products, including mentholated cigarettes and flavored nicotine-based e-cigarettes. Along with this ban, the bill also imposes a 75% tax on e-cigarettes and improve access to smoking cessation programs. Illinois’ HB 3887 is similar to Massachusetts’ bill. The bill would create the Flavored Tobacco Ban Act, prohibiting the sale of flavored e-cigarette and tobacco products. Stores that violate the ban would risk losing their retailer’s license.
Michigan introduced a three bill, bipartisan package banning products containing vitamin E acetate covering marijuana, nicotine, and nicotine alternative vapor products. HB 5159, sponsored by Abdullah Hammoud, revises the Medical Marihuana Facilities Licensing Act to now prohibit the processing and sale of marijuana products containing vitamin E acetate. HB 5160, sponsored by Frank Liberati, would revise the Michigan Regulation and Taxation of Marihuana Act to prohibit the processing and sale of marijuana that contains vitamin E acetate. HB 5161, sponsored by Joseph Bellino Jr., would prohibit the sale of vapor products or alternative nicotine products containing vitamin E acetate.
Conclusion.
It makes sense to me that vaping is harmful; inhaling a liquid into your lungs cannot be without impact. It also makes sense to me that the CDC is maintaining its recommendation that consumers consider refraining from using all vaping and e-cigarette products, including those containing nicotine, because they have not been able to find the culprit with some of the sick vapers. In a November meeting about vaping, Trump pointed out something I do not see spoken about often when talking about vaping and banning the “tasty” flavors, “When you watch prohibition, when you look at the alcohol, you look at cigarettes, you look at it all, if you don’t give it to them, it’s going to come here illegally. That’s the one problem I can’t seem to forget.”
So while we have seen with the illnesses and studies so far that illicit vapor has played a huge, if not the most important, role in making people sick; and I do believe something needs to happen to mitigate the danger of these new products; banning companies that produce safe vapor from producing tasty e-cigaret cartridges will not make them go away, it will push them underground, thus making them much less safe. We have already seen how this battle shakes out with the prohibition on alcohol and marijuana, we know what happens when we make products illegal that people want. Also, the kids we are trying to get this away from are the most tech savvy generation thus far, making it much easier for them to find the ways to get illicit substances.
When Trump announced his support of a flavor ban on nicotine vaping products in September, he was under the impression that “vaping” in general was killing people. Today, we know that the focus of the Centers for Disease Control investigation is not store-bought nicotine vaping products, but illicit marijuana oil cartridges containing a dangerous contaminant called vitamin E acetate. My boyfriend was a cigarette smoker for ten years and switched to vaping last year. Although I’d rather have him stop inhaling anything other than pollution free air, switching from cigarettes to vaping has seriously improved his life. He feels much better in general and has smoked less than a pack of cigarettes over the last year. Ignoring two factors, one that it is actually helping people move away from cigarettes, and two, that it is now a booming industry employing over 150,000 people, is just not practical.
Vaping Infographic from calculators.org.
Vaping Infographic provided by Calculators.org
Cover Photo: Pixabay License Free to use under the Pixabay license: https://pixabay.com/photos/people-man-alone-smoking-vape-2598820/
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