The Smoke Alarm Is Still Ringing

Recent research links vaping-related deaths to certain THC-infused vapes. Staff Writer Nelson Espinal provides the latest updates in a follow-up to his previous feature about vaping. 

The rapid pace at which vaping entered mainstream youth culture presented little time for researchers to confidently determine its safety. This lack of certain research often allows for a notion of safety to enter the minds of vape users, even when there might be more harmful consequences. Determining the level of safety when vaping is an ever-evolving question that requires additional research in order to track the long-term effects. The process of having these findings trickle down to people who are considering vaping or have just started has been elongated because of the vape-positive studies that came out at first that portrayed it as a safe and viable alternative to smoking. This hurdle limits how seriously it will be seen by people who currently vape.

The Centers for Disease Control and Prevention has recently been providing constant updates on hospitalizations and deaths from vape-associated lung injury, also known as EVALI. Its website lists the symptoms of lung injury as “respiratory symptoms, including cough, shortness of breath, or chest pain” and “gastrointestinal symptoms, including nausea, vomiting, stomach pain, or diarrhea” with other general symptoms like fever, chills, sore throat, et cetera. The aerosol, which is found in the smoke that is both inhaled and exhaled, has been labeled as a key cause for these symptoms because it contains compounds that can cause cancer and possible lung injury. The CDC started tracking EVALI in June 2019 and provided monthly updates on its latest findings. 

According to its website, there have been 60 EVALI-related deaths in 27 states as of Jan. 14, 2020. Additionally, 2,602 people have been hospitalized for EVALI. 

Recent CDC research provides potential explanations for EVALI’s causes, stating that“the latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.” 

This finding links THC, the compound that generates cannabis’s physiological effects, in tobacco-based vapes as a potential cause of EVALI. The CDC has not definitively labeled a certain component of electronic cigarettes as the main cause of the outbreak of EVALI because it can only draw conclusions based on its most recent sample that began in August 2019. 

According to its website, “no one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. We do know that THC is present in most of the samples tested to date, and most patients report a history of THC-containing products.”

The early conclusions about vaping studies were positive because vaping was framed as a safer alternative to smoking. The overall feeling about vaping was generally positive despite the warnings about a lack of research. A study from the Royal College of Physicians dating back to 2016 also highlights the initial wave of positivity around vaping. 

“The hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco,” the RCP’s Tobacco Advisory Group concluded. “Technological developments and improved production standards could reduce the long-term hazard of e-cigarettes.” 

This past study presents current-day ramifications for a person that is interested in vaping or who currently vapes. They can use the RCP study to provide a foundation for a counterargument against the work that the CDC is actively doing. A back and forth occurs between older studies that endorse vaping and newer ones that shed a negative light on vaping. This constant clashing can lead to further misunderstanding.  

The brand of vape used does matter when it comes to EVALI cases, as there are tobacco-based vapes and also those modified to include both THC and tobacco. According to the CDC, “the most commonly reported product brand included Dank Vapes (56 percent), followed by TKO (15 percent), Smart Cart (13 percent, and Rove (12 percent).” When THC and nicotine are mixed, there appears to be a trend of unhealthy results. The brands responsible for the high volume of hospitalizations and fatalities show that the combinations of nicotine and THC result in damage to the lungs. 

On a different note, the CDC reports that there are 13 percent of cases in which the patients reported use of tobacco-only vape products. The variety of different vapes used by the victims calls for more time needed to directly pinpoint the root cause since it is not narrowed down to a specific type of vape. It is possible that it may simplify to certain kinds of vapes eventually, but until then, generalized leads create a lack of clarity on what devices to avoid.

The Food and Drug Administration issued a federal ban on flavored vapes on Jan. 2, 2019 as reported by CNBC. This action was an attempt to slow down the marketing that targeted children. “The ban has little to do with the vaping-related lung illness,” a FDA official said in the article, explaining that this policy was not meant to address the issue of THC-infused vaping products. The same FDA official also said that the THC vapes are a separate issue and their current focus is stopping younger audiences. 

Apart from what the FDA did to control the marketing toward younger audiences, UC San Diego addressed the THC-related vaping issue by sending a campus-wide notice via email on Nov.r 15, 2019 from Vice Chancellor of Student Affairs Alysson M. Satterlund and CEO of UC San Diego Health Patty Maysent. In this email, they alerted the student body to refrain from vaping until further findings are determined. 

“The California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC) have issued an advisory urging everyone to refrain from vaping effective immediately, due to a continued increase in vaping-associated pulmonary injury,” the email stated “Until the cause of the condition is known, the state is advising against ALL manners of vaping or electronic cigarette use.” 

Apart from the EVALI-based research done by the CDC, the CDPH has “identified 136 cases of acute lung disease in California among people with a history of vaping cannabis or nicotine. All patients required hospitalization, with some needing respiratory support. Three deaths associated with the disease have also been reported.” These are separate cases from the lung injury EVALI that is being researched by the CDC. Now with multiple illnesses being linked to vaping, the UCSD email gave students who vape some advice.

“Quit vaping altogether, no matter the substance or source,” the email stated. “For those who continue, please avoid purchasing any vaping products on the street and never modify a store-bought vape product.”

The findings from both the CDPH and the CDC lean toward the conclusion that vapes are not completely safe products. With this in mind, it is important to gauge how people who actively vape reacted to the most recent findings. 

A group of students were collectively vaping outside the bounds of UCSD near the bus stop around the Keeling Apartments. They were sharing a single vape amongst the four of them. The mango scent caught my attention and I went to ask them about the findings that recently have come to the forefront.

 “I know that there are a lot of issues with vaping, but I’ve been doing this for three years and I trust the brand that I use,” one of the students, who wanted to remain anonymous, said. “I feel like it is people that don’t do the research that end up being hurt.” The statement carried plenty of confidence and it soon became clear that it was the only words that I would get out of this particular group. 

On a separate occasion, as I walked to my car, I saw a student smoking a cigarette in the parking lot. As a self-described “traditional smoker,” her resistance to the vaping trend must be grounded in fear of vaping. Her reaction to the findings confirmed my intuition.

“There is no way that inhaling all of those artificial chemicals could be good for you,” the student said with a proud smile “That is why I stick to natural tobacco. If smoking is going to be the end of me, it has to be the real thing.”

With a lack of a conclusive, definite cause for EVALI and the acute lung disease discovered by CDPH, there is still some uncertainty that comes in accepting these recent findings. While the off-market devices have been pegged as more dangerous than those of bigger brands like Juul, the latest results show that no brand is completely safe. The end result is a lack of ability to dissuade people who vape consistently since they have typically been doing it for a while and have not suffered any immediate consequences. The fire alarm has now started to sound and these findings can initiate some hesitancy in starting to vape. 

Illustration by Angela Liang.

Editor’s Note: A previous version of this article misstated the number of EVALI-related deaths. This article was updated on 1/21/20 to reflect the correct statistic.

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