Where There Is Vapor There Is Not Always Fire
If you’ve been paying attention to the news – or even if you haven’t – you may have heard about some serious problems going on with vaping. It seems like the news is finally catching up to the reality of the situation, but since this is the sort of thing that can persist and because the correction often doesn’t get nearly as much attention as the splashing headline, I thought I would explain what is happening and why.
A couple of months ago, emergency and urgent care centers got a rash of young admits demonstrating lung problems. In some cases, quite severe. Eventually there was a lethal case (there have since been two more). It turned out that they were vapers, and thus it became linked to vaping. The vaping industry and pro-vaping community were hit very hard with a lot of people saying “See? See?!”
There were problems with the idea that vaping as such was the culprit. Vaping has been around for a while, so why is this suddenly a problem? This isn’t a case of long-term wear. This is an acute condition so it’s not a matter of it taking until now to manifest. Something changed. But it only changed in the United States because no cases were reported elsewhere. More specifically, it changed in clusters rather than nation-wide. Since lungs don’t differ much from state to state, an inherent problem would not be so localized. Perhaps most revealingly, the afflicted were predominantly young (college age or high school). College kids’ lungs aren’t weaker than that of older people (who vape in greater numbers) including a lot of people whose lungs have been worn down by years or decades of smoking.
Where young people are weak, however, is in their judgment. They might, for instance, be vaping things they shouldn’t be vaping. Nine in ten of the afflicted reported using THC oils (something not traditionally found in market ejuice). The remaining 10%? It’s possible they’re lying (hiding it from their parents), instead of vaping THC oils they’re vaping laundry detergent or something stupid like that, or they are unrelated cases of (probably minor) lung distress lumped in with the others.
It took about a week and a half but gradually state health departments started discussing additives and contaminants as a factor. The articles had a tendency to glide over this fact, such as how this one did:
But in an ongoing state investigation among all ages of those with lung disorders who reported vaping, 89% said they inhaled THC products in the form of waxes or oils. THC is the active ingredient in marijuana.
The problem is not isolated. In Utah, Alexander Mitchell, 20, was placed in intensive care after vaping. And now his lung capacity has been diminished by 25%. “Vaping is promoted as a safer alternative when in reality it is not,” he said.
The vaping industry is blaming unlicensed retailers selling unsafe chemical mixtures and wants federal officials to clarify where the problem lies.
In three paragraphs we go from pointing out the likely source of the problem to a claim that vaping (as such) is bad to reducing the original part to a vaping industry claim.
As it turns out, federal officials have since clarified the nature of the problem, though are still suggesting that people not vape altogether (which, for a lot of people, is telling them to smoke cigarettes instead). Some of the media as well is now reporting that the problem is mostly related vitamin E.
So what happens now?
Well, some vapers are probably smoking again and others will be discouraged from using it as a method to quit. I doubt the damage here can be undone. Public health advocates will make sure of it. When a new method was found to zap e coli out of meat, nutritionist Marion Nestle commented that this was an unwelcome development because people would start thinking that meat is okay. What’s a few cases of e coli compared to a meat eating epidemic? From early on a similar decision was made by a lot of people that this is more of a tool to be used against vaping more broadly than it is an immediate health crisis for which timely and accurate information would be helpful. Even knowing what we know, there are Democrats using this as a pretext to ban flavors and condemn dominant ecigarette manufacturer Juul.
Except that Juul was not responsible, of course. Whatever the product source was, it was almost certainly not in the locked up Juul cartridges. It was not a product of their nefarious fun flavors that the governor of Michigan just banned and Dick Durbin is demanding of the FDA in response to an unrelated crisis. You can try to argue “Well it’s flavoring that drew them to it” except flavoring was supposed to draw them to nicotine and we’re talking about people who were using non-nicotine varieties. If it was flavoring they liked, they would have chosen products with more flavor (I suspect the THC subtracts rather than ads to the bubble gum flavor). This was a different user profile.
But that brings to light a big question for which there is no answer: How do you regulate against this? We have a regulation regime and this occurred outside of it. There is no reason to believe that tightening that regime would have any effect. You could try banning open systems but again this occurred outside of regulation. All you need is a device to burn them and then you can put widely available products in them. It would make devices harder (though far from impossible) to get a hold of, and would eliminate cases where the user may not have known about a product substitution. So while the cost of this policy would be immense, it could have an effect.
That would be the opposite of targeting Juul, though, the great bogeyman. In fact, as the perveyor of solely closed systems, it would benefit them greatly. You can actually tell which advocates and politicians don’t know what they’re talking about or don’t care by whether they try to rope Juul into this. Even if we consider this a vaping problem, it’s decidedly not a Juul problem. It is occupying the far other side of the industry from where they rest. I say all of this as someone who is generally critical of Juul and their effect on the vaping marketplace. But there are two companies in the vaping market that have called for more regulation of vaping products: RJ Reynolds and Juul.
As I allude to above, you can try to ban flavoring as a mechanism to get them to avoid vaping in the first place. There is likely, however, a different user profile between those attracted to bubble gum flavoring and those putting illicit products their devices. I suspect, in fact, that the THC oils disrupt the flavoring. So if it’s flavoring their attracted to, they are less rather than more at risk for this sort of experimentation. Likewise, the impetus behind the ecigarette bans is nicotine addiction. If nicotine-addiction were driving this, however, they’d be using nicotine products rather than branching out into other things. In short, these are the people who like experimenting for the sake of experimenting. That’s just a harder nut to crack.
There might be something we can do on the THC end. That’s outside of my realm.
The biggest thing I can think of that might help would be the dreaded occupational and business licensing. It’s possible that some of these were purchased at unscrupulous but traditional vape shops. Or fly-by operations that look like traditional outlets. The FDA is already regulating makers of ejuice more generally but it’s not entirely clear the best way to handle ad-hoc mixing. Some combination of required practices and a license that can be pulled from operators that don’t adhere to it may help, though.
Ultimately, though: Perspective. We are talking about three deaths and a few hundred illnesses in a nation of over 300,000. It’s unfortunate but it is not likely to scale with overall ecigarette use. Awareness may be sufficient to attack it, provided that we are giving accurate information rather than opportunistically seeing this as an opportunity to tell people Don’t Vape. Beyond that, finding a way to authorize retailers and telling people to only get their stuff from authorize retailers would probably help a lot.
Despite being an ardent advocate, I do recommend caution when it comes to vaping. There is a lot we don’t know. If your body is telling you something when you try it, you should listen. I am skeptical of Royal Health England’s “95 safer” statistic. There are almost certainly risks that we don’t know about, especially for individuals with other health problems. Eventually somebody may die from an allergic reaction to regular vaping and the vaping community needs to be prepared for that. But that’s not what is happening here.
That said, I quit vaping in April of 2017 and nothing I have learned since has lead me to be more thankful that I did or sorry that I ever took it up. I may or may not be healthier due to my vaping cessation, but most of the gains were made when I switched away from smoking. That is the anniversary I celebrate. The day may come when something truly damning does come out, but so far almost everything that does ends up – like this – being followed by clarifying additional information. My present main concern is that vaping was already struggling with a perception problem that discourages smokers from trying it or even convincing them to switch back to smoking, and this will almost certainly make that a bigger problem.
For now, though, keep on keeping on. But only with approved products, please.
I haven’t paid a GREAT deal of attention, but my thought, as a scientist, is this: it’s gonna come down to grey-market or black-market cartridges. Like, they’re adulterated. Or that the THC in them is sufficiently concentrated to do something bad to the lungs.
Or, as an outside: that the carrier oils (or some carrier oils) do a lot more harm than originally thought (remember the whole thing with the fake-popcorn oil and illnesses in some microwave-popcorn packaging plants).
I don’t know what the answer is. I will say, as someone highly sensitive to tobacco smoke (asthma), I welcome that I’m around it less and less these days.
And yes, I admit it, I have judgily rolled my eyes and thought “I get it, you vape” when some dudebro out on the street blows out a giant dragon cloud. But I am too polite to SAY anything, even when my campus hadn’t yet asked people not to do it in the classroom. And I would like the rules for vaping to be similar to those for cigarettes – in other words, if people can smell you doing it or be bothered by whatever you’re outgassing, don’t do it around them, please.Report
They actually looked at popcorn lung early on. I gave a section to it here. Long and short of it is that there is some diacetyl in some flavors and there is a theoretical threat, but not a likely one with real-world use. Doesn’t mean that there isn’t some other chemical that’s going to cause some other problem. When this first surfaced I thought it was going to be regular vapes but with people that had some sort of severe allergy. But the fact that it kept happening in clusters and kept happening to young men started raising flags pretty quickly.
Regarding courtesy, Halo (a products company that I used to get devices from) had a really productive newsletter n vaping etiquette basically suggesting that people not be in others’ faces with the vapor. Things might be going smoother with more vaping courtesy (though there is always going to be some give and take).
One of the funny things about Juul is that among its selling points is that it is relatively invisible and odorless. I never used them so I don’t really know, but school administrators have actually complained about it (“How do we know if they’re doing it?”) and it’s been argued as proof of Juul’s nefarious nature.
(It’s funny how often I end up defending Juul. I don’t actually care for them and I think things might be better off without them. But they are what they are, and they aren’t what they aren’t.Report
Once, while on a layover in Chicago in the deepest darkest depths of winter, I was riding the shuttle from someplace to someplace else and it was cold enough for everybody’s breath to be visible.
There was a guy on the shuttle who was sneaking tokes on a vape pen every half-minute or so and his breath clouds were bigger and more persistent than everybody else’s… but as I compared his exhalations to my own, I couldn’t help but notice that we’re all walking around in each other’s clouds.Report
It does seem to be specific to products that use vitamin E oil – which is a perfectly healthy nutritional supplement when ingested (i.e. at worst it’s useless but harmless), but a terrible thing to inhale.
I can’t imagine the THC itself would be the culprit – we’ve been inhaling THC for a longish time now.
Just generally the idea of buying vape liquid produced by illegal operations not bound by any list of allowed ingredients just seems so bad. Especially given that the older style marijuana vaporizers have been around for ages, and they just heat regular marijuana hot enough to cause the desirable cannabinoids to sublimate but not hot enough to burn the plant matter, so it’s basically the known quantity of marijuana, minus all the tar and soot.Report
Yes, but isn’t it more concentrated in the vape cartridges than in your garden-variety blunt? Or am I totally wrong, being the square that I am?
It does seem like….black-market products without quality control or requirements to conform to some kind of standards would be a pretty bad idea.
(Thought: if some do-gooders get their way and added sugars get banned, brace for people dying from black-market candy….)Report
I imagine more will die from saying something like “no, but would you like carob?”Report
It’s hard to tell but it probably is possible to get vape juice that puts much more THC into a lungful of vapour than just smoking even high potency hash oil would do.
Folks claim to sell liquid that has 1000 mg THC / mL. That seems very dubious to me as there wouldn’t be much room for carrier liquid at that point, but I’m not a physical chemist nor do I play one on television.
Cannabis concentrates up to about 90% THC by weight exist, and have names like ‘wax’ or ‘shatter’ because that accurately describes their consistency – presumably a relatively thin liquid would have to have less THC than that.Report
300,000,000.Report
99.Report
Methinks thou doth protest too much.Report
You jest at scars that never felt a wound, sir.Report
I often wonder what the overlap is between people who want to decriminalize marijuana and people who just hate nicotine.
I mean, I wonder if it’s about the drug, or the commercialization of the drug?Report
I wonder about the overlap, too, but from a different angle. How many pro-legalizers are wont to declaim against Big Tobacco but would support a system in which there is Big Marijuana?
To be sure, many, many–maybe a majority of–pro-legalizers claim to want to promote self-cultivation and smaller firms. But widespread legalization, in order to take place, will probably require some larger corporations and not a little rent-seeking and regulatory capture. Also: it’s likely to see Big Marijuana conduct studies downplaying, using not entirely scrupulous methods, the averse health effects of marijuana.Report
I think this is a cultural issue. There is a culture that like marijuana, sees it as harmless and want to make it legal everywhere. That same culture looks at smoking nicotine as evil and there nothing good about it. Any kind of way to produce less harm is basically complicit in evil.Report
Lung cancer deaths did not start within a few years of widespread cigarette use. The curve went up after decades. Illnesses caused by exposure to toxins often take a bit of time to show up. Public health authorities should look for the occurrence of issues when something novel comes along. Now, I agree that we do trend to shout when we ought to speak calmly in many situations in public health and lots of other things. To me vaping is new enough that concern about a few cases is appropriate.Report
Lung cancer deaths didn’t start immediately, but lung damage is pretty immediate. We know where to look (and we should definitely be looking there, and are).
This is a little bit different in that it did come out of nowhere. Not the product of a long grind, but an immediate reaction (and among otherwise less at-risk users and only in some places). So they should be looking at rather specific triggers rather than vaping in general, in this case.Report
It’s also the case that there is a clear and definite correlation between “used illegal third-party products” and “experienced lung damage”, which was not the case for cigarettes. It’s not as though the vapers experiencing lung damage or death are spread randomly across all users, which you would expect if there were a general hazard from the activity.Report
In California, they sell THC vaping products in the marijuana stores. I have shopped in such stores, and never seen flavored THC oil. The point of vaping THC is the same as regular vaping — one wants the pleasant effects without the unpleasant side effects of yucky smoke.
As for flavors luring youngsters to vape — if they love bubble gum or grape soda so much, you’d think they’d actually consume those products rather than bothering with an expensive device just to inhale their scent.Report