Electronic cigarettes, or e-cigarettes, include a diverse group of battery-powered devices that allow users to inhale aerosolized substances. E-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke.However, e-cigarette aerosol is not harmless; it can expose users to substances known to have adverse health effects, including ultra-fine particles, heavy metals, volatile organic compounds, and other harmful ingredients.
E-cigarettes and other vaping devices were first developed to help cigarette smokers quit their dangerous habit by providing a way to satisfy their nicotine addiction without inhaling the toxins the come from burning tobacco. But many medical experts now think even smokers should think twice about turning to e-cigarettes — and anyone who does not smoke should not vape.
The only states that do not regulate indoor vaping at all, be it by state territory or on a local level, are the states of Nebraska, Nevada, Rhode Island, and Tennessee. The rest of the United States has a patchwork of regulations, varying from state to state and in some instances, from locality to locality. With recent illnesses and deaths related to the use of vaping products, some states and the Federal Government are considering outrights ban on e-cigarettes and vaping products.
Health investigators believe the illnesses are linked to vaping for several key reasons: The patients have vaped nicotine or marijuana extracts, or both, and do not have an infection or other condition that would explain the lung disease. Patients are now characterized as having the illness only if they have reported vaping within 90 days. In many of the reported cases, the patients had vaped much more recently.
San Francisco was the first major U.S. city to ban e-cigarettes, in a measure city supervisors passed unanimously in June of 2019.
Michigan has become the first state to prohibit sales of most flavored e-cigarettes in a bold move to curb the underage vaping epidemic.
The Trump Administration, in a statement by Health and Human Services Secretary Alex Azar , intends to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities.
The F.D.A. recently issued this statement: “Because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”
Acute Physical Injuries
Anyone who uses e-cigarettes or other vaping devices, whether to consume nicotine or substances extracted from marijuana or hemp, may be at risk because investigators have not determined whether a specific device or type of vaping liquid is responsible.
But some of the patients who have fallen severely ill said they did not vape THC. In 53 cases of the illness in Illinois and Wisconsin, 17 percent of the patients said they had vaped only nicotine products, according to an article published on Friday in The New England Journal of Medicine.
The researchers who wrote the journal article cautioned, “e-cigarette aerosol is not harmless; it can expose users to substances known to have adverse health effects, including ultrafine particles, heavy metals, volatile organic compounds and other harmful ingredients.”
The health effects of some of those chemicals are not fully understood, the researchers wrote, even though the products are already on the market.
Hundreds of people across the country have been sickened by a severe lung illness linked to vaping, and a handful have died. Many were otherwise healthy young people, in their teens or early 20s. Investigators from numerous states are working with the federal Centers for Disease Control and Prevention and the Food and Drug Administration in an urgent effort to figure out why.
The early symptoms include fatigue, nausea, vomiting, coughing and fever, escalating to shortness of breath, which can become so extreme it can prompt an emergency room visit or require hospitalization.
Some patients have needed supplementary oxygen, including a ventilator in as many as a third of cases analyzed in The New England Journal of Medicine.
On lung scans, the illness looks like a bacterial or viral pneumonia that has attacked the lungs, but no infection has been found in testing.
Anyone who has shortness of breath that lasts more than a few hours or becomes severe should seek medical attention quickly. It is a warning that should not be ignored, doctors say.
Outbreak of Sudden Deaths
The popularity of e-cigarettes and vaping products among teenagers has skyrocketed in recent years. In February, the US Centers for Disease Control and Prevention reported a 78 percent increase in high school students’ vaping from 2017 to 2018.
Vaping has recently been linked to at least five deaths and 450 illnesses nationwide, prompting the US Centers for Disease Control and Prevention to warn people “to consider not vaping pending further investigation.” The first death from lung illness linked to vaping in the United States was reported in Illinois in August of 2019. The person who died was an adult. Oregon saw the second death in the nationwide outbreak, then Minnesota and Indiana. The fifth death was in California in September of 2019.
The Michigan Department of Health and Human Services reported that the state is investigating six cases of severe respiratory illnesses linked to vaping.
Although the US Food and Drug Administration is still investigating the cause and circumstances of the both the illness and the death, it is warning that there appears to be a particular danger for people who vape THC, the psychoactive chemical in marijuana. The F.D.A. said a significant subset of samples of vaping fluid used by sick patients included THC and also contained a chemical called vitamin E acetate.
Federal health authorities say vaping giant Juul Labs illegally pitched its electronic cigarettes as a safer alternative to smoking, including in a presentation at schools. All the while, the JUUL product delivers higher concentrations of nicotine than other available vaping devices.