In response to the seventh death from severe lung injury associated with vaping, which occurred in Tulare County, California, the Tulare County Health and Human Services Agency issued a warning against the use of electronic cigarettes: "The Tulare County Public Health Branch would like to warn all residents that any use of e-cigarettes poses a possible risk to the health of the lungs and can potentially cause severe lung injury that may even lead to death."
In response to an earlier death that occurred in southern California, which is part of the same national outbreak that has affected nearly 400 individuals, the Los Angeles County Department of Public Health issued a similar warning not to use e-cigarettes, which it defined as "battery-powered devices that heat a liquid substance (e-liquid or e-juice) that contains nicotine, flavorings, and other additives and deliver the nicotine and flavoring to the user in the form of an aerosol." Based on this definition, a warning not to use e-cigarettes is likely to be interpreted as a warning not to vape nicotine-containing e-liquids.
At first glance, these warnings might appear to be reasonable public health messages. But a closer examination reveals that the communications that health agencies, including the Center for Disease Control, are disseminating to the public are hiding some critical information.
What ties together the patients who died in Tulare County and Los Angeles County is not that they both vaped "electronic cigarettes," but that they both used illicit THC (marijuana) vaping cartridges that they purchased illegally off the black market. In the two other deaths in which authorities released information about the products used (one in Oregon, one in Minnesota), each involved vaping marijuana, not electronic cigarettes.
All in all, approximately 90% of the confirmed cases have admitted to, or been found to have been using, illicit THC carts. Although the death in Oregon has been attributed to the use of a legal THC cart purchased from a dispensary, it was recently revealed that cannabis distillate cut with vitamin E acetate oil was being sold at Oregon dispensaries. This is the same oil that was detected in every THC vape cartridge tested in New York state.
In light of these facts, it is inexcusable that health authorities continue to blame the outbreak on electronic cigarettes generally rather than on vaping marijuana specifically. By failing to explicitly warn the nation's youth not to vape marijuana, the CDC and other health agencies are actually helping to further spread the outbreak, not to curtail it.
But the negative public health implications of this public deception goes much further. Because of the CDC's conflation of the problem of youth e-cigarette use and the respiratory disease outbreak, policymakers nationwide (including the Trump administration and officials in several states) are now considering a complete ban on all flavored electronic cigarettes. Michigan's governor has already issued such an order using her emergency executive powers. This is like responding to an outbreak of contaminated lettuce by banning flavored cabbage.
To call this an overreaction is an understatement.
The irony is that banning flavored e-cigarettes is only going to make the outbreak worse. Instead of vaping flavored e-liquids, more and more youths will switch to vaping black market THC liquids. Moreover, ex-smokers who currently rely on flavored e-cigarettes to stay away from smoking will most likely either return to smoking or purchase illicit vape juice from what will be a new black market for flavored e-liquids.
Unlike illicit THC vape cartridges, which we now know can be deadly, there are no known, serious acute health effects of e-cigarette use. Although these products do cause respiratory irritation and have short-term, subclinical effects on the lining of blood vessels, the short-term use of e-cigarettes is not linked to clinical disease.
Does this mean that youth e-cigarette use is not a serious health problem? No.
However, it is a problem not because it is causing life-threatening respiratory injury, but for two other reasons. First, it can be highly addictive, especially the use of e-liquids containing nicotine salts, such as Juul or Saurin. Second, we just don't know what the long-term effects may be.
We do need to address youth e-cigarette use, but banning flavored e-cigarettes is not the right way to do this. Instead, the FDA should regulate these products to limit their access to youth. This could be done by restricting the sale of all tobacco products, including both cigarettes and e-cigarettes, to adult-only stores.
Prohibition does not work, but proper regulation could.
Michael Siegel is a professor in the Department of Community Health Sciences at the Boston University School of Public Health. He wrote this for InsideSources.com.
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