Hundreds of serious e-cigarette or vaping product use associated lung injuries – collectively called “EVALI” by the Centers for Disease Control and Prevention (CDC) – have recently been reported in the U.S. The more than 1200 cases of severe pulmonary disease and lipoid pneumonia — with several reported as fatal — followed use of an e-cigarette or vaping device, both of which work by heating liquid that is turned into an aerosol inhaled by the user. Patients experienced extreme shortness of breath, cough, chest pain, fever, vomiting, diarrhea and fatigue, and many required hospitalization.
No single ingredient linked to lung disease cases
In response, the CDC launched an investigation and found that several of those sickened after they used e-cigarette devices inhaled the aerosol from liquids that contain cannabinoid products, such as tetrahydrocannabinol oil, popularly known as THC. In fact, 76% of those suffering with EVALI reported using TCH products, while 58% reported using products containing nicotine.
However, the agency has been reluctant to label one single compound or ingredient as the cause of the injuries and nicotine-containing products have not been excluded as a possible cause. Therefore, the CDC partnered with the U.S. Food and Drug Administration (FDA) and state and local agencies to issue an advisory recommending against the use of all e-cigarette or vaping products that contain THC, nicotine or a combination of the two.
Other CDC recommendations include the following:
- Do not buy any type of vaping products, particularly those containing THC, off the street.
- Do not modify or add any substances to vaping products that are not intended by the manufacturer, including products purchased through retail establishments.
- If using e-cigarette or vaping products to quit cigarette smoking, do not return to smoking cigarettes and instead talk to your doctor about evidence-based cessation treatments.
- If you choose to continue to use these products, carefully monitor yourself for symptoms and see a health care provider immediately if symptoms develop.
- E-cigarette or vaping products should never be used by children, young adults or women who are pregnant.
Concerns about youth and vaping
While vaping products were originally marketed as a tool to help adults quit smoking, vaping has reached what experts are now calling an epidemic among youth. The sweet-sounding flavors and vape pens that look like innocuous USB drives attract teens who were led to believe they are a “safe” alternative to tobacco. In fact, of those reporting symptoms of EVALI, the median age is 24 years old and 15% of patients are under 18.
“Due to the relatively recent development of these products, there is grave concern that our youth are being used as human guinea pigs with a well-known neurotoxic product,” says Dr. Matthew Messoline, a family medicine doctor at Sharp Rees-Stealy. “We already know that smoking nicotine and THC in any form during adolescence increases the risk of developing psychiatric disorders like anxiety, depression and cognitive impairment in later life.”
In general, e-cigarettes and other vaping devices — the most popular tobacco product among youth, according to Truth Initiative, an organization dedicated to encouraging youth to reject tobacco use — are dangerous, whether they contain THC or not.
There are several concerns about the dangers of e-cigarettes and other vaping devices, including:
- They contain toxic substances, such as flavorings and humectants that have not been approved by the FDA for inhalation.
- The products can have variable levels of nicotine, some as high as a full pack of cigarettes.
- Vaping increases the likelihood young people will smoke cigarettes or use other tobacco products.
- The use of nicotine by young people has an effect on key brain receptors, making them more susceptible to addiction.
- The risk of stillbirth or preterm delivery increases when pregnant women use nicotine.
- Devices can explode and lead to severe burns or other injuries.
- Secondhand aerosol exposure can be dangerous, especially to people with chronic illness, pregnant women and children.
In fact, the CDC reports that there is no safe tobacco product, and the use of any tobacco products – including vaping products – carries health risks for people of all ages. The agency further advises that if you do not currently use tobacco products, you should not start using vaping products.
“It is best to avoid these products, as surveys have shown the majority of adolescent users were not aware these products always contain nicotine,” Dr. Messoline says. “If you are looking for help, we strongly encourage you to talk with your doctor for information and assistance with quitting.”
Update: In November 2019, the CDC identified Vitamin E acetate as a factor in all EVALI cases.
This story was updated in October 2019 to include new information from the Centers for Disease Control and Prevention.