Who would ever bet that products used without serious issues for over a decade by more than 20 million people worldwide would suddenly cause an outbreak of acute (sudden, developing within a few days of weeks) lung failure and several deaths only in one geographical region? For the past month, this has been a prevailing narrative about electronic cigarettes in the United States. Health authorities describe a “vaping disease,” a severe inflammatory condition affecting the lungs. The illness develops within a very short period and is in reality poisoning of the lung. Over 800 cases have been reported in the past few weeks, including thirteen deaths.

E-cigarette use has escalated globally since 2009. Almost 11 million adult Americans used them in 2016, which represents 4.5 percent of the adult population. There are probably more than 20 million vapers worldwide; people who use conventional, flavored, nicotine liquids. But there was no outbreak of serious lung failure in any country other than the United States. Why? The answer is simple: conventional e-cigarette products and liquids are not associated with the disease. Simple epidemiology and common sense make this clear: it is impossible for products which have been used for years without any intoxication outbreaks to cause this serious illness only today and only in one region. These cases are not related to long-term use of e-cigarettes, and they are not linked to vaping products that have been available for years. Instead, these cases can only be associated with the recent release of new products or to recent modifications in the ingredients of products.

THC Vaping Liquids

A recent modification of nicotine products has not been reported anywhere and is highly unlikely. Raw ingredients of nicotine e-liquids are cheap, easy to find and work well as solvents. But there is the THC story. The vast majority of cases reported the use of THC liquids, some in addition to conventional nicotine products. Some people described a transition from legal to illicit (black market) products shortly before developing the disease. The use of THC liquids should not even be called vaping, and the products should not be called e-cigarettes, because they are very different from the conventional e-cigarette products that have been used for the past decade.

This teen used e-cigarettes – as much as one pod per day – for 1 1/2 years with no problems, then switched to THC oils and developed the dreaded "vaping-associated pulmonary illness." And CDC is still not even mentioning the use of THC oils in its public warning. @CDCTobaccoFree

— Michael Siegel (@mbsiegel) September 12, 2019

THC has been used through inhalation for decades, mainly through smoking and dry herb vaporizers. This makes THC itself an unlikely culprit for the disease cases. However, THC oils used in cartridges for inhalation represents a relatively recent phenomenon and contain other ingredients besides THC. Thickeners are solutions used to increase the viscosity of the THC concentrate to make use through a cartridge easier. Vitamin E acetate, used as a thickener, has been reported as a common finding in THC liquids used by patients. A common characteristic of vitamin E and THC is that they are water-insoluble but easily dissolved in lipids, such as vegetable or mineral oils. The use of vegetable oils in THC liquids as a solvent-thickener could be the cause for these disease cases. While this is still under investigation, it is clear that THC oils are associated with the outbreak.

Crusade Against E-Cigarettes

The biggest catastrophe for public health may not even be the disease cases and deaths of the past few weeks. More than 1,200 Americans die prematurely due to smoking-related disease every day. E-cigarettes have helped millions to quit smoking. The reasonable and justified concerns of regulators, politicians, and scientists about the recent outbreak have resulted in a relentless, hysterical crusade against e-cigarettes.

Recommendation such as the American Lung Association’s that “none should use e-cigarettes” have been addressed to millions of vapers, including many who formerly smoked cigarettes. The knee-jerk regulatory reactions of banning flavors are irrelevant to the outbreak’s cause. Adolescents and young adults who are now (or have been) hospitalized with a life-threatening condition are very unlikely (probably impossible) to have chosen THC oils because of flavors. The current recommendations and regulatory actions will neither prevent nor discourage anyone from using illicit THC oils. At the same time, adult vapers who use flavors and report they have helped them quit smoking and avoid relapse will also be harmed. This climate of terror and intimidation against e-cigarettes, which is far from being justified, will very likely result in a massive wave of vapers relapsing to smoking. Regulatory reactions send the wrong message to everyone.

Hysteria and Common Sense

Imagine having a crisis of deaths due to injecting illicit narcotics or contaminated medications and blaming the syringes for the deaths, the same syringes that people with diabetes use to inject their insulin. Insulin is not safe for everyone, but it is life-saving for diabetics. E-cigarettes are not safe for everyone, but they are life-saving for smokers unable or unwilling to quit with other methods. Importantly, e-cigarettes do not appear to be implicated in the recent outbreak of lung intoxication. This hysteria will cause far more deaths for many years to come by missing a historical opportunity to eliminate smoking forever.

Photo: AFP

As for the lung disease outbreak, the advice that everyone should receive is clear. Do not use illegal THC oils or any THC oils for inhalation until we know which ingredients cause the disease. Avoid using newly-developed nicotine e-cigarette liquids that were not previously available in the market (as a precaution for a very unlikely scenario). Do not (at any cost) relapse to smoking by falsely thinking that vaping conventional e-cigarette liquids is more harmful than smoking. There is only one hope: that common sense will prevail.

dr. Konstantinos Farsalinos Physician and researcher who has written chapters for two books on e-cigarettes and has published over 70 studies on e-cigarettes and tobacco harm reduction in the international scientific literature

Source: Crusade Against Vaping E-Cigarettes is Catastrophic for Public Health

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We have. Many times. And it’s still frustrating.  That’s why we decided to try and collect all the potentially confusing frequently asked questions and statements about vaping  Not because these statements could be correct, but because the answers are often too complex to answer in a simple and quick manner if you’re unprepared.  Of course, we will try and find clear, simple and effective answers, which are true and supported by proper scientific research.

Let’s see:

“Vaping is at least as harmful as smoking cigarettes”

Not true. Research has shown that vaping is at least 95% less harmful than smoking cigarettes. So far the research has not shown any relevant clear effects on health.

Source: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456704/McNeill-Hajek_report_authors_note_on_evidence_for_95_estimate.pdf

“By using an e-cigarette you are inhaling toxins”

Unlike with smoking regular cigarettes, we are inhaling vapour, not smoke. Since there is no combustion in e-cigarette, the vapour does not contain carbon monoxide and numerous other harmful products of incomplete combustion. Inhaling vapour has been proven to be a lot less harmful than inhaling smoke.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

“Vapour contains some carcinogenic substances, just like cigarette smoke”

Partly true. Emission measurements have shown presence of some carcinogenic substances in e-cigarette vapour. However, these substances are present in far smaller or even trace quantities. Often these same substances are also present in other products or foods which we use every day and are proven to have no relevant effect on health.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

“I read in a paper that Japanese scientists have proven that vaping has very harmful effects on health”

It is true that there was a study conducted in Japan which showed high concentrations of formaldehyde and other carcinogenic substances in the vapour. The findings were later discarded due to improper methodology. The researchers used the “smoking machines” which literally burned the cotton in the heating coils and thus created harmful combustion products. In practice such use of e-cigarettes never occurs, as it is impossible to inhale such vapour.

Source: http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/2014/188-frm-jp

“Vaping liquid contains antifreeze and other chemical garbage«

E-cigarette liquid contains mainly different ratios of two ingredients – propylene glycol and natural vegetable glycerine. Both compounds have been known for a long time and are used in many foods and cosmetic products which we use daily. Many studies have been conducted and they have all shown that these substances are safe for consumption. It is true that propylene glycol is used in anti-freezing products, but that doesn’t mean it is harmful. In addition to these two substances, e-liquid may contain nicotine, water and flavours used in food industry. Only minor amounts of these substances are used.

“Nicotine causes cancer”

Proven to be incorrect. While nicotine is responsible for addiction, scientific research has unequivocally shown that it does not cause cancer. Cancers are caused by carcinogenic substances in cigarette smoke which are products of incomplete combustion. In e-cigarette vapour, these substances are either present in trace amounts, or not present at all.

However, even though there is no scientific basis, the belief that nicotine is responsible for all adverse effects of smoking is deeply rooted in people’s consciousness.

Source:  http://annals.org/aim/article-abstract/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement

“Why would the government adopt a law restricting and regulating e-cigarettes if they are so harmless?”

The government adopted the Restriction on the Use of Tobacco Products and Related Products Act because of the EU Directive which is the result of pressure from the WHO and some interest lobbies in the EU parliament. The pressures are the result of fear that e-cigarettes may potentially have long-term health effects which are still unknown to the science. Also, there is a fear that e-cigarette use could encourage adolescents to start smoking tobacco cigarettes. These arguments have already been refuted by later research.

“Only long-term studies will show the true harmfulness of vaping”

Not true, although it may sound like a good argument. All components of e-liquid have been well researched. The biggest unknown are the flavours which are already used in food industry. Long-term studies are essentially statistics – monitoring the probability of an illness in relation to vaping for decades. Since it is not really known what should be monitored (the subject of the research), and since it will not be possible to find a representative sample to be followed (sufficient number of non-smokers who use e-cigarettes for decades), it is likely that the long-term studies will never be conducted.

Also, let’s not forget that several millions of people have been vaping for more than a decade, and no relationship was found between vaping and occurrence of any illness.

“E-cigarette vapour contains diacetyl which causes bronchiolitis.”

Partly true. Vapour from e-liquid containing some creamy flavours contains diacetyl. It is also true that inhaling large amounts of diacetyl for decades causes bronchiolitis. However, the Food and Drug Administration lists diacetyl as a safe component of flavours, as there is no substantiated evidence that it is harmful in amounts inhaled.  Bronchiolitis is caused by long-term inhalation of diacetyl for decades. It has been proven that the amount of diacetyl inhaled with the e-cigarette use is approximately 750-fold lower than inhaled with smoking.

So far no cases of bronchiolitis as a result of smoking have been documented.

Sources: http://tobaccoanalysis.blogspot.si/2015/12/new-study-finds-that-average-diacetyl.html
http://www.ecigarette-research.org/research/index.php/research/research-2015/190-niosh-da

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