Deaths linked to vaping - what do we know so far?
The headlines about vaping over the past week have been dominated by the news of a severe respiratory illness that has killed five people, and hospitalised many more, in America. As the deaths are being linked to vaping, we felt compelled to investigate further.
As of 6th September 2019, the CDC (Centers for Disease Control and Prevention) has reported over 450 possible cases, across 33 states, of mysterious lung illnesses. Although they haven’t officially identified a cause, all patients have a history of using e-cigarettes.
Predictably, this has caused the anti-vaping contingent to come out waving their pitchforks and brandishing their torches. Peak vape panic ensues as US public officials, and the media, escalate their war on e-cigarettes. E-cig users are being warned to ‘stop vaping NOW’. State Governors call for immediate bans and declare vaping a ‘public health emergency’ and an ‘epidemic’.
In order to deliver a more balanced report, and make sense of the facts behind these headlines, we wanted to find out if vaping really is a public health crisis, or if its risks are being blown out of all proportion.
What is the diagnosis of the illness?
All reported cases are pulmonary in nature, which means the diagnosis is related to the lungs. All affected individuals experienced respiratory symptoms including cough, chest pain, shortness of breath, and fatigue. Some also reported vomiting and diarrhoea. Symptoms worsened over days or weeks until the patients required hospital admission. Tragically, in five known cases so far, the illness has led to death.
There seem to be two main conditions being attributed to the outbreak. The first is a specific form of lung inflammation called lipoid pneumonia.
Lipoid (or lipid) pneumonia is a rare form of pneumonia that can occur when either oils or lipid-containing substances enter the lungs. Once in the lungs, the substance causes an inflammatory reaction; the severity of the reaction depends on the type of oil and the length of exposure. Severe inflammation can permanently damage a person’s lungs.
The second condition being widely diagnosed in these reported vaping cases is Acute Respiratory Distress Syndrome (ARDS).
ARDS is a type of respiratory failure characterised by rapid, widespread lung inflammation and is caused by fluid building up in the tiny air sacs (alveoli) in the lungs. The fluid prevents the lungs from filling with enough air which means that less oxygen reaches the bloodstream and organs.
ARDS usually follows a major illness or lung injury. One of the most common underlying causes of a lung injury capable of triggering ARDS is the inhalation of certain chemical fumes. Many people who develop ARDS don't survive; the risk of death increases with age. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs.
What’s causing the illnesses?
Since each of the patients has reported a history of vaping, e-cigarettes were immediately seized upon as the culprit. However, if a person dies or is injured in a house fire because they put a foil tray in the microwave, you wouldn’t tell people to stop using microwaves. Instead, you’d remind them not to put metal objects *IN* the microwave.
In all cases, evidence is pointing to what was put *IN* the e-cigarette that is causing the illness.
Bootleg vape juice
As more cases are thoroughly investigated, reports suggest that there are links to people using illicit ‘bootleg’ vaping fluid. Either bought from black market sources, or homemade, the counterfeit vape juice is created so that people can vape THC oil or synthetic cannabinoids, like Spice, to exploit their high-inducing properties.
A new ingredient, known as Honey Cut or Clear Cut, is being (mis)used in these bootleg THC vape cartridges. The product is made from Vitamin E oil (tocopheryl-acetate) and is used in black-market THC e-liquid as a cheap way of diluting the THC without thinning the viscosity, which makes it suitable for vaping.
Tocopheryl-acetate was found in nearly all the samples taken from patients who fell ill across New York State in recent weeks. It is the first common element to be discovered since, to date, officials have found no commonality amongst brands of e-cigarette or vape juice used by patients.
Why does Vitamin E cause a problem in vape juice?
Vitamin E is found naturally in certain foods such as olive oil and almonds. The oil derived from vitamin E (tocopheryl-acetate or vitamin E-acetate) is available as a food supplement, and is commonly used in topical skincare products. It is safe when ingested or applied to skin; so why is it causing people to fall ill?
The problem lies when it is taken into the lungs. The molecular structure of vitamin E-acetate can make it hazardous when inhaled. It is definitely credible that the oil-like properties are what is causing the two main respiratory conditions that we outlined above.
Is there cause for concern for UK vapers?
The US outbreak has led to fears that UK vapers could be affected by these terrible lung conditions. However, Martin Dockrell, head of Tobacco Control at Public Health England, was quick to remind people of the distinction between vaping in the UK compared to the US. He said,
“Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare Products Regulatory Agency and they operate the yellow card scheme, encouraging vapers to report any bad experiences.”
Further to this, the chief executive of health charity Action on Smoking and Health (ASH), Deborah Arnott, said that to date none of these serious side effects had been reported in the UK. She went on to state,
“In Britain, you can check on the Medicines and Healthcare Products Regulatory Agency (MHRA) website whether the product you’re using has been notified and can be legally sold.”
Why do some American states want to ban vaping?
Short-sighted knee jerk reactions are, unfortunately, all too prevalent across the pond. If e-cigarettes are a common denominator in this outbreak of illnesses, then banning vaping is their (il)logical conclusion.
However, history has shown us that blanket bans and prohibition simply don't work. When consumers have no legal alternative, they will invariably turn to black market options.
If we look at the number of outbreaks by state, the majority come from states where legal access to tested cannabis products is restricted, or completely prohibited. Therefore, we can safely conclude that if the product is illegal now, and people are still getting hold of it, a further ban won't help.
All a ban will achieve is ensuring that people who want access to e-cigarettes to help them overcome their addiction to nicotine will suffer. Following the same logic as the cannabis bans that have contributed to this issue, if nicotine vaping is banned then people will look to the black market for vaping products, or they will go back to smoking traditional cigarettes.
Vaping saves lives
Smoking is the single biggest cause of preventable deaths - in England alone smoking accounts for 80,000 deaths each year. It is widely known that e-cigarettes are more than doubly effective at helping people to quit smoking than any other method.
We have never tried to claim that vaping is harm free. However, when compared to smoking, vaping certainly falls under the harm reduction tactics that our health officials in the UK are so keen to promote. Public Health England published their report that vaping is proven to be at least 95% safer than smoking back in 2015, and they have maintained this stance ever since. As long as people have access to properly regulated and tested vaping products, they should see significant health benefits when switching from smoking to vaping.
A heavy handed crackdown on e-cigarette use is an irrational response to a tragic event. If these state governors think that tens of thousands of vapers are simply going to quit nicotine cold turkey, then they clearly don’t know much about nicotine addiction.
Rather than punishing vapers, they should be focused on the root cause of the illnesses. All the current evidence for this points to bootleg THC, CBD, and synthetic cannabinoid vape juice.
Deaths linked to vaping takeaways
However tragic the current events in the US are, it is always worth remembering that the truth is often hidden behind scaremongering headlines. The US media, in particular, has an anti-vaping agenda which is influenced by the Master Settlement Agreement (MSA). Any decrease in cigarette sales means less money for the individual states because the major tobacco companies are contractually obliged to split their profits with the US government. Hence, they are very wary of e-cigarettes becoming too popular.
If you’re concerned about harmful additives in your e-liquid, make sure you only purchase your vaping products from reputable sources. In the UK that is far easier to do since the sale of such products is regulated by the Tobacco Product Directive. Never be tempted to purchase ‘cheap’ e-liquid from unscrupulous merchants. It could be bootleg and made from unregulated ingredients - your health simply isn’t worth the cost savings.
Finally, a quote from Paul Aveyard, a professor of behavioural medicine at the University of Oxford, regarding these recent reported illnesses. He said,
“These cases are worrying and need investigating but advice from all official bodies in the UK is that it is always preferable to vape than to smoke. These reports should not change that advice.”
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- Nicola Webster