Up in Smoke – The Ugly Truth About Vaping

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The first symptoms may be unexpected—severe nausea, prolonged vomiting, diarrhea. These don’t seem like symptoms that would be caused by inhalation. But the gastrointestinal issues are followed by shortness of breath and asthma-like wheezing. Symptoms may come on suddenly or worsen for weeks before a person goes to the hospital for help. Some don’t go to the hospital and die at home. So far, 83 lung illnesses in Utah have been reported as related to vaping with one resulting in death.

“They’re calling it the snapchat of smoking. All the kids are doing it, and even older millennials don’t know what’s going on. I’m talking of course, about vaping.” That’s not a direct quote from a local news broadcast, but with all the frighteningly vague stories popping up on television, it may as well be. Utah, like the rest of the country, has become embroiled in a vaping crisis over the past year. Misinformation abounds, engendering a dangerous level of confusion surrounding the surge in vaping-related illnesses and lung injuries. Now, legislators, officials and health care professionals are caught playing catch-up in an attempt to regulate a perplexing product and control a situation that has gotten out of hand before it was even recognized.

The vaping crisis consists of two distinct issues. The first—which has been the primary subject of panicky news coverage—is the surge in acute lung disease, which is associated with use of illicit THC vape products. The other concerns widespread nicotine-based vape product use, particularly among teens. The two problems, however, do intersect in several ways, including sharing a lack of data-driven information and regulatory oversight.

Dr. Sean Callahan, Assistant Professor of Internal Medicine at the University of Utah and a pulmonologist at the U of U hospital who works in the ICU, provided us with concrete information about vaping-related illness. On the probable causes and health outcomes associated with vaping illicit THC products, he stressed the importance of battling misinformation.

“Something changed in 2019 with the rise in acute lung disease related to vaping,” Dr. Callahan says. “There’s a misconception that people are inhaling a bunch of oil. That’s not what’s happening. Something people are inhaling is causing an inflammatory response in their lungs. We’re not certain what substances are to blame, but I suspect there are several. Vitamin E acetate is a likely culprit, but even if we remove that from the supply there are so many different ingredients being heated to different temperatures by different devices that it’s hard to identify what’s causing all cases.”

Most cases can be directly linked to the use of illicit THC products, which does not include THC products purchased legally in states neighboring Utah like Colorado and Nevada. Still, between 10 and 20 percent of cases are unaccounted for as patients deny having used THC products. Dr. Callahan said treatment for vaping-related illness typically consists of vaping cessation and the use of steroids to control inflammation. Some cases are relatively easy to treat, while others have been deadly. Long-term effects are largely unknown.

“We’re almost certainly going to see long-term pulmonary issues like asthma and COPD in some people who vape, but it hasn’t been around long enough, and it hasn’t been studied enough,” Dr. Callahan says. “In the U.K. vaping has been used effectively to facilitate smoking cessation, and I’m not opposed to that. The idea was marketed similarly in the U.S., but we don’t have the regulatory support to do that here.” The high rate of vaping among teens in Utah, often fueled by a lack of information, is particularly concerning. “A lot of teens we see in the clinic don’t think there’s nicotine in what they’re vaping, but there is,” Dr. Callahan says. Many users think they’re just inhaling harmless flavored water vapor when they’re using an insidiously habit-forming product, and flavored vape cartridges are undoubtedly targeting minors in ways that would make Joe Camel blush.

Callahan says research shows people who use standard nicotine vaping products are more likely to try smoking cigarettes and THC-containing vape products. That trend was at the heart of efforts by Utah officials to implement an emergency restriction that would remove all flavored vape products from grocery and convenience stores. District Judge Keith Kelly struck down the measure, saying the Utah Department of Health’s (UDOH) assertion that the trend of nicotine users moving on to vaping THC doesn’t constitute imminent peril, which is required to implement emergency restrictions. UDOH responded by following the state’s normal 120-day process for making new regulations and published draft rules on January 1 that would reinstate the ban on flavored vape products outside of specialty tobacco shops. As of the present time those rules are still being debated with attorneys representing vape retailers arguing the new rules would hurt 90 percent of the state’s 1,700 tobacco retailers, 1,300 of which are classified as small businesses.

Meanwhile more than 125 cases of vaping-related lung illness have been identified in Utah. By the end of 2019 vaping rates in Utah were higher among high school seniors than any other age group surveyed by UDOH.

Health officials are stuck playing regulatory catch-up, but pro-business factions in Utah have historically wielded strong political influence against what they deem “overreach.” We’ll soon find out if Utah legislators have the moral courage to stand up for the health of their Utah residents, particularly minors. I wouldn’t hold my breath.