E-cigarettes - The Dangers of Vaping

E-cigarette companies like Blu, JUUL, and NJoy have been on the market for nearly a decade, establishing their brands of cartridges, pods and delivery devices early with little to no FDA oversight.  In 2016, the FDA granted retailers and companies with these products on the market two years to submit applications for evaluation. The applications are due in May 2020, and while under review, these companies can continue to sell their products.
 
Are E-cigarettes less harmful than smoking?

• E-cigarettes nearly always contain ingredients that are harmful, including nicotine.
• Many e-cigarettes contain acrolein, an ingredient known to cause irreversible lung damage. In addition, exposure to nicotine during adolescence can harm brain development.
• Experts are working to determine the cause of respiratory illnesses and related deaths, but believe acrolein and formaldehyde could be to responsible, in addition to vitamin E acetate (a component of vegetable oil frequently used to turn THC or nicotine into the aerosol users inhale).
• The most popular product among teens is JUUL. According to manufacturer JUUL, a single JUUL pod can contain as much nicotine as a pack of cigarettes.  
• Currently, the FDA has not found any e-cigarette to be a safe and effective way to help smokers quit.

 
American Cancer Society 
Are there any differences between e-cigarettes and JUULing?

• No. JUULs look different, but they are a type of e-cigarette.
• JUUL's design looks like a USB drive.
• E-cigarettes are battery-powered and deliver nicotine through a liquid, which turns into an aerosol.
• E-liquids come in mint, mango, cream, cucumber, menthol, Virginia tobacco and classic tobacco, flavors that appeal to youth.
• JUUL's cartridge-based e-cigarettes contain nicotine salts that do not produce a plum of visible smoke vapor, which may make the JUUL's product even more enticing and addictive.
• The manufacturer JUUL claims that some of its products have roughly as much nicotine as an entire pack of cigarettes.

 
American Cancer Society
Formerly employed at the FDA, Dr. Scott Gottlieb, believes that counterfeit pods are responsible for the respiratory illnesses and deaths. He stated that he believes the manufacturers are culpable if their products are being used, regardless if the liquids are counterfeit or real. “Ultimately, they are responsibility lies with keeping their products out of the hands of kids.” Business Insider
 
The National Academies of Science, Engineering, and Medicine released a consensus study report in January 2018 that reviewed over 800 individual studies. The report was clear: e-cigarette use causes health risks. E-cigarettes contain and emit a number of conceivably toxic substances. The report also asserts there is moderate evidence that youth who use e-cigarettes are at increased risk for asthma exacerbations, coughing and wheezing.

• A University of North Carolina study found the two primary ingredients found in e-cigarettes - vegetable glycerin and propylene glycol - are toxic to cells and when more ingredients are added to e-liquid, the greater the toxicity.
• E-cigarettes contain several dangerous chemicals including formaldehyde, acetaldehyde, and Acrolein. Aldehydes can cause lung disease and cardiovascular (heart) disease.
• E-cigarettes also contain Acrolein, an herbicide primarily used to kill weeds. It can cause acute lung injury, asthma, COPD and possibly lung cancer.

• The U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have issued warnings regarding the risks of inhaling secondhand e-cigarette emissions.
• The Surgeon General concluded in 2016, that secondhand emissions contain ultrafine nicotine particles from flavorings such as diacetyl. 
• Diacetyl is linked to serious lung disease; as well as volatile organic compounds such as benzene, which can found in car exhaust and heavy metals, such as tin, lead, and nickel. 
• The Food and Drug Administration has yet to find an e-cigarette that is safe and effective in helping smokers quit. Recommending instead that smokers who want to quit smoking call 1-800-QUIT NOW or speak to their doctor about available solutions using FDA approved methods, treatments, and counseling.

 
American Cancer Society.
One e-cigarette study found users were inhaling nickel, lead, manganese, and chromium in concentrations that neared, met, or exceeded limits the EPA defined as safe. Business Insider, Sept. 19, 2019.
 
The Numbers

• August 2019 - first vaping-related death was reported
• August 22 - 193 potential vaping-related illnesses in 22 states
• September 13, 2019 - Six deaths and 450 cases of reported lung illness
• September 17, 2019 - 530 reported cases of vaping-related illnesses in 38 states and 7 deaths in 6 states (California, Indiana, Illinois, Kansas, Minnesota and Oregon). [According to NBC News, “several” of the deaths were adults.]

The CDC has advised against using e-cigarettes and vaping devices, especially those “purchased off the street,” as investigators are unable to identify a specific product, devise or ingredient as the source of the respiratory illnesses thus far. If the products in question were purchased from unregistered retailers and manufacturers,’ outbreak detectives will have a harder time pinpointing the product or chemical culprit... Kaiser Health News.
 
Not just respiratory issues
Some e-cigarette users have reported vomiting, feeling nauseous, or have diarrhea. Similar to the lung conditions, the cause of digestive system reactions is unknown. The numerous chemicals, including nicotine, in e-liquids are likely linked to the nausea, vomiting, and diarrhea reported after vaping too much. Toxic exposure to metals like lead are also present, as the metal coils in e-cigarette devices are used to heat the vape juice into a vapor.
 
Litigation       
Juul and e-cigarette users report experiencing:

• Severe addiction
• Nicotine poisoning
• Seizures
• Stroke
• Lung or respiratory failure
• Cardiovascular disease
• Heart attack or heart problems
• Mental health or behavior issues
• Pregnancy complication or birth defects
• Other complications

 
To date, over 30 lawsuits related to vaping-related injuries around the country have been filed, including both individual lawsuits and class actions. The suits target Juul Labs Inc, which dominates about 75% of the e-cigarette market. Some also named Altria Group Inc., which has a minority stake in Juul, as a defendant. Altria is the parent company, Philip Morris, a tobacco giant. The plaintiffs claim Juul failed to warn consumers about their dangers, illegally marketed their products to minors, and that the products were defectively designed. Vaping users suffered seizures, strokes and became seriously addicted to nicotine, according to the filed suits.
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Source: Factbox: U.S. lawsuits take aim at vaping, Reuters, Sept. 16, 2019.

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