'A New Epidemic': A Seventh Person Has Died From Vaping

09/17/2019

In the outbreak of what health officials have dubbed 'a new epidemic', a seventh person has died due to complications from e-cigarette use. The death was confirmed on Monday by the Tulare County Health and Human Services Agency in California. This is the state's second vaping-related death.

Over the summer, there have been a series of unfortunate events surrounding the use of e-cigarettes. According to the Center for Disease Control (CDC), there are currently 380 cases in 36 states revolving around vaping-related illnesses and deaths. Up until Monday, a total of six people died after using e-cigarette products. 

Timeline of Vaping-Related Deaths

  • On August 23rd, the first vaping death is confirmed in Illinois. Officials said the person was hospitalized after experiencing extreme respiratory issues. He primarily used nicotine vaping products.
  • The second death occurred in Oregon on Septemeber 3rd. According to the Oregon Health Authority, the individual was using an e-cigarette containing cannabis oil purchased from a legal dispensary. 
  • The third vaping-related death was confirmed in Indiana on September 6th. The individual was an adult.
  • The fourth victim was a 65-year-old man from Minnesota, also confirmed on September 6th. The state's health officials said the man had a history of respiratory issues, including a severe lung disease that may have progressed to other issues. Health officials said the 65-year-old fell ill after vaping THC products, specifically cannabis oil. 
  • A fifth person died in California on the same date. California officials confirmed that the individual vaped a cannabis product before passing away. 
  • The sixth death occurred in Kansas on Tuesday, September 11th. According to Kansas health officials, the individual was a 50-year-old who had a history of health problems and was hospitalized after their symptoms worsened.
  • As of Monday, September 16th, a seventh person has died in California.
A man vaping an e-cigarette. Photo by Wikimedia Commons
A man vaping an e-cigarette. Photo by Wikimedia Commons

According to the U.S Food and Drug Administration (FDA) and the CDC, many of the e-cigarette users who died or fell ill after vaping were using THC and other cannabis products. Though it has still not been confirmed what the exact cause of the reoccurring deaths are, the CDC and other state officials believe the main cause could be Vitamin E acetate since it is the primary ingredient found in nearly all of the devices containing cannabis products. Vitamin E acetate is an oil typically found in foods such as canola oil and almonds, along with nutritional supplements. While it is inherently safe to use on the skin or in food, the inhalation of Vitamin E acetate can be hazardous.

As health officials and government agencies scramble to find the real culprit behind the mysterious vaping illnesses and deaths plaguing the country, an emergency call to action was issued over the weekend.

On Sunday, New York State Governor Andrew Cuomo announced an emergency executive action to ban the sale of all flavored e-cigarettes, save for tobacco and menthol. The initiative comes days after the Trump Administration announced to take similar action on the flavored but seemingly dangerous devices.

The ban is the first step to dissuading children and teenagers from utilizing vapes and other e-cigarette products, most of which contain the highly addictive chemical, nicotine. 

During the announcement, Gov. Cuomo voiced his health concerns over vaping, calling the act "dangerous" and denouncing the widespread belief that vaping is safe. Cuomo also expressed his concerns about early exposure to nicotine.

"...Vaping is dangerous...It is addicting young people to nicotine at a very early age and nicotine is highly addictive," Cuomo said. "It doesn't even matter what product you're using, it is getting young people addicted to nicotine."

"We do not know the long-term health effects of the use of this product," the governor continued. "Why? Because there has been no long-term study. So no one can sit here and say long-term use of vaping-where you're inhaling steam and chemicals deep into your lungs-is healthy."

Although Gov. Cuomo dismissed the notion that vaping is healthy, he regarded the act as being technically better than smoking traditional cigarettes. However, the governor believed vaping should only be used as a last resort, citing that there are other alternatives to quitting the deadly habit.

"There are much better ways to stop smoking than vaping. There are patches, there are lozenges, there are gums, there are therapy sessions, there are medications. There's a whole host of ways to stop smoking which are better for you than vaping," Gov. Cuomo said. 

"The only situation factually that justifies vaping is if you have a person who said 'I currently smoke and I have tried every other device to stop smoking. I've tried everything, nothing has worked except vaping.' That is the only situation that logically justifies vaping."

Cuomo went on to criticize vaping companies for targeting younger demographics with enticing flavors such as Bubble Gum, Cotton Candy, and Captain Crunch, essentially blaming the advertising of the flavored products for the increased usage amongst children and teenagers. He pointed out that it is a "criminal offense" to not only market tobacco and nicotine-based products to minors, but to sell to them as well.

The governor also provided statistics of current high school users, concluding that the number of teenaged vapers increased 160 percent over the past four years, 40 percent of seniors are vaping and that a total of 27 percent of high schoolers currently vape.

While Gov. Cuomo's ban intends to discourage young people from using vaping products, the initiative does not include menthol, a minty flavor commonly found in cigarettes and other tobacco products. According to the FDA, menthol can reduce irritation and harshness when smoking cigarettes, but adds that smoking menthols may be harder to quit than smoking non-menthol products. Cuomo explained his reasoning behind keeping the popular flavor on the shelves.

"There is a debate on whether or not menthol should be banned," Gov. Cuomo began. 

"[Commisioner of Health for New York State] Dr. [Howard] Zucker and I have discussed this. He feels at this point he is not yet ready to ban menthol."

"There is some data that suggests for menthol cigarette smokers again who have tried every other device to stop smoking-they tried lozenges, they tried medication, they tried everything, nothing else works, very limited pool- and tried vaping, the menthol flavor for the vaping helps menthol cigarette smokers. So at this point, Dr. Zucker's recommendation is [that] he is not prepared to recommend banning menthol."

While menthol will remain on the market, Cuomo suggests that the decision could change in the future.

Along with banning flavored products, the governor also announced a plan to ban all advertising directed towards minors within the next year.

Even though Governor Cuomo's decision to ban flavored e-cigarettes may sound promising to some, the American Lung Association is not in favor of keeping menthol on the market. 

Since menthol is still a relatively popular flavor amongst young vapers, the American Lung Association believed the governor's ban will be ineffective in getting users to stop, regardless of the omission of other flavors.

"The Lung Association opposes today's announcement by Governor Cuomo regarding flavored e-cigarettes in New York," Harold Wimmer, President and CEO of the American Lung Association, said in a press release on Sunday. "While today's announcement was well-intentioned, it will drive our youth to use menthol-flavored products in even greater numbers."

"We will continue to work towards the permanent removal of all flavored tobacco including e-cigarettes from the marketplace," Wimmer continued. "Flavors have been shown to initiate kids to tobacco use and a lifetime of addiction and tobacco-related death and disease."

The American Lung Association has harbored strong views on e-cigarettes and vaping long before the trend turned sickly. Finnie Says spoke with Elizabeth Hamlin, Director of Advocacy for the American Lung Association in New York, about the health organization's firm stance on vaping. With the dramatic increase in flavored e-cigarette use amongst teens, Hamlin attributed part of the popularity surge to Big Tobacco.

"We have been seeing a surge in tobacco use among youth, and we know that flavored e-cigarettes are part of the reason why," Hamlin said. "Big Tobacco has been using this flavor trap for years to dupe kids into thinking that they are safe and kid-friendly, while they ultimately become addicted to dangerous tobacco products."

Aside from Big Tobacco, the American Lung Association also criticized the FDA for passing a decision back in August 2017 that allowed e-cigarettes, cigars, and other candy-flavored products to remain on the market without premarket review by the agency until the year 2022. 

Along with delaying premarket reviews, the FDA also delayed a rule that required manufacturers of e-cigarettes still on the market to report salient information to the FDA about each product, which would determine if the product was safe for consumption and whether or not it appealed to children. Outraged by the decision, the Lung Association, along with several other health organizations such as the American Heart Association and the Truth Initiative, filed a lawsuit against the agency.

"In March [2018], the American Lung Association and our public health partners filed a lawsuit against the Food and Drug Administration challenging its decision that allows electronic cigarettes and cigars-including candy-flavored products that appeal to kids-to stay on the market for years without being reviewed by the agency," Hamlin explained. 

"The lawsuit contends that the FDA's decision leaves on the market tobacco products that appeal to kids, deprives the FDA and the public of critical information about the health impact of products already on the market, and relieves manufacturers of the burden to produce scientific evidence that their products have a public health benefit."

This past May, U.S. District Judge Paul W. Grimm of the U.S. District Court for the District of Maryland ruled in favor of the health groups, finding that the FDA's decision was unlawful and played a prominent role in increased usage of e-cigarette products amongst children and teens.

"The American Lung Association has been urging the FDA to take action to protect the public and our kids for more than 10 years," the director concluded. "FDA must use its authority over all of these products."

Despite the lawsuit and the official ruling, the FDA remains "deeply concerned" in the wake of the recent outbreak of illnesses and deaths surrounding vaping. The agency contends that they have been working diligently alongside the CDC to determine the exact cause of the epidemic while urging users to avoid THC and other cannabis products while the investigation continues.

Although the number of high school students who vape continues to increase to staggering new heights, Maya Leinwand, a high school sophomore, is not a part of the statistic. The 15-year-old told Finnie Says that while a few of her friends and acquaintances vape, she "very much dislikes the idea of vaping."

"I know that some people think that [vaping] is better than normal cigarettes, but it is just as bad," Leinwand said. "Vaping has become so big in my age group and the age of people starting is going to continue to get younger and younger. I think, quite frankly, that it's very stupid because sure it might make you feel good or relaxed for those few moments, but all it's going to do in the long run is hurt you." 

The sophomore said she is horrified by the numerous reports of deaths and illnesses related to vaping. Leinwand also empathized with parents whose children fell ill or died due to a habit they were unaware that their even children had. 

"I can't even imagine being a parent and having lost my kid due to a Juul or vape that I hadn't even known they had," Leinwand said. 

According to Leinwand, many of her friends' parents are currently being kept in the dark about their kids' vaping tendencies. When asked why she believes her classmates consume vaping products, the 15-year-old confessed that the everyday stress of school could play a vital role along with peer pressure and the need to fit in. Leinwand also attributed her classmates' attraction to vaping to the diverse flavors e-cigarettes have to offer. 

"I think that a big part of the reason they are attracted to [vaping] is that our age group is being targeted by the flavors," the sophomore explained. "Also, they are being "influenced" by other classmates. I know that people say this a lot, but it's true that a lot of people think it will make them look cool and help them to fit in." 

The sophomore then went on to say that while her classmates may or may not know about the contents of their e-cigarettes, many of them are unaware of the potential dangers due to their lack of research and are more concerned with staying trendy and looking cool to their peers.

In regard to Gov. Cuomo's move to ban flavored e-cigarettes from the market, Leinwand said she supports the decision. However, she felt that the government should redirect their focus to more detrimental issues.

"I believe that [the ban] is a good action being taken," the 15-year-old began, "but there are things more important than this. In fact, I think it would be wonderful if Gov. Cuomo decided to focus on this while Trump focused on things like guns and trying to prevent school shootings which end up killing more young kids and teens than flavored e-cigarettes are doing."

"That way," Leinwand continued, "we can work towards both of these things that take a toll on young ones and hopefully end up saving many lives."

While Maya Leinwand vowed to never touch a vape or other e-cigarette product within a 10-foot-pole, 21-year-old Brittany enjoys taking a hit every once in a while.

The college freshman told Finnie Says that she has been vaping for almost a year, citing Juul as her device of choice with her favorite flavor being Mango. Although e-cigarettes have been accredited, though heavily disputed, to helping cigarette users quit smoking, Brittany has never smoked cigarettes prior to vaping.

"I don't know why I started," the 21-year-old admitted. "I kind of just did."

Brittany said she prefers to vape both nicotine and THC products, stating that she vapes due to a  "nervous-habit". The 21-year-old also said she is not aware of the chemicals in either the e-liquid nor the aerosol produced. 

Despite the insurmountable evidence linking vaping to the recent deaths and illnesses around the country, Brittany is not worried about being subjected to a similar fate. However, the college freshman is on board with the governor's executive emergency action to prevent young children from vaping.

"I'm with [the ban]," she said. "I think that if the flavors are targeting children then it's good to ban them."

What is Vaping?

The American Lung Association defines vaping as the use of electronic cigarettes, or e-cigarettes, which includes e-pens, e-pipes, e-hookah, and e-cigars, collectively known as ENDS, or electronic nicotine delivery systems.

In simple terms, vaping is the act of inhaling aerosol. While many e-cigarette companies refer to aerosol as water vapor, the CDC and American Lung Association contend that the term is incorrect. The aerosol is produced after heating e-liquid, or vape juice, in the pod or cartridge. In many cases, the e-liquid contains nicotine, flavoring, and chemicals such as propylene glycol, acetone, glycerine, and propylene oxide. After the liquid is heated, it emits the aerosol which is inhaled and exhaled by the user. However, upon heating the liquid, other chemicals and fine particles are produced in the aerosol as a result. Some of the known chemicals are:

  • Lead (Heavy metal)

  • Nickel (Heavy metal)

  • Tin (Heavy metal)

  • Cadmium (Metal found in cigarettes)

  • Diacetyl (A chemical linked to a lung disease called bronchiolitis obliterans, aka popcorn lung)

  • Acrolein (A herbicide used to kill weeds that cause irreversible lung damage)

  • Benzene (A volatile organic compound found in car exhaust)

  • Nitrosonornicotine (A chemical used to produce tobacco and is classified as a Group 1 carcinogen)

  • Formaldehyde (Classified as a carcinogen)

  • Acetaldehyde (Classified as a Group 1 carcinogen)

A majority of these chemicals are listed under the California Proposition 65, a list of toxins known to cause respiratory issues, reproductive toxicity, birth defects, and cancer. The list is a part of the California Office of Environmental Health Hazard Assessment (OEHHA), an agency that reviews and provides an evaluation of environmentally toxic chemicals that pose a threat to humanity. Their mission is to "protect human health and the environment through scientific evaluation of risks posed by hazardous substances. " The list is updated at least once a year and currently hosts 900 chemicals to date. 

The OEHHA requires all businesses whose products contain any chemicals on the list to explicitly state so to consumers by providing the list as a warning. Businesses are not required to issue this warning if the levels of chemicals contained in their products are significantly low and do not pose a risk to cause cancer or other health defects. 

Juul, one of the most popular e-cigarette brands on the market, is one of the businesses required to provide the OEHHA warning. Juul is a battery-powered vape that resembles that of a USB. All of Juul's products contain nicotine, some more than others depending on the flavor. According to Juul's website, one Juul pod is designed to equal 200 puffs or 20 cigarettes both in amount and nicotine strength.  Here are all of the flavors that Juul offers along with their nicotine strengths:

  • Virginia Tobacco (5% and 3% nicotine strength) 

  • Mint (5% and 3% nicotine strength)

  • Mango (5% and 3% nicotine strength)

  • Creme (5% and 3% nicotine strength)

  • Fruit (5% and 3% nicotine strength)

  • Cucumber (5% and 3% nicotine strength)

  • Menthol (5% nicotine strength)

  • Classic Tobacco (5% nicotine strength)

Each 5% Juul pod contains 40 milligrams (mg) of nicotine while a 3% pod contains 23mg of nicotine. Every Juul pod is composed of glycerol, propylene glycol, benzoic acid, flavoring, and nicotine. 

A Juul pack with multiple flavors. Photo by phillyvoice.com
A Juul pack with multiple flavors. Photo by phillyvoice.com


Although Juul provides fruitful and otherwise delectable flavors, the vape company has a Youth Prevention page in which the company discourages underage use of its products, stating, "We have no higher priority than preventing youth use of our products, and the steps we have taken to date are far-reaching and comprehensive." 

The company page then goes on to outline various steps taken to prevent minors from Juuling, including suspending distribution of non-methanol and non-tobacco flavors to their retail partners, tracking and tracing where Juuls are bought, shutting down their social media accounts, and by requiring individuals who enter their website to verify their ages before gaining access. Juul also states on their FAQ page that no tobacco or nicotine product should be considered safe and even suggests that those who have not smoked cigarettes or other nicotine devices use their products. 

However, despite Juul's combative efforts to prevent youth vaping, gaining instant access to their website-much like other e-cigarette websites-is no harder than solving a two-piece puzzle. Upon going to the website, a pop-up asks to confirm that the visitor is 21 by clicking a button that says 'Yes, I am 21+ and agree to be age verified.' Yet, the only time an actual age verification-where a visitor has to put in their name, address, and social security- is offered is if the visitor tries to purchase a product and has to sign up for a Juul account, though the initial access has already been granted to view the contents of the website. 

What Do Experts Think About Vaping?

Before the rapid rise in vaping and other e-cigarette products, some health professionals saw the tobacco-less devices as a surefire way to quit smoking once and for all. 

Professor Ann McNeill of King's College in London published a review back in August 2015 that glorified the usage of e-cigarettes, going as far as to call them "a game-changer" in public health. The review also suggested that encouraging current cigarette smokers to switch to e-cigarettes instead could help decrease smoking-related illnesses, deaths, and diseases.

This time last year, the Center on Addiction weighed the pros and cons of utilizing e-cigarettes.  In the pros column, the Center mentioned the lack of tobacco in e-cigarettes as well as being an ostensibly safer alternative for long-term cigarette smokers who previously tried other ways to stop smoking. The health organization also mentioned that e-cigarettes do not consist of as many toxins and carcinogens as regular cigarettes do. 

However, the cons column was relatively longer than the pros, with some cons including the presence of nicotine-which can increase heart rate, blood pressure, and can be poisonous in elevated amounts-, the discovery of heavy metals and ultrafine particles found in the aerosol emitted, and the lack of evidence regarding e-cigarettes as a way to stop smoking.

In 2016, the Surgeon General's report confirmed that using nicotine in any form is a danger to the developing adolescent brain.

Back in August, Albert Rizzo, Chief Medical Officer of the American Lung Associaton spoke on the potential dangers and risks of inhaling vape aerosol in a press release. "The inhalation of harmful chemicals found in e-cigarettes can cause irreversible lung damage and lung disease," Rizzo said. "Developing lungs of teens and young adults may be particularly vulnerable to these harms. This is particularly alarming in light of the dramatic increase in youth use of e-cigarettes - what the Surgeon General refers to as a youth e-cigarette epidemic."

On their website, the CDC says that e-cigarettes have the potential to benefit adult smokers and non-pregnant women if they are used as a complete substitute for smoking cigarettes and other tobacco products. However, the organization says e-cigarettes are not safe for kids, teenagers, young adults, or adults who have not previously used tobacco products. The CDC says there is still some research to be done to determine if e-cigarettes are effective for quitting smoking. They advise people who have not previously used tobacco products or e-cigarettes to not start, calling the use "unsafe." 


As U.S health officials race to find a cure, government agencies struggle to find a culprit, and families across the country say goodbye to their loved ones, only time will tell whether or not America will succumb into the new epidemic.