E-Cigarette & Vaping- Michigan Poison Center Position
Sales of e-cigarettes and other nicotine vaping devices began in the US in 2007. Marketing of these products has primarily targeted teenagers and young adults as a safer alternative to tobacco cigarettes. Fruit flavored vape liquids intended to appeal to this demographic has led to widespread use in the US. (Consumer Advocates for Smoke-Free Alternatives Association, 2019).
Vaping devices and e-cigarettes have been marketed as posing less of a risk for many of the negative health effects caused by smoking tobacco cigarettes. In 2018, over 34 million Americans were known to smoke tobacco. It is also now known that smoking tobacco cigarettes is harmful to multiple organ systems in the body, including containing chemicals known to be carcinogenic. The annual death rate related to smoking tobacco is greater than 480,000 (Center for Disease Control and Prevention, 2020).
In March 2019, a sudden increase in hospitalizations related to vaping was evident. A total of 2,807 vaping-related hospitalizations and 68 deaths had been confirmed in 29 states and the District of Columbia as of February 18, 2020. These deaths were primarily related to e-cigarette, or vaping, product use-associated lung injury (EVALI) (Center for Disease Control and Prevention, 2020). Although deaths related to tobacco use are more prevalent than deaths related to vaping, this is nonetheless a cause for significant public health concern.
Vaping devices and e-cigarettes are electronic devices used to heat and vaporize liquids so vapors can be inhaled. The liquids used to deliver nicotine or THC are a significant concern. E-liquids may contain propylene glycol, vegetable oil, vitamin E acetate and a multitude of other potentially harmful ingredients. Nicotine content in these products is also concerning as e-liquids have been found to contain higher amounts of nicotine than what is advertised on labels (U.S Food & Drug Administration, 2020). Over the preceding 10 months, the Michigan Poison Center has received 156 calls regarding exposures to e-cigarettes and other vaping-related exposures. Children who ingest vaping products are often referred to an emergency room for monitoring and treatment if needed. Poisoning from nicotine can cause severe symptoms. A minor amount of nicotine may cause stomach discomfort, vomiting, and dizziness; however, large exposures to nicotine can cause seizures and other life-threatening effects.
The U.S. Surgeon General has determined the use of e-cigarettes is an epidemic among young people. The availability of flavored e-liquids like candy, fruit, chocolate, and other sweets are packaged in bright colors and appealing designs to youth. In 2018, more than 14 million middle school and high school students had seen e-cigarette advertising in stores, on the Internet and television, movies and magazines. Approximately 68% of high schoolers who use e-cigarettes use products with added flavors. The flavors and availability both attribute to increased use among individual youth. Nicotine use in teens and young adults can cause long term health effects. Nicotine addiction is associated with mood disorders, impulse control issues, and impaired learning. Inhaling nicotine and other chemicals found in vaporized e-liquids can cause damage to the respiratory system. Diacetyl, which is used to flavor e-liquids, has been associated with serious lung injuries. (Surgeon General of the United States Public Health Service, 2020)
Individuals who choose to vape using devices and liquids are at risk for adverse health effects. Symptoms may develop over a short period of time and may include abdominal pain, nausea, vomiting, diarrhea, coughing, chest pain and shortness of breath. Users of vaping devices who develop any of these aforementioned symptoms are at risk for or may already have developed an electronic vaping associated lung injury (EVALI) and should seek medical care immediately. Severe lung injuries have occurred in teenagers and young adults with the use of vaping devices and liquids. Currently, there are no assurances that any vaping product is risk-free.
Among the most significant cases of EVALI was observed in Michigan in 2019. A local teenager required a double-lung transplant due to injury associated with vaping. Due to lack of regulations surrounding vaping products received by mail order and other sources, it is difficult to determine which products may be responsible for resulting harm. More effective legislation and regulation of vaping products are necessary to protect vulnerable populations (i.e. youth) and the public at-large. At this time, the Michigan Poison Center only supports commercially sold menthol and tobacco flavored e-liquids.
References
Center for Disease Control and Prevention. (2020). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping Products. Smoking and Tobacco Use. Georgia, United States of America.
Center for Disease Control and Prevention. (2020). Smoking and Tobacco Use. Data and Statistics. Georgia, United States of America.
Consumer Advocates for Smoke-Free Alternatives Association. (2019). A Historical Time-Line of E-cigarettes. CASAA.org. New York, United States of America.
Surgeon General of the United States Public Health Service. (2020). Know the Risks: E-cigarettes & Young People-Get the facts. Know the Risks: E-cigarettes & Young People. District of Columbia, United States of America.
U.S Food & Drug Administration. (2020). Vaporizers, E-Cigarettes, and other Electronic Nicotine Deliver Systems. United States of America.
