The recent February 10th, 2020 article in the Wall Street Journal about a teenage boy on a ventilator tears at the heart strings. He is suffering from E-cigarette or Vaping Product Use-Associated Lung Injury or EVALI for short. The mother brought his nicotine vape cartridges to the hospital questioning why he is ill. There have been a total of 2,700 EVALI reported across the U.S. since last March according to the CDC with a total of 60 who have died.
Cannabis vape pens have been popular since 2013. They were widely used without evident problems until April 2019 when the first cases of EVALI were reported. It is noted that the EVALI is a U.S. phenomenon. There has been no outbreak in the UK which regulates additives more effectively than in the U.S. The Food and Drug Administration is attempting to address EVALI linked to vaping products and a spike in use among high-school students, 28% of whom now vape.
Lawmakers are blasting CEO’s for the popularity of youth vaping. Adult and youth tobacco smokers like the flavors as it helps with the switch to nonsmoking. A Juul survey of 70,000 people showed that 50% of adult smokers who responded had fully switched from combustible cigarettes to Juul products after six months. Recently, on the 6th of February, 2020, was the first day of the federal ban on fruit and mint-flavored e-cigarettes. These regulations will not affect other cigarette alternatives. Some states have already banned all vape pens.
The issue with vaping is not the cannabis or the Juul. The California Bureau of Cannabis Control (BCC) has reported that not a single California licensed product has been linked to EVALI so far. The source of the problem is the new additives developed, defects in the device, or a contaminant not the technology of the vape pen. Another source is the counterfeit Juul or cannabis vape label attached to illicit products by black market manufacturers. The black market is three times the legal market. The California chapter of NORML (the National Organization for the Reform of Marijuana Laws) issued a health advisory last September informing the public to not buy and consume illegal cartridges given the outbreak of EVALI.
The CDC found that the additive Vitamin E acetate, a thinner, was being used to dilute the cannabis oil primarily by the black market and found that to be a frequent cause of EVALI. But the CDC has also stated there is no known single cause of EVALI. Most EVALI is concentrated in states where recreational sales of cannabis are illegal. At present there is no legal restriction for the use of Vitamin E acetate or other harmful contaminants. Flavors are listed only if they are considered allergens.
The CDC reports cigarette smoking causes about one in every five deaths in the United States each year or more than 480,000 deaths annually. Licensed cannabis vapes should not be banned as this will drive consumers to more dangerous illicit products. Prohibition of flavors or vaping is not the single solution to prevent EVALI.
Adopting a list of prohibitive additives and flavors that are toxic, and enforcement of labeling by illicit manufacturers would be more productive in reducing EVALI.