HEALTH MATTERS: Vaping-related illnesses, deaths continue to rise nationwide

October is most known as Breast Cancer Awareness Month. However, the month also is designated Healthy Lung Month by the Lung Institute and the American Lung Association. In recent months, vaping-related illnesses and deaths have continued to rise throughout the country. As a result, federal and local governments, as well as some businesses, have taken actions on vaping. The U.S. Centers for Disease Control and Prevention, Food and Drug Administration, state and local health departments, and other clinical and public health organizations are investigating a multi-state outbreak of lung injuries associated with the use of electronic cigarettes and vaping products.  

Vaping products can come in various shapes, sizes and designs and even go by different names. Electronic cigarettes, or e-cigarettes, such as Juuls are some of the most popular and prevalent among vape users. Although e-cigarettes have been sold for more than a decade, incidents of vaping-related illnesses have started to proliferate this year. Furthermore, the impacts of the long-term use of vaping products have yet to be determined. 

Dr. Jenna Wheeler is a pediatric critical care physician at Orlando Health. She said a common misconception about vaping is that water vapor is exhaled after a person takes a hit from a vaping device.

“Vaping is essentially inhaling and exhaling an aerosol vapor that’s produced by an e-cigarette or a (vaping) device that goes by some different name,” Wheeler said. “There’s actually a misconception as far as the ‘water vapor’ that is (associated with vaping). There is not any water vapor associated with it. It’s actually an aerosol-like (substance) from these chemicals that creates fine particles, and that’s what you’re inhaling when you’re vaping. You’re not inhaling a water vapor.”

THC AND VITAMIN E ACETATE

The latest discoveries from the investigation into lung injuries related to vaping indicate that products containing Tetrahydrocannabinol — or THC, which is the psychoactive compound in marijuana that causes a “high” — play a role in the outbreak of vaping-related injuries. The FDA reported that samples of vaping fluid — more commonly known as vaping “juices” — that caused individuals to get sick included THC and also contained a chemical called vitamin E acetate. And in some cases, the vaping products containing THC were purchased on the black market.

Locally, Wheeler said, some physicians at Orlando Health have seen patients with drug-related issues related to vaping. She added some of those thought the product they were vaping contained THC but were unaware of what else could have been in the product.

“We have seen some patients who have come in not necessarily from a respiratory issue related to vaping — but from a drug-related incident where they were vaping and they were unaware of what substance they were vaping,” Wheeler said. “Because of that, they had some serious consequences and were having to come in and be hospitalized in our intensive care unit.”

Although the specific chemical or chemicals that are causing injuries have yet to be determined, the FDA has issued a warning against using vaping products containing THC as they also might contain vitamin E acetate or other dangerous chemicals. Additionally, the FDA has urged consumers to avoid purchasing THC vaping products on the street, as a consumer might not know exactly what chemicals are in those products. The FDA also has urged consumers to refrain from adding or modifying THC oil purchased from stores.

“One of the problems with vaping is that you don’t know exactly what you’re inhaling,” Wheeler said. “When (vaping patients) come to us, we can run a common drug panel, but there’s so many other chemicals out there that can cause problems with your neurological status that don’t show up on just the basic (drug) panel.” 

AN EPIDEMIC

According to the CDC, as of Oct. 1, a nationwide total of 1,080 cases of lung injury associated with the use of vaping products have been reported to the CDC, and 18 deaths linked to vaping-related illness have been confirmed in 15 states. Most of those patients  — about 70% — admitted for vaping-related injuries are males. Furthermore, many of those impacted have been individuals in their teens or early 20s, with 80% of patients younger than age 35. The youngest individual to die as a result of vaping-related illness was a 17-year-old from The Bronx. 

Vaping among youth has been on the rise in recent years. In 2017 and 2018, vaping skyrocketed among youth and led the U.S. Surgeon General to declare vape use among youth an epidemic in the country. Moreover, in 2018, data from the CDC and FDA showed that more than 3.6 million youth — including one in five high-school students and one in 20 middle-school students — used a vaping product within the past month. 

That nationwide rise of vaping among youth also is reflected locally, according to Orange County Public Schools spokesperson Lorena Arias.

“Similar to what school districts are facing nationwide, we have seen an increase in students vaping on campus districtwide,” Arias said. “The district has video cameras in all OCPS facilities that can be viewed at any time and can provide playback when a violation is suspected. I would not be able to say if vaping among students occurs more often in schools on the west side, since vaping and e-cigarettes are categorized under ‘Smoking and Other Use of Tobacco Products’ in the Code of Student Conduct and doesn’t have its own separate category.”

Capt. Daniel Gutierrez and Lt. Clay McCullough both are school resource officers at the Orange County Sheriff’s Office. They said although OCSO isn’t always notified of vaping incidents at the schools, they also reported that vaping among youth has increased locally.

“(I) polled our supervisors and personnel because I have (personally) not seen an increase (of vaping among youth) at my level,” McCullough said. “After checking with them, they’re not seeing or not being notified by school admins of vaping issues. I can tell you that the general consensus is an agreement that it has increased. We’re just not seeing it or being notified of it at the schools.”

McCullough added that because vaping falls under the category of smoking and other use of tobacco products under the OCPS code of student conduct, incidents involving students and vaping are handled internally at the schools, and the schools don’t have to notify law enforcement in those instances. He also said some vaping products don’t even contain nicotine.

“If they (students) are (caught vaping), schools aren’t notifying law enforcement,” Gutierrez said. “It’s not a criminal violation to have a vaping device unless it has THC in it, and of course, there’s a test kit that will determine that (presence of THC). … It’s clearly coming out nationwide that this vaping is a detrimental harm to children and the people that are doing (it). … Even if it’s not an illegal substance, the vapor they’re inhaling with these products can cause some really bad health problems, apparently.” 

BUSINESS IMPACTS

Vaping always has been marketed as an alternative to traditional smoking, and, like with traditional smoking products, vaping has been geared toward adults. However, some have argued the array of different flavors can appeal to youth. Because of this, some state and local governments have taken action against the sale of flavored vaping products and juices. For example, the states of Massachusetts and Michigan both have imposed bans on the sale of flavored vaping products, but these actions don’t come without consequence, because they could have impacts on small businesses.

Megan Wertsching is the manager at My Vape Room in Winter Garden. She said the news of vaping-related illnesses and deaths has negatively impacted business. She has seen a recent decline in customers coming in and has even heard of some of her customers putting down their vaping devices and going back to traditional smoking. She added that, traditionally, most vaping juices are made with products that are in food, such as vegetable glycerin and artificial flavoring.

“I definitely think it’s a shame that people aren’t being more educated on what’s actually harming people,” Wertsching said. “The media is going on a frenzy about vaping, and it’s such a broad term that really can refer to so many differing things. In reality, people have been vaping for years, and it hasn’t been a problem until right now. I feel like that has everything to do with the fake THC cartridges and nothing to do with (traditional vaping products). … A lot of the ingredients that are in these (vaping) juices are stuff that you get in food every day.”

Furthermore, Wertsching emphasized vaping products are supposed to be for adults. She said although she understands why some governmental entities and organizations have been cracking down on the sale of flavored vaping products, she also said parents should take the responsibility of talking to their children about vaping. 

“I definitely understand where people are coming from — everyone just wants their kids to be safe,” Wertsching said. “E-cigarettes are geared toward people who have been smoking cigarettes and are trying to find an alternative, and that’s what this is. … It’s not for your teenager. I also think that parents should take more action rather than have the government regulate everything. It should be in the parents’ hands. If you don’t want your kid vaping, educate them.”

OCSO spokesman Capt. Carlos Torres agrees with Wertsching’s sentiment and adds that parents should be aware and involved with what goes on in their child’s life.

“Like anything that we would recommend to a parent is to be involved in their child’s life, and to be aware of what they’re doing on social media, to see what they are putting in their rooms (and) backpacks,” Torres said. “(Parents) being actively involved in their child’s life … would definitely give them a better play on what their children are doing.