Originally Published for RELX Tech – August 2019
Vaping is in the news again, with hundreds of headlines around the world talking about the tragic death of a man in Illinois, and close to 200 cases of lung injury and respiratory sickness. Most of the reporting, and virtually all of the headlines mention “vaping”, generating clicks and consumer panic. In reality, this story seems to be the continuation of the Anti-Vaping Moral Panic. It’s apparent, with a little research, that the causes of these injuries have very little to do with a scientifically-proven effective aid in smoking cessation, and a lot with unscrupulous black-market commerce, drug abuse, and simple fearmongering. We hope that our investigation helps you make sense of the sensational reporting, and helps prevent smokers who are trying to quit from smoking even one unnecessary cigarette for fear of vaping.
A few months ago, a story about eight Wisconsin teens getting hospitalized with a “Mysterious Vaping Illness” kicked off the latest vaping-related health scare. The symptoms varied widely, as did the devices, e-liquids, and the patient’s vaping behaviors. Another story, where a young man in Florida blamed vaping for getting hospitalized with a collapsed lung. In all, over 2400 cases have been reported, with over 50 people succumbing to injuries.(Numbers updated on Dec 12th, 2019).
Scary stuff for the 1 in 20 American adults who vape regularly, many of whom credit vaping with helping them stop smoking cigarettes for good.
However, very little of the current story as framed in the media seems to be grounded in the facts of the medical cases, many of which are still under investigation. Each of the 8 Wisconsin teens had a different medical issue, and their history of vaping in the weeks and months prior to the incident was a tenuous connection that the headlines embraced.
The story of the young man with a collapsed lung was quickly debunked, but only after the Daily Mail and other popular news outlets reported on the teen’s claims without endorsing the veracity of the story itself.
Is there a “mysterious vaping illness”?
The CDC, FDA, and state authorities are stepping in to investigate. So far, no direct link to vaping has been established by the CDC. No product has been officially identified as the cause, which has led to the CDC making broad generalizations about all vaping products, potentially contributing to the panic. (Editor’s note: As of December 2019, several months after the outbreak began, the CDC has identified black market THC products, especially those containing Vitamin E acetate, as a ‘strong culprit’, with no particular brand identified as the sole cause).
Many industry watchers have pointed out that in the midst of the moral panic around vaping, the current style of headlines combined with social media and pervasive (if erroneous) skepticism towards vaping can make for a textbook case of mass hysteria.
What we know is these cases frequently involve illicit black-market drugs, known for at least a decade to cause severe reactions. Some may have been caused by home-brew or black market e-liquids. A handful of these cases were due to a congenital medical issue.
There is no reason to panic, and if you vape, protecting yourself is easy: don’t use illicit black-market vaping products, avoid home-made e-liquids, and seek medical attention if you encounter respiratory issues.
Illicit drugs from the black market have plagued Middle America for longer than a decade — they’re simply taking on a new form this time around. Unscrupulous dealers of illicit and illegal drugs are selling products on the black market that are putting people in the hospital.
The State of Wisconsin has been dealing with synthetic drugs that skirted Marijuana prohibition for over a decade. A 2017 report from Wisconsin Public Media Wisconsin press described the “devastating impacts” of these drugs, which can cause severe lung injuries, psychosis, and heart attacks. Periodically, clusters of cases appear with bleeding and respiratory problems, and have resulted in death before.
As vaping rose in popularity, synthetic pot pushers unsurprisingly sought to capitalize on its popularity. A clinical report documents potentially the first incidence of the “mysterious illness” resulting from vaping cannabis oil in 2017. The case presented with lung injury, bleeding, and shortness of breath, an all-too-familiar profile of symptoms for those following the news.
Black market THC vaping cartridges are inherently dangerous, and may contain fungicides and can produce hydrogen cyanide when heated, or other adulterants like oils, which can cause pneumonia symptoms when inhaled. Multiple cases of severe illness resulted directly from buying a fake THC vape cartridge.
The use of black market THC vaping cartridges is prevalent across the United States, regardless of the legality of the substance, and users are easily able to find dangerous and unregulated alternatives. Vape products advertised as “CBD” were also found to contain synthetic cannabinoids in 2018, and the US Army warned military personnel against using them because of the dangers adulterants pose to vapers. Many of these stories explain the context — the injury was caused by vaping black-market THC cartridges, early on in the outbreak.
A congenital, hereditary condition causes spontaneous lung collapse, usually in young men. One vape user with this conditioned erroneously blamed the vape, and the media inflated the hysteria, chasing clicks.
Congenital and possibly hereditary weak points in the lung tissue, or “blebs”, can rupture and leak air, causing primary spontaneous pneumothorax, or spontaneous lung collapse. This condition is not caused by vaping, or even smoking, but occurs spontaneously, often affecting young, lanky men.
One such young man gained significant media exposure when the story of his hospitalization started trending on Instagram. The story was quickly debunked, but other news outlets ran the story, reporting on the teen’s claims.
The incidence of spontaneous primary pneumothorax in young men is 7.4 to 16 per 100,000 per year. Based on the census data for 2017, somewhere between 11,796 and 25,505 men would encounter this problem. This comes out to around 983 to 2125 cases of spontaneous lung collapse in young men per month. It is overwhelmingly likely that a few of these men smoked cigarettes or used drugs, climbed mountains, did scuba diving, or vaped, with none of these behaviors being the cause of their collapsed lung. None of these cases were caused by vaping.
You can get very ill from inhaling oils, which are not present in high-quality vaping liquids manufactured by major e-cigarette or e-liquid companies. Inhaling oil can cause lung illness called “Lipoid Pneumonia”. Several stories even draw a connection between vaping and the condition caused by inhaling aerosolized lipids (or fats), including academics mistakenly suggesting there is a link.
Yet high-quality professionally-made e-liquids do not contain lipids. The main components of e-liquid are Propylene Glycol and Vegetable Glycerin, which are alcohols, not fats.
Unfortunately, even medical professionals unfamiliar with the e-liquid formulations assume that there are oils present. The e-liquids look oily, after all. This error has persisted since at least 2013, when the German Cancer Research Center of Heidelberg had to issue a correction after Dr. Siegel of the Boston University School of Public Health published work debunking the claim.
Of course, for those who mix their own e-liquid, or purchase shady cartridges on the black market open themselves up to the risk of contamination. Making your own e-liquid is complicated, and possibly dangerous because it increases the likelihood of introducing adulterants.
Is it time to panic yet?
Yes, about drug abuse, mental illness, and cigarettes.
In the months since the outbreak began, many of the cases were already shown in the initial reports to be connected to shady black-market practices and congenital respiratory conditions. Around 80,000 Americans died from smoking-related illnesses in these same two months. Over 11,600 died of drug overdoses. Around 2,000 men have experienced primary spontaneous pneumothorax.
The outbreak, by CDC’s own statement, can be understood not to have been caused by people using typical, high-quality vaping products that millions are using to quit smoking — lowering the risk of respiratory infections, pneumonia, and more serious health effects. Given the dangers posed by black market products, we hope that governments around the world learn from the example of the United States, and engage in sensible regulation and public health awareness campaigns that educate consumers to avoid future tragedies, whether they be caused by the use of illegally-produced vapor products, the unreasonable restriction of legal ones, or by the continuation of cigarette use due to misinformation and hysteria over vaping.