LftS: The Vaping Crisis
On October 1st the CDC, FDA, and numerous other health departments and organizations announced a nationwide investigation into an outbreak of lung injuries that have been associated with vaping. For years vaping has spread through the US as a substitute for smoking cigarettes, a way to stop smoking cigarettes, a way to take marijuana, and as a cool recreational tool. in the last few years, we have also seen vaping being utilized by teenagers in increasing fashion. In this episode of Lessons from the Screen we will be taking a look at the Vaping Outbreak.
At the risk of sounding like your uncle at a barbeque after you finish showing a new dance. Vaping ain’t new. People have been heating liquids to gas and inhaling that vapor for more than 1000 years. Vaporizers in the modern age might be smaller and more sporty, but they are still functionally the exact same things as the heated stones of Ancient Egypt. All over the globe at varying times thousands of years ago various cultures developed different methods for creating vapors and inhaling them.
But this isn’t to be confused with simply smoking. There is a difference between a vapor and a gas and there is a difference between the processes used when vaping vs. smoking. For starters, a vapor is a state of matter that exists in 2 phases simultaneously: liquid and gas. Vapors can be maintained by managing the pressure and/or temperature affecting a substance. Most importantly, vapors with regards to vaping tools, don’t cause chemical reactions that create new substances to be inhaled. This is both a gift and a curse. Vaping tools like e-cigarettes take a cartridge filled with a substance, convert that substance into a vapor, and allow that vapor to be inhaled by the user.
We know what gas is, it is one of the 3 regular singular states of matter, the other two being liquid and solid. It’s the stuff that makes riding in an elevator a dangerous experiment. It’s also the stuff that my mom claims she has whenever something isn’t feeling quite right in the world or a particular situation. But smoking is not simply inhaling the gas form of the substances packed inside of the cigarette. Smoking is a chemical process that uses combustion to quickly make a gas out of a solid but also causes new substances to be created due to the high temperatures effects on the substances present in a cigarette, cigar, or other smoking devices. These temperatures get to be as high as 900 degrees during puffs and remain as high as 400 degrees in between puffs.
When you light a smoking tool combustion takes place and the atomic makeup of the fuel (the substances being smoked) changes. The result of this change is the ash that is knocked off of the smoking tool and a plethora of gaseous compounds that get inhaled into the lungs. The roughly 2500 chemicals already found in tobacco before combustion turns into more than 4000 after combustion as the heat reorganizes the atoms present in tobacco and the paper when smoking cigarettes. We know that some of those newly created substances are tar, cyanide, formaldehyde, carbon monoxide and more. While tobacco produces the nicotine in cigarettes, it is important to remember that it is the combustion that produces many of the toxic chemicals and particles present in smoking. As such, even tobaccoless smoking is dangerous.
All that aside, these differences between Smoking and Vaping have been touted by many as the reason why vaping is superior to smoking. For a while, vaping companies had muscled in on the smoking market by advertising themselves as a product that can help people quit smoking. As vaping devices became cooler and vaping cartridges began to be filled with all sorts of flavors both with and without nicotine, more and more people started vaping. It was healthy, it was cool, and it helped people quit smoking, with all of that going for it of course kids also got involved. But that’s getting a bit ahead of ourselves, so let's go back again.
While it is true that vaping has ancient origins, the modern e-cigarette can be traced back to the late-1920s and modern vaping specifically has its origins in the mid-1960s. But the idea never really took off. In the 80s electronic smoking and vaping devices rolled back around bringing the term “vape” into modern history as a verb. But the e-smoking devices produced never reached any level of success. In the 90s there was a flurry of legal activity surrounding electronic smoking systems. Numerous patent applications were submitted for everything from electronic semi-combustibles to pure inhalers. Tobacco companies who were feeling the effects of the crackdown on cigarettes finally began taking a serious interest in e-delivery systems. But progress was stalled when the FDA did not give approval to bring an e-cigarette to market. This wasn’t because of the tobacco as tobacco wasn’t regulated by the FDA at the time, it was because the drug delivery system, which was regulated by the FDA, wasn’t an approved delivery system. With that, the 90s ended and e-smoking devices seemed to stall out in America as a commercially viable, widely accepted product.
E-cigs wouldn’t be a commercial product in the US until 2006 on the back of a product made in China. As the use of E-cigs grew internationally, more and more claims were being made about the safety of them and their use as an aid to stop smoking. So much so that the World Health Organization had to release a statement in 2008 saying that it did not consider e-cigs to be a “legitimate therapy for smokers trying to quit.” The statement goes on to say that there is no scientific data supporting the notion that e-cigs are safe and effective and that marketers should stop proclaiming that in their advertising and on their websites. Later in October of 2008, a study done in New Zealand concluded that carcinogens and toxicants are present below harmful levels. The study was funded by Ruyan, the Chinese makers of the e-cig that was being studied. E-cigs don’t use combustion and are tobacco-free, meaning you can get a direct concentration of the drug you want without all the extra stuff (nicotine in the case of tobacco), as such the findings of the study make sense when looking at the study narrowly for one device and one drug. Ruyans was developed to be a safe alternative to smoking by a smoker.
But despite this report, concerns over nicotine addiction persisted and countries began banning e-cigs all over the world in 2009. The FDA (which had gained control of tobacco products) also banned e-cigs because they were still an unapproved delivery device and US Customs and Border Protection began rejecting the entry of E-Cigs into the US. With all this pressure the major e-cig players decided to form a coalition, the Electronic Cigarette Association was formed in 2009 and didn’t last very long. Probably not the best idea considering it was the tobacco industry following in the footsteps of previous generations of the tobacco industry. But the war continued to heat up as the tobacco industry found a new lease on life in the form of e-cigs and the FDA trying to grapple with this new delivery system. Numerous tests were run, most of which indicated only trace amounts of some of the harmful chemicals available in abundance in smoking.
Even back in 2009 some of the FDA tests revealed nicotine in some of the cartridges that were supposed to be nicotine-free and that the labeling did not indicate the toxic substances present even in trace amounts. This was a concern because the marketing of cigarettes to kids was still fresh in the minds of many and there was a fear that e-cigs would be marketed to kids who would then get hooked on nicotine. Opponents of the FDAs stance and their studies argued that the trace elements present in e-cigs were the same elements at the same quantities found in approved cessation products. Numerous doctors fell on both sides of the equation and things looked like they did at the height of the cigarette boom in the mid to late 60s politically and medically. Although things were a little different because people had the experience of the 1960s to fall back on, that was clouded a bit by the fact that these devices were not combustion devices and so a lot of the dangers of smoking were negated.
Later that same year in 2009 Oregon announced a lawsuit that was settled in 2010 alleging that an e-cig company was making false health claims and targeting children with sweet flavors. The FDA’s statement that e-cig cartridges contained a substance that was also used in antifreeze was enough to get several states to take action against e-cigs. California tried to ban them but Arnold Schwarzenegger vetoed the bill asserting that if adults wanted to purchase the products they should be able to do so. Amidst all this fighting, major vape fest were also being held all over the world in 2010 and subsequent years with the first one in America being held in Richmond, Virginia in 2010.
Through 2013 e-cig companies were buoyed by a growing distrust of the FDA, CDA, and WHO, leading to large public outcries of support. People held large vaping parties of varying names, vaping bars began opening all over the place, and people began buying vaping devices for their children and even relatives and friends that didn’t smoke. While all of this was going on, the major medical organizations all lined up against e-cigs urging the Obama Administration to force the FDA to move forward with plans to take control of the E-cig industry and issue more controls and regulations on e-cig drug delivery devices and cartridges. Meanwhile, the e-cig industry reformed into a new coalition, consumer groups formed major coalitions, and even the e-cig liquid manufacturers formed a coalition, all of these coalitions linked up into an e-cig voltron fighting against regulations and impediments to easy access to e-cig devices.
While the consumer groups were focused on maintaining and even increasing access to e-cig as a way of helping people quit smoking, the concerns of the FDA with regards to products marketed towards children went unaddressed by all parties. By 2014, the CDC announced that there had been an 800% increase in child vaping over the previous 3 years. 80% of those questioned about why they vaped said because it comes in the flavors they liked. Advertisements and the conversation around vaping mirrored those around smoking decades ago to some degree and even the flavor profile of some of the fruity and sweet flavors mirrored the flavor profile of kids candy and kool-aid. Other flavors according to reporting done by the LA Times in reviewing FDA documents also showed high levels of toxicity, like the cinnamon flavoring that contained cinnamaldehyde. What’s interesting about that is that cinnamaldehyde is the naturally occurring substance that makes cinnamon, cinnamon. Cinnamon Oil from Cinnamon Bark from a Cinnamon Tree is roughly 90% cinnamaldehyde. That does not change the fact that it is still a toxic substance in large quantities, but I wasn’t able to find out how much of the substance is used in vaping liquids. However, aldehydes, in general, were found in solutions and that family of substances can restrict airways.
By 2016 the number of children vaping had reached the millions. About 70% of them thought they were just vaping flavoring while about 15% admitted to vaping nicotine and about 5% admitted to vaping marijuana. More kids reported not knowing what they were vaping than those that reported vaping marijuana, which is extremely troubling in itself. Just as many 10th graders as 12th graders were reporting vaping with 8 graders only slightly behind. Most people felt safe because vaping was being promoted as safe instead of the more accurate label of simply being safer than smoking tobacco. The concerns about not knowing exactly what was in the cartridges was only seemingly affecting the FDA and the CDC who were and continue to suffer from a credibility crisis in America for a number of reasons. As mentioned earlier, some of the products marked nicotine-free had been discovered to have nicotine in them.
In 2016 the FDA took steps to ban fruity flavored liquids from the market citing a concern that the tobacco companies were once again targeting kids. But the science about vaping was inconclusive with regards to kids transitioning to cigarettes and on the net harm of nicotine without the combustion effect of smoking tobacco. Even though there were decades of experience to rely on, the necessary studies hadn’t been done and the tobacco industry had partnered with the e-cig industry to produce favorable studies that called the FDA science into question. After dozens of meetings and public hearings, the FDA decided to drop its ban on flavored fluids.
Over the next 3 years, nicotine use exploded amongst middle and high school children. An explosion driven by the explosion in vaping. The occasional call to poison control centers from a parent or friend concerning a vaping related issue prior to 2016 grew dramatically over the next 3 years. Now in 2019 25% of 12th graders, 20% of tenth graders, and 9% of 8th graders vape nicotine. That is 1 in 4 for 12th graders, 1 in 5 for 10th graders, and 1in 11 for 8th graders. It has become accepted science that nicotine has a different effect on developing brains than it does on developed ones. But the nicotine issues while significant, aren’t the cause of all of the problems.
There is currently an alarming lung injury spreading through the vaping community. 1300 cases have been reported through 49 states with 26 confirmed deaths and no one is really sure about what is going on. What they do know is that all of the people suffering from the lung injury (which they are calling an injury because they don’t know what it is) vape. With millions of kids vaping there is a concern that this is going to get worse before it gets better. People that are vaping nicotine products are at risk, but people that vape marijuana products represent a large portion of the victims. There also seems to be a prevalence amongst those vaping street created products. 70% of the victims are male and 80% are under 35 years old.
This problem is exacerbated by the fact that many kids that thought they were vaping flavors have now become addicted to nicotine and can’t stop vaping. Even with all of this happening, many are still fighting against more regulation in the vaping industry and many are still claiming that vaping is 100% safe. Despite all those years of dealing with the tobacco industry, society was still unable to prevent a resurgence of the tobacco industry as most of the work that was done to reduce smoking tobacco and nicotine addiction amongst kids has been undone by vaping. And vaping has largely come to prominence largely through the same marketing tools of coolness and safety that ushered in many tobacco products.
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