- Vaping Q&A: Johns Hopkins Expert on E-Cigarettes and Tobacco Alternatives
- Vaping cannabis produces stronger effects than smoking cannabis for infrequent users
- California Cannabis Vape Pen Lung Injury Attorney –
- Will proposed e-cig ban affect vaping at Hopkins?
- 22 People in 3 States Have Now Been Hospitalized For Severe Lung Damage as A Result of Vaping
Vaping Q&A: Johns Hopkins Expert on E-Cigarettes and Tobacco Alternatives
Home > News > Stories > 2019 > Vaping Q&A: Johns Hopkins Expert on E-Cigarettes and Tobacco Alternatives
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Last updated September 17, 2019
Vaping-related illnesses and deaths have drawn national attention since they first were documented last month. More than 380 confirmed and probable cases of lung disease and six deaths associated with e-cigarette use have been recorded in 36 states and the U.S. Virgin Islands as of September 11, according to the CDC.
The illnesses and deaths emphasize that there are risks associated with vaping, says Joanna Cohen, PhD, Bloomberg Professor of Disease Prevention and director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.
In this Q&A, Cohen shares her thoughts on myths behind vaping, what’s in e-liquids, how e-cigarettes are marketed to young people, and other issues.
What’s causing the sudden surge in illnesses and deaths related to vaping?
At this point, health authorities have not been able to identify what is causing the illnesses and deaths related to vaping. So far, there has not been one factor— type of e-liquid, brand, where the vaping device and e-liquid were purchased, etc.—that has been common across all cases.
When will we know what’s behind the cause?
Hopefully very soon. The CDC and FDA are continuing to work around the clock to investigate what is causing these serious health problems.
How would people know if their vaping cartridges are safe?
Vaping is not safe.
The propylene glycol and/or vegetable glycerin that form the basis of e-liquids are generally regarded as safe for ingestion, but we do not yet know the effects when inhaled.
The Surgeon General has concluded that nicotine in e-cigarettes can harm the developing brain. Little is known about inhaling flavor chemicals, but some ingredients used as flavorants are clearly harmful when inhaled.
And there can be many other kinds of chemicals in the liquids people vape.
People have used vaping devices to vape other substances, including THC. There are no regulations yet on what the e-liquids contain, and there could be contaminants.
No one should be vaping unless they are a cigarette user trying to quit using cigarettes.
What’s your advice for people who used to smoke traditional cigarettes and have switched to vaping since it was supposed to be safer? Should they go back to tobacco?
The only group who should use vaping products are cigarette smokers who are trying to quit smoking, or former smokers who have successfully switched to vaping. If you fully switched and no longer smoke cigarettes, congratulations! Now, it’s important to try to get off vaping products as well because these products are not safe.
If you are in the midst of trying to quit smoking, do not go back to using cigarettes. However, you should monitor yourself for the symptoms associated with the outbreak related to e-cigarette use. The CDC has advice for the public.
Why are flavors in e-cigarettes being targeted for regulations?
Flavors are a focus of regulations because flavored products appeal to youth. Most youth who vape use a flavored product.
How has vaping been marketed to children and young people?
Youth have been exposed to a marketing for e-cigarette products through a range of channels, including social media/social influencers, product displays in stores, and ads outside of stores.
What laws on e-cigarette sales to young people exist?
The Public Health Law Center tracks e-cigarette laws at the state level. There are laws related to vendor licenses, product packaging, taxes, and sales to minors.
Michigan recently announced that they are using an administrative rules process to ban the sale of flavored e-cigarettes unless and until they are authorized for sale by the FDA.
Last year the city of San Francisco banned the sale of flavored e-cigarettes.
The FDA requires a warning on liquid nicotine. Last week the President indicated that unauthorized flavored e-cigarettes will have to come off the market, but no timelines are available yet. The Institute for Global Tobacco Control tracks e-cigarette policies at the country level.
What are some common myths/perceptions about vaping that are refuted by evidence?
One common myth is that vaping is safe.
E-cigarettes have been available for just over 10 years, and there is evidence that these products can result in negative effects on our lungs, breathing, and cardiovascular system. E-cigarettes are NOT safe. Cigarettes are also not safe; in fact, they are extremely lethal.
So if cigarette smokers have tried various approaches to quitting smoking, unsuccessfully, it is felt at this time that they can try to use e-cigarettes to help them quit cigarettes.
What should schools do about young people and vaping? Pediatricians? Parents?
No one other than cigarette smokers trying to quit smoking should be using e-cigarettes.
Schools should prohibit vaping … but realize that when they find a student who is vaping, that student needs their help to get off e-cigarettes. The same with parents and pediatricians. They should advise kids not to use e-cigarettes, and then provide help and support to quit if their child or patient is using these products.
What’s Big Tobacco’s role in e-cigarettes?
All major tobacco companies own e-cigarette brands. For example, Altria has a 35% stake in Juul. RJ Reynolds Vapor company is a subsidiary of RJ Reynolds American and markets the Vuse line of e-cigarette products.
For more information on vaping and tobacco issues:
Institute for Global Tobacco Control
The Facts About Electronic Cigarettes—CDC
E-cigarettes, Juuls and Heat-Not-Burn Devices: The Science and Regulation of Vaping—Hopkins Bloomberg Public Health
Vaping cannabis produces stronger effects than smoking cannabis for infrequent users
In a small study of infrequent cannabis users, Johns Hopkins Medicine researchers have shown that, compared with smoking cannabis, vaping it increased the rate of short-term anxiety, paranoia, memory loss and distraction when doses were the same.
The findings of the new study, described in the Nov. 30 edition of JAMA Network Open, highlight the importance of dose considerations with the perception that vaping is a safer alternative to smoking cannabis, the researchers say. And they ask regulators of medical and recreational cannabis dispensaries to take note.
Vaping devices heat cannabis to a temperature in which the mind-altering compounds in the plant are released as a vapor that is inhaled. Vaping is thought to be safer for cannabis and tobacco use because it doesn't produce many of the harmful components of burning material such as tar and other cancer-causing agents.
But, the researchers say, their study suggests that at least for first-timers or others who don't use cannabis regularly, vaping delivers greater amounts of THC, the primary intoxicant in cannabis, which increases the lihood of adverse reactions.
“In light of increased legalization of cannabis, we designed our study to be more representative of the general population's exposure to cannabis, namely someone who has never smoked it and wants to try it for medical or recreational purposes, or someone who does not use it regularly enough to understand or predict its effects,” says Ryan Vandrey, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “What our study suggests is that some people who use cannabis infrequently need to be careful about how much cannabis they use with a vaporizer, and they should not drive, even within several hours after use. It could be dangerous for themselves and others, and on top of that, they may experience negative effects such as anxiety, nausea, vomiting and even hallucinations,” he adds.
For their study, the researchers chose 17 volunteer participants (nine men and eight women, average age 27 years), who hadn't used cannabis in the past 30 days, which was verified by a drug screen, and together on average hadn't used in over a year.
In a controlled setting at Johns Hopkins Bayview Medical Center's behavioral pharmacology research unit, each participant either smoked or vaped cannabis containing 0, 10 or 25 milligrams of ?9-tetrahydrocannabinol (THC), the active component in cannabis that gives people the high, in single visits once a week over six weeks.
The researchers say that 25 milligrams of THC is a relatively low dose, and much less than is typically found in pre-rolled cannabis “joints” sold in dispensaries where cannabis is legal. The participants either smoked preloaded pipes or inhaled vapor from a vaporizer.
Neither the participants nor the researchers knew the doses of THC that were delivered in a given experimental test session.
During each of the six sessions, the research team observed and assessed drug effects in the test subjects, including for adverse reactions. They also measured vital signs such as heart rate and blood pressure and collected blood samples just after smoking, every 30 minutes for two hours and then every hour for eight hours.
Each participant also completed the Drug Effect Questionnaire — rating self-reported drug effects a score of 100 — shortly after smoking and each hour for up to eight hours later. The survey assessed overall drug effect; feeling sick, anxious, hungry, sleepy and restless; and experiencing heart racing, dry mouth, dry eyes, memory impairment and coughing.
Results showed that a few minutes after smoking, those who vaped the 25-milligram THC dosage reported an average of 77.5 on the overall strength of the drug's effect, meaning how high they felt compared with the average score of 66.4 reported by those who smoked the same dose.
Participants who vaped 25 milligrams of THC reported about a 7 percent higher score on average for anxiety and paranoia, compared with people who smoked the same amount of the compound. Those who vaped any dose of THC also reported higher levels of dry mouth and dry eyes than those who smoked it.
For example, when vaping 25 milligrams of THC, the participants rated dry mouth at 67.1 on average compared with 42.6 for those smoking it.
Researchers say the participants also completed three computerized tasks designed to measure attention span, memory, physical reaction time and motor movement.
One task required the participant to replicate the shape of patterns, another required them to add up strings of single-digit numbers and the third required them to follow a dot across the screen with the cursor while also tracking a dot that pops up in the periphery.
The tests are meant to represent skills needed for proper workplace performance, operating a car or other daily activities. Reaction times on average were slower by more than 120 milliseconds with both active test doses of THC, using either smoking or vaping, when compared with reaction time after smoking or vaping cannabis without any THC.
Next, the researchers compared the effects of vaping compared with smoking on participants taking the computerized Divided Attention Task, which required participants to track a square on the computer screen while also monitoring numbers in each corner of the screen. The amount of time participants accurately tracked the square on the computer in the Divided Attention Task dropped by an average of 170 percent after smoking 25 milligrams of THC compared with the cannabis without THC.
The amount of time they accurately tracked fell an average of 350 percent when vaping 10 milligrams of THC and fell 500 percent when vaping 25 milligrams of THC, compared with those smoking either dose.
“Our participants had substantially higher impairment on the tasks when vaping versus smoking the same dose, which in the real world translates to more functional impairment when driving or performing everyday tasks,” says postdoctoral fellow Tory Spindle, Ph.D., a researcher in the behavioral pharmacology research unit at Johns Hopkins Bayview.
Other results showed that blood levels of THC were at their highest immediately after smoking or vaping cannabis. At 10 milligrams of THC, blood levels of THC reached an average of 7.5 nanograms per milliliter in vapers, compared with 3.
8 nanograms per milliliter in smokers 10 minutes after they inhaled the drug. At 25 milligrams of THC, blood levels reached an average of 14.4 nanograms per milliliter when vaped compared with 10.2 nanograms per milliliter when smoked.
“There's a definite differences in the amount of drug making it into the blood when using a vaporizer versus smoking the drug, so considerations need to be made when dosing to ensure people are using cannabis safely,” says Spindle.
The researchers note that they could only detect THC in the blood samples up to four hours after using, even though the participants reported the drug's effects lasted five or six hours. The researchers say this suggests that blood testing isn't an accurate way to tell if someone is high or perhaps driving under the influence.
Two participants vomited after vaping 25 milligrams of THC, and another experienced hallucinations. One person vomited after smoking 25 milligrams of THC.
Vandrey cautions that the study involved only a small number of younger adults and lasted only six weeks.
“We still don't have a full look at the long-term effects of vaping, such as whether there is a risk for chronic bronchitis, and more work needs to be done on that front,” he says.
It is important to note that these effects were observed in individuals who don't use cannabis very often, and may not extend to people who use cannabis routinely; they may have developed tolerance to these effects and also may be better able to regulate their dose.
In recent years, Canada and several U.S. states including Washington, California, Colorado and Massachusetts have legalized cannabis for recreational use. Thirty-two states have made cannabis available with a doctor's prescription, including Maryland, where the research was performed.
Additional authors include Edward Cone, Nicolas Schlienz and George Bigelow of Johns Hopkins; John Mitchell of RTI International and Ronald Flegel and Eugene Hayes of the Substance Abuse and Mental Health Services Administration (SAMHSA).
This research was funded by SAMHSA.
Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.
California Cannabis Vape Pen Lung Injury Attorney –
How do I know if I have a Lung Injury from Vaping?
A Lung Injury caused by vaping is more commonly referred to as “EVALI, which stands for E-cigarette or Vaping Associated Lung Injury.
EVALI results when a consumer has inflammation in the lungs caused by inhaling harmful substances as a result of using an electronic drug delivery systems (EDDS), more commonly referred to as a “vape pen.
” Medical conditions such as pneumonia, damage to alveoli (lung sacs), fibrinous pneumonitis, bronchitis, asthma, COPD, and even lung cancer have been associated with EVALI.
Most often, patients with EVALI start off with a gradual progression of symptoms, which can include a persistent cough, sore throat, difficulty breathing, shortness of breath, or chest pains. However, typically in EVALI cases, these symptoms do not resolve without medical intervention. Some EVALI cases can result in permanent injury, such as hard-metal lung disease, or even death.
I thought vaping was supposed to be safe, so how can vaping result in Lung Injury?
Vaping can result in EVALI in a number of ways including as a result of poor extraction methods, tainted e-liquid cartridges, and exposing the consumer to heavy metals such as chromium, cadmium, cobalt, and lead.
How can I be exposed to heavy metals while vaping?
Vape pens are electronic devices that produce an aerosol by heating a liquid (e-liquid) containing nicotine or tetrahydrocannabinol (THC). The e-liquid is put into a plastic or glass cartridge that is used in conjunction with the vape pen.
Vape pens use a battery-supplied electric current that passes through a metal coil to heat the e-liquid containing cartridge, which creates an aerosol.
When a consumer draws on the vape pen, the air intake holes on the device activate the battery which in turn ignites a wick in the cartridge causing its contents to heat into an aerosol. Consumers inhale this aerosol into their lungs, which is commonly referred to as “vaping.”
Vape pen hardware can introduce heavy metals into a cartridge in the vape pen containing e-liquid. Such exposure to heavy metals occurs as a result of a process known as “leaching.
” Leaching is a process whereby soluble heavy metals that may be present in the hardware of a vape pen dissolve into the formulation contained in the e-liquid cartridge over time.
Studies have shown that this leaching of heavy metals in vape pen hardware stems from both the heating coils found in vape pens as well as the battery compartments of vape pens.
According to a February 21, 2018 study published in Environmental Health Perspectives by scientists at Johns Hopkins Bloomberg School of Public Health, heating coils from vape pens, which are typically made nickel and chromium, are leaking or leaching toxic metals into the vape pen cartridge containing liquid nicotine or THC.
Vaping THC raises the risk of this leaching of hard metals, because the heating coils must be heated to much higher temperatures to aerosolize THC than to aerosolize nicotine. Prior research has shown that a greater amount of toxic substances are released as the voltage needed to heat vape devices increases.
As a result, heavy metals can enter the e-liquid cartridge and be inhaled by the consumer.
A consumer can also be exposed to heavy metals from the battery compartment of a vape pen. Heavy metals have been found in the electrodes of lithium polymer cells contained inside the battery compartment.
Consumers are exposed to such heavy metals because inhalation-activated vape pens have air channels that open directly into the battery compartment.
As a result, heavy metal solder and particles of metal oxides can readily enter the e-liquid cartridge and be inhaled by the consumer.
Is my potential exposure to hard metals through vaping a cause for concern?
Yes. Exposure to heavy metals through vaping can result in a consumer inhaling toxic metals such as chromium, cadmium, cobalt, and lead.
Inhalation of these toxic heavy metals can permanently alter the cells of human lung tissue and result in conditions such as hard-metal lung disease, “cobalt” lung, “popcorn” lung, or various forms of pneumonia.
While some of these conditions can be treated with long-term use of steroids as well as supplemental supplies of oxygen, such conditions may be permanent and require a lung transplant in order for the injured consumer to experience any long-term “cure” from their Lung Injury.
Can I sue the distributors of my vape pen and/or e-liquid cartridge if I have a Lung Injury that I believe was caused vaping? How does a vape lawsuit work?
If you have vaped cannabis and experienced symptoms associated with Lung Injury (including but not limited to: a persistent cough, sore throat, difficulty breathing, shortness of breath, or chest pains) and/or have been diagnosed with a pulmonary or Lung Injury (including but not limited to: pneumonia, hard-metal lung disease, cobalt lung, popcorn lung, damage to alveoli (lung sacs), fibrinous pneumonitis, asthma, bronchitis, COPD, and lung cancer), you should contact a law firm to discuss what options for legal recourse you may have. Please contact Ribera Law Firm at (415) 576-1600 or firstname.lastname@example.org if you would to schedule a free consultation to evaluate whether you may have a potential EVALI case.
Will proposed e-cig ban affect vaping at Hopkins?
Two weeks ago, the Trump administration announced plans to ban the sale of flavored e-cigarette products within the U.S. The announcement followed the spread of vaping-related illnesses.
Flavored e-cigarettes are popular among teenagers and college-age students. Hopkins students reflected on how these reports of recent illnesses have impacted their vaping habits.
Junior Noah Johnson spoke to The News-Letter about her experience with vaping. Johnson began vaping in order to quit smoking.
“If I were to smoke a cigarette after vaping, it was kind of gross,” she said.
Johnson has completely stopped smoking any form of nicotine because of the recent medical scare related to vaping.
“I got freaked out that all the people were dying,“ Johnson said. “I’d rather not take the risk of getting a mysterious lung disease.”
Jacki Stone, the director of student well-being at the Center for Health Education and Wellness (CHEW), told The News-Letter in an email that vaping on campus was nowhere near as widespread as students believe, according to a 2018 survey.
“In the spring of 2018, 83% of JHU students who took the survey had never used an e-cigarette. Of those who have used e-cigarettes, just over 9% of survey respondents used in the past 30 days.
554 students answered this question,“ Stone wrote. “When survey respondents were asked how often they think the typical student at JHU used e-cigarettes within the last 30 days, 67.
5% of students reported believing that students used in the last 30 days.”
E-cigarettes were seen as a better option for people addicted to cigarettes or other tobacco products as they do not involve the combustion of toxic particulate matter, which is known to cause lung cancer. Health and Human Services Secretary Alex Azar explained at a joint press conference with Trump on Sept. 11 why the administration banned the sale of cigarette products within the U.S.
“An entire generation of children risk becoming addicted to nicotine because of the attractiveness, appeal-ability and availability of these vaping products,” Azar said. “With the president’s support, the Food and Drug Administration intends to… require that all flavors, other than tobacco flavor, be removed from the market.”
The Trump administration’s actions are not unprecedented. Michigan became the first state to ban the sale of flavored e-cigarettes, with a ban that will go into effect on Oct. 2. Juul Labs had halted its wholesale distribution of fruit-flavored pods to stores nationally late last year, leaving only mint, menthol and tobacco flavors in most retail settings.
Former Chief Executive Officer of Juul Labs Kevin Burns, who stepped down on Wednesday, told CNBC that Juul’s youth appeal was unintentional and called for further studies on the long-term effects of using e-cigarettes.
“It’s not intended for [children]. I hope there was nothing that we did that made it appealing to them,” Burns said. “We have not done the long-term, longitudinal, clinical testing that we need to do.”
A number of Hopkins students spoke to The News-Letter about their opinions on the flavor ban.
Sophomore David Wang explained that his friends’ use of e-cigarettes had encouraged him to start vaping.
“I vape mainly to relieve stress, also because it is a fun thing to do,” Wang said. “I got into vaping because a lot of my friends did. I do consider myself addicted.”
When asked about the potential effects of the ban, Wang expressed interest in the outcome, saying that he would consider quitting vaping and switching to tobacco products cigarettes.
Freshman Hokin Deng told The News-Letter that vaping has had an impact on his academic career at Hopkins. While Deng said that he now regrets his decision to begin vaping, he is no longer able to take tests at Hopkins without doing so.
“I get anxious before every test, so I have to vape,” Deng said.
A possible downside to the flavor ban is the potential it has to encourage e-cigarette users to transition into consuming tobacco products.
“If they ban all the e-cigarettes, I’ll have no choice but to smoke cigarettes,” Deng said.
Though Stone only began working at Hopkins in August, she wrote that she is partnering with Hopkins Kicks Butts, a student-run anti-smoking organization, to discourage students from using nicotine products.
“I am working with the leaders of the Hopkins Kicks Butts group on campus who are invested in doing campus policy work to address smoking and vaping,” she wrote. “The research suggests that e-cigarettes are particularly harmful for children and young people so it is unly that any studies will suggest them as a cessation technique.”
Stone explained why she believes e-cigarette products are so attractive to young adults.
“Ease of access coupled with messaging for e-cigarettes and desirable flavors make these products appealing to young people,“ Stone said. “Nicotine is a powerful substance which has significant health consequences in the immediate and in the future.”
22 People in 3 States Have Now Been Hospitalized For Severe Lung Damage as A Result of Vaping
Nearly two dozen people—mostly young adults—have now been hospitalized with severe breathing difficulties as a result of vaping.
According to NBC News, a total of 22 cases have been reported: four in Minnesota, 12 in Wisconsin, and six in Illinois—up from 14 reported cases in Wisconsin and Illinois in early August.
Even more concerning: Doctors don't know for sure what exactly is causing these hospitalizations. Per NBC News, it's unclear what type of e-cigarette devices the people were using, what they were inhaling, and where they purchased the devices or e-liquids in the first place.
RELATED: Teens Are 'Juuling' At School. Here's What That Means
In an August press release from the Wisconsin Department of Health Services (WDHS), the admitted patients experienced symptoms shortness of breath, fatigue, chest pain, cough, nausea, and weight loss—and NBC News notes that four patients in Wisconsin were hospitalized with what they initially thought was pneumonia. The department said that while the severity varied among patients, some cases were so bad that they require breathing assistance.
One patient, a Burlington, Wisconsin man in his mid-20s, was even put in a medically-induced coma as a result of lung damage from vaping, according to Fox 6 Now, a Wisconsin-based news channel.
(It's believed, however, that specific incident may have been caused by a vape cartridge containing THC—the main psychoactive compound in marijuana; a trend that hasn't been seen in the other Wisconsin and Illinois cases).
“Vaping among teens has increased dramatically over the last several years,” Illinois Department of Public Health Director Dr. Ngozi Ezike wrote in a press release.
“While the short- and long-term effects of vaping are still being researched, these recent hospitalizations heighten the need for parents talk with their teens about vaping and for both to understand the consequences and potential dangers of vaping.”
Of course, the Midwest isn't alone in this vaping increase: According to a 2018 report from the surgeon general, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, use e-cigarettes regularly. Unfortunately, teens are even more ly to reap the consequences of e-cigarettes than adults.
RELATED: FDA to Regulate E-Cigarettes and Ban Sales to Minors
“Teens may be poised to suffer more harm from e-cigarettes than adults for a few reasons.
The first is that their brains are more susceptible to nicotine addiction compared with adults,” Christy Sadreameli, MD, a pediatric pulmonologist at Johns Hopkins Hospital and spokesperson for the American Lung Association, tells Health.
“Another is that the lungs, and specifically the tiny air sacs in the lungs called alveoli, are still developing into mid-adolescence. Therefore, teens may be exposing themselves to very harmful chemicals while their lungs are not even fully developed.”
RELATED: E-Cigarettes to Be Regulated as Tobacco Products
As far as those harmful chemicals go, e-cigarettes typically contain “ultra fine particles, harmful flavorings, and heavy metals,” says Dr. Sadreameli—which are harmful for even developed lungs.
“For some examples of harmful components, e-cigarette emissions have been shown to contain formaldehyde, a carcinogen, and materials that can cause permanent damage to the lung, such as diacetyl (which can cause a condition called ‘popcorn lung’) and acrolein (which can also do permanent lung damage).”
While the possible cause of theses incidents is still under investigation, officials are warning those who use e-cigarettes to seek immediate medical attention if they experience any type of chest pain or difficulty breathing after vaping. Health care providers caring for patients with unexpected serious respiratory illness have also been urged to ask about a history of recent vaping.
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