The New Kid on the Block: E-cigarette

The New Kid on the Block: E-cigarette

Tobacco has long been used in the Americas, with some cultivation sites in Mexico dating back to 1000 BC. Many Native American tribes traditionally grew and used tobacco. Following the arrival of the Europeans to the Americas, tobacco became increasingly popular as a trade item. Tobacco smoking, chewing, and snuffing became a major industry in Europe and its colonies by 1700. In the late 19th century, cigarettes became popular. The automated production allowed tremendous growth in the tobacco industry until the health revelations of potential cancers. 

A meta-analysis citing 167 analyses was published in 1930, and concluded that tobacco use causes cancer. Increasingly solid observational evidence was published in Europe, throughout the 1930’s and the 40’s, but widespread attention was first drawn by five case-control studies published in 1950 by researchers from the US and UK.  Follow up prospective cohort studies in the early 1950s clearly found that smokers died faster, and were more likely to die of lung cancer and cardiovascular disease. These results were first widely accepted in the medical community, and publicized among the general public, in the mid-1960s.

Despite these medical concerns about tobacco and smoking, production of tobacco leaf increased by 40% between 1971, when 4.2 million tons of leaf were produced, to 5.9 million tons of leaf in 1997. According to the Food and Agriculture organization of the UN, tobacco leaf production hit 7.1 million tons in 2010. China’s share of the world market increased from 17% in 1971 to 47% in 1997. The top producers of tobacco are China (39.6%), India (8.3%), Brazil (7.0%) and the United States (4.6%). Not only does tobacco contain carcinogens but tobacco production requires the use of large amounts of pesticides. Tobacco companies recommend up to 16 separate applications of pesticides just in the period between planting the seeds in greenhouses and transplanting the young plants to the field. Pesticide use has been increased to produce larger crops in less time because of the decreasing market value of tobacco. Pesticides often harm not just the consumers of tobacco, but also tobacco farmers who manipulate the pesticides.

Cigarette smoking causes more than 480,000 deaths each year in the United States. Smoking causes about 90% of all lung cancer deaths. More women die from lung cancer each year than from breast cancer. But smoking rates in the United States dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults. 15% of the US population was smoking in 2016. Among male smokers, the lifetime risk of developing lung cancer is 17.2%; among female smokers, the risk is 11.6%. This risk is significantly lower in nonsmokers: 1.3% in men and 1.4% in women. There has been a world effort toward tobacco smoking prevention. 

A new technology called E-cigarette or more commonly know as vaping, has been advertised by manufacturers as tools for weaning cigarette smokers off tobacco and a safer alternative then the mix of carcinogens found in tobacco. The evidence that E-cigarette helps smokers decrease or cure their habit is sparse at best.  Even if E-cigarettes succeed at lowering the risk of lung cancer and other diseases, they may create new problems that are surfacing and may be far worse in consequences. 

E-cigarettes are illegal in almost every state and in Canada for those under 18 years of age. Unfortunately, vaping has became a huge practice among teenagers, helped by the sleek design and candy like flavouring that appeal to young users. The fact that the flavored liquid contains nicotine and other inhalable chemicals has gone almost unnoticed.  Only 8% of high school students smoke cigarettes, but the statistics are now quoting 20% of high school students are vaping. Of great concern, in trying to decrease cigarette addiction and smoking altogether, the development of this new E-cigarette technology has addicted a new generation. For instance, a single reservoir of vaping liquid allows for about 200 puffs, packing the same nicotine punch as an entire pack of cigarette. Recent studies found that only 37% of 15-24 year-olds who vape, knew that E-cigarettes contains nicotine, and even fewer know the chemicals involved in the vaping liquid. 

In 2019, an outbreak of severe vaping-associated lung illness affected users in USA, Canada and internationally. The Centers of Disease Control and Prevention reported 2,290 lung illness cases so far and as of November 20, 2019, 47 deaths have been confirmed in the US. Based on reports from several states, symptoms typically develop over a period of days but sometimes can manifest over several weeks. The patients presented with progressive respiratory distress, sometimes initially diagnosed as pneumonia or bronchitis. Although some cases included fevers and gastrointestinal symptoms, all cases failed to respond to an initial course of antibiotic treatment. Evaluation for infectious etiologies has been negative and antibiotic therapy alone has not consistently been associated with clinical improvement.  Many patients required admission to the hospital with significant respiratory support, including high-flow oxygen, bilevel positive airway pressure (BIPAP), or intubation with mechanical ventilation

Diagnoses included pneumonitis and acute respiratory distress syndrome (ARDS). Several cases of vaping-associated pulmonary injury (VAPI) and ARDS were connected to vaping cannabis products that were traced back to pop-up retailers. Patients have improved with systemic steroids.  All patients reported vaping in the weeks prior to hospital admission, and a reported common similarity among these patients is that they had been vaping cannabis or CBD oils. Under the New York State Department of Health tests conducted by the Wadsworth Center found exceedingly high amounts of Vitamin E acetate in most of the cannabis e-cigarette products. “At least one vape product containing vitamin E acetate has been linked to each patient who submitted a product for testing,” the New York State Department of Health stated. None of the nicotine-based product samples contained vitamin E acetate.

On November 8, 2019, Dr. Anne Schuchat, principal deputy director of the CDC, said, “for the first time we have detected a potential toxin of concern — Vitamin E acetate — in biologic samples from patients with lung injuries associated with the use of e-cigarette or vaping products.” The sample types were bronchoalveolar lavage (BAL) fluid  (fluid samples collected from the lungs). The chemical was found in samples collected in ten different states from the lungs of 29 patients with the disease. “These findings provide direct evidence of Vitamin E acetate at the primary site of injury within the lungs,” said Dr. Schuchat. The CDC tested for a wide range of substances that might be found in e-cigarette or vaping products including plant oilpetroleum distillates like mineral oilmedium-chain triglyceride oils – or MCT oils – and terpenes which are compounds found in or added to THC products. No other potential toxicants were detected in the testing conducted so far. 

 What people are inhaling is causing the lung illnesses. The lung illnesses are likely to be caused by a chemical exposure. Counterfeit cannabis cartridges are being sold to users at a reduced cost. The e-cigarette-related lung illnesses currently sweeping across the country reaffirm the belief that the use of e-cigarettes and vaping is an urgent public health epidemic that must be addressed, be regulated by the U.S. Food and Drug Administration (FDA) and flavored E-cigarettes be banned. 

Many parents are extremely concerned about their teenagers becoming addicted to vaping. In addition teenagers are beginning to identify that they need help to not become addicted. Finding treatment for vaping is really hard, because nobody knows how to treat people of any age hooked on E-cigarettes. No rehabilitation centers are equipped or providing any programs to help these young adults. It is really painful to think that our society has created a new technology based on helping people addicted to tobacco which has lead to a new addiction in a group of vulnerable people such as our teenagers. 

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