The Mystery Lung Disease Caused by “Vaping” Was a Textbook Drug Panic

    The opportunity that tobacco harm reduction haters have been waiting for finally arrived. On September 4, Governor Gretchen Whitmer (D) used emergency powers to issue an executive order banning sales of flavored vapes in Michiganthe first state to take such a step. “Companies selling vaping products are using candy flavors to hook children on nicotine and misleading claims to promote the belief that these products are safe,” declared Whitmer. “That ends today.”

    Her talk-tough move was denounced by experts including Dr. Micheal Siegel, a professor at Boston University, who wrote, “I cannot overemphasize how insane this policy is. From a public health perspective, it makes absolutely no sense to ban these fake cigarettes, but to allow the real ones to remain on the shelves.”

    The US war on vaping has been relentless for years, waged through lies, misinformation and bad policy from agencies like the US Food and Drug Administration, with propaganda support from organizations like the Campaign for Tobacco-Free Kids

    But a spate of cases reported in August of severe lung problemstermed a “mystery lung illnessand deaths due to vaping had created a perfect storm for Whitmer to push through a ban.

    In recent months, 450 people, mostly teenagers and young adults, have been sickened by a severe lung illness in 33 states and one US territory. Five have died, according to public health officials. From the beginning of the outbreak, the knee-jerk response from the Department of Health and Human Services (DHHS), the Centers for Disease Control and Prevention (CDC) and the FDA was to blame vaping of nicotine. This despite the absence of proof, as well as credible evidence that the culprit was actually contaminated, illicit e-liquid containing tetrahydrocannabinol (THC)typically purchased off the street and in open cartridges.

    The DHHS issued these recommendations: “Americans who use e-cigarettes and are concerned about these specific, potential risks of illness should consider refraining from their use, and should not buy them off the street or modify them or add substances in ways not intended by the manufacturer; In general, youth, young adults, and pregnant women should never be using e-cigarettes.”

    During a press briefing, Brian King of the CDC warned that “e-cigarettes do not emit a harmless aerosol” and “can include a variety of potential[ly] harmful ingredients.”

    For over a decade, millions have vaped nicotine. A sudden rash of deaths now is supposed to show that all along, it was deadly? Come on.

    For nearly two weeks, the CDC and the FDA deliberately put a singular focus on the delivery device instead of the substances that now seem to have been at the core of the outbreak. They put out ambiguous and confusing warnings against “vaping” or “e-cigarettes,” with no mention of THC oil. Vapers were told to just stop vaping. How likely is that for people who are dependent on nicotine?

    “With food poisoning scares, it’s unlikely that the government would tell everyone to stop eating chicken if salmonella was a problem,” Dr. Ray Niaura, a professor at the New York University Global School of Public Health, told Filter of this inept response. “They would work to rapidly localize the location of the outbreak, track the source, and warn people to avoid eating chicken purchased in a particular area or at particular stores.”

    The constant emphasis on nicotine vaping gave the green light for respected organizations like the American Lung Organization, which opposes vaping, to pile on. A spokesperson said: “We urge the federal government to send a clear message to the public that e-cigarettes are not safe and contain harmful chemicals that can cause severe and irreversible lung damage and disease. The bottom line is that e-cigarettes are not safe, and from the American Lung Association’s perspective, no one should be using e-cigarettes. [My emphasis.]”

    What rubbish! Research shows that vaping nicotine is about 95 percent safer than smoking cigarettes. This, combined with evidence that vaping is about twice as helpful for quitting smoking as nicotine patches or gum, demonstrates that the availability of vaping products is a huge net win for public health in a country where almost half a million people die annually of smoking-related causes.

    For over a decade, millions of people have vaped nicotine liquidsover 3 million of them in the UK, where the environment for vaping is much friendlierwith few adverse effects and no recorded deaths. But a sudden rash of deaths now is supposed to show that all along, vaping was deadly? Come on.

    Yet by whipping up a full-blown drug panic, public health officials and professional organizations can get away with lying to the public.

     

    Eerie Similarities With the Crack Panic

    We’ve seen this playbook before, and the omens aren’t good. Lies last. Remember the “crack baby” panic? The idea persisted in the public consciousness for years, despite being soundly debunked. Or how about the “addicted baby” slur tied up with the opioid-involved overdose crisis? It’s still being peddled by the likes of New York Times columnist Nicholas Kristof today.

    There are lies, too, of omission. At no point in the latest vaping panic did government agencies or the media reassure the public that commercial e-liquids are regulated by the FDA, and manufactured in registered facilities.

    The panic around youth vaping centers the worries of white, wealthy parents. The concerns of overwhelmingly-marginalized groups with the highest smoking rates are ignored.

    There are other ways in which public health agencies’ pursuit of the vaping panic is eerily reminiscent of the crack cocaine panic of past decades: Credence given to reams of junk sicence; hyperbolic claims that “the children” are in danger; depictions of “instantly addictive” substances; the misuse of the word “epidemic,” the rush to pass laws without balanced consideration of their wider impact; and the use of tragic deaths to enforce drug prohibition.

    Remember when the crack panic reached stratospheric proportions? It was the 1986 death of star Maryland basketball player Len Bias that provided much of the impetus to pass increasingly draconian drug laws. Facts were an afterthought: The media widely and falsely reported that Bias smoked crack cocaine, leading to his fatal heart attack. In fact, he snorted powdered cocaine.

    That didn’t stop the establishment of a grotesque 100-to-one sentencing disparity for crack versus power cocaine, which had everything to do with the race of people perceived to be using each form of the drug.

    Similarly, the panic around youth vaping centers the worries of white, wealthy parents. The concerns of the overwhelmingly-marginalized groups of people, disproportionately people of color, who have the highest smoking rates and the most to gain from the availability of vaping, are ignored.

     

    Irresponsible Messaging and Media

    Not surprisingly, the vaping haters couldn’t pass up on the recent opportunity to bash their favorite target, Juul—even though the company’s products haven’t been linked to one case. Chance Ammirata, an 18-year-old, told CBS News that his lung collapsed as a result of using Juul. An Instagram photo of him with a chest tube was prominently featured in the report. Incredibly, CBS didn’t question this unverified claim. Ammirata has started a social media campaign (#LungLove) to get people to stop using Juul. Make no mistake, attacks on vape manufacturers have the ultimate goal of severely limiting or outright banning vaping products.

    The biased, bumbling response of the FDA and the CDC to a deadly outbreak of tainted drugs raises serious ethical questions.

    “The irresponsibility of the government to put out false information to the public when lives are at stake is criminal,” Spike Babaian, a tobacco harm reduction advocate who owns the VapeNY stores in New York City, told Filter. “People are continuing to die because the government has failed to warn them which products present a risk to their health and their lives.”

    The National Organization for the Reform of Marijuna Laws (NORML) put out a warning far more responsible than those of public health officials. “These unfortunate incidents reinforce the need for greater regulation, standardization, and oversight of the cannabis market,” said Deputy Director Paul Armentano. “Consumers must also be aware that not all products are created equal; quality control testing is critical and only exists in the legally regulated marketplace.”

    As a result of prohibition, contaminated drugs that harm or kill people are a constant threat. The overdose crisis which claimed an estimated 66,000 lives last year is due in significant part to heroin and other illicit drugs being cut with fentanyl. K2, a synthetic cannabinoid, caused 56 overdoses and sickened hundreds in New York City in 2018.

    The New York Times, which played such a formidable role in fomenting the racist crack panic, has now doubled down by publishing article after article sowing fears about vaping.

    The recent outbreak of tainted THC was clearly enabled by the continued existence of unregulated cannabis markets. And as experts have noted, banning vape flavors is sure to boost illicit nicotine markets, increasing risks there, too. Babaian said, “People will make flavored e-liquid themselves once it is banned and use adulterated ingredients which will cause further illness and death.”

    The media is highly culpable for the recent panic. The New York Times, which played such a formidable role in fomenting the racist crack panic, has now doubled down by publishing article after article sowing fears about vaping. At publication time, not one headline from “the paper of record” about the recent outbreak references THC.

    In articles about vaping, New York Times journalists overwhelmingly quote health officials who favor bans or recommend total cessation of use. The voices of reputable scientists, tobacco harm reduction experts or organizations of vapers, like the Consumer Organization for Smoke-Free Alternatives (CASAA), have been almost completely absent.

    So let’s redress the balance. “The recent cluster of vapers developing lung problems follows a decade of widespread e-cigarette use without reports of similar adverse effects,” said Dr. Sarah Jackson, a senior research fellow at University College London. “E-cigarettes are the most popular quitting aid used by smokers–and among the most effective. Advice to discourage people from vaping legal, regulated e-liquids appears to be unwarranted and risks pushing people back to smoking.”

     

    Emerging Facts and Real Solutions

    On September 6, the FDA revealed what it believes may be the chemical cause of the pulmonary illnesses and deaths: vitamin E acetate (although this is not yet certain, and there could be other causes as well). Apparently, for every single case in New York State, vitamin E acetate was found in at least one of the illicit THC vape cartridges that were used by the patient. When inhaled, vitamin E acetate becomes grease-like and coats the lungs, which damages them. Importantly, the FDA reported that it found no contamination in any of the nicotine e-liquids tested.

    But how many headlines do you think will be generated by this clarification, compared to those sparked by the initial blaming of “vaping”? The damage done will take a long time to repair.

    An urgent response is needed to any outbreak of substance-related diseasebut not the kind that urges bans on flavors, punishment of underage users, or arrests of sellers.  

    Ways to eliminate contaminated drug supplies include legalizing and regulating all drugs, pricing substances to undercut illicit markets, and enforcing minimum ages for purchase. Harm reduction interventions, like safe consumption sites, cannabis cafes and drug checking kits should be widely available. A harm reduction approach should also apply to youth vaping.

    “It is a tragedy that former smokers will return to smoking tobacco because their government told them that vaping will kill them.”

    While the recent deaths and illnesses associated with vaping are heartbreaking, there could be even more dire consequences.

    “I have received dozens of phone calls [from vapers] who are concerned about their health and lives,” said Babian. “Even those who are educated about the lies we have been told by our government in the past are starting to worry. Many of them expressed intent to quit vaping and return to smoking. It is a tragedy that former smokers who smoked for decades and finally quit will return to smoking tobacco because their government told them that vaping will kill them.” 


     

    Graphic by Filter; photo of e-cigarette devices by Ecig Click via Wikimedia Commons 

    • Helen Redmond

      Helen is the senior editor of Filter. She has written about nicotine, mental health and drug policy for publications including Al Jazeera, AlterNet, Harper’s and The Influence. As an LCSW, she works with drug users in medical and community mental health settings. An expert on tobacco harm reduction, she provides training and consultation on mental health, nicotine use and THR, and in 2016 organized the first Tobacco Harm Reduction Conference in the US. Helen is also a documentary filmmaker.

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