Vaping: what persons are getting mistaken | The Economist

published on July 3, 2020

E-cigarettes could be a game-changer in public health

helping millions of people to quit smoking

Something in the region of 7m people a year

are dying because they smoke

E-cigarettes can provide a route out of smoking for many of those people

More than 40m people worldwide are vaping

e-cigarettes are more controversial than ever before

There was yet another death connected to the use of e-cigarettes

Nicotine exposure during adolescence

can uniquely harm the developing adolescent brain

30 countries have banned e-cigarettes outright

But the facts have gone up in smoke

The death toll linked to vaping is climbing tonight

His infected lungs nearly collapsed

Colorado’s first case of a rare, vaping-related illness

America has been in the grip of a health scare over e-cigarettes

Because of a deadly outbreak of what is being called “EVALI”

EVALI is electronic cigarette, or vaping, product-use associated lung injury

People were complaining of respiratory symptoms

really having trouble breathing and in some cases it was fatal

Since April 2019, 60 deaths and over

two-and-a-half-thousand hospital cases have been reported in America

The American Medical Association and the Centres for Disease Control

advised the country’s 11m vapers to quit

Seven states proposed partial or total bans

Some politicians called for a national ban on all e-cigarettes

Yet the health scare isn’t down to nicotine-based vaping

but illicit cannabis-vaping products

Tetrahydrocannabinol, THC, is the

ingredient in cannabis that makes you high

And so people have been vaping THC for a long time

But at some point Vitamin E acetate was cut in with THC

and that became a contaminant that people were inhaling

Vitamin E acetate thickens the THC

and makes it seem like it’s more high quality than it actually is

There are over 40m vapers across the world

but this outbreak of EVALI is unique to America

In the United States, you’ve got a market that is really not well regulated

It’s possible for manufacturers to put these

dangerous chemicals into the liquids

But in addition to that, you’ve got this varied legalisation of cannabis

and heavy usage of cannabis oil

Put the two together and you’ve got a very dangerous situation

The misconception that this EVALI outbreak

is caused by vaping nicotine products

could have dire consequences

Globally more than 8m people die every year

from smoking tobacco but also inhaling second-hand smoke

Almost half a million of these in America alone

Come to where the flavour is, come to Marlboro country

The concern is that e-cigarette users

who have used an e-cigarette to stop smoking will go back to smoking

If that happens, many lives will be lost

There’s a fair chance I’d be dead right now if it wasn’t for electronic cigarettes

I started smoking when I was nine I smoked for 41 years

The last 30 of those trying to quit

I poked my head in the door here at 906 Vapor

and 20 minutes later I walked out a non-smoker

Then Marc Slis went one step further

He decided to buy the vape shop in Michigan

that had introduced him to e-cigarettes

My customers come from a wide variety of backgrounds, ages

The average customer is a middle-aged professional

but they do have one thing in common and that’s a desire to quit smoking

Do you want another?

Yet there is major concern that vaping is appealing

to increasingly younger customers

The device has now hooked countless teenagers

In 2018 the Food and Drug Administration reported

an alarming increase in high-school students vaping

A 78% increase in 2018 alone

I am officially declaring e-cigarette use among youth

an epidemic in the United States

The reaction we’re seeing in the United States is a kind of mass hysteria

The problem is nothing like what it’s being portrayed as

by public-health officials in the United States

The evidence doesn’t support that kind of language

A national youth tobacco survey in America revealed

that there are many more teenagers trying e-cigarettes

But the number using them more regularly, nearly every day, is far smaller

And the vast majority of those previously used tobacco products

What you see is actually that among never-smokers, e-cigarette use is rare

The use regularly on a daily or nearly daily basis is extremely rare

And among all of those

the reports of cravings and signs of addiction is very small

Whereas with a cigarette, you see the conversion rate

from trying a cigarette to becoming a regular, addicted smoker

is really quite high In people who just use an e-cigarette

and have never smoked, is really quite low

The e-cigarette phenomenon has really called into question

whether it’s just nicotine on its own that is highly addictive

or whether there’s something else going on

This goes against decades of widely held beliefs

around the addictive nature of nicotine

Nicotine is the chemical that causes addiction

It can change the way your brain works causing you to crave more nicotine

Combustible cigarettes are far more addictive

than vaping products because they deliver

many other chemicals, along with nicotine

What we call monoamine oxidase inhibitors

When you use nicotine, that causes release of dopamine

that dopamine is part of the dependence process

Now, if you’ve got a monoamine oxidase inhibitor that you’re inhaling as well

and that’s preventing that dopamine from being broken down

it’s amplifying the effect of nicotine

Cigarettes are actually giving you a cocktail of psychoactive drugs

And bingo, you’ve got a highly addictive product

when if you had nicotine alone, not so much

If nicotine is more addictive in cigarettes than vapes

then is it harmful on its own?

We’ve conflated nicotine with cigarettes, so nicotine was the devil

Really it’s not nicotine that’s causing the damage

In the doses that you get it from a cigarette, the risks are minimal

And the reason we know that is because

there is a part of the world which takes in a lot of nicotine

in a form that isn’t smoking

Scandinavians have been using snus, a form of chewing tobacco, for centuries

Frequent users receive high concentrations of nicotine

on a daily basis, for decades

Now, if nicotine were causing the kind of consequences

that smokers suffer from

we would definitely see it and we don’t see it

But the myth still persists

It’s a myth that is driving health campaigns

in America and around the world

especially focusing on teenagers

Scientists say it can change your brain

There’s a narrative going around now born out of the United States

around nicotine being damaging to the adolescent brain

This is based on studies in animals in their

version of the adolescent stage of development

But the epidemiology itself is not backing up what they are trying to assert

People have been using nicotine for centuries

If nicotine in adolescents were causing this lasting damage to the brain

would we not have seen it?

What critics will say to this

is that absence of evidence is not evidence of absence

And that is a good point

That said, we should be careful about getting too hysterical about

the long-term impacts of children vaping nicotine

British public-health experts say that e-cigarettes are around

95% less harmful than tobacco

That’s only a back-of-the-cigarette-packet calculation

So other than nicotine, what else is in them?

The liquid contains glycerol or propylene glycol

which is the substance that makes the visible vapour

Basically what we use in stage smoke

There’s a lot of studies done on it and we know

what effect it has on the lungs

As far as we can tell, it doesn’t cause an inflammatory reaction

It causes a local dryness in the membranes

Also, trace amounts of heavy metals

from the heating elements can be inhaled

Heavy metals are not the sort of thing

you want to be inhaling in any amount

It’s fair to say that we don’t really know the long-term effects

that these are going to have on anyone who vapes

Indeed, for any of the components of e-cigarettes

But the point about vaping is you’re supposed to use it to stop smoking

which is really harmful, and then use vaping to help yourself quit

In 2018 the global e-cigarette market was valued at $157bn dollars

It’s expected to almost triple by 2023

Appealing flavours have helped the vaping industry to flourish

I’ve got a blue raspberry candy, a strawberry kiwi custard

One of my favourites—whipped peanut butter and caramel

it tastes great and it helps people to quit smoking

Yet the many flavours have caused an uproar in America

Cherry crush! How can you sit here and say you’re not marketing to children?

Today Michigan will become the first state in the nation

to ban flavoured e-cigarettes and vaping products

Marc Slis gave testimony to help block

an emergency flavour ban in his state of Michigan

The numbers in my shop are that 99% of my customers use flavours

The flavours are absolutely necessary and they are the key to quitting smoking

In early 2020 President Trump banned almost all flavours

of e-cigarette cartridges across the nation

And globally e-cigarettes are now entirely banned in 30 countries

For many of us that sounds crazy because in those same countries

you’ve got high smoking prevalence

and they’re not really doing very much about it

In Lebanon, for example, where e-cigarettes are now banned

the World Health Organisation says

almost 26% of all male deaths were tobacco related in 2017

My concern is that forbidding e-cigarettes is going to deter smokers

from switching to something far less deadly

Countries should regulate e-cigarettes very tightly

rather than banning them

Public Health England, they are now currently opening up vape shops

in their hospitals They know it works, they know it saves lives

Governments need to think about tightly regulating e-cigarettes

Take a leaf out of the book of the EU

What goes into them, the quality of the devices

and tightly control how they’re marketed

What you want from a public-health perspective is to capture

the benefits of e-cigarettes as a tool for helping smokers to quit

whilst not appealing to young people who never would have smoked at all

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