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“Vaping epidemic among teens is causing lung injuries”  

The Tired Narrative: 

An epidemic of youth e-cigarette vaping is causing deadly lung injuries around the country. These lung injuries are caused by using “e-cigarette” and “vaping” devices. Specifics about precisely what devices or substances are being vaped (nicotine vs THC) and what is actually causing people to become ill are muddled and conflated. Some have cautioned that “there is no evidence that vaping is safer than smoking cigarettes.”

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The Informed Narrative: 

The cause of the current outbreak is almost never linked to e-cigarettes (which is a specific term for vaping products containing nicotine). The outbreak of injuries (technically called e-cigarette, or vaping, product use–associated lung injury (EVALI)) has been most directly linked to vitamin E acetate, a substance recently introduced in (mostly) illicit manufacturing of cannabis “vape pen” cartridges. This substance is used to dilute the THC (one of the psychoactive compounds in cannabis). Tweets, headlines, and news reports conflate “e-cigarettes” (a term exclusive to nicotine vaping), with “vape pens” and other devices used to vaporize THC. Such devices must be much more tightly regulated and tested to protect consumers. 

As of now, health officials have linked lung injuries to THC-related vape products containing Vitamin E acetate, often procured by informal sources, and not nicotine-related vape products.



The policy response to lung injuries caused by vaping contaminated THC resulted in proposed and implemented bans of flavored e-cigarettes, an entirely different product unrelated to the injuries. THC has been dry-vaporized for decades and it was not until poorly manufactured and contaminated THC products penetrated the market in large numbers that it produced this outbreak. More broadly, conflating THC and nicotine vaping, including by government agencies like the CDC, has muddled the policy response to this issue. Product-wide bans on e-cigarettes or flavored e-cigarettes cannot be rationalized by effort to reduce lung injuries, since these products have almost never been linked to such injuries. These bans create the risk of harm to adults, who are trying to avoid combustible tobacco. Failing to distinguish between the contaminants in THC vape cartridges that are causing the illnesses, and THC itself, does nothing to inform cannabis users about which products to avoid. 

There needs to be much more coherent, sensible regulation of how vaping products are manufactured and advertised. Additional restrictions on marketing targeting children make sense, but must be considered in context of a plethora of other factors, including the broad availability and marketing of flavored alcohol products. Policies that make it harder for adult tobacco smokers to vape nicotine cause harm. Conservative estimates suggest that if vaping nicotine were to replace most tobacco smoking over the next 10 years, 1.6 million premature deaths would be prevented in the United States. That amounts to over 20 million years of life saved.


Connect with Expert Sources:

Amelia Howard, sociologist, PhD Candidate University of Waterloo Ontario, Canada


Ethan Nadelmann, founder of Drug Policy Alliance


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