An outbreak of lung injuries nationwide has prompted public health officials in Nevada to push for additional research into the safety of vaping and vape products.
There have been six confirmed cases of vaping-related lung injuries in Nevada since September — all six in Southern Nevada. According to the Department of Health and Human Services, a seventh case is probable — that one in Washoe County.
Complete details on the cases aren’t public but the SNHD has reported that one of the confirmed cases was a minor and two were patients under the age of 20. One of the confirmed cases was a College of Southern Nevada student who went to the hospital for acute respiratory distress. That patient was put into an induced coma and put on a ventilator.
None of the cases in Nevada have been fatal.
But nationally there have been 54 confirmed deaths, spread out across 27 states and the District of Columbia, with additional deaths still under investigation. According to the CDC, as of Dec. 17, there have been a total of 2,506 cases of hospitalization across all U.S. states and territories.
According to the CDC, the vaping-related injuries are presenting with respiratory (cough, shortness of breath or chest pain), gastrointestinal (nausea, vomiting, stomach pain or diarrhea) and miscellaneous symptoms (fever, chills or weight loss). These symptoms have developed over a period of days or several weeks and are not associated with a lung infection.
“We think there’s underreporting,” says Malcolm Ahlo, senior health educator at the Southern Nevada Health District. “One: Not all providers are looking for it. Two: Some (patients) are just coughing and vomiting and not getting associated with it. We don’t think there is accurate reporting.”
State officials are looking to change that. They have begun taking steps to get ahead of what they see as a potential public health crisis. Of particular interest is the association the outbreak has with THC products. THC is the psychoactive chemical component of marijuana.
Earlier this month, Attorney General Aaron Ford and state public health officials sought approval from the Interim Finance Committee to use $1.7 million to collect data, conduct epidemiological research, host a vaping and cannabis summit, and launch a marketing campaign to address the public.
“The public health consequences are still unknown,” Ford told the committee of vape products. “Four years ago we were deciding if we wanted to tax them like tobacco … Today we’re talking about an issue that’s affecting our youth, and not just our youth. What we endeavor to do is nip this in the bud.”
The former state senator added that he didn’t want to be four years down the road and have missed addressing the public health issue earlier.
The IFC approved the release of $400,000 for four epidemiological research positions and $125,000 for a vaping-cannabis summit to be held next year. However, the committee — led by chair Rep. Maggie Carlton (D-Clark County) — opted to keep additional money in reserve until public health officials could provide more details on their findings and explain how an informational campaign would be specific to Nevada. The money comes from a settlement Ford’s office announced earlier this year with Johnson & Johnson over improper marketing of metal-on-metal hip implants.
According to Nevada Department of Health and Human Services officials, some states built research into public health impacts into their legal marijuana revenue.
Nevada did not.
The outbreak is not exclusive to vape products containing THC but is associated with it. Nationally, 80 percent of hospitalized patients reported using THC products, 35 percent reported exclusive use of THC products, 54 percent reported using nicotine products, 13 percent reported using nicotine products exclusively and 40 percent reported using both THC and nicotine products.
Within Nevada’s confirmed cases, the specific products used by the patients are similarly varied.
The CDC has reported that a variety of products — both from the legal market and the illegal market — have been associated with the patients. It does not appear to be contained to any single brand, product or manufacturer.
The science behind the lung injuries are still unclear. The CDC has identified vitamin E acetate as “chemical of concern” associated with it but has cautioned “there are many different substances and product sources that are being investigated, and there may be more than one cause.” Vitamin E acetate is an additive used in some THC vaping products as a thickening agent. Vitamin E acetate is not considered harmful when in food or topical products (like skin creams), but it may interfere with lung functionality when inhaled.
In response to the outbreak, at least two states — including Colorado — have banned vitamin E acetate and certain other additives in vaping products.
“What I like to tell people is: There is no safe level,” said Ahlo. “No safe vaping product. It’s too early. To be safe, do not use them period.”
Ahlo acknowledges that message might be difficult for some people to swallow.
“People ask: Why is there all this fuss on vaping? I say: The onset is happening so quickly. The people have been using them for less than a year. They have permanent lung damage. It’s happening so quickly.”
Beyond just the immediate threat of a possibly fatal lung injury, public officials are also concerned that vaping appears to be ushering in a reversal of the smoking rate, which had been on the decline due to public awareness over the dangers of combustible cigarettes.
According to the DHHS, half of all Nevada middle and high schoolers in 2015 had tried vaping. A quarter of all middle and high schoolers were current users.
“(E-cigarettes and vaping products) were really marketed as a way for individuals to quit smoking,” says DHHS Senior Advisor on Behavioral Health Stephanie Woodard, “but there we’ve begun to see the increased use of vaping products among individuals who had not previously consumed nicotine.”
Kristi Robusto with the Chronic Disease Prevention & Health Promotion program within DHHS notes the U.S. Food & Drug Administration has not approved e-cigarettes or vape products as a nicotine cessation device. There are no vaping products approved for any therapeutic use or marketing by the FDA.
Yet, culturally and socially the perception is quite different, especially since the legalization of recreational marijuana in 2017.
“There’s a perception of it being safe,” says Robusto. “Because it’s a vapor product. People misunderstood. ‘I thought it was water and inhaling is okay.’ As we are learning, that is not the case.”
The Nevada Vaping Association, which has described vaping products as “life saving” and boasted about their ability to help stop people from smoking, did not respond to an email request for comment.
This year, the Nevada Legislature passed Senate Bill 263, which placed vape products in the same category as tobacco products — subjecting them to a higher tax rate of 30 percent. Some of the revenue generated from that tax is also being earmarked for additional vaping prevention measures.
Ahlo with SNHD says he would like to see a ban on flavored products in Nevada. Other states and local municipalities have begun banning flavored products, largely driven by skyrocketing youth vaping rates.
Meanwhile, Congress is scheduled to raise the legal smoking age to 21. The ban would include vape products in addition to combustible cigarettes.