Vaping is inhaling (and exhaling) water vapor mixed with other substances, like nicotine or CBD oil (Dreamstime/TNS)

By Paul Sisson The San Diego Union-Tribune (TNS)

A mysterious vaping-related illness that has sickened more than 1,000 people and claimed 18 lives has prompted health officials nationwide to advise the public to immediately stop using the electronic cigarettes. Alarmed local, state and national officials are considering strict regulations or outright bans on the devices. The swift backlash has left questions about the safety of vaping. We attempt to answer some of the most common questions about this new technology that has so rapidly become a worldwide cultural phenomenon:

Q: What is vaping?

A: Vaping is the inhalation and exhalation of water vapor mixed with other substances such as nicotine or marijuana oil.

Q: How does vaping work?

A: It’s really just electricity moving through a wire. Vape pens all use electricity from a battery to instantaneously heat a tiny coil of wire which in turn heats vaping liquid, instantly turning it into the very fine mist that is inhaled through a mouthpiece connected to the heating chamber. A steady supply of liquid is steadily fed into the chamber from a small tank often called a cartridge.

Q: What’s with all of the flavors?

A: Because the heater inside a vaping pen can turn pretty much any liquid into an inhalable mist, it is possible to add food-grade flavors to the vaping liquid. Today there are thousands of flavors available, everything from apple to strawberry cheesecake. While the flavors used generally appear on the U.S. Food and Drug Administration’s list of food additives that are “generally recognized as safe,” researchers note that the word safe, in this context, assumes that flavoring compounds will be eaten, not inhaled. There is no definitive scientific research on the health effects of inhaling food flavorings, though several studies have found that several such compounds, especially a compound called diacetyl that can produce a buttery flavor, can cause lung inflammation and cellular damage.

Q: How is vaping different from smoking?

A: It’s all about the burning. Smoking, as the name implies, literally involves inhaling the smoke released when tobacco or marijuana leaves catch fire. Vaping, because it involves inhaling vapor and not smoke, is significantly different from smoking.

Q: Is it true that vaping is safer than smoking?

A: Research does seem to agree that vaping is safer than smoking because, without combustion, vaping has significantly fewer carcinogens and other cancer-causing compounds found in cigarette smoke. A comprehensive evidence review from Public Health England updated in 2015 backed up previous findings that, on balance, vaping is 95% safer than smoking. Studies have also found that vaping nicotine is a highly effective way to get people to stop smoking.

Q: So, if vaping’s safer than smoking, what’s with all of this talk about a nationwide outbreak of vaping-related illnesses and deaths? That doesn’t sound so safe.

A: Just because vaping is safer than smoking doesn’t mean it’s safe. Over the summer hundreds of cases of severe respiratory distress have popped up in 48 states. Patients come in with severe cough, sometimes have gastrointestinal problems, and often progress to such severe breathing problems that they require hospitalization. In many cases, inflammation inside the lungs has become so severe that respirators and breathing tubes have been required. Eighteen people, as of the latest update from the U.S. Centers for Disease Control and Prevention, have died.

Q: What’s causing so many people to get sick?

A: The CDC says it’s not sure, though, as the investigation continues, it’s really starting to look like it’s something that’s being added to the vaping liquid that people are using. Many have reported using “bootleg” vaping liquid obtained from shady sources online or on the street, and most cases have reported vaping marijuana oil, rather than nicotine. A letter published in the New England Journal of Medicine by Mayo Clinic researchers recently examined lung tissue samples from 17 different patients and found what looked like chemical burns “from one or more inhaled toxic substances.” Though the CDC hasn’t yet identified a common chemical compound across all or most of the affected patients, there has been much speculation that vitamin E acetate is the culprit. The chemical, which can be harmful if inhaled, is used to thicken cannabis oil.

Q: Couldn’t it just be that vaping is harmful to the lungs even without dangerous additives?

A: Sure. Vaping pens are not considered medical devices and are not regulated by the U.S. Food and Drug Administration. That means rigorous clinical trials were not required before these products started appearing on the market in 2006. It is entirely possible that there are vaping risks that are not entirely understood.

Q: If people have been vaping for more than a decade, and it looks like the current outbreak is tied to black market operators, why is there such an intense call for everyone to stop vaping?

A: Indeed, we have never seen this level of harm associated with vaping since the technology first came into broad use. However, as the current investigation has gathered steam, it has become clear that there were isolated reports of such lung damage trickling into the medical literature for years, and regulators have been slow to spot a larger pattern, causing many in the public health community to speculate that the current rash of cases are just the tip of a much larger iceberg. Given the current uncertainty, and the fact that these products have never undergone full-blown clinical trials, public health officers have said they are advising vaping abstinence out of an abundance of caution.

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