Over the past six weeks, vaping went from a safe way to quit smoking to a killer of at least nine people, including one in Minnesota. Hundreds of other people in more than three dozen states have been sickened. So, what happened?
A deadly duo
The medical community has long been concerned that the flavorings of vaped nicotine will cause “popcorn lung.” This is a condition caused by inhaling the butter-flavoring on microwave popcorn. It sickened workers in factory with a condition called bronchiolitis obliterans. The only definitive treatment for popcorn lung is a lung transplant. However, because of the low dose of flavoring in vaping products, we expected that it would take a decade or more for this condition to develop among people who vape.
The current epidemic appears to be due to the ability to load THC and CBD oils into vaping devices, such as Juul. The vaping devices deliver the oils to the smallest airways of the lungs where the oils cause inflammation and destruction of the lung tissue. Steroids can reduce the inflammation. However the problem is so new that we have no idea about the long-term effects. It is most safe to assume the worst: the lungs are irreversibly damaged.
An impending epidemic
Now, one in nine high school seniors in the U.S. vapes nicotine daily or nearly so. If the teens of today are anything like I was at their age, they are more likely to laugh at us than heed our advice or warnings about vaping. But even if only 1% of the 15 million high school students in the U.S. vapes cannabis oil, we’ll have a major epidemic on our hands with 140,000 cases of severe lung disease each year. By comparison, only 2,500 lung transplants are done in the U.S. each year. And as a cardiologist, I can tell you that a lung transplant makes a heart transplant look like a walk in the park.
What we need to do
• Ban the sale of flavored nicotine. This will make vaping less attractive to children.
• Ban vaping in work places. Minnesota did this in the last legislative session. Other states should follow suit.
• Be a role model: Don’t smoke, don’t vape.
• Control online sales of vaping devices and vaping fluids.
• Develop and implement a campaign by youth for youth that publicizes the hazards of vaping. Emphasize the particular hazard of bootleg products.
• Develop and disseminate model conversations for parents so that they can start talking to their children about the dangers of vaping when they are as young as five or six.
• Increase the monitoring of vaping behaviors and vaping-related illness rates.
• Increase the purchase age of all vaping products to 21 years old at a minimum.
• If the epidemic continues, look at even stronger steps, such as banning online sales and/or prohibiting vaping devices entirely.
Thomas E. Kottke, MD, HealthPartners medical director for well-being