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LMS President’s Message – October 2019

LMS President’s Message, October, 2019
Vapor Clouds
By Charles L. Papp, MD

Over the last several years the number of e-cigarette users has sharply increased. In 2017 the CDC reported 6.9 million users. These products have been heavily marketed as a safe alternative to smoking. They operate by heating a liquid or “juice” with a battery-operated coil into a cloud-like aerosol that is inhaled into the lungs. The “juices” often contain flavorings, chemicals, and nicotine. The aerosol is not simple water vapor. The maker of JUUL e-cigarettes claims it has the same content of nicotine as traditional cigarettes and can deliver it up to 2.7 times faster than other e-cigarettes. Most of the manufacturers try to make the experience fun by producing a wide variety of attractive flavors. These include Strawberry Watermelon POP! and Pink Lemonade Risky. The manufacturers push these products by claiming they are satisfying and safe cigarette substitute for smokers. Unfortunately, new evidence is raising questions. The CDC is reporting an increasing number of pulmonary illnesses and deaths related to e-cigarettes. It is essential that clinicians become aware of the risks and current recommendations.

On September 3 of this year, the Kentucky Department of Public Health sent an alert to healthcare providers regarding the possibility of seeing “progressive, severe pulmonary disease related to e-cigarettes.” At that time, the CDC reported 215 cases and 1 death. By September 19 the numbers had increased to 530 cases and 7 deaths. 72% are male and the majority (67%) are 18-34 years of age with 16% under 18. The CDC states that “most patients have reported a history of using e-cigarette products containing THC. Many have reported THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.” As a result, the CDC has released interim recommendations for health care providers.

The CDC recommendations for patients include:

  • Until we know more, if you are concerned about these specific health risks, CDC recommends that you consider refraining from using e-cigarette or vaping products.
  • If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
  • If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak see a healthcare provider.
  • Regardless of the ongoing investigation:
    • Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street and should not modify or add any substances to these products that are not intended by the manufacturer.
    • Adults who do not currently use tobacco products should not start using e-cigarette products.

One troubling and tragic aspect of this data is that most of those affected are young. Middle school and high school use rates are increasing rapidly.

High school and middle school students who never smoked are now becoming addicted to nicotine by using e-cigarettes. Nicotine is believed to harm the developing brain, and the brain is still developing up to age 25. Because nicotine is felt to be more addictive than heroin, adolescents are now at high risk for a continuing craving for nicotine that easily could lead to actual smoking or use of smokeless tobacco. There is even some evidence that using nicotine in adolescence increases the risk for future drug addiction. Despite these serious concerns, marketing of these products seems to be purposefully aimed to attract young people. Here is a screenshot of the first web page I came to when searching for “best vape flavors.”

The page speaks for itself. To me it looks like the menu at an ice cream store.

E-cigarettes pose serious questions, problems, and now a new developing health concern, especially among young people. The KMA is aware and very concerned. In response, we passed a resolution this September at the KMA annual meeting. It includes recommendations regarding marketing, packaging, and taxation.

Resolution 15: Regulation of the Marketing, Packaging, and Sale of Electronic Nicotine Delivery Systems, Electronic Non-Nicotine Delivery Systems and Associated Products in Kentucky
RESOLVED, that the Kentucky Medical Association supports regulation of marketing and packaging of e-cigarettes, in a way that mirrors the regulation of traditional cigarettes; and be it further,
RESOLVED, that the Kentucky Medical Association supports a ban on e-cigarette use in locations where tobacco use is prohibited; and be it further,
RESOLVED, that the Kentucky Medical Association supports the extension of laws prohibiting tobacco advertising to e-cigarettes; and be it further,
RESOLVED, that the Kentucky Medical Association supports federal and state bans on flavorings for electronic nicotine delivery systems, electronic non-nicotine delivery systems and associated products; and be it further
RESOLVED, that the Kentucky Medical Association support legislation to tax electronic nicotine delivery systems, electronic non-nicotine delivery systems and associated products at rates similar to conventional, combustible cigarettes; and be it further
RESOLVED, that KMA educate the public, especially youth, of the dangers of using electronic nicotine delivery systems, electronic non-nicotine delivery systems and associated products, and so discourage the use of them.

I strongly recommend all physicians become familiar with the CDC guidelines and be aware of the developing issues regarding e-cigarettes. Bring the subject up with the children you see as well as their parents. Talk to your adult patients as well. Be sure to especially engage high schoolers and middle schoolers. Kentucky ranks too high in the nation for cancer incidence, heart disease, lung disease and tobacco usage. We must not let a new generation continue this legacy.

Charles L. Papp, MD