Is vaping safe? Just say no!

Vaping is a method to inhale nicotine or just about anything else that can be vaporized. Research into its effects on human health has been going on for as long as vaping has existed. This body of research, combined with clinical reports, is now making it very clear that vaping is not safe—with or without nicotine. This includes vaping THC and vaping CBD.

Vaping—with or without nicotine—is not safe.

Most vaping devices are “electronic nicotine delivery systems” (ENDS), the most well-known probably being the e-cigarette. Other devices include vapes, e-hookahs, vape pens, tank systems, and mods. None are regulated, except that sale of nicotine-containing devices to minors is now illegal.

Other than nicotine, the most popular vaping substances seem to be CBD (cannabidiol), vitamins (A, B12, C, and D), and the controlled substance tetrahydrocannabinol (THC, the compound in marihuana [or marijuana] that produces a “high”), as well as flavored liquids, both with and without nicotine. Unfortunately, little is known about how such inhalants might affect your health.

Vaping use by teens and adults

Vaping was introduced to the U.S. in 2006 and went unregulated for a number of years, possibly contributing to its rapid spread and popularity, especially among teens. In fact, among youth vaping nicotine is now more common than smoking tobacco. In addition, vaping appears to encourage use of illegal substances such as THC.

Almost 25% of adults 18–24 have used e-cigarettes, many as a means to quit smoking tobacco. Whether vaping really helps people quit smoking is still in question, but tobacco use continues to decline. One recent study of Air Force members showed all forms of nicotine use declined except e-cigarettes, which rose significantly from 2013 to 2018, especially in the last year.

Regulation of vaping

In 2016, FDA’s Center for Tobacco Products was given regulatory authority over all electronic nicotine delivery systems (ENDS), including e-cigarettes. The popularity of ENDS use among adolescents has largely driven FDA’s efforts since then, including thousands of warning letters and penalties issued to retailers and more than 1,200 inspections of manufacturing and retail establishments. However, vaping continues to grow.

In January 2019 the “Youth Vaping Prevention Act of 2019” (H.R.293) was submitted to Congress, but it has not yet passed. In September, the U.S. House of Representatives issued a consumer warning after a series of press releases, warnings, and online articles from FDA and CDC about vaping in light of accumulating research and recent clinical reports that have revealed its dangers.

Severe lung injury and death associated with vaping

According to the CDC web page on vaping and lung injury, more than 2,400 cases of severe lung injury (including more than 50 deaths) have been reported nationwide as of early December 2019. (This web page is updated frequently, as new information becomes available.) Many occurrences of “e-cigarette, or vaping, product use associated pulmonary illness,” or EVALI for short, have resulted in hospitalization and, in some cases, death. Patients age from 13–75 years, but 80% are under 35. Many of the reported cases involve use of THC-containing products, almost half without nicotine. In addition, CDC has now associated vitamin E acetate, used in THC-containing and other vaping products, with EVALI.

From CDC: Number of Lung Injury Cases Reported to CDC as of December 10, 2019. This U.S. map shows the occurrence of cases by state, with Texas having the highest number (200–249 cases), California and Illinois next (150–199 cases each), and other states fewer than 150 each. No state is without at least one reported case.

While vaping devices in general deliver fewer carcinogens and other toxins than conventional cigarettes, no information is available about the long-term effects of vaping, and little is known about exactly what makes vaping dangerous.

A number of potentially harmful substances have been associated with various devices (with and without nicotine), including diacetyl, 2,3-pentanedione, acetoin, 2,3-dimethylpyrazine, caffeine, volatile organic compounds, microbial toxins, flavoring chemicals, formaldehydes, ethylene glycol, heavy metals, and glass particles.

The carriers in vaping liquids, such as propylene glycol and vegetable glycerin, are FDA-approved for use in foods, but very little information is available about their effects as inhalants except that they appear to have adverse effects on the lungs even without nicotine present.

Concerns over vaping CBD

Aside from cases associated with vaping in general, specific adverse events have been reported for vaping of products sold as containing CBD oil. Testing found a synthetic cannabinoid (4-cyano CUMYL-BUTINACA, or 4CCB) in some products, but no CBD. Testing of other CBD vaping liquids revealed the presence of 5-fluoro MDMB-PINACA (5F-ADB; a dangerous synthetic cannabinoid that is a controlled substance) and dextromethorphan (DXM; a frequently abused drug).

For more information about cannabidiol, please read the Operation Supplement Safety (OPSS) article about CBD. In summary, however, CBD use of any kind is prohibited for Military Service Members.

As of October 2019 AAFES stores and Navy Exchanges no longer sell e-cigarettes and other vaping products. Similar moves are already taking place in the public sector.

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