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Research & Commentary: Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC Products

September 30, 2019

The Centers for Disease Control and Prevention's latest Morbidity and Mortality Weekly Report finds nearly 77 percent of vaping-related hospitalizations are due to the use of THC products.

The Centers for Disease Control and Prevention’s (CDC) latest Morbidity and Mortality Weekly Report examines the recent outbreak of vaping-related hospitalizations. According to CDC’s findings, more than 70 percent of hospitalizations have been linked to vaping tetrahydrocannabinol (THC).

As of September 24, CDC has identified 805 reported cases of vaping-related hospitalizations in 46 states and one U.S. territory. Of these, 69 percent of patients were males. The median age was 23 years, with a range from 13 to 72 years. There have been 12 deaths reported in 10 states, including California (two deaths), Florida, Georgia, Illinois, Indiana, Kansas, Minnesota, Missouri, Mississippi, and Oregon (two deaths).

Of the 805 cases, information on the substances vaped was available for 514 patients, about 64 percent of the reported cases. Of the 514 patients self-reporting, 395, 77 percent, “reported using THC-containing products.” Further, 210 patients, 41 percent, “reporting using both THC-containing and nicotine-containing products.” Only 82 of the 514 patients,16 percent, “reported exclusive use of nicotine-containing products.” At this time, the CDC still does not know the “specific chemical exposure(s) causing this outbreak.

These findings mimic state health department records. On September 16, the Utah Department of Health linked the state’s hospitalizations to THC products, with 60 percent of individuals “self-reported vaping nicotine” and 90 percent “self-reported vaping THC.”

On September 19, the Connecticut Department of Public Health had “interviewed 9 of the 13 patients with vaping-related injury.” All nine patients reported using THC products.

On September, 26, the Oregon Health Authority (OHA) reported the state’s second vaping-related death, finding the patient “had been hospitalized with respiratory symptoms after vaping cannabis products.” Earlier, on September 3, OHA announced the first vaping-related death, which was a patient who “had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary.”

On September 23, the Texas Department of State Health Services reported a total of 89 cases under investigation, with 34 “classified as confirmed cases,” and 20 “classified as probable cases.” Of these, 76 percent “reporting vaping products containing [THC].”

Of all cases reported by state health departments and the CDC, no single vaping product has been identified as a culprit in vaping-related hospitalizations. Health departments and the CDC have urged consumers to avoid using black market products and to refrain from manipulating products.

Despite findings linking hospitalizations to illicit products, in recent weeks several states have moved to further restrict adult access to electronic cigarettes and vaping devices. Michigan, New York, and Rhode Island have all banned the sales of flavored e-cigarettes. Massachusetts has banned the sale of all e-cigarette products for four months. On September 27, Gov. Jay Inslee (D-WA), directed the Washington Department of Health to issue an executive rule to regulate e-cigarettes, including adoption of “emergency rules to ban all flavored vaping products, including flavored THC products.”

Legislation banning flavored e-cigarette products has been introduced in Illinois and Ohio. Lawmakers in Connecticut, Delaware, Maine, Oregon, and South Carolina, have hinted at possible flavor ban legislation. Vermont’s governor is also “considering” a ban on flavored e-cigarettes.

Many lawmakers believe flavor bans are necessary to reduce youth e-cigarette use. However, The Heartland Institute analyzed results from the 2017-18 California Youth Tobacco Survey (CYTS) and found that despite flavor restrictions in some localities, youth use of e-cigarettes in those areas increased after the bans went into place.

Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16 CYTS, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.

Further, flavors are essential in helping adult smokers quit combustible cigarettes. A survey of more than 70,000 American adult vapers found flavors play an important role in e-cigarettes, with 83.2 and 72.3 percent of survey respondents reporting vaping fruit and dessert flavors, respectively. Only 20 percent of survey respondents reported using tobacco flavors at the point of e-cigarette initiation.

Lawmakers should refrain from enacting legislation that would further restrict adult access to electronic cigarettes and vaping devices. Numerous public health groups, including Public Health England, the Royal College of Physicians, and the American Cancer Society have found e-cigarettes to be significantly less harmful than combustible cigarettes. Further, an estimated three million American adults have used these devices to quit smoking.

It is imperative that policymakers understand the recent vaping-related hospitalizations are overwhelmingly linked to unregulated vaping products. Lawmakers (and the media) should not confuse these cases with legal e-cigarettes, which are regulated by the U.S. Food and Drug Administration. Rather than enacting unnecessary, counterproductive legislation and misguided bans, lawmakers should address youth use by utilizing existing tobacco moneys and working with local businesses, schools, and public health departments to develop better solutions to address and reduce youth vaping use.

The following articles provide more information on electronic cigarettes and vaping devices and tobacco harm reduction.

Tobacco Harm Reduction 101: A Guidebook for Policymakers
https://www.heartland.org/publications-resources/publications/latest-heartland-policy-booklet-addresses-vaping-myths
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

Podcast Series: Voices of Vapers
https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Policy Tip Sheet: Vaping Hospitalizations Likely Linked to Black Markets
https://www.heartland.org/publications-resources/publications/policy-tip-sheet-vaping-hospitalizations-likely-linked-to-black-markets
In this Policy Tip Sheet, State Government Relations Manager Lindsey Stroud examines recent headlines, finding vaping-related hospitalizations are likely linked to illegal black market vaping products. Stroud examines reports from January 2019 which found youth were being hospitalized due to marijuana vaping products. Further, in 2018, the U.S. Army warned of the dangers of vaping synthetic marijuana after more than 90 military personnel were hospitalized and two died after vaping such devices. Further, none of the reports on the recent hospitalizations have been able to identify a single product that would have caused adverse health effects.

Policy Tip Sheet: E-Cigarettes Are Safer than Combustible Cigarettes
https://www.heartland.org/publications-resources/publications/policy-tip-sheet-e-cigarettes-are-safer-than-combustible-cigarettes
In this Policy Tip Sheet, Lindsey Stroud, a state government relations manager at The Heartland Institute, rebuts claims that electronic cigarettes and vaping devices are just as harmful as combustible cigarettes. Stroud points to the numerous public health groups that have found e-cigarettes to be significantly less harmful, with at least two public health organizations claiming their use to be at least 95 percent safer than combustible cigarettes. E-cigarettes reduced harm is due to these products not containing tobacco and that they do not use combustion, or burn tobacco, which is believed to cause the most harm with tobacco cigarette use.

Popcorn Lung, Formaldehyde, and Now Seizures, Oh My!
https://townhall.com/columnists/lindseystroud/2019/04/19/popcorn-lung-formaldehyde-and-now-seizures-oh-my-n2545054
In this opinion piece in Townhall, Lindsey Stroud, state government relations manager at The Heartland Institute, responds to exaggerated and false claims of e-cigarettes. Despite fearmongering news stories, myths surrounding e-cigarettes containing formaldehyde and creating popcorn lung are unfounded, and the risk of seizures is minute. Stroud urges lawmakers to refrain from enacting egregious legislation in response to these claims.

Research & Commentary: Randomized Trial Finds E-Cigarettes Are a More Effective Smoking Cessation Tool than Nicotine Replacement Therapy
https://www.heartland.org/publications-resources/publications/research--commentary-randomized-trial-finds-e-cigarettes-are-more-effective-smoking-cessation-tool-than-nicotine-replacement-therapy
In this Research & Commentary, Lindsey Stroud, a state government relations manager at The Heartland Institute, examines a study in The New England Journal of Medicine that shows e-cigarettes and vaping devices are twice as effective as nicotine replacement therapy (NRT) in helping smokers quit using tobacco cigarettes. Nearly 700 participants were studied during a 52-week period. Researchers found that 18 percent of e-cigarette users reported abstinence, compared to 9 percent of those using NRT. Stroud wrote that “these latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States,” and she implores policymakers to regulate these devices in a way that promotes, rather than prohibits, their use.

Research & Commentary: Vaping Taxes Do Not Deter Youth Use of E-Cigarettes
https://www.heartland.org/publications-resources/publications/research--commentary-vaping-taxes-do-not-deter-youth-use-of-e-cigarettes
In this Research & Commentary, Lindsey Stroud, a state government relations manager at The Heartland Institute, examines the effects of Pennsylvania’s 2016 40 percent wholesale tax on youth vaping. Using data from the Pennsylvania Annual Youth Survey, Stroud finds the tax did not curb youth e-cigarette use, and from 2015 to 2017, youth use of e-cigarettes increased in Pennsylvania. Stroud cautions lawmakers to avoid enacting taxes on e-cigarettes in an effort to address youth e-cigarette use.

Research & Commentary: Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/qualitative-study-on-e-cigarettes-shows-more-evidence-of-tobacco-harm-reduction?source=policybot
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

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