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Research & Commentary: More State Health Departments Link Recent Vaping-Hospitalizations to THC

September 24, 2019

Health departments in Connecticut and Utah have joined Minnesota, Oregon, and Wisconsin in linking vaping hospitalizations and deaths to THC-products.

Almost all of the recent vaping-related hospitalizations in Connecticut and Utah are linked to the use of tetrahydrocannabinol (THC) products according to the Connecticut and Utah state health departments.

As of September 16, the Utah Department of Health noted 60 percent of individuals “self-reported vaping nicotine” and 90 percent “self-reported vaping THC.”

The Utah Public Health Laboratory tested 39 vaping devices: 51 percent contained e-liquid nicotine and 49 percent contained THC. Moreover, 100 percent of nicotine-containing liquids “contained nicotine and none have shown unexpected compounds.” On the other hand, 90 percent “of the THC cartridges contained Vitamin E acetate.”

Similarly, the New York Department of Health found “very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” Vitamin E acetate is currently being examined to determine its link to the hospitalizations. This is especially noteworthy in New York, because vitamin E “is not an approved additive for New York State Medical Marijuana Program-authorized vape products.”

As of 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. Six patients admitted they had purchased the THC-containing devices from another person. One individual bought his weed pen from a dispensary, another purchased their device from an unregulated store, and one claims they were given the THC device by a friend. Three of the nine patients “reported using e-cigarette products containing nicotine, in addition to products containing THC.”

These recent findings mimic earlier findings. The Oregon Health Authority reported an individual who died in July 2019 “had recently used an e-cigarette or vaping device containing cannabis.” The Minnesota Department of Health reported an individual died from a “lung injury [that] was associated with vaping illicit THC products.”

In late August ,2019 the Wisconsin Department of Health Services noted 89 percent of patients “reported using e-cigarettes or other vaping devices to inhale THC products, such as waxes and oils.”

Additionally, a report in The New England Journal of Medicine analyzed vaping-related hospitalizations in Illinois and Wisconsin. Of the 53 patients examined, 84 percent “reported having used [THC] products in an e-cigarette device.”

It is imperative that lawmakers understand the vast majority of vaping-related illnesses are associated with unregulated, and in some states, illegal products.

Unfortunately, Michigan and New York have already imposed bans on the sale of flavored electronic cigarettes and vaping devices. Illinois has introduced a bill that is expected to be heard when lawmakers return to Springfield in the fall. Lawmakers in Connecticut, Rhode Island, and South Carolina are considering similar legislation.

Banning flavors in e-cigarette products will have disastrous effects and will likely produce a flourishing black market. In short, bans on flavors will not stop the onslaught of THC-associated hospitalizations. Even worse, flavor bans unfairly punish adult ex-smokers who prefer flavors.

A 2015 study of 27,343 American adults noted 72 percent of respondents “credit[ed] interesting flavors with helping them quit.” A 2018 survey of nearly 70,000 American adults found that 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

Despite a constant and concerted fearmongering campaign perpetuated by the media and policymakers, the vast majority of vaping devices sold in convenience stores and vape shops are regulated. Since 2012, the U.S. Food and Drug Administration (FDA) has had the authority to regulate such products. In 2016, FDA issued deeming regulations that extended the agency’s authority over e-cigarettes and vaping devices. Since 2016, all e-cigarette products must complete a lengthy and expensive process known as a “premarket tobacco product application.” Additionally, FDA required all e-cigarette products be registered with the agency by December 31, 2016.

As more states link vaping-related hospitalizations to the use of unregulated THC-cartridges, it is disingenuous and counterproductive for lawmakers to place restrictions and/or bans on products that have helped an estimated three million Americans quit smoking. E-cigarettes are 95 percent less harmful than tobacco cigarettes and twice as effective as traditional nicotine replacement therapy. Rather than restrict adult access to e-cigarettes and flavors, policymakers should address the use of illegal and unregulated products and how to reduce youth use of such products.

The following documents provide more information on 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.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations department, at governmentrelations@heartland.org or 312/377-4000.