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Research & Commentary: Utah Department of Health Links More Than 90 Percent of Vaping Hospitalizations to THC, Still Restricts Access to Tobacco Harm Reduction Products

October 16, 2019

The Utah Department of Health found that 94 percent of patients diagnosed with vaping-related illnesses reported vaping THC-containing devices.

On October 9, 2019, the Utah Department of Health (UDOH) announced the state’s first death due to a “vaping-related lung injury.” The reported death, under the age of 30, passed away “at home without being hospitalized prior to their death.” UDOH “determined the individual vaped THC (tetrahydrocannabinol) prior to their death.”

In its investigation of adverse health effects related to e-cigarette use, UDOH has “reported 76 cases of vaping-related lung injuries.” UDOH officials note 94 percent of patients “self-reported vaping THC products.” The newly released findings are similar to earlier reports by UDOH. On September 30, UDOH reported “71 cases of vaping-related lung injury.” UDOH gathered data on 36 cases and found 34 patients, or 94 percent, self-reported use of “any THC cartridges.” In Utah, 13 patients, or 36 percent, reported exclusive use of THC vaping devices.

Similar to UDOH reports, several other state health departments and the Centers for Disease Control and Prevention (CDC) are consistently linking recent vaping-related hospitalizations to the use of unregulated, illegal vaping devices containing THC.

Minnesota, Oregon, Texas, and Wisconsin have all linked recent vaping-related lung illnesses to the use of THC vaping devices. Similarly, on October 3, CDC noted 78 percent of patients “reported using THC-containing products, with or without nicotine-containing products.” Further, 37 percent of patients reported “exclusive use of THC-containing products.”

The Utah Public Health Laboratory has tested 39 vaping devices, including 19 THC cartridges, and 20 vaping products containing nicotine. According to its findings, 100 percent of the nicotine-containing devices “contained nicotine and none have shown unexpected compounds.” On the other hand, 90 percent of “the THC cartridges contained Vitamin E acetate.”

Numerous health departments are examining the adverse health effects of vaping devices containing vitamin E acetate. The New York Department of Health tested various vaping products, and found “very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” Further, vitamin E “is not an approved additive for New York State Medical Marijuana Program-authorized vape products.” Although the specific effects of vaping vitamin E acetate are still unknown, the substance is a lipid, or oil, which is “highly toxic and [has] been associated with lung injury for years.” 

Unlike other statesincluding Massachusetts, Michigan, Montana, New York, Oregon, Rhode Island, and Washington—which have banned, or are in the process of banning, flavored and, in one case, all e-cigarettes and vaping devices, UDOH issued an emergency rule on October 2, restricting the sales of flavored e-cigarette products.

Beginning October 7, Utah e-cigarette and tobacco retailers “shall display a mandatory warning sign, warning sign, warning consumers not to use electronic-cigarette products to consume unregulated THC electronic-cigarette substances.” Further, only “retail tobacco specialty businesses with a valid retail tobacco specialty permit” are allowed to sell flavored e-cigarettes and vaping devices. General retailers, including convenience stores, may still sell “non-flavored electronic-cigarette products.” The emergency rule is in place for 120 days.

Although UDOH claims its rule is an effort “to protect health, safety and welfare of the Utah youth,” the flavor restriction will likely reduce adult access to tobacco harm reduction products.

Despite fearmongering media campaigns insisting that flavors are only in e-cigarettes to attract youth, flavors are an important component in helping adult smokers quit (and abstain from returning to) combustible cigarettes. Indeed, a 2018 survey of nearly 70,000 American adults who use e-cigarettes and vaping devices found 83.2 and 72.3 percent reported vaping fruit and dessert flavors, respectively. Moreover, only 20 percent of respondents reported using tobacco flavors at the point of e-cigarette initiation.

Although UDOH has been proactive in attempting to identify the specific vaping devices behind adverse health conditions, many health groups, including UDOH, are linking recent hospitalizations to black-market THC brands.

A September 6 report in The New England Journal of Medicine examined vaping-related hospitalizations in Illinois and Wisconsin. In these cases, 21 of 41 patients reported “using a THC product … marketed under the ‘Dank Vape’ label.” Further, 38 percent of self-reporting patients in Utah used Dank Vapes prior to their lung illnesses. This is particularly frightening because Dank Vapes is an illegal, unlicensed product. Dank Vapes is a shady packaging company, not a legitimate company.

Although Utah’s recent emergency ruling is not as encroaching as all-out bans on flavored e-cigarettes, it is still disingenuous that policymakers would restrict access to tobacco harm reduction products while dedicating very little in tobacco revenue (from taxes and legal settlements) to help smokers quit, or prevent youth tobacco use. For example, Utah first sued tobacco companies in 1996 and was one of the states that settled in 1998, resulting in the Master Settlement Agreement (MSA). From 1999 and 2019, Utah has received an estimated $710.2 million in MSA payments. Despite receiving an estimated $141.9 million in MSA payments and taxes in 2019, Utah dedicated only $7.0 million, or 0.04 percent, of state funds toward tobacco control programs including education and prevention.

Utah’s restriction on tobacco harm reduction products is a disservice to public health. Moreover, UDOH has identified the use of THC-laden cartridges, which are illegal and unregulated, to be the primary cause of the state’s recent vaping-related hospitalizations. If Utah lawmakers actually want to address youth vaping, policymakers should dedicate more than 0.04 percent of the state’s vast tobacco moneys to anti-smoking programs.

The following documents provide more information on e-cigarettes 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.

Research & Commentary: Centers for Disease Control and Prevention Link Major of Vaping-Related Hospitalizations to THC Product
https://www.heartland.org/publications-resources/publications/research--commentary-centers-for-disease-control-and-prevention-link-majority-of-vaping-related-hospitalizations-to-thc-products
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report which found nearly 77 percent of vaping-related hospitalizations are due to the use of tetrahydrocannabinol products. These findings are similar to what have been reported in other states, including Connecticut, Oregon, Texas, and Utah.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

Research & Commentary: Flavor Bans Do Not Reduce Youth E-Cigarette Use
https://www.heartland.org/publications-resources/publications/research--commentary-flavor-bans-do-not-reduce-youth-e-cigarette-use
In this Research & Commentary, State Government Relations Manager Lindsey Stroud examines the California Youth Tobacco Survey results from 2017-18, finding youth vaping has increased in several California localities that have restricted access to flavored tobacco product. Stroud finds youth vaping has increased in both Santa Clara and Contra Costa counties. Stroud also notes that banning flavored e-cigarettes is likely to reduce the number of adult smokers switching from combustible cigarettes to tobacco harm reduction devices, and could lead former smokers back to cigarettes.

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.