Author: Kimberly Go

Blue Razz, Peach Ring and Strawberry-Watermelon sound like flavors that a person would see in a candy shop. However, these same flavors happen to be those that you might find on a vape device. Vaping refers to the use of electronic cigarettes, vape pens or other vaping devices such as JUUL. Most commonly, individuals are inhaling nicotine or marijuana. It is usually aimed to help individuals in the process of smoking cessation.  Vaping is considered less harmful than smoking, but lung injury is still present.

            Increased vape usage in teenagers has become a rising trend in the United States over the past few years. According to a survey from the National Institute of Health, the percentage of 12th graders who vaped nicotine in the past year has increased from 15.8% in 2017 to 34.5% in 2020. However, the majority of teenagers are vaping what is considered to be “just flavoring” in the study (Miech et al., 2016). The term “just flavoring” refers to vape juice that usually does not contain nicotine or THC, but it contains flavoring and dyes. According to Johns Hopkins cardiologist Dr. Michael Joseph Blaha, there have been reports that the flavoring may contain essential oils, multivitamins and medicine. The health consequences from utilizing e-cigarette fluid or vape juice has led to the concern over public policies regarding vaping regulation.

            The Center for Disease Control and Prevention has classified acute severe respiratory distress after the use of vaping products as EVALI (e-cigarette, or vaping, product use-associated lung disease). Studies on EVALI cases have shown a range pneumonitis patterns. The presence of lipid-laden pulmonary macrophages with vacuolization along with vacuolated pneumocytes is the most common pathologic feature. In a study with a sample size of 50 patients who smoked vaping products containing THC, vitamin E acetate was found in 94% of the bronchoalveolar-lavage samples. This result suggested that vitamin E acetate may be responsible for EVALI. It is important to note that e-cigarette fluid, by itself, contains at least nicotine, carbonyls, volatile organic compounds (benzene or toluene), trace metal elements, bacterial endotoxins, fungal glucans. These components are harmful to the lung parenchyma as well (Christiani, 2020). Further research needs to be done in order to have greater understanding of EVALI. 

            While marijuana continues to be the most common illicit drug used by adolescents, the rise of vaping use in teenagers is concerning. A study suggested that the use of a vaping device is a risk factor for future cigarette use (Miech et al., 2016).  The maximum blood nicotine level depends on the e-cigarette type and individual’s behavior. Thus, it can potentially lead to nicotine addiction (Herron & Brennan, 2020). If you or a loved one need help with quitting vaping or smoking, some available resources include:

• https://teen.smokefree.gov/quit-vaping
• https://truthinitiative.org
• https://www.lung.org/quit-smoking
• https://www.cdc.gov/tobacco/quit_smoking/index.htm
• https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/E-Cigarettes-(1)

References

Christiani, D. C. (2020). Vaping-induced acute lung injury. New England Journal of Medicine, 382(10), 960-962. doi:10.1056/nejme1912032

Herron, A. J., & Brennan, T. (2020). The ASAM essentials of addiction medicine. In The ASAM essentials of addiction medicine (3rd ed., pp. 108-111). Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Johns Hopkins Medicine. (n.d.). Vape flavors and Vape Juice: What you need to know. Retrieved March 15, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/vape-flavors-and-vape-juice-what-you-need-to-know

Miech, R., Patrick, M. E., O’Malley, P. M., & Johnston, L. D. (2016). What are kids vaping? Results from a national survey of US adolescents. Tobacco Control, 26(4), 386-391. doi:10.1136/tobaccocontrol-2016-053014

National Institute on Drug Abuse. (2020, June 04). Vaping of marijuana on the rise among teens. Retrieved March 15, 2021, from https://www.drugabuse.gov/news-events/news-releases/2019/12/vaping-of-marijuana-on-the-rise-among-teens