Traditional smoking of cigarettes has become less appealing to the public over time, and there is still a significant segment of the population that partakes in this activity. Some willingly view this activity as an outlet for stress relief, while others have acknowledged their addiction and are open to quit with an implemented program. As the dangers of smoking have become more exposed over time, a variety of quitting mechanisms have arisen from gum, to skin patches, to other forms of pharmaceutical interventions. Unfortunately, with the use of these options, there has only been a 10% success rate in quitting smoking.

In 2003 the first commercially available E-cig was created by Hon Lik in China, and in 2006 the E-cig was introduced to the U.S. market. Today, the most influential player in the E-cig market is Juul, a startup which after launching in 2015 captured 70% of the E-cig market within 3 years. The intention was to provide a “healthy cigarette” and as opposed to attaching itself to the stigma of smoking, E-cig usage was popularly dubbed “vaping”.

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Instead of burning the nicotine-containing substance or other alternative, that main ingredient is suspended in a complex liquid which is heated to an aerosol for inhalation. Much contention has arisen over the effect heating may have on the ingredients, and whether enough reproducible research has been conducted on the health impacts of vaping. Over the course of marketing the product, a perception developed that this product could be used as a bridge to lead smokers to a non-smoking lifestyle, if desired. Unfortunately, controversy has struck, as a mysterious lung disorder initially described as “vaping associated pulmonary illness” (VAPI), and now reclassified as “e-cigarette, or vaping, product use associated lung injury” (EVALI) began impacting hundreds of vaping clients requiring them to be hospitalized, with over 3 dozen individuals dying from the symptoms, as of this post. Below is a list of states with some of the most EVALI-related cases, including some statistics from the current EVALI epidemic:

CALIFORNIA

According to the CDC, as of September 24, 2019, there had been 805 confirmed and suspected vaping-related cases in the U.S. and U.S. territories. By November 5*, they saw that number jump to 2051 cases. Pertaining to deaths related to vaping, as of October 2, there had been 17 deaths reported. Now, that number has more than doubled to 39, with 3 of those deaths occurring in California.

Regarding what is physiologically leading to this outcome, research has shone the spotlight on what appears to be an infiltration of certain immune cell types that typically don’t represent the quiescent lung environment, seemingly caused by vaping.

ILLINOIS

In addition to having the highest number of reported cases amongst reporting states for lung illness related to vaping, Illinois has 3 vaping-related deaths reported to the CDC. To determine if these cases are legitimately related to vaping, teams including state investigators, clinicians, and public health officials are organized to align their findings with a validated case definition. If possible, interviews are also conducted with the patient to establish confirmation of the case.

Based on the cases investigated so far, all patients were reported to have been vaping leading up to their hospitalization status. Additionally, most patients used THC-containing products or a combination of nicotine-containing and THC-containing products; one subset of patients only used nicotine-containing vaping products. No consistent evidence of infection has been associated with these cases.

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MINNESOTA

Minnesota is among the top three reporting states, regarding the enumeration of vaping associated lung illness cases, including 3 EVALI-related deaths being reported from this state, as of this posting.

65% of total patients were between the ages of 18 and 34. As of the latest statistics, roughly 70% of these EVALI cases involved male patients; 40% of patients were between 18 and 24 years old. Alarmingly, 14% of patients were under 18 years old, as this product is prohibited for sale to minors. This implies that further enforcement of this law is needed.

INDIANA

Indiana, also among the top reporting states, has reported 3 EVALI-related deaths as of this posting.

Investigators are diligently working to uncover what may be the primary culprit in manifesting this mysterious lung illness, as this is still unknown. Contrary to some E-cigarettes being marketed to contain zero percent nicotine, they have been found to contain the substance. The aerosolized liquids used in these vaping vectors typically contain:

Nicotine

Ultrafine particles

Flavorings (such as diacetyl, which has been linked to serious lung disease)

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin, and lead

Although many countries have long banned the import of E-cigarette products, more bans are now cascading down from the U.S. federal government and sweeping across the country. There is simply too much controversy around not only the marketing practices of E-cig manufacturers, but also the safety of the vape fillers themselves when heated and inhaled. A similar dark cloud of uncertainty hovers over the hookah community, too, as similar arguments have been made regarding the safety of the activity. It is best advised to avoid E-cig use until more substantiated reviews and studies are conducted, regarding the concerns therein. And of course, it is best to avoid the habit of smoking altogether.

*This content has been updated, as of November 7, 2019, to provide you with the most current coverage of the EVALI outbreak in the U.S.

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