Vaping: e-Cigarette and Marijuana Vape Risks

The long-term dangers of vaping remain unclear, but it has been implicated in some lung problems.

E-cigarettes (e-cigarettes, or vaping) are smokable, refillable, or replaceable cartridges or containers that hold liquid that contains nicotine, solvents, and chemical flavors. When a person inhales ("vaping"), they are putting negative pressure on the device that triggers a battery to heat the liquid solution, which is then atomized into an inhalable vapor.

Depending upon the cartridge, it may contain no nicotine or up to about 16 mg of nicotine. One container or cartridge has enough fluid for about 250 "puffs." However, nicotine concentrations and fluid volumes plus the compounds in the fluids can vary, depending upon who makes the e-cigarette.

Vape cartridge fluid is also similar to marijuana e-cigarettes, except the fluid contains THC (the main active ingredient in cannabis) and sometimes other cannabis components. The market for marijuana e-cigarettes has grown rapidly as more U.S. states legalize the substance for medicinal and recreational use.

An e-cigarette has three main parts 1) a rechargeable battery, 2) a vaporization chamber/atomizer, and 3) a liquid cartridge usually containing nicotine or THC, chemical flavoring, and other compounds. When you inhale on the tip of the e-cigarette, a valve opens to allow some fluid into the vaporization chamber/atomizer. The battery then heats the liquid, which vaporizes it, and then it is inhaled into the lungs.

It is not known how safe or how unsafe these products are. September 2019 saw a rash of nearly 500 cases of respiratory illness linked to vaping throughout the US, according to the CDC, which reports symptoms to include cough, chest pain, nausea, shortness of breath, vomiting, or diarrhea. As of September, six had died of "vaping lung disease." The exact component of vape fluid had not been identified as of that time, but illness seems to affect users of both nicotine and cannabis e-cigarettes.

“While this investigation is ongoing, consider not using e-cigarette products,” the CDC advised as of Sept. 6. They further state, regardless of the ongoing investigation, youth, young adults and women who are pregnant should not use e-cigarette products.

Nicotine is considered to be very addictive, and that seems to be a cause for concern. Low doses may cause nausea, vomiting, abdominal pain, and eye irritation. High doses of nicotine may cause tachycardia, high blood pressure, seizures, coma, and death. Moreover, the FDA reported detecting ethylene glycol in some of the e-cigarettes and cancer-causing substances called nitrosamines in others. In addition, some e-cigarettes have caught fire and/or exploded because of faulty batteries or malfunctioning battery chargers.

It took several decades to determine the problems associated with tobacco use. Likely, it will also take some time and study to determine how safe (or unsafe) e-cigarettes are. Experts claim that to stop cigarette smoking, it is probably better to use studied material such as nicotine gum, nicotine patches, and/or counseling than to use e-cigarettes. They also suggest people do not start smoking e-cigarettes for fun or for quitting any tobacco products.

The CDC published a report about the number of calls to poison centers involving e-cigarette liquids containing nicotine. The proportion of calls to poison centers increased from 0.3% in 2010 to 41.7% as of February 2014. The bulk of these calls is related to small children that open the liquid nicotine containers. The liquid nicotine containers are not childproof; they appeal to young children because of the candy and fruit flavors. They can cause vomiting and eye irritation.

Not much is known about the secondhand "vapor" that is expelled from users, including levels of nicotine, nitrosamines, and other components that are yet to be identified. Nevertheless, many people would prefer not to be in a restaurant or other place of business and be exposed to vapors that contain addictive nicotine, and possibly other products that have a potential for harm.

“Popcorn lung” (bronchiolitis obliterans) is a lung disease that results in scarring and narrowing of the airways in the lungs. The disease was linked to a chemical, diacetyl that provides flavor to microwave popcorn. This compound and others that are similar, when inhaled, cause a high risk for this disease.

Researchers found that 92% of e-cigarettes studied had at least one of three different compounds known to cause popcorn lung. Although long-term studies are absent, the American Lung Association considers e-cigarettes to be a dangerous risk factor for popcorn lung.

There is some concern that e-cigarettes are being marketed to attract younger non-smokers with "flavored" liquids such as bubblegum, piña colada, vanilla, and others. Because most e-cigarettes contain nicotine, it is possible that people can become addicted to them. Some doctors are concerned that if they become addicted to the nicotine in the e-cigarettes, it may be an easy step up to smoking tobacco, which is associated with so very many health consequences.

Although e-cigarettes have been touted as a way for tobacco smokers to kick their cigarette habit, e-cigarettes in one study were only about as effective as nicotine patches. The FDA does not recognize e-cigarettes to be a method to augment quitting smoking. However, there are 7 FDA-approved safe smoking quit aids available (patches, gum, mints, etc.), and has warned electronic cigarette maker Juul to stop saying vaping is safer than smoking.

Since this product was first developed in 2004 in China as a tobacco cessation device, it has grown rapidly so that in 2013 the estimated market is about 1.5 billion as compared to 100 billion for tobacco sales. However, the sale of this product is growing rapidly worldwide. The CDC suggests that as more people utilize e-cigarettes, the dramatic increase in nicotine poisoning in children will continue if nothing is done to prevent young children from gaining access to nicotine-containing liquids. According to the FDA, over two million middle and high school students were e-cigarette users in 2016.

As of 2016, the FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS (electronic delivery systems, such as e-cigarettes), including components and parts of ENDS (not including accessories. The American Lung Association is urging the FDA to require that diacetyl and other harmful chemicals be removed from e-cigarettes (removal from the fluid accessories).