Since I’ve been reading about vaping, my patients have been expressing concern that I’m asking them as much about physical symptoms related to lung disease as I am about mental health. Last week, one regular patient quipped, “Hey, Dr. Beck, if I had problems breathing, my Dad would have me at the family doctor before you could say hypochondriac, so you don’t have to ask those questions. I can see your stethoscope and all, but is it even legal for you to use that?” Still, when I review some of the information emerging about vaping with patients and their families, they do cut me some slack.
It is only two weeks since I wrote about the risks of vaping nicotine and teen health, but new information about lung injury and deaths because of vaping has continued to emerge. This past week, the Centers for Disease Control (CDC) in the United States has published the details it has collected with respect to the 805 cases of lung injury because of vaping that have been reported to date. Of these cases, there have been 12 deaths. The CDC has age and sex data on 771 cases – 69% of these individuals are male and 62% are between the ages of 18 and 34, with 22% between 18 and 21. While Health Canada’s website updated its information with respect to vaping on September 28, 2019, the number of confirmed cases of vaping injury are much lower in Canada, with only 1 confirmed case of severe lung injury due to vaping in Quebec and a second possible one in London, Ontario.
In its update late last week, however, the CDC reported a connection that has been observed in 514 cases where the substances being vaped have become known. The CDC was able to learn that 77% of this group consumed Tetrahydrocannabinol (THC), the main psychoactive component of marijuana, by vaping. Of these 77% of persons, 36% reported exclusive use of THC-containing products. In fairness, 57% of the 514 persons, reported having used nicotine products but only 16% had used nicotine exclusively. This data is important because it has led to the CDC recommending that users avoid vaping THC-containing products altogether. The true cause of these lung injuries is not yet known, and while the link to vaping THC-containing products is not yet clear, it should not be ignored. These lung injuries are causing serious illness and caused 12 deaths.
Having gone through the data, let’s think about vaping marijuana and THC-containing products. Vaping is only legal in Canada and the United states for nicotine products. That means that if someone is selling vaping products for use with marijuana, they are doing so illegally. Also selling vaping products, for either nicotine or marijuana, to minors is illegal. However, among the 771 victims known to the CDC, 16% are under 18. These youth are minors in every American and Canadian jurisdiction, and we know that it will be more difficult to get the information we need about their use of these products because of the risks if they report illegal activity.
There are several reasons that youth are likely to be vaping marijuana. As I noted in my blog two weeks ago, vaping is reported as being safer than smoking. Marijuana is reported as being safer than nicotine. But, as I also said two weeks ago, this is a bit like saying one alligator is safer than 3 alligators. Neither vaping nicotine nor vaping marijuana is completely safe and, if we accept the concerns of the CDC reports, vaping marijuana may be more dangerous – leading to serious lung injury that can cause death.
It is becoming more and more evident that massive public health education campaigns are needed to offset the misinformation that is influencing 18 to 34 year old persons to vape. For my part, we will be putting out information with website references tomorrow in the clinics where I work. I am speaking at the University of Ottawa medical school on cannabis next Thursday and I am already revising the slide deck. The Centers for Disease Control and Health Canada are working hard to ensure that clinicians have access to the information about the risks of vaping and vaping cannabis. We must use this information to inform young people and their parents.