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Vape-Related Deaths Are Scaring People Back into Smoking Cigarettes

"I realised that if I'm going to die from nicotine, I'd rather have it be at age 60 from cancer than 24 from my lungs exploding or whatever."

by Alex Norcia; illustrated by Lia Kantrowitz
11 September 2019, 8:22am

Spooked vapers are switching back to cigarettes. That is not a good idea.

This article originally appeared on VICE US.

Even when he was vaping every day, Andrew preferred premium cigars.

The 30-year-old, who like some other current and former smokers in this story requested anonymity to speak candidly about nicotine addiction, said he simply likes the taste of tobacco. Naturally, he smoked cigarettes more often, as it's difficult to take a break at work to inhale an entire Cuban. He also tried to quit smoking for health reasons, only to eventually pick the habit back up again. On average, Andrew said, he smoked about 10 to 15 cigarettes a day before transitioning to vaping.

That change made sense to him in an era when vaping has become ubiquitous, as he had read online that e-cigarettes were safer. (This is a matter that's up for debate.) He still had a regular cigarette every once in a while—it was easier to justify when he was on vacation, for example. But even if his cravings for regular tobacco cigarettes persisted, he didn't truly relapse.

That is, until this summer.



In the past few weeks, reports of lung illness related to vaping have soared. So far, at least 450 potential cases have been tallied, and there have been at least six connected deaths, the most recent of which was confirmed on Tuesday. Most of those afflicted have apparently been young, otherwise healthy, and (at least in Wisconsin and Indiana) predominantly male. Some—but not all—of these cases have also been linked to user experimentation, whether with homemade or black-market products or THC oil.

Of course, any short-term surge in vaping-related illnesses doesn't alter the fact that traditional cigarettes are the "leading cause of preventable death" in the world, according to the Centers for Disease Control (CDC). The long-term effects of cigarette smoking have been established: It's a slow burn, and can cause, among other diseases, cancer, heart disease, stroke, and emphysema. Advocates for e-cigarettes and companies that make the products, like JUUL Labs, have long benefited from the perception of vaping as a healthier alternative to traditional cigarettes, and as a potential means to help smokers quit.

Now, as more and more reports come out about vaping-related illness, health experts canvassed by VICE expressed fear that former smokers might reach quick conclusions about the danger of these relatively novel devices and return to cigarettes, even as officials have not yet clearly articulated nor completely figured out a definitive cause for the growing spate of cases—and even though cigarettes remain proven killers.

Some, like Andrew, are already lighting up. He said a co-worker of his had done the same thing.

"With regards to vaping, frankly, it was a compromise," he explained, adding that he now smokes two to four cigarettes daily. "You have something that's maybe 60 percent as 'nice' as smoking cigarettes, but it's cheap and not as bad for your health. If it turns out it is actually quite bad for your health, then why even compromise in the first place?"

While it's too early to label this kind of reversal a bona fide trend, the dozen vapers VICE spoke to for this story were going through their own version of that thought process.

Torren Longenecker of West Palm Beach, Florida, said he was "currently switching back [to cigarettes], mainly because it's not worth the risk." Jake, a 24-year-old from Michigan who initially vaped only after he got out of rehab, was much more assured in his decision. Like Andrew, he offered a sort of existential shrug of the shoulders.

"After enough articles, it started fucking with my newfound love for vaping," he said. "I realized that if I'm going to die from nicotine, I'd rather have it be at age 60 from cancer than 24 from my lungs exploding or whatever. Whether or not it's been blown out of proportion is yet to be seen. So I picked up a pack of American Spirits and went on my merry way."

Even before the media firestorm over vape-related deaths, some cities and states were already issuing or hinting at sales moratoriums and bans until—at the very least—JUUL and other popular vape companies receive approval from the Food and Drug Administration (FDA), which they don't yet have. (In July, a federal judge ordered the agency to institute a 10-month deadline to submit such applications.) In San Francisco, a JUUL-backed coalition is now battling a lawmaker-passed prohibition on e-cigs, and more and more states—such as Michigan, New York, and Massachusetts—are flirting with measures that would prevent the sale of flavored pods and e-juice. JUUL has also been under fire for marketing practices critics said explicitly targeted teenagers, including with flavors (now only available online) like mango. (JUUL Labs has denied targeting young people.)

Mark, a Massachusetts man who has worked at a vape shop for two years and requested anonymity for fear of losing business, said he had heard from many customers in recent days that they were making the transition—getting rid of nicotine-based e-cigarettes because of what they've been seeing in the media.

Although any shift was in the earliest of stages, it was still a remarkable concern for tobacco-control experts like Michael Siegel, a professor of community health sciences at Boston University, who views getting smokers off traditional cigarettes to be the primary public-health matter. Even now.

"There are two big fears here," Siegel said. "That former smokers are going to return to smoking cigarettes, because they'll think, Why not just have the real thing? And also that smokers who might have otherwise wanted to try e-cigarettes won't any longer."

Another problem Siegel and other experts mentioned is that health officials themselves cannot even seem to agree on what's happening—and that confused message, he emphasized, could be the most dangerous thing of all.

"There is clearly a split between the CDC and the FDA," he said, adding that the message now is so "general" that it's not "actionable," and that, by not issuing specific warnings and leaving it so vague, it "actually fails to alert people to the real risk."

This contradiction was apparent last Friday, when the CDC and the FDA put out two separate statements. The former urged people to avoid using electronic cigarettes altogether (as did the American Medical Association and other leading doctors, until a concrete cause could be identified), while the latter warned chiefly against vaping THC specifically.

Meanwhile, even as some former smokers appeared to be returning to traditional cigarettes, JUUL's problems were compounded: On Monday, the FDA sent a letter to the company, saying it had violated certain federal regulations by claiming that its product was a safer substitute to smoking traditional cigarettes. It was a not-unexpected admonition that could further tarnish the behemoth's brand, and one that arrives, for many advocates focused on the youth vaping epidemic, much too late.

Leo Beletsky, a professor of law and health sciences at Northeastern University, said this government reaction was counterproductive, and could lead to catastrophic consequences down the line. Namely, that a failure of regulation has potentially gotten a new generation addicted to nicotine, and now products that could help save the lives of older generations will be stigmatized and perhaps more difficult to obtain.

"This is the typical knee-jerk panic that then produces major downsides," he continued. "People will say, 'Oh, this was unintended.' Maybe it will be unintended—but it will also be totally foreseeable and foreseen."

At the same time, experts VICE consulted about what current vapers should do were clear: Quitting vaping is currently the only surefire way to protect yourself.

In a statement, Ted Kwong, a spokesperson for JUUL Labs, which according to the Times controls more than 70 percent of the vape market and has said it is "monitoring the situation closely," insisted the company was "fully committed to the [FDA approval] proces" and "confident in the content and quality of the materials we will submit with our application." He added, "We are confident that our growing body of evidence as well as our industry-leading actions to combat underage access and use will ensure adult smokers continue to have a true alternative to cigarettes."

But for his part, Andrew did not yet have any intention of quitting cigarettes again.

"For all the hand-wringing about how vape companies are targeting minors," he said, "they should have to answer for how they've been targeting adult smokers, too—if it turns out it's as harmful as it now seems."

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