On September 6, federal health officials warned the public that a mysterious illness linked to vaping had killed five people in the U.S. Kansas officials confirmed on September 10 that a sixth person has died and California health officials said on September 17 that a seventh person had died from vaping-related illness. At least 450 cases of vaping-associated illness are suspected in hospitals across 33 states and one territory, with the numbers continuing to rise.
Those hospitalized are mostly young and healthy, and were admitted with symptoms beginning with fever and nausea, escalating to coughing, chest pain, and shortness of breath. Among the first five reported deaths, all had vaped—either weed, nicotine, or a combination of the two—in the previous 90 days; most had vaped much more recently.
The cases represent a small percentage of the vaping population, but the severity of the illness—which looks like viral or bacterial pneumonia, but isn’t—has investigators worried. (An editorial in The New England Journal of Medicine declared “there is clearly an epidemic that begs for an urgent response,” and that doctors “should discourage their patients from vaping.”)
Doctors have described “severe lung injury” and, in one death in an older patient, a “long and complicated hospitalization.” One patient, chronicled in The Washington Post, went from feeling sick to being “on death’s door” in two days; six weeks after leaving the hospital the 20 year-old former hiker still has diminished lung capacity and struggles with his short-term memory. Doctors aren’t sure whether he’ll fully recover.
While authorities have published case studies describing the acute lung disorder observed in people who vape, its exact cause remains unclear. It hasn’t been linked to a specific product or device; investigators also aren’t sure whether it’s a new phenomenon or something they’re just recognizing, though details point to the former.
As a discerning user, how can you know if you’re vaping responsibly? We asked the experts.
Am I safe if I'm avoiding THC vapes?
No. “Many but not all of the cases have been linked to THC-containing products,” said MeiLan K. Han, professor of internal medicine in the Division of Pulmonary and Critical Care Medicine at Michigan Medicine and director of the Michigan Airways Program. She notes that Food and Drug Administration testing showed vitamin E acetate, an oil derived from vitamin E, in weed products vaped by people who’d gotten sick. That oil could be causing lung inflammation, she said. But not everyone who got sick reported using such products, and some were using only nicotine vape product. “At this time there is no guaranteed ‘safe’ form of vaping,” Han said.
How can I tell if my vape is safe to use?
The FDA has warned vapers against buying products “off the street,” or those that have been mixed or tampered with, implying that “reputable” products are safer. But as Buckles noted, “There is no regulation or inspection of these manufacturers or vape shops, so there is no way to tell if a device or liquid is from a ‘reputable place.’” This means that even if you’re using a fancy pen that you bought legally in L.A., you can’t be guaranteed to escape this mystery illness. In June 2017, the Trump administration delayed rules being put in place for the e-cigarette industry by four years—they're set to go into effect in 2022, though a court case may accelerate the deadline.
Wow, ok. I vape several times a day. Should I completely stop?
“Yes, you should stop completely,” said Deborah Buckles, program director of the Tobacco Treatment Program at the Indiana University Melvin and Bren Simon Cancer Center. Because investigators haven’t identified the source of the lung disorder, she said, right now the safest bet is simply not to vape. The Centers for Disease Control and Prevention said on Friday that it recommends not vaping while the investigation is ongoing.
Uh, but I’m addicted to nicotine, and THC helps me sleep. Are cigarettes less risky for me than vapes?
Combustible cigs are still bad for you, as you well know. “Cigarettes contain their own risks for increasing risk of lung cancer, heart disease, and a host of other lung problems,” Han said. “The bottom line is that the lungs were not designed to breathe anything other than clean air. Anything other than that is a potential health risk.”
The health risks of cigarettes are well known; right now, the risks from vaping are not well understood—and that lack of information goes beyond the current spate of illnesses. That’s because e-cigarettes are a relatively recent phenomenon. Touted as a safer alternative to cigarettes, they were brought to market with very little scientific study; there are a lot of unknowns about them, and the more they’re studied, the less safe they seem to be.
“Vape shop owners and e-cigarette manufacturers like to say they are helpful with quitting smoking,” Buckles said, “However, there is no evidence at this time to indicate this is true.” The FDA regulates vapes as tobacco products, and has not approved them for smoking cessation or anything else.
The bottom line is that there’s currently an epidemic of illnesses related to vaping; beyond that risk, the long-term safety of vaping is far from established. In the face of those uncertainties, returning to the devil you know—cigarettes—may seem safer. But in the long run, that’s a bad idea too. “Cigarettes are certainly not safe,” Buckles said. “There are 69 known or suspected cancer-causing agents found in every cigarette.”
Not to be a total buzzkill, but getting away from smoking and vaping is pretty much your only solution. “The safest route is FDA- approved smoking-cessation medications,” Buckles said, referring to options like gum, patches, nasal sprays, and lozenges. “And there are currently 7 on the market. We know these medications are effective and safe. The most effective and safest way to quit smoking is to use medication and counseling in combination.” As for getting your dose of THC, you’ve got other, probably safer options, including edibles, drinkables, and other things not involving lighting chemicals on fire and inhaling them.
Update 9/10/19: This story's headline and text have been updated to reflect the sixth death linked to vaping, announced in Kansas.
Update 9/17/19: This story's headline and text have been updated to reflect the seventh death linked to vaping, reported in California.
Sign up for our newsletter to get the best of VICE delivered to your inbox daily.