IOWA
Analysis, Commentary, Musings
IOWA
Analysis, Commentary, Musings
RESEARCH 2019
CONNECTICUT DEPARTMENT OF HEALTH LACKS TRANSPARENCY WHEN REPORTING VAPING-RELATED HOSPITALIZATIONS
October 16, 2019
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Lindsey Stroud examines reports by the Connecticut Department of Public Health (CDPH), finding the department is now omitting specific details about recent vaping-related hospitalizations.
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On August 21, 2019, CDPH reported two cases of vaping-related hospitalizations involving patients who admitted to vaping “both nicotine and marijuana products.”
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On September 19, CDPH confirmed 11 more cases, for a grand total of 13. Of these, CDPH interviewed nine patients, who all admitted “using vaping products containing tetrahydrocannabinol (THC), a psychoactive component of the marijuana plant.”
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CDPH press releases on October 3 and October 11 did not mention anything about which substances individuals vaped prior to hospitalizations.
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Recently, the Centers for Disease Control and Prevention (CDC) found a majority of vaping-related hospitalizations were due to vaping THC products. On October 3, CDC announced 78 percent of patients with vaping-related illnesses “reported using THC-containing products.” Similar results have been reported by health departments in Minnesota, Oregon, Texas, and Utah.
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It is imperative lawmakers understand these illegal, unregulated THC-laden “vaping cartridges,” which are mostly homemade or available on the black market, are not e-cigarette products regulated by the U.S. Food and Drug Administration (FDA).
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E-cigarettes and vaping devices first entered the U.S. market in 2007.
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In 2012, FDA was granted authority to regulate vaping devices as tobacco products.
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In 2016, FDA extended its regulatory authority over e-cigarettes, issuing deeming regulations. Under these rules, no new vaping product could come to market after August 8, 2016, without first completing a premarket tobacco application.
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An estimated three million American adults have used vaping devices to quit smoking tobacco cigarettes. Further, e-cigarettes are twice as effective as nicotine replacement therapy in helping smokers quit.
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In June June 2019, the American Cancer Society found “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”
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Making matters worse, far too many policymakers seek to reduce youth e-cigarette use, yet spend little tobacco revenue on such programs. 1998, Connecticut joined other sates in settling with tobacco companies in what became known as the Master Settlement Agreement (MSA).
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The Nutmeg State is estimated to receive “between $3.6 and 5 billion over the first 25 years” in MSA payments. Despite this, Connecticut lawmakers continue to shortchange anti-smoking efforts. In 2019, Connecticut received an estimated $500.8 million in tobacco settlement payments and taxes, yet dedicated $0 of state funds towards smoking education and prevention programs.
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MONTANA’S PREMATURE FLAVOR BAN IGNORES HARM REDUCTION, UNLIKELY TO REDUCE RECENT VAPING-RELATED HOSPITALIZATIONS
October 15, 2019
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On October 8, Montana Gov. Steve Bullock “directed the Montana Department of Health and Human Services (DPHHS) to implement emergency administrative rules to temporarily prohibit the sale of flavored e-cigarettes.”
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The ban includes mint and menthol, but does not include tobacco and marijuana flavors. The rules will become effective October 22, and will be in place for 120 days.
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An encroaching ban on e-cigarette products restricts adult access to tobacco harm reduction products and will likely lead former smokers back to much more harmful combustible cigarettes. Moreover, there is overwhelming evidence that recent vaping-related hospitalizations are due to the use of illegal vaping products containing tetrahydrocannabinol (THC).
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Despite recent fearmongering, almost all electronic cigarettes and vaping devices are regulated.
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In 2016, the U.S. Food and Drug Administration (FDA) issued deeming regulations on e-cigarettes and extended the agency’s authority to regulate e-cigarettes as tobacco products.
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As of August 8, 2016, all e-cigarettes have required FDA approval before coming to market.
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Furthermore, all e-cigarette products have been registered with FDA since December 31, 2016.
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All companies selling e-cigarettes and vaping devices must complete a premarket tobacco product application by May 12, 2020.
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Since their introduction to the U.S. market in 2007, e-cigarettes have helped an estimated three million American adults quit smoking combustible cigarettes
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E-cigarettes are significantly less harmful than combustible cigarettes.
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In 2015, Public Health England (PHE) found e-cigarettes to be 95 percent less harmful than combustible cigarettes. In 2018, PHE reiterated this finding, noting that e-cigarette use is “at least 95% less harmful than smoking.”
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In 2016, the Royal College of Physicians found e-cigarette use “unlikely to exceed 5% of the harm from smoking tobacco.”
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Most recently, in June 2019, the American Cancer Society found that “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”
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Many adults credit flavors in helping them quit combustible cigarettes. Indeed, a 2018 survey of nearly 70,000 adults who use vaping devices, with “almost 95% of participants [reporting] that they were ever smokers,” found only 20 percent of respondents reported “using tobacco flavors” at the point of e-cigarette initiation. Further, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively.
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Moreover, the recent move by Montana’s governor ignores findings by state and national health agencies, which have linked recent vaping-related hospitalizations to the use of illegal and unregulated vaping devices containing THC.
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An October 3 report by the Centers for Disease Control and Prevention examining vaping-related hospitalizations found that 78 percent of patients “reported using THC-containing products.” Other state health departments, including Minnesota, Oregon, Texas, Utah, and Wisconsin, have linked recent vaping-related hospitalizations to vaping products containing THC.
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Although Bullock seeks to prevent youth e-cigarette use, Montana currently dedicates very little of existing moneys towards programs that could deter youth from using e-cigarettes. For example, in 2019, Montana received an estimated $108.5 million in tobacco settlement payments and taxes. In the same year, the Treasure State dedicated only $5 million, or 0.04 percent, of state funding towards tobacco control programs, including education and prevention.
OREGON’S MISGUIDED FLAVOR BAN IS DISSERVICE TO PUBLIC HEALTH, UNLIKELY TO REDUCE RECENT HOSPITALIZATIONS
October 10, 2019
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On October 4, Oregon Gov. Kate Brown ordered “state agencies to enact a temporary ban on the sale of flavored vaping products.”
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Although the Oregon Health Authority (OHA) and the Oregon Liquor Control Commission have yet to enact a ban, rules are expected to be published in the second week of October.
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Although addressing youth use of age-restricted products is laudable, flavor bans are ineffective measures to reduce youth e-cigarette use. Further, many state health departments and the Centers for Disease Control and Prevention (CDC) have linked a majority of vaping-related lung injury cases to the use of illicit and unregulated vaping devices containing tetrahydrocannabinol (THC).
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The Heartland Institute examined the effects of flavor bans, finding these measures to have no impact on youth e-cigarette use.
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Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. Despite this, youth e-cigarette use increased. In the 2015-16 California Youth Tobacco Survey (CYTS), 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.
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A 2018 survey of nearly 70,000 American adult vapers found flavors to be integral to e-cigarette use. In fact, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively.
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Oregon’s flavor ban will likely lead to even more hospitalizations because it does absolutely nothing to diminish use of the products causing the outbreak of hospitalizations: illicit THC products.
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On September 3, OHA announced “the individual, who died in July, had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary.”
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On September 26, OHA announced the second Oregon death, stating it was “an individual who had been hospitalized with respiratory symptoms after vaping cannabis products.”
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These findings are similar to an October 3 CDC report examining recent hospitalizations nationally. CDC was able to gather information on 578 of the supposed 1,080 hospitalizations. Of the 578 patients, 78 percent “reported using THC-containing products, with or without nicotine-containing products.”
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Even more alarming, although Brown wants to address youth use of e-cigarettes, Oregon directs very little of existing tobacco moneys to tobacco control programs.
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In 1996, through Measure 44, “Oregon became the fourth state to enact a tobacco tax through an initiative.” Although public health groups claim sin taxes “discourage tobacco use,” Measure 44 directed a measly 10 percent of the revenue received from the tax increase to tobacco control programs.
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Oregon first sued tobacco companies in 1997 and was a plaintiff in the 1998 Master Settlement Agreement (MSA). From 1999 and 2016, Oregon “received $1.4 billion in MSA payments.”
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Even more alarming, in 2019, Oregon received an estimated $338.8 million in MSA payments and tobacco taxes, yet the state dedicated only $10 million, or 0.02 percent, to tobacco control programs.
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GOV. INSLEES’ PROPOSED FLAVOR BAN WILL VAPORIZE TOBACCO HARM REDCUTION IN WASHINGTON STATE
October 10, 2019
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On September 27, 2019, Washington Gov. Jay Inslee issued an executive order requesting the State Board of Health to use its emergency rulemaking authority to impose a ban on all flavored vapor products, including flavored [tetrahydrocannabinol] THC vapor products.”
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On October 9, 2019, the Washington State Department of Health passed an emergency rule banning the sale of flavored e-cigarettes and vaping devices. The rule takes effect October 10, 2019 “and lasts for 120 days.”
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The Heartland Institute analyzed results from the 2017-18 California Youth Tobacco Survey (CYTS) and found that despite flavor restrictions in some localities, youth use of e-cigarettes in those areas increased after the bans went into place.
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Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16 CYTS, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.
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A 2018 survey of nearly 70,000 American adult vapers found flavors play a vital role in the use of e-cigarettes. Indeed, 83.2 and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”
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A September 2019 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), the agency identified 805 possible cases of vaping-related lung injury and was able to gather data on 514 patients.
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Of these 514 patients that self-reported, 395, or about 77 percent, “reported using THC-containing products.”
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Since 2007, electronic cigarettes and vaping devices have been available on the U.S. market. Until recently, these products were not linked to any significant adverse health effects. The American Cancer Society noted in June 2019 that “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”
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Moreover, Inslee is worried about youth e-cigarette use, yet the Evergreen State dedicates very little funding on programs that could prevent such use. For example, Washington received an estimated $552.6 million in tobacco settlement payments and taxes in 2019, yet the state directed only $1.5 million (0.02 percent) of state funding on tobacco control programs, including education and prevention during the same period.
UPDATED CDC REPORT ON VAPING-RELATED HOSPITALIZATIONS FINDS NEARLY 80 PERCENT LINKED TO THC PRODUCTS
October 9, 2019
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Lindsey Stroud examines a recent report by the Centers for Disease Control and Prevention (CDC) finding that 78 percent of recent vaping-related hospitalizations have been linked to the use of vaping devices containing tetrahydrocannabinol (THC).
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37 percent of patients reported “exclusive use of THC-containing products.”
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These findings are similar to a CDC Morbidity and Mortality Weekly Report (MMWR) published as Early Release on September 24, 2019.
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Of the 514 patients self-reporting, 395, 77 percent, “reported using THC-containing products.”
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CDC’s findings are similar to reports from several state health departments
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In August 2019, the Wisconsin Department of Health Services reported 89 percent of patients who had been interviewed “reported using e-cigarettes or other vaping devices to inhale THC products.”
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In September, the Minnesota Department of Health concluded a vaping-related death “was associated with vaping illicit THC products.”
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The Oregon Health Authority reported two-vaping related deaths. In both cases, OHA reports the victims had consumed THC products before passing away, according to statements issued on September 3 and September 26.
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Even states in which no vaping-related deaths have occurred have had patients report use of vaping devices containing THC.
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The Connecticut Department of Public Health “interviewed 9 of the 13 patients with vaping-related injury.” All nine patients reported using THC products.
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According to the Texas Department of State Health Services, 87 percent of interviewed patients “reported vaping products containing [THC].”
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The Utah Department of Health (UDOH) reported “71 cases of vaping-related lung injury.” UDOH gathered data on 36 cases and found 34 patients, or 94 percent, self-reported use of “any THC cartridges.” In Utah, 13 patients, or 36 percent, reported exclusive use of THC vaping devices.
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Utah Public Health Laboratory tested 39 vaping devices: 51 percent contained e-liquid nicotine and 49 percent contained THC. Among the nicotine-containing liquids, 100 percent “contained nicotine and none have shown unexpected compounds.” On the other hand, 90 percent “of the THC cartridges contained Vitamin E acetate.”
MISGUIDED MASSACHUSETTS BAN IS A WET BLANKET ON TOBACCO HARM REDUCTION
October 9, 2019
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On September 24, 2019, Massachusetts became the first start to ban all vaping products, including devices containing nicotine, tobacco, and tetrahydrocannabinol (THC). Gov. Charlie Baker “called for a temporary four-month statewide ban” while authorities attempt to “identify” the cause of recent vaping-related hospitalizations.
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A unilateral ban on all vaping devices will likely do more harm than good. Why? Because health departments throughout America have linked vaping-related lung illness to the use of illegal and counterfeit vaping devices containing THC
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In a late September, 2019 report, the CDC found that 76.9 percent of self-reporting patients “reported using THC-containing products.”
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Perhaps the most infamous of these black-market products is Dank Vapes.
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Eager entrepreneurs can purchase empty packaging with the Dank Vape label online, as well as empty cartridges, which they can fill with who knows what, including unknown chemicals.
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One marijuana research company found Dank Vapes to be an illegal, unlicensed brand.
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Dank Vapes has already been implicated for putting a Wisconsin man into a coma.
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The Utah Department of Health concluded 38 percent of self-reporting patients who were hospitalized due to THC used Dank Vapes.
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In an instance of stunning hypocrisy, Massachusetts Lt. Gov. Karyn Polito emphasized the need to “educate youth and parents about the dangers of vaping.”
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Massachusetts spends almost none of the enormous funds it receives from tobacco settlement moneys on such programs.
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In 2019, the Bay State received an estimated $864.5 million in tobacco settlement payments and taxes, yet spent a pathetically low $4.2 million, or 0.04 percent on tobacco education and prevention programs.
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Massachusetts raised the cigarette tax by a $1 per pack in 2013. From 2013 to 2016, the Bay State collected an additional $542 million in cigarette taxes, “none of the cigarette revenue [went] directly into anti-smoking programs.”
FLAVOR BAN UNLIKELY TO REDUCE YOUTH E-CIGARETTE USE, DOES NOT ADDRESS RECENT HOSPITALIZATIONS, AND WILL VAPORIZE SMALL BUSINESSES IN NEW YORK
October 7, 2019
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On September 17, 2019, New York Gov. Andrew Cuomo issued an order to the New York Department of Health (NYDOH) banning the sale of flavored electronic cigarettes and vaping devices.
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The New York Department of Health gave retailers “an approximate two-week grace period before conducting visits to enforce” the ban, with inspections “beginning on Friday, October 4.” Retailers in violation were to “face fines of up to $2,000 per violation.”
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On October 3, 2019, in response to a lawsuit filed against the ban by the Vapor Technology Association and two vaping manufacturers (VTA et al.), a New York Appellate Court “granted a temporary restraining order to halt New York’s enforcement of the ban.” The ban is effectively delayed until October 18, 2019.
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Analysis of flavor bans indicate they do not deter youth use of vapor products.
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Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18, this increased to 10.7 percent.
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CDC and several state health departments have linked the vast majority of recent vaping-related hospitalizations to the use of illicit and unregulated products, not lawful and regulated flavored products.
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A CDC Morbidity and Mortality Weekly Report obtained information for 514 of 805 possible vaping-related hospitalizations. Of the 514 patients, 395, or 77 percent, “reported using THC-containing products.”
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The Connecticut Department of Health “interviewed nine of [their state’s] 13 patients with vaping-related injury.” All nine patients reported the use of THC products.
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The Texas Department of State Health Services identified 75 potential vaping-related hospitalizations, with “87% of cases interviewed” reporting using THC products.
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A statewide flavor ban will also prove to be a huge economic loss for New York
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“the [New York] vapor industry accounts for over [$1.197 billion] annually in economic output and generates jobs for approximately 8,110 individuals.”
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This industry annually pays an estimated $99 million in state taxes and more than $30 million in sales taxes.
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Most brick-and-mortar vape shops in the Empire State “are small businesses, with many having five or fewer employees.”
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New York spends little money on helping smokers quit
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In 2019, New York received an estimated $2.0371 billion in tobacco settlement payments and taxes, yet only allocated $39.3 million, or 1 percent, on tobacco education and prevention programs.
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New York state’s pension fund also has investments in “Philip Morris, Altria, Reynolds America, British American Tobacco and Imperial Tobacco.”
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On October 4, 2019, the Rhode Island Department of Health issued “emergency health regulations banning the sale of flavored” electronic cigarettes and vaping devices.
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The ban on flavored e-cigarette products will be in effect for 120 days, “and can be extended for an additional 60 days.”
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Flavor bans do not reduce youth e-cigarette use.
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Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18, this increased to 10.7 percent.
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Many states and the CDC have linked a majority, if not all, of such hospitalizations to the use of products containing tetrahydrocannabinol (THC).
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A CDC Morbidity and Mortality Weekly Report obtained information for 514 of 805 possible vaping-related hospitalizations. Of the 514 patients, 395, or 77 percent, “reported using THC-containing products.”
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Oregon’s two vaping-related deaths have been attributed to THC products, as announced on September 3 and September 26.
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The Minnesota Department of Health reported an individual died from a “lung injury [that] was associated with vaping illicit THC products.”
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The Connecticut Department of Health “interviewed 9 of [their state’s] 13 patients with vaping-related injury.” All nine patients reported the use of THC products.
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The Texas Department of State Health Services recently identified 75 potential vaping-related hospitalizations, with “87% of cases interviewed” reporting using THC products.
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Of the 23 vaping-related hospitalizations in Iowa, 18 “have reported the use of THC.”
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Policymakers should utilize existing tobacco moneys on programs to reduce youth e-cigarette use. In 2019, Rhode Island received an estimated $195 million in tobacco settlement payments and taxes. In the same year, the Ocean State spent only $390,926, or 0.02 percent, on tobacco control programs including education and prevention efforts.
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Lindsey Stroud examines the Centers for Disease Control and Prevention’s (CDC) latest Morbidity and Mortality Weekly which linked more than 70 percent of recent vaping-related hospitalizations to the use of vaping devices containing tetrahydrocannabinol (THC).
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As of September 24, CDC has identified 805 reported cases of vaping-related hospitalizations in 46 states and one U.S. territory.
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69 percent of patients were males.
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The median age was 23 years, with a range from 13 to 72 years.
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There have been 12 deaths reported in 10 states, including California (two deaths), Florida, Georgia, Illinois, Indiana, Kansas, Minnesota, Missouri, Mississippi, and Oregon (two deaths).
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Of the 805 cases, information on substances used was available for 514 patients, or 64 percent of reported cases.
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395, or 77 percent, reported vaping THC-containing products.
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210 patients, or 41 percent reported using both THC and nicotine products.
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Only 82, or 16 percent self-reported exclusive use of nicotine products.
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At this time, the CDC still does not know the “specific chemical exposure(s) causing this outbreak.”
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These findings are similar to other state findings.
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On September 16, the Utah Department of Health linked the state’s hospitalizations to THC products, with 60 percent of individuals “self-reported vaping nicotine” and 90 percent “self-reported vaping THC.”
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On September 19, the Connecticut Department of Public Health had “interviewed 9 of the 13 patients with vaping-related injury.” All nine patients reported using THC products.
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On September, 26, the Oregon Health Authority (OHA) reported the state’s second vaping-related death, finding the patient “had been hospitalized with respiratory symptoms after vaping cannabis products.” Earlier, on September 3, OHA announced the first vaping-related death, which was a patient who “had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary.”
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On September 23, the Texas Department of State Health Services reported a total of 89 cases under investigation, with 34 “classified as confirmed cases,” and 20 “classified as probable cases.” Of these, 76 percent “reporting vaping products containing [THC].”
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Lawmakers should refrain from enacting legislation that would further restrict adult access to electronic cigarettes and vaping devices.
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Numerous public health groups, including Public Health England, the Royal College of Physicians, and the American Cancer Society have found e-cigarettes to be significantly less harmful than combustible cigarettes.