A new study in JAMA, analyzed 2,155 patients that had been diagnosed with a vaping-related lung injury, finding that many youths reported using informal sources to obtain vaping devices containing both nicotine and tetrahydrocannabinol (THC).

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In the May, 2020 study, researchers analyzed “360 hospitalized or deceased adolescents (age range, 13-17 years),” 859 “young adults (age range, 18-24 years),” and 936 adults, categorized as being 25 to 49 years old.

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Of the adolescents, 50.5 percent and 96.5 percent relied on informal sources to obtain nicotine and THC-containing vapor products, respectively. Of the young adults, only 19.8 percent relied on informal sources for nicotine, and 86.9 percent relied on such sources for THC-containing vaping devices. Of the adults, 24.3 percent and 75.1 percent utilized informal sources to obtain nicotine-containing and THC-containing products, respectively.  

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The findings add to the plethora of research on vaping-related lung injuries, which have been overwhelmingly linked to illegal products containing THC, and often obtained through black market sources. Further, the new study adds to existing literature in how youth are acquiring tobacco and vapor products, which is often through social sources, including family and friends. Lawmakers should take note of such channels, as legislation has been introduced in many states and localities to regulate and tax vapor products, and in some instances – completely ban the sale of these tobacco harm reduction products.

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As of January 14, 2020, the Centers for Disease Control and Prevention (CDC) had information available on 2,022 patients that had been hospitalized due to a vaping-related lung injury. Of these, 82 percent reported using THC-containing products and 33 percent of patients reported exclusive use of THC-containing vaping devices.

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Overwhelmingly, vaping-related lung injuries have been linked to illegal brands of vaping devices containing THC. Lindsey Stroud, creator and manager of Tobacco Harm Reduction 101, first directed policymakers to these brands in August, 2019.

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In this Policy Tip Sheet, Stroud shows empty packaging of a popular THC vape brand on Amazon and eBay, as well as empty cartridges, which can be filled with any illicit substance. YouTube even offers videos on how to make THC oil that can be used in a vaping device. In December 2019, the CDC noted that 56 percent of patients with a vaping-related lung injury who had used THC cited using the same illicit THC vape brand. Unfortunately, banning legal, regulated vapor products fails to address brands such as these.

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Moreover, the study adds to growing literature that youth rely on friends and family members for obtaining tobacco and vapor products. A U.S. Food and Drug Administration study found that 86 percent of youths aged “15 to 17 years old obtained cigarettes by asking someone else,” and 89 percent relied on these sources for e-cigarettes. These so-called social sources include siblings, friends, parents, and even strangers.

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Data from 2019 Youth Risk Behavior Surveys (YRBS) indicate youth are obtaining e-cigarettes through the same social sources. For example, in the 2019 Montana YRBS, 10.6 percent of Montana high school students reported “borrowing” e-cigarettes and 6.9 percent reported giving “someone else money to buy them.” According to the 2019 Vermont YRBS, 52 percent of high school students under 18 years of age reported borrowing e-cigarettes and 26 percent reported giving “someone else money to buy them.” The findings are similar to other states’ 2019 YRBS.

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It’s important for lawmakers to understand how youth are obtaining vapor products as states move forward with draconian legislation that restricts adult access to tobacco harm reduction products. E-cigarettes have emerged as an effective smoking cessation tool that have enabled millions of American adults to quit smoking and are twice as effective as nicotine replacement therapy in helping smokers quit.

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Further, the use of e-cigarettes has been an economic boon to the United States’ economy. For example, according to the Vapor Technology Association, in 2018, the vapor industry the industry created 87,581 direct-vaping related jobs, including manufacturing, retail, and wholesale jobs, which generated more than $3.2 billion in wages alone. Moreover, the industry has created thousands of secondary jobs in the United States, bringing the industry’s total economic impact in 2018 to $24,457,512,300. In the same year, the industry provided more than $4.9 billion in taxes.

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Rather than restricting adult access to tobacco harm reduction products, lawmakers should divert more of existing tobacco monies to tobacco control programs. For example, in 2019, states collected a total of $27.3 billion in monies from tobacco taxes and tobacco settlement payments. In the same year, states spent only $655 million, or 2.4 percent, on tobacco control programs including education and prevention. It is abhorrent that lawmakers would choose to snuff out options that have helped American adults quit smoking – while dedicating so little of tobacco monies to such programs.

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As more data continues to become available, lawmakers should take note and promote policies that maintain adult access to tobacco harm reduction options, while simultaneously addressing youth use of tobacco and vapor products.

 

Nothing in this analysis is intended to is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101. For more information on tobacco and vapor products, please visit https://www.thr101.org.