The vices of vaping

We recently hosted a webinar on the harmful effects of vaping, and the potential health implications that could result from long-term use. Smokeless tobacco has been evolving over the past 55 years and now, with various forms of e-cigarettes and additives available, this once ‘safer’ recreational activity is showing implications on brain, lung, and cardiovascular function. 

Over the past several years, we have seen a decline in both adult and youth smoking use. Adult cigarette smoking dropped from 42.6% in 1965 to 13.7% in 2018, while youth cigarette smoking dropped from 27.5% in 1991 to 8.8% in 2017.

In contrast, over the past 7 years, the global market size for e-cigarette has nearly quadrupled. And in the United States we are seeing increased use most noticeably in the 25-44 year age group.  

With new research studies being published regularly, many insurers ask us about potential mortality concerns for those who indicate they vape, or if vaping can be detected through laboratory results. We’ve outlined some of the most commonly asked questions below

Do all e-cigarettes contain nicotine?

E-cigarettes were developed as a tool to assist with smoking cessation, but the nicotine or THC cartridges are additive. Vape pens can be used with just a flavored cartridge, but statistics show that the vast majority of users purchase with nicotine/THC inhalation in mind. If a user is smoking nicotine through an e-cigarette device, cotinine levels could still report a positive through their laboratory results.

While e-cigarette aerosol/vapor is not harmless, it seems clear from the research that it is materially less toxic than the chemicals in the combustible cigarette?

Correct. E-cigarettes have the potential to benefit adult smokers who are not pregnant, if they are used as a complete substitute for regular cigarettes and other smoked tobacco products. However, a major concern is for those who are “dual-using” both e-cigarettes and combustible cigarettes. There is also concern for youth who may not otherwise have started smoking combustible cigarettes but start down the path of e-cigarette use and progress to the more dangerous option. If they continue to use long-term, they may be at risk for multiple health issues.

Do we have information available to educate our insurance applicants on the harmful health risks?

While much research is underway on the health effects and risks of using e-cigarettes, we recommend going to the Centers for Disease Control (CDC) website for the most up-to-date information. 

For e-cigarette or vaping associated lung injury (EVALI), what specific types of lung injuries are occurring and are they permanent?

EVALI represents a spectrum of acute lung injury responses to vaping exposure, including acute respiratory distress syndrome (ARDS), hypersensitivity pneumonitis, organizing pneumonia, and diffuse alveolar hemorrhage. Vitamin E acetate was identified in bronchoalveolar lavage (BAL) or lung fluid samples in over 94% of EVALI patients. The map below from the CDC shows the number of hospitalized EVALI cases or deaths per state as of February 2020.

Can e-cigarette use be identified through laboratory results if nicotine is not present?

If nicotine or THC is not present in the e-cigarette cartridge, the laboratory will not be able to detect e-cigarette use. 

While much more research still needs to be completed on the long-term health effects of vaping/e-cigarette use, it is becoming clear that even occasional use can adversely impact one’s health. Additionally, the current research shows there may be correlations with high blood pressure, chronic lung diseases, and addiction in the developing brain.

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