Photo by Alex Boerner
Kirby Hoekstra, left, of Raleigh, and Devon Scott, center, of Durham, hang out at the counter of The Vape Shop in Durham with manager Mat DeJesus.
On September 26, North Carolina reported its first vaping-related death, an unidentified patient at Cone Health in Greensboro who was the eighth person admitted to the hospital in two months with an illness linked to vaping. At the time, the state had received reports of forty such hospitalizations, including two people in their twenties who were put on life support in Winston-Salem.
In the media and among politicians, this is a public health crisis. Since April, at least twenty-six deaths and more than a thousand hospitalizations have been linked to vaping across the U.S. President Trump has called on the FDA to ban the sale of flavored vape juice, an effort to encourage the estimated 3.6 million middle and high schoolers who use e-cigarettes to quit. At least a half-dozen states, including New York and Oregon, have already done do, at least temporarily.
In May, North Carolina attorney general Josh Stein became the first to sue JUUL, arguing that the e-cigarette company “targeted young people as customers” and employed business practices that “are not only reckless, they’re illegal,” he told the INDY last week in an email. “And I intend to put a stop to them. We cannot allow another generation of young people to become addicted to nicotine.”
Last month, Stein’s lawsuit—along with the threat of similar lawsuits from other states and pressure from Washington—led to the collapse of a $200 million merger between the Big Tobacco companies Phillip Morris International and Altria, a key stakeholder in JUUL. JUUL also announced that it would end all e-cig marketing.
But vaping advocates say that, while the industry is an easy target, the opprobrium is misplaced.
“The issue that we have had with the president’s action is that he is equating vaping to a product, and it’s not,” says Sherwin Mena, president of the N.C. Vaping Council.
Mena argues that many of the health concerns aren’t linked to vaping itself, but to elicit THC-infused vape juice. “Vaping is a delivery method, and the sicknesses and illnesses that you have seen across the United States, ninety percent are attributed to black-market THC cartridges that have been cut with vitamin E acetate, which is an oil.”
Scientists aren’t clear about what’s causing the rash of hospitalizations. But Mena says vaping an oil can cause lipoid pneumonia, a build-up of fat in the lungs.
Mena says politically fueled misconceptions about vaping could lead people who have used vapes to quit smoking to go back to cigarettes, which cause 480,000 deaths a year in the U.S.
Vaping advocates point to the UK, a country that hasn’t seen the same health vaping-related health problems—something they credit to a regulatory approach that doesn’t “turn health issues into moral crusades,” as Brad Rodu, a professor of medicine at the University of Louisville and expert in tobacco addiction harm reduction, told Vice earlier this month.
With a system focused more on harm reduction than outrage, the UK has created a regulatory structure that assiduously monitors what’s in vaping products, including nicotine levels. So while U.S. advertising campaigns tell kids how dangerous vaping is, the U.K.’s National Health Service encourages smokers to vape instead.
Stein argues that it’s important to head off the youth-vaping epidemic. Young people’s still-developing brains, he says, are “particularly vulnerable” to nicotine, which studies have linked to a number of health risks as well as “increased risk of addiction to other drugs—cocaine, opioids, meth—in the future.”
There’s no denying that more minors are vaping in the U.S.—and in North Carolina. According to Stein, in 2011, 1.7 percent of North Carolina high school students reported using e-cigs; by 2017, nearly 17 percent did.
“In our high schools, Stein says, “it’s not called a bathroom anymore—it’s called a vape room.”
Mena says the industry is concerned about youth vaping, but it wants a seat at the table. Focusing on policies that target black-market products and distributors would help alleviate the health crisis without harming legitimate vape shops, he argues. And the latest push to ban flavors won’t deter young people from vaping.
“Kids don’t care about flavors,” Mena says. “Unfortunately, you can’t regulate delinquency. They want the nicotine high, unfortunately.”
Boot Bullwinkle, a spokesman for the Campaign for Tobacco-Free Kids, says that’s not accurate. A recent FDA study found that 70 percent of youth said they vape because they like the flavors, he says.
The vaping industry also argues that the government is being hypocritical. While two-dozen vaping-related deaths since April have prompted a crackdown, there’s been no such urgency following 220 deaths as a result of mass shootings in the same time period, according to the Gun Violence Archive.
This is just as much a public health crisis, they say.
Gun-reform advocates agree, saying they’d like the government to be at least as focused on assault rifles as e-cigarettes.
“We mourn the life of any life that is lost, but it can be concerning that we are not tackling both problems at the same time—the opioid crisis, vaping, and other public health concerns,” says Becky Ceartas, executive director for North Carolinians Against Gun Violence. “Anything that is causing American deaths, especially in large numbers, needs to be examined and studied, and then commonsense regulations need to be put into place to protect everyone.”
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