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A Recap of What Really Caused the Vaping Epidemic in 2019


While vaping has become increasingly popular, the sharp uptick in e-cigarette use grabbed public attention last summer when the practice was linked to a sudden outbreak of severe lung illnesses. Over the past few years, as vaping flavored liquid nicotine grew, the practice drew only limited health concerns largely because it was considered far preferable to smoking cigarettes. But that all changed in 2019. Vaping is now linked to 2,506 hospitalizations and 54 deaths in the US by year’s end due to previously unseen respiratory illnesses. Especially concerning is that 64% of the cases were among adults 18-34 years old. Surprised health officials at first believed a vaping-related epidemic had emerged out of nowhere, spreading fear to the nation’s millions of vapers.

But in November, after months of uncertainty, the US Centers for Disease Control finally put the mystery to rest. The government health agency confirmed earlier reports circulating on social media that the lung damage was principally due to a sudden increase in the black-market sales of flavored vaping cartridges and pods that contained the THC chemical from marijuana.

The Real Culprit

The real culprit is a liquid form of Vitamin E that black marketers added to enhance the potency of small amounts of THC, the chemical that creates marijuana’s high. Inhaling the heated Vitamin E, studies now confirm, damage the lining of lungs and can severely restrict breathing. Especially worrisome, the CDC reports that dozens of patients had to be re-hospitalized shortly after discharge, and of those seven died. This suggests that lung damage due to Vitamin E inhaling may be long-lasting.

Even though the CDC is certain the problem was limited to the Vitamin E laced THC, the sudden and surprising outbreak spurred a swift response against legal vaping products. In late November the American Medical Association called for a ban of all vaping products. In December, Congress raised the national age of tobacco use to 21 from 18 in an attempt to quell the rapid growth of vaping among teens. The new government restrictions followed the banning of all flavored e-cigarettes sales by several states, including New York. 

In the face of mounting state lawsuits, Juul, the leading vaping device maker, has halted sales of its mint and other flavored vaping pods that are especially popular among teens. The lawsuits allege that the company targeted young people with deceptive advertising, failed to warn customers that the products contain nicotine, and misrepresented them as a safer alternative to cigarettes. 

Hidden, Shadowy Marketplace

Indeed, the summer outbreak spurred the National Institute on Drug Abuse, for the first time, to explore the jump in vaping use. In one report released in the fall, the agency reported that THC vaping among teens more than doubled over the past two years. The study found that 21% of high school seniors students in one sample were vaping THC. As a result, in November the US Food and Drug Administration shut down 44 websites that were marketing illicit THC laced with Vitamin E.

The summer outbreak also drew the attention of health officials to a national spike in nicotine use from vaping that had largely gone unreported. The rapid rise in vaping nicotine has surprised health officials who believed they were winning the war against tobacco because cigarette use in the US has fallen sharply over the past decade. That decline, in turn, has led to a reduction in the incidence of life-threatening heart and respiratory illnesses. Lung cancer cases are down, too. 

Prime Brain For Substance Abuse

Addiction specialists are now worried anew about the increase in nicotine use, especially among young people. Nicotine in e-liquids is readily absorbed from the lungs into the bloodstream, much faster than from smoking. Once in the bloodstream, the nicotine quickly stimulates the central nervous system, increasing blood pressure, breathing and heart rate. Like most addictive substances, inhaled nicotine also turns up the brain’s pleasure and reward circuitry. New research suggests that by priming the brain’s reward system, the use of nicotine can lead some vapers to seek the same feeling from other similarly addictive substances such as heroin and fentanyl. 

Meanwhile, vaping for many users is a way to self-medicate away stress and feelings of sadness, anxiety, and depression. This alone is a cause for concern as vaping may mask underlying emotional issues. While vaping may seem cool and safer than smoking, lost is the long-term health concerns associated with becoming a nicotine addict.