Mystery toxicity

Behind the scenes at Butte County Public Health, officials are preparing for the reverberations of a national outbreak of vaping-related lung illnesses.

Six people have died—including one in California—and 380 cases have been confirmed, according to the Centers for Disease Control and Prevention, which has launched a national investigation into the cause. Most patients have reported using cannabis products, though some used only tobacco e-cigarettes, the CDC says. No substance or product (i.e., device, liquid, pod or cartridge) has been identified as the clear culprit.

So far, no cases have been reported in Butte County, but Dr. Andy Miller, the county’s public health officer, said this outbreak is “absolutely” concerning to the department. That’s why it has issued advisories to local health providers detailing what has been going on and asking for all potential cases to be reported to Public Health as soon as possible.

Vaping-associated pulmonary injury is a condition that can mimic infections like pneumonia, but does not typically respond to antibiotics, Miller wrote in one advisory. Nationally, commonly reported symptoms include shortness of breath, coughing, fatigue, body aches, fever, vomiting and diarrhea.

Part of why this outbreak has been so concerning to health officials, Miller added, is that the symptoms can progress quite rapidly. Media reports have detailed several cases in which young people have been rushed to the hospital and hooked up to ventilators to keep them alive.

The CDC has taken a stance that consumers should refrain from vaping any products, even those sold legally, until it knows more. Miller told the CN&R he’s inclined to agree with that approach.

“We are at that early stage where we don’t know enough to give people even a false sense of security that there’s a safe product,” he said. “There’s kind of this general belief in our society … that if something is legal that someone has proven it’s safe. And that is definitely not always the case, especially in an industry that has evolved so rapidly, and really with little regulation.”

Health officials aren’t the only ones concerned about the outbreak. Vapes make up the majority of cannabis sales in California, with consumers spending $283 million on such products from January to June of 2018, according to BDS Analytics, a data-analysis company that tracks the cannabis market. This represents 79 percent of all concentrate sales.

Cannabis-industry advocates have argued that the devil’s in the details. Statewide, since late June, 67 potential cases of acute lung disease were found in those with a recent history of vaping. According to the California Department of Public Health (CDPH), “most” patients reported purchasing from unregulated and unlicensed street vendors or pop-up shops, and “some” vaped unlicensed or unregulated cannabis products, specifically.

Josh Drayton, a spokesman for the California Cannabis Industry Association, said this is an important aspect of the crisis to acknowledge.

“We really prioritize public safety and public health with all of our regulations in California,” Drayton told the CN&R via phone from his office in Sacramento. “When folks don’t have the opportunity to purchase from a regulated industry or delivery service, they’re going to turn to the unregulated market, which is a safety hazard at this point.”

The trade association’s members are working closely with CDPH to provide data on their products and testing, he added. “Right now, it is still a situation where information-gathering is the No. 1 priority.”

At the same time this crisis is unfolding, the federal government announced it is cracking down on e-cigarettes due to a spike in usage by youth.

For years, vaping products were largely unregulated. As of August 2018, e-cigarette product manufacturers have been required to file applications with the U.S. Food and Drug Administration to stay on the market. Before this rule, which was adopted in 2016, the products could be sold without any review of their ingredients or how they were made.

In the coming weeks, the FDA will unveil a compliance policy that will remove all flavored e-cigarette vaping products from the market, U.S. Department of Health & Human Services Secretary Alex Azar told reporters last week in the Oval Office. The primary goal is “to reverse the deeply concerning epidemic of youth e-cigarette use,” Azar said in a press release.

Legislative changes also are taking place in California. On Monday (Sept. 16), Gov. Gavin Newsom signed an executive order that directs the state Department of Tax and Fee Administration to step up enforcement of illegal or counterfeit vaping products. CDPH also will spend $20 million on a public information campaign and create health risk signs that will be posted at stores and on advertisements.

Approximately 21 percent of high-schoolers and 5 percent of middle-schoolers vape, according to data from the 2018 National Youth Tobacco Survey. This marks a 78 percent increase among high-schoolers and 48 percent increase among middle-schoolers compared with 2017.

Preliminary data for 2019 show that the problem only has gotten worse, with more than a quarter of high school students saying they currently vape. An overwhelming majority cited the use of fruit, menthol or mint flavors.

Bruce Baldwin, tobacco treatment coordinator for the local chapter of the California Health Collaborative, said a flavored e-cigarette ban is long overdue.

When he asks kids why they vape, they always offer the same reasons: “They like the flavor and they like the fact that it’s strong … they get a buzz.”

Though vaping cartridges have been found to contain metal, volatile organic compounds and cancer-causing agents, “there’s been this notion that somehow vaping is safer than smoking,” he said. “To me, it’s like saying it’s safer to get run over by a Volkswagen than by a pickup.”

Ellen Michels, Butte County Public Health’s Tobacco Program project director, said her program has been urging local policy makers to adopt a ban or more stringent regulations for flavored e-cigarette products for years. So far, it has been discussed in Oroville and Chico, but not acted upon.

“At this point in time, the message really is ‘don’t vape,’” Michels said. “Don’t use anything, because we don’t know yet what’s causing these serious illnesses and deaths.”