Comparing the Tobacco Death Toll to E-Cigarette Uncertainty

"[Using e-cigarettes is] exposing yourself to all kinds of chemicals that we don't yet understand and that are probably not safe."
"There's almost no doubt that [e-cigarettes] expose you to fewer toxic chemicals than traditional cigarettes."
Dr.Michael Blaha, M.P.H., director of clinical research, Ciccarone Center for the Prevention of Heat Disease, Johns Hopkins Medicine

"As a safer alternative than smoking for people addicted to nicotine, [e-cigarettes] are analogous to prescribing methadone for people addicted to opioids, a strategy called harm reduction."
Dr.Sally Satel, The Vaping Overreaction, The Atlantic

"As a doctor who takes care of people who use drugs, I don't have a problem with people who use drugs."
"But there are so many people in this country who really hate them and don't care if they die. Or don't care if they are able to have lives of dignity and respect."
Dr.Kimberly Sue, Harm Reduction Coalition, New York and California

"The Canadian market is six to twelve months behind where we thought it would be."
"Sales of recreational cannabis are not living up to expectation. We built an incredible team here, and an incredible company."
Mark Zekulin, CEO, Canopy Growth, Canada

Photo by Amelia Holowaty Krales / The Verge

The U.S. Centers for Disease Control and Prevention announced over 2,100 cases of lung injury linked to e-cigarettes or vaping reported in the United States as of Wednesday. Canada has been waiting to see whether instances of pulmonary disease linked to vaping would be found among Canadians and instances are now emerging in Quebec, New Brunswick, British Columbia and Ontario. "The Public Health Department in collaboration with its doctors, is currently investigating [the latest case reported this week in Quebec]. The person was consuming legal nicotine-based products", added the statement.


In the U.S. the steadily emerging cases of lung disease attributable to vaping, has pointed at vaping pens bought on the black market, where the pens' ingredients included vitamin E acetate, forbidden in Canada as an ingredient in e-cigarettes. But the legal market in Canada has not taken off to the extent of expectations. The causes are diverse; though recreational cannabis has been legal for over a year, too few commercial retail outlets have been granted licenses, and their prices are substantially higher than products available on the black market.

The U.S. Centers for Disease Control and Prevention named "e-cigarette, or vaping, product use associated long injury (EVALI)", claiming to have detected "a potential chemical of concern in biologic samples from patients with EVALI". The identification of the chemical in fact, has been in the public domain for quite awhile. The addition of vitamin E acetate in some black market vaping products containing the canabinoid THC suggests risks of vaping can be ameliorated by avoiding black market products.

On the other hand, the latest identified case of lung injury in Quebec associated with vaping was said to have been acquired with legally-bought product which presumably was free of vitaimin E acetate. And then there is the perspective of harm and product and usage comparisons. Traditional cigarette smoking according to the CDC is the cause of over 380,000 deaths yearly in the United States, as opposed to the total number of reported vaping-related lung injuries standing at 2,100, with 39 deaths.

The evidence is strong that vaping cannabis products is infinitely safer than the use of traditional tobacco-filled cigarettes. Ideally, habitual smokers are encouraged to quite their habit of their own volition, and not to rely on a substitute as a crutch to enable them to move toward smoking cessation. Vaping, as a stop-smoking technique is not encouraged until and unless one's own efforts unaided by such devices fail, according to the Johns Hopkins Medical Center.

Yet the use of e-cigarettes is fairly universally recognized as a less health-dangerous treatment for tobacco addiction than the continuation of cigarette use. The horrendous death count linked to cigarette use seems to be accepted with a measure of equanimity, yet the far fewer lung disease presentations and even smaller number of deaths associated with pulmonary disease has sent shockwaves through the vaping and medical community.

The casual attitude toward vaping that saw a widespread take-up has been replaced in some quarters with suspicion and avoidance, except for attitudes among the youth generation who have taken up vaping with great enthusiasm, as a social recreational tool, not as a transitional tool away from cigarette use. In fact, there are fears in the medical community that vaping among teens will proceed to regular cigarette use.

"[Doctors found an] enormous amount of inflammation and scarring [on the teen's lungs]."
"This is an evil I haven't faced before. The damage that these vapes do to people's lungs is irreversible. Please think of that — and tell your children to think of that."
Dr.Hassan Nemeh, surgical director, thoracic organ transplant, Henry Ford Hospital

"We asked Henry Ford doctors to share that the horrific life-threatening effects of vaping are very real!" 
"Our family could never have imagined being at the centre of the largest adolescent public health crisis to face our country in decades."
"Within a very short period of time, our lives have been forever changed. He has gone from the typical life of a perfectly healthy 16-year-old athlete — attending high school, hanging out with friends, sailing and playing video games —  to waking up intubated and with two new lungs, facing a long and painful recovery process as he struggles to regain his strength and mobility, which has been severely impacted."
Family of 17-year-old teen transplant patient

A Michigan teenager was the recipient of what could be the first double lung transplant on a person whose lungs were severely damaged from vaping, health officials said Tuesday. (Tony Dejak, File/Associated Press)