In response to the seventh death from severe lung injury associated with “vaping,” which occurred in Tulare County (California), the Tulare County Health and Human Services Agency issued a warning against the use of “electronic cigarettes.” The alert stated that: “The Tulare County Public Health Branch would like to warn all residents that any use of e-cigarettes poses a possible risk to the health of the lungs and can potentially cause severe lung injury that may even lead to death.”

In response to an earlier death that occurred in Southern California, which is part of the same national outbreak that has affected nearly 400 people, the Los Angeles County Department of Public Health issued a similar warning not to use “e-cigarettes,” which it defined as “battery-powered devices that heat a liquid substance (e-liquid or e-juice) that contains nicotine, flavorings, and other additives and deliver the nicotine and flavoring to the user in the form of an aerosol.” Based on this definition, a warning not to use “e-cigarettes” is likely to be interpreted as a warning not to vape nicotine-containing e-liquids.

At first glance, these warnings might appear to be reasonable public health messages. But a closer examination reveals that the communications that health agencies, including the Centers for Disease Control, are disseminating to the public are hiding some critical information.

What ties together the patients who died in Tulare County and Los Angeles County is not that they both vaped “electronic cigarettes,” but that they both used illicit THC (marijuana) vaping cartridges that they purchased illegally on the black market. In the two other deaths in which authorities released information about the products used (one in Oregon, one in Minnesota), each involved vaping marijuana, not electronic cigarettes.

All in all, approximately 90 percent of the confirmed cases have admitted to, or been found to have been using, illicit THC carts. Although the death in Oregon has been attributed to the use of a legal THC cart purchased from a dispensary, it was recently revealed that cannabis distillate cut with vitamin E acetate oil was being sold at Oregon dispensaries. This is the same oil that was detected in every THC vape cartridge tested in New York state.

In light of these facts, it is inexcusable that health authorities continue to blame the outbreak on electronic cigarettes generally rather than on vaping marijuana specifically. By failing to explicitly warn the nation’s youth not to vape marijuana, the CDC and other health agencies are actually helping to further spread the outbreak, not to curtail it.

But the negative public health implications of this public deception goes much further. Because of the CDC’s conflation of the

problem of youth e-cigarette use and the respiratory disease outbreak, policymakers nationwide (including the Trump administration and officials in several states) are now considering a complete ban on all flavored electronic cigarettes. Michigan’s governor has already issued such an order using her emergency executive powers. This is like responding to an outbreak of contaminated lettuce by banning flavored cabbage.

To call this an over-reaction is an understatement.

The irony is that banning flavored e-cigarettes is only going to make the outbreak worse. Instead of vaping flavored e-liquids, more and more youths will switch to vaping black market THC liquids. Moreover, ex-smokers who currently rely on flavored e-cigarettes to stay away from smoking will most likely either return to smoking or purchase illicit vape juice from what will be a new black market for flavored e-liquids.

Unlike illicit THC vape cartridges, which we now know can be deadly, there are no known, serious acute health effects of e-cigarette use. Although these products do cause respiratory irritation and have short-term, subclinical effects on the lining of blood vessels, the short-term use of e-cigarettes is not linked to clinical disease.

Does this mean that youth e-cigarette use is not a serious health problem? No.

However, it is a problem not because it is causing life-threatening respiratory injury, but for two other reasons. First, it can be highly addictive, especially the use of e-liquids containing nicotine salts, such as Juul or Saurin. Second, we just don’t know what the long-term effects may be.

We do need to address youth e-cigarette use, but banning flavored e-cigarettes is not the right way to do this. Instead, the FDA should regulate these products to limit their access to youth. This could be done by restricting the sale of all tobacco products, including both cigarettes and e-cigarettes, to adult-only stores.

Prohibition does not work, but proper regulation could.

Michael Siegel is a professor in the Department of Community Health Sciences at the Boston University School of Public Health. He wrote this for

(4) comments


While they're at it, ban perfumes and fragrances too. They aren't good for lungs and can hide any sort of toxins under the label "fragrance" and not have to have FDA insight as to what that could be. If you went around an office spraying some of those chemicals that are in perfumes, you'd need a permit and an MSDS sheet. People just happily slather that on not knowing it may contain toluene, benzene, petroleum products or even DDT...(yes...they would not have to disclose that either). Kids are already supposed to not have access...parents don't know enough about what their rugrats are doing, nor do the schools.


This is really a no brainer. How can anything you suck into your lungs, other than air, be good for you?


Look for the tobacco industry to put nicotine in ice cream, then flavor it. Don't know why they haven't thought of that yet. Ice cream is unregulated as a food except in at a very high level, so ice cream makers can pretty do what they want. Before long, ice cream sales will skyrocket. Profits will soar! Little kids may get sick but who cares? It's all for profit and what good for ice cream makers is good for America! Let the market decide! God Bless America!


Is this about what makes people sick or what is addictive? And when will they tell us if nicotine is a problem or if the problem is combustion products? And if they really do not know, now is the time to collect the data. We have all the children serving as "lab rats."

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