Tagged Vaping

As Vaping Illnesses Rise, So Do Pleas To Quit-Smoking Help Lines

“I stopped for a few days and then I ended up buying new pods. The withdrawals got to me.”

“My friends are the ones who got me into vaping. And they think I shouldn’t stop, but I want to because I don’t want to hurt my family if I get sick.”

“I feel like I get winded easily and I just know it’s not good for me. I want to quit so bad but it’s really hard when all your friends are vaping around you.”

These are just a few of the messages that teen vapers texted in September to the new “My Life, My Quit” program, which offers phone, text and chat lines to young people trying to quit smoking in 13 states.

Even though “quitlines” were designed to help people kick cigarette habits, calls and texts from people who use e-cigarettes are climbing as more people fall ill with a mysterious and devastating respiratory illness linked to vaping.

Health officials are investigating 1,299 cases in 49 states and the District of Columbia, including at least 26 deaths. In California, more than 120 residents have fallen ill, at least three of whom died, according to the California Department of Public Health.

The department in September called on everyone to refrain from vaping, “no matter the substance or source,” while the investigations continue. The Centers for Disease Control and Prevention also advised people to “consider refraining” from using e-cigarette products, especially those that contain THC, the main psychoactive ingredient in marijuana, which has been linked to most of the illnesses.

The rise in calls to help lines means the message is penetrating, said Stanton Glantz, director of the University of California-San Francisco Center for Tobacco Control Research and Education.

“The more we learn about e-cigarettes, the more dangerous they look,” Glantz said. “Callers are right to be worried, frankly.”

Optum, which operates tobacco quitlines for 23 states and the District of Columbia and for more than 1,000 employers, logged a 50% increase in callers asking for help to quit vaping since the CDC released its first report on the illnesses in early September, said Seth Serxner, the company’s chief health officer.

The majority of state quitlines are run by Optum or National Jewish Health, a respiratory research hospital in Denver, whose My Life, My Quit program is aimed at youths. National Jewish Health runs help lines for 16 states — not all of which offer My Life, My Quit — enrolling about 100,000 people each year into tobacco cessation programs.

The quitlines are publicly funded, and the counseling is free.

Almost 20% of callers to Optum’s help lines said they used vapes, up from 3% during the same period in 2015, Serxner said.

“People are going, ‘Whoa, I didn’t know this was that bad for me,’” he said.

In July, National Jewish Health enrolled 88 people into its cessation program who said they vaped exclusively. In August and September combined, the organization enrolled 457 people who vaped exclusively, more than five times the July figure, said Thomas Ylioja, clinical director for health initiatives at the organization.

Calling 1-800-QUIT-NOW routes callers to counselors in their state, where they can get counseling to help them set quit dates and identify triggers that could lead to a relapse. If clients give permission, counselors follow up with them in the days and weeks after their initial call, when quitting can be most difficult.

Depending on where callers live and what kind of insurance they have, they may qualify for free nicotine replacement therapy, like patches, gum, lozenges or prescription medication. Vapes and e-cigarettes are not a federally approved treatment for smoking cessation, so help lines have not recommended them to clients to help them quit.

Not all state quitlines are seeing an uptick in calls. Calls from vapers were flat for West Virginia’s help line from July through September compared with the same period in 2018, said Lindsy Hatfield, program director for First Choice Services, which operates the state’s quitline.

But starting in August, Hatfield noticed that some callers didn’t realize that their Juul e-cigarettes, the nation’s most popular brand, could addict them to nicotine, even though it is listed as an ingredient on the package.

“Some people we found did not know that Juul was an e-cigarette, vape or nicotine device,” Hatfield said. “They felt that Juul did not have nicotine in it, and so it couldn’t be the same thing” as an e-cigarette.

The University of California-San Diego runs California’s tobacco quitline (which offers help in English and Spanish) and serves about 30,000 callers a year. It also runs a national help line for people who speak Mandarin, Cantonese, Vietnamese and Korean.

Since 2017, the quitline has received a steady increase in calls from people who vape. Most said they were using e-cigarettes to quit or cut down on cigarettes because they thought of vapes as a “better alternative,” said Niki Hoang, a San Diego-based counselor and former smoker who has been with the help line for seven years.

Hoang and her colleagues noticed a change this summer: Callers who used vapes to quit cigarettes are now trying to quit vaping, she said.

And smokers who have never tried vaping are vowing to stay away, saying they don’t want to “be the guinea pig,” according to Hoang.

The summer’s influx of calls prompted the help line to train the California staff — about 60 counselors — on the history of the devices and how to counsel people who want to quit.

The calls for help are a far cry from 2007, about the time vapes hit the U.S. market and were described as safer than cigarettes.

Millions have started using them since then, including teens and young adults. Recent federal data funded by the National Institute on Drug Abuse shows that 25% of this year’s high school seniors and 20% of 10th graders reported vaping nicotine in the past month. That’s more than double the use reported in 2017.

Little research exists on the best strategies to stop vaping, so quitline counselors generally employ techniques they’d use for cigarette addiction.

But there is at least one key difference between smoking and vaping that might make the latter more difficult to quit, said Ylioja of National Jewish Health. Vapers have an easier time evading restrictions on smoking in indoor spaces or public places because the smell dissipates faster, he said.

That makes it difficult for vapers to make a plan to avoid situations or people sparking future cravings.

“They have a harder time identifying what triggers might be,” Ylioja said. “They were using these products in so many different social situations.”

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‘We Vape, We Vote’: How Vaping Crackdowns Are Politicizing Vapers

Vapers across the country are swarming Twitter, the White House comment line and statehouse steps with the message “We Vape, We Vote.”

They’re speaking out after a slew of attacks on their way of life. President Donald Trump announced his support for a vaping flavor ban in September. Some states temporarily banned the sales of vaping tools or flavors. And the Centers for Disease Control and Prevention has warned people to stop vaping until public health experts can find the cause of more than a thousand cases of lung injuries nationwide.

The backlash from vapers and vape shop owners is getting louder as they argue their small businesses and their rights to what some see as a smoking cessation tool are being trampled.

“Rather than just vote a party ticket, they may in fact change their vote for anybody who comes out and wants to have a critical conversation about vaping,” warned Alex Clark, the CEO of the Consumer Advocates for Smoke-Free Alternatives Association, a self-described tobacco harm-reduction nonprofit in Plattsburgh, N.Y.

Political groups are noticing that vaping is an identity, not just a hobby. Conservative powerhouse Grover Norquist, whose Americans for Tax Reform group hosted over 200 vaping advocates last month in Washington, D.C., cautions this is an electorate Trump should not ignore for 2020.

Vaping activists have already claimed success in a handful of races. Now some advocates say this burgeoning anger could shape the votes of the nation’s more than 10 million adult vapers and 20,000 vape shop owners.

“Are there enough vapers to swing states like Michigan?” added YouTube vaping influencer Matt Culley. “Absolutely.”

The Vaping Electorate

Jason Volpe has owned a vape shop in Caledonia, Mich., for six years. He supports raising the age to buy tobacco to 21 and encourages young customers to use products with lower levels of nicotine.

Volpe, who voted for both President Barack Obama and Trump, is not afraid to talk about politics in his shop. He gives discounts on Election Day to customers with an “I voted” sticker.

Lately, he said, his customers come in angry at what they call government overreach. They are unhappy with Democratic Gov. Gretchen Whitmer, who temporarily banned the sale of nearly all flavors of vaping liquid.

“That’s not supposed to happen in America,” Volpe said. “Are they going to come after our guns next?”

He said his customers — from the liberal to the “very red farmers” — feel under attack. It’s a common grievance in a community that sees itself as continually marginalized by the government even after some vapers used the devices to quit smoking.

There’s a strong libertarian and conservative streak in the movement that the Libertarian Party has capitalized on, selling “I Vape I Vote” T-shirts online alongside a pledge to “vote for candidates who support vaping.” Issues surrounding vaping, like supporting small businesses and promoting personal liberty, are a natural fit for this segment of the right.

Clark, the “smoke-free” advocate, is a registered Democrat who is disappointed that the left isn’t embracing vaping. He considers it hypocritical for them to back marijuana legalization but not vaping.

Volpe just wants his shop to stay open. He feels betrayed that people with heroin addictions can have a safe place to use drugs and that flavored alcohol is still on the market, but not the blueberry maple syrup-flavored vape juice he uses. The stress around the flavor ban sent him to the emergency room last month. What he thought was a heart attack turned out to be anxiety.

A Vaper Voting Block?

Vocal vapers point to Wisconsin Republican Sen. Ron Johnson’s shocking election victory in 2016 as proof of their power.

Johnson became a folk hero on vaping websites after pushing back on proposed Food and Drug Administration vaping regulations. But early in fall 2016, the incumbent was down in the polls and not expected to recover.

Then Mark Block got involved. He’s the former chief of staff for Republican Herman Cain’s 2012 presidential campaign and owned an online vape store at the time. Block said he met with at least a hundred vape shop workers across the state and leveraged their networks to contact what he estimates was upward of 200,000 voters. Some shops registered people to vote. He also started a political action committee, Vape PAC, which raised over $3,000 and distributed some 400,000 postcards.

After Johnson’s victory, the senator specifically thanked vapers: “You made tonight possible; I truly appreciate it. I will be on your side.”

But Tom Russell, campaign manager for Johnson’s opponent, former Sen. Russ Feingold, doesn’t buy the idea that vapers swung the election, saying he didn’t see any money or data to that effect.

“The reality is to the extent there was a Tea Party, previously unmotivated voting bloc, they were motivated by Donald Trump,” he said. “I’m pretty sure it wasn’t ‘Vape Nation.’”

Vaping advocates also point to a 2014 state election in New Mexico as an early victory for their growing cause. That year, state Rep. Liz Thomson, a Democrat, lost her reelection bid to Republican Conrad James, a pro-vaping candidate who got a last-minute boost from Clark’s CASAA and vaping groups. The American Vaping Association put out a celebratory press release, and Americans for Tax Reform called Thomson vaping’s “first victim.”

Thomson, though, considers the loss a fluke, not the work of vapers. “I do not believe they had any effect in my race,” said the legislator, who later won back her seat. “It was a confluence of factors that was bigger than their group.”

In 2018, Block joined the late stages of the California race of embattled U.S. Rep. Duncan Hunter. Known as the vaping congressman, the Republican has helped create pro-vaping legislation.

But he was indicted for campaign finance violations in 2018.

Reusing the 2016 playbook, Block went to vape store after vape store in the last three weeks of Hunter’s race, handing out postcards with an illustration of the congressman vaping that say “Blaze your own trail.”

Hunter narrowly won.

What’s Next

Those races were almost like a practice run. Right now, vaping activists are scrambling to create the framework for a broader political campaign.

Clark said CASAA feels pressure to make a voting guide, but it doesn’t have the resources to figure out which candidates are truly pro-vaping. The group’s first attempt at a guide in 2016 involved surveys sent to some 900 candidates, but Clark said only 200 or so of the “most fringe” candidates responded.

The American Vaping Association, a nonprofit advocacy organization in Stratford, Conn., is training vapers on the basics of politics — how to speak at local government meetings, register people to vote and talk to the press and elected officials without getting worked up, said its president, Gregory Conley. He also is focused on targeting primaries, where he said it’s a lot easier and less expensive to have impact.

The seeds of a grassroots movement seem to be in place. The organizing and get-out-the-vote work is happening online and in vape shops, which Norquist calls the “megachurches” of this community.

The Vapor Technology Association, a trade group that represents e-liquid manufacturers, vape shops and other vaping professionals, said state and local associations are ahead of the national organization when it comes to voter mobilization.

“We haven’t really had to move them because they’re doing it already,” said Chris Howard, the association’s board treasurer.

Vapers are terrified they’re about to lose what they say is the only tool that saved them from smoking — and saved their lives. That’s a powerful motivating force, Culley said. Plus, all the jobs lost from a potential flavor ban — which Trump had announced his support for on Sept. 11 — wouldn’t be a good look for the president, he said.

Trump followed that announcement with a tweet two days later that was more ambiguous about his intentions for a ban: “While I like the Vaping alternative to Cigarettes, we need to make sure this alternative is SAFE for ALL! Let’s get counterfeits off the market, and keep young children from Vaping!”

The damage was already done, according to vape shop owner Mike Moran, who offers customers voter registration paperwork in his two stores in New Jersey. He blames Trump’s initial tweet for kicking off the wave of state bans.

“If Donald Trump lets this go down because of his misstatement, I’ll vote against him,” Moran said. “His words caused this.”

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Vapers Accuse Officials Of Overreach As Investigation Into Deadly Lung Illness Lags

On Sept. 16, Tulare County in California announced the nation’s seventh death from vaping-related illness. Its advisory warned about “the dangerous effects of using electronic cigarettes, or e-cigarettes.”

Like so many of the official warnings coming out around the country, it lacked details about the specific products involved in the vaping death. But by the time of the announcement, the family of the man who died had been in touch with Gregory Conley, president of the American Vaping Association, which advocates for vaping products.

The man had vaped THC oil in the days before his death, Conley said the family told him, and they described the product’s black-and-gold packaging. Someone on an online vaping forum found a photo of a product matching their description, the family confirmed it was the same one, and Conley took to Twitter to share it.

It was a necessary move, Conley said, because state and federal authorities had chosen not to be more specific about what may have caused the illness. “Ultimately, we want people to know what products and what kinds of products are sending people to the hospital,” he said.

As federal and state health officials struggle to identify what exactly is causing the deadly outbreak, vaping advocates are stepping into the void and crafting an alternative narrative that is being echoed broadly in online communities. The people getting sick, according to their version of events, all vaped THC — the psychoactive ingredient in cannabis — using products bought on an illicit black market. They also contend federal officials have seized on the crisis to crack down on a nicotine vaping culture they don’t appreciate or understand, a culture proponents insist has helped them and millions of others quit smoking.

As of Oct. 1, the federal Centers for Disease Control and Prevention had identified more than 1,000 cases of vaping-related lung illness in 48 states. Eighteen people have died, including two in California. Of the 578 patients who have reported using specific products, most said they had vaped THC, but a significant portion — 17% — said they had used only nicotine. CDC officials maintain they can’t identify one product or chemical culprit, and while they recently began emphasizing the risks of vaping THC, they continue to warn against any vape use at all.

Meanwhile, cities and states have responded with a divergent mix of warnings and bans. Michigan, New York and Rhode Island have moved to ban most flavored nicotine vaping products. The California Department of Public Health recently warned against all vaping devices, and the governor of Massachusetts issued a four-month ban on all vaping products. Utah officials have focused their warnings on unregulated THC. Los Angeles County voted last week to ban flavored tobacco products, and dozens of other California cities have enacted or are considering similar legislation.

The actions have sparked a backlash among hundreds of thousands of people who say they’ve been vaping for years without a problem. Compounding their distrust: the political calls to ban flavored nicotine products even though the vast majority of illnesses identified appear to involve people who were vaping THC.

They see a government out to quash nicotine vaping because its popularity with teens has caused a public outcry, ignoring the adults who find it a pleasing alternative to cigarettes. When it comes to vaping, they have stopped looking to the CDC for advice.

Debbye Saladine-Thompson is a registered nurse in Michigan who was a smoker for 32 years before she switched to vaping. She now manages the Michigan Facebook page for Consumer Advocates for Smoke-Free Alternatives Association (CASAA), a nonprofit that advocates for access to e-cigarettes and receives industry funding.

“I do not trust the CDC. Not anymore” Saladine-Thompson said. “I cannot trust an agency that says the product that I and so many people have been using for 10 years and hasn’t caused one death is now causing hundreds of illnesses. No, I do not believe that.”

Online vaping forums are roiling with accusatory messages suspicious of the government response. In Facebook groups, including one called ‘BLACK MARKET THC CARTRIDGES CAUSED THIS QUIT LYING ABOUT VAPOR PRODUCTS,’ vapers have expressed outrage over the bans on nicotine products while cigarettes remain readily available. They’re organizing phone calls to legislators and rallies at state capitols. “The people we trust in protecting US the USA Americans, have gone against US! We really need to get a MILLION (maybe 20 million) Vapor march in every state and march to our capitals,” one member wrote.

“We’re living and dying by these decisions,” said Kristin Noll-Marsh, the member coordinator for CASAA who moderates the group’s national Facebook group and is adamant that people who use vaping as a way to quit smoking should not return to cigarettes. “This vaping panic of 2019 is gonna go down in the history books as being like flat Earth, bloodletting and burning witches.”

Tonya Burgess, a 24-year-old from Crown Point, Ind., said she started vaping two years ago to quit smoking. The broad focus on all forms of vaping has made her feel targeted by government officials, who she feels essentially are suggesting she go back to smoking. “I spent my whole life trusting the government, and now I’m wondering, what’s going on?” she said.

Tonya Burgess of Crown Point, Ind., is among the vaping advocates who have criticized the federal government’s response to the outbreak of vaping-related illnesses. “I spent my whole life trusting the government, and now I’m wondering, what’s going on?” she says. (Photo courtesy of Tonya Burgess)

Throughout the outbreak, the CDC has said that people who vape to quit smoking should not return to cigarettes. But the emphasis on all vaping devices drowns out that warning, said Dr. Michael Siegel, a professor at Boston University and proponent of e-cigarettes as a smoking cessation tool.

“In an outbreak investigation like this one, you have to be as specific as possible if you want people to listen. If you say ‘Just don’t vape,’ that’s not telling anyone anything they don’t already know.”

Many also are critical of the messaging used by the CDC, states and some media outlets, saying they are out of touch with vaping culture and its terminology. Public officials often use one word — e-cigarettes — to describe what to people who vape is a wide range of products with different names.

People who see headlines about illnesses linked to “e-cigarettes” may not know it applies to them, said Jim McDonald, a journalist with Vaping360, a consumer news site. “Cannabis vapers don’t use the term e-cigarettes. They never, never use that term.”

Even among e-cigarettes, a term many equate with nicotine delivery devices, people differentiate between cartridge-based devices like Juul and the handheld “mods,” which tend to be larger and produce more vapor. E-liquids can come prepackaged in ready-to-use form or can be mixed in stores or at home. Whether cannabis is legal and regulated also varies among states.

The problem with the alternative narrative, say doctors who are treating patients, is that it’s not clear whether only illicit THC is to blame. Dr. Dixie Harris, a critical care pulmonologist with Intermountain Healthcare in Utah, has been reporting five to seven cases a week for the past six weeks. While many patients have reported using illicit THC, she also has had patients who have fallen ill after using products purchased at licensed medical dispensaries in states where cannabis is regulated. One patient swore he’d vaped only nicotine purchased from the same vape shop he has used for seven years.

A new study looking at lung tissue samples from 17 patients found the damage resembled chemical burns and included two samples from people who fell ill before the outbreak. The findings cast doubt on a popular theory that vitamin E oil, which has been used as a thickening agent in THC oil, is the culprit.

The investigation is challenging on many fronts. Vaping — both legal and illicit, nicotine and cannabis — has exploded in the past few years with little regulation. There are hundreds of products, do-it-yourself kits and home brews. The potential culprits are many: popular flavorings in nicotine vapes never tested for inhalation. Oils used to dilute THC. Contaminants. Pesticides. Possible toxic residue from the containers themselves.

The CDC is grappling with a dearth of information. The process of alerting the many agencies and entities involved — doctors, hospitals, law enforcement, public health departments — has been slow.

Among 86 cases in Illinois and Wisconsin, where the outbreak first was identified and investigators are further along in their work, people reported using 234 different products involving both nicotine and cannabis, according to a report published last month. Those products, in turn, involved a variety of brands, numerous supply chains and packaging without listed ingredients.

Dr. Anne Schuchat, principal deputy director of the CDC, said the agency wasn’t narrowing the investigation only to cannabis, stressing it needed to “have an open mind” to understand the possible risks.

“Personally, with all the data that I’ve been seeing,” Schuchat said Friday, “I don’t know what ‘safe’ is right now.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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