Calling It QUITS

There is a new bipartisan bill in Congress now, called the Quell Underage Inhaling of Toxic Substances (QUITS) Act.  And to be honest, it is a mixed bag overall.  It would:

• Ban flavored e-cigarettes (i.e. vape products) and other flavored tobacco products, including menthol.
• Increase the federal cigarette tax from $1 per pack to $3 per pack.
• Create a tax on e-cigarettes equivalent to $3 per pack.
• Increase annual funding for the CDC's Office of Smoking and Health from $210 million to $500 million.

The first item on the list, the flavor ban as we have noted before, is too broad and largely due to the moral panic around vaping these days.  Throwing out the proverbial baby with the bathwater is likely counterproductive, and slopes are slipperier than they appear.  other items on the list are overall a good idea though.  At least all of these also apply to, and does not ignore, the real elephant in the room:  combustible cigarettes and other combustible tobacco products, which kill over 480,000+ Americans per year, while vaping has killed eight people so far in all of its history, and even then, mostly via black-market THC products rather than legitimate ones.  And while even one such death is one too many, compared to combustible cigarettes, that's essentially a mere rounding error in statistical terms.

Another strength is that it does not raise the age limit for tobacco or vaping products at the federal level.  And that, Twenty-One Debunked is happy about.

So what can be added to the bill to improve it, while also removing or narrowing the flavor ban?  Here are some of our ideas:

• Cap and reduce the maximum allowable nicotine content of vape products down to current European and Israeli levels. 
• In fact, while we're at it, cap and gradually phase down the maximum allowable nicotine content of combustible cigarettes down to a non-addictive level as well.
• Tax vape products in a manner that is directly proportional to nicotine content.
• Enforce better (targeting vendors) the current federal age limit of 18 for both vaping and combustible tobacco products.
• Restrict advertising of vape products, similar to how it is for combustible tobacco products.
• Actually REGULATE the vaping industry, and require quality control testing.
• Crack down on black-market and counterfeit vape products, and root out any bad actors in the legitimate market as well.
• Legalize and regulate cannabis at the federal level, and implement strict quality control standards as well for both cannabis as well as tobacco/nicotine products.
• Require ALL vape products, whether nicotine, THC, CBD, or otherwise, to transparently disclose all ingredients, and immediately ban the use of questionable additives believed to be linked to the outbreak of the mystery vaping illness.

Let's be adult about this, shall we? 

When It Comes To Vaping, Don't Throw Out The Baby With The Bathwater

In the wake of both the mysterious vaping-related lung illness epidemic, and also the recent increase in vaping among young people (something for which Tobacco 21 laws have apparently done NOTHING to stem the tide, by the way) both the federal government and several state and local governments are beginning to crack down on vaping to one degree or another.  Yes, Houston, we have a problem.  But it is important to keep a cool head and not throw out the proverbial baby with the bathwater.

The FDA plans to ban all flavored vape products other than tobacco (yuck!) or unflavored (meh), as is Michigan.  San Francisco, on the other hand, already passed a ban on ALL vape products regardless of flavor.  The state of New York just passed an emergency executive ban on all flavored vape products other than tobacco or menthol, effective October 4th.  And California's governor announced a crackdown on counterfeit vape products, though he lacks the authority to pass any flavor bans without the state legislature passing it.

Going too far with such bans would only increase the very black market that is the most likely cause of the mystery vaping illness (though with that it is mostly black-market THC products, though some appear to have been nicotine only).  At the same time, while vaping can help some adult smokers quit, it's not like there really is any overarching benefit society from nicotine that comes in fruity, candy, or dessert-like flavors either.  It really is a balancing act.

Twenty-One Debunked once grudgingly supported some degree of flavor bans in the past, mainly as an alternative to Tobacco 21 laws, but in light of current events, we no longer support such bans today.

New York's flavor ban--if there must be one at all--is somewhat more reasonable than the ones that don't even allow menthol.  And clearly counterfeit products need to be cracked down upon, and bad actors and questionable additives rooted out at once.  And capping and reducing nicotine levels of vape products down to European and Israeli levels would also make such products less addictive than they are currently.  But anything more stringent than these things would likely do more harm than good.  (That goes for setting the age limit any higher than 18 as well.)

As for cannabis vaping products, the best way to eradicate the sketchy and janky black and gray market products is to fully legalize and regulate cannabis nationwide, period, with an age limit of 18, strict quality control, and reasonable taxes on such products.  And again, crack down on counterfeit products and products with questionable additives.  But that would make too much sense, wouldn’t it?

So let's be adult about this, shall we?

UPDATE:  Looks like Michigan's emergency executive flavor ban contains a loophole that allows flavored nicotine-free e-liquids and pods, and also allows flavorless nicotine packets one can combine with such e-liquids (albeit sold separately).  So this particular ban is actually far more reasonable than meets the eye, while still having the intended effect of making it somewhat harder and less convenient for people under 18 to vape flavored nicotine.  And it will likely keep vape shops open for business for the foreseeable future, while JUUL will still get a swift kick in the margins now that their ready-made pods will be verboten if they have any flavor other than tobacco.

And at the other extreme, on September 24th, Massachusetts Governor Baker has literally banned ALL vape products for four months by an emergency executive action.  And that will just throw gasoline on the fire by dramatically growing the black market. DERP!  Didn't think that one through, did you Charlie?

About That Mysterious Lung Illness Related To Vaping (Updated)

There have been recent reports of a mysterious lung illness, a pneumonia-like syndrome that appears to be linked to vaping.  Fingers are being pointed all over the place right now, since it is still not clear exactly what (let alone which products) are causing it and why, but several theories abound, and there are some very strong, if not probative, clues now.

Here's what we do know so far.  As of September 16, 2019, there have been over 450 possible cases (revised down to 380 confirmed cases) of severe lung illness and/or damage (and even six seven confirmed deaths) in the USA that may be linked to vaping, though the symptoms haven't always followed a consistent pattern.  Not all cases have had all variables teased out, and it all still needs to be fleshed out some more, but vaping of some sort is the only factor that we know is common to them all.  And it's not just young people either (though many of them are), as even people in their thirties, forties, fifties, and now sixties have also succumbed to this syndrome as well.

Many, but by no means all, of the cases involved vape products containing THC (i.e. the primary psychoactive component of cannabis), and virtually all of those had been purchased on the black market (mostly in non-legalization states) based on what we know so far.  And many of those have been found to contain questionable additives, such as Vitamin E oil, that are NOT friendly to the lungs.

Thus far, only one case has been linked to a THC vape product (of undisclosed brand) purchased from an undisclosed licensed dispensary in Oregon, which could be a fluke or perhaps confounded by other products, but it is still possible that even some legitimate products contain such harmful additives, as not all legalization states specifically ban all of such additives.  (Why authorities are being so hush-hush on the details of this case, we really don't know.)

As for the cases that reportedly only involved nicotine, keep in mind that there are also many counterfeit nicotine vape products going around too, so that could perhaps be another culprit in this epidemic.  (That, and perhaps underreporting of illicit THC vaping in non-legalization states.)  That said, as much as JUUL Labs wants to believe and assert it, this does NOT yet automatically exonerate legitimate brand nicotine-containing vape products such as theirs.  And no one should pretend that it does either.

(Separately, there are also three recent reports of seizures and even one report of a stroke thought to be linked to the JUUL brand specifically, presumably due to their very high nicotine content, so they really shouldn't be so smug.  Especially since JUUL is basically circling the drain right now.)

It is important not to create or fan the flames of a moral panic about vaping in general, as that is likely to be counterproductive.  Much more research is necessary until we know more.  So what advice should be given in the meantime?

• First and foremost, do NOT vape, juul, or dab anything that you get from the black market, whether it's THC or otherwise.  They are inherently unregulated by definition, with no quality control, and thus you really don't know what you are getting.
• Especially avoid the pseudo-legitimate sounding (but actually always black market) THC brands "Dank Vapes", "Chronic Carts", and "West Coast Carts".  Avoid them like the plague!  (Ditto for the apparently very bad actor, gray market CBD vape brands "Diamond CBD", "Green Machine", "Magic Puff", and "Yolo!" as well.)
• Do your research and due diligence before buying any vaping product on the legitimate market as well.  Google is your friend, but don't believe everything you hear or read.  This is true whether it is nicotine, THC, CBD, "just flavoring", or anything else for that matter.
• Avoid any oil-based vape products when possible, especially for unfamiliar brands.
• Do NOT modify vaping devices or use any homebrew products with vaping devices.
• And last but not least, if you are not currently addicted to nicotine, do NOT vape (or smoke) anything that contains nicotine.  Keep in mind that all JUUL brand products contain high levels of nicotine, as do many other brands as well.

That seems like sensible advice for now.  As for government officials, the best thing they can do right now is regulate the vaping industry better to quash bad actors and improve quality control, cap nicotine levels, and also legalize cannabis nationwide for everyone over 18 (while keeping the taxes low) in order to quash the black market as well.

And for those who are still concerned:

If you currently vape nicotine, DO NOT go back to combustible cigarettes or any other combustible tobacco products!  If you are concerned about vaping, you can always switch to snus, lozenges, or any of the available nicotine replacement therapy products currently on the market (patches, gums, lozenges, and inhalers).  At the very least, stick to the top-shelf stuff.

If you currently vape "just flavoring", be sure that it really IS "just flavoring" (spoiler alert:  it usually is NOT, and all JUUL brand products contain high levels of nicotine).  But really, what's the point of that?

If you currently vape cannabis derivatives (whether it's THC, CBD, or both), and you don't have access to legal and licensed dispensaries where you live and/or you still don't trust the stuff on the shelves there, but you still don’t want to combust (smoke) weed, there are always dry-herb vaporizers out there (remember those?), as well as edibles, capsules, oils, and tinctures for using cannabis products orally.  Or at least stick to the top-shelf stuff for now.  But DO NOT vape, juul, or dab anything from the black market, the street, pop-up shops, or any homemade concoctions.  EVER.

(For the record, at least in some states like Oregon, with as low as $5 per eighth and $40 per ounce in some places, plain old bud purchased from legal stores is now actually cheaper than vape cartridge concoctions after several years of legalization there.)

Let's be adult about this, shall we?

UPDATE:  As of September 20, 2019, the number of reported cases of what is now called Vaping Associated Pulmonary Injury (VAPI) has crossed the 500 mark, and the number of deaths has increased to eight.  All deaths, and all reported cases except one, have occurred in the USA (the remaining one reported case was in Canada), and no other countries.

As of September 26, 2019, the number of confirmed cases has now crossed the 800 mark, and the number of deaths has now reached 12.  Again, if you must vape, stay away from anything bought on the street or in pop-up shops, or anything otherwise suspicious or sketchy in any way.  Consider alternative methods of use as noted above.  And if you notice any of the telltale signs and symptoms of VAPI, get thee to a doctor, stat!  And be sure to be honest about your vaping with them, so you will be properly treated with corticosteroids rather than antibiotics.

As of October 10, 2019, there are additional theories as to the cause of the outbreak, most notably acute "toxic chemical injury" to the lungs.  More specifically, it seems that inhalation of cadmium fumes from the solder in cheaply made vape pens and cartridges may be causing a particularly severe form of "metal fume fever" known as cadmium pneumonitis, which presents rather differently from lipoid pneumonia.  Though the oil (such as Vitamin E Acetate) causing lipoid pneumonia theory has not been entirely disproven either, as some cases do seem consistent with lipoid pneumonia, and there could in fact be more than one cause as well.  Caveat emptor.