Finally, Some "Reefer Sanity" In The Vaping Debate

It seems that at least some pundits, politicians, and public health officials are just starting to catch up with reality.  There is rapidly mounting evidence now that the primary culprit in the mystery vaping illness (that has killed over 40 people and sickened at least 2000 in the USA as of November 15, 2019) is the thickener additive Vitamin E Acetate in mostly black-market or counterfeit THC cartridges. This "thick and greasy" oil is harmless when used topically or ingested orally, but when inhaled it is apparently VERY bad for your lungs, much like any other "thick and greasy" oil would logically be.  And finally, several cannabis legalization and even medicalization states are belatedly banning or trying to ban its use in both legal and illegal THC cartridges, since until now almost no state banned or restricted this additive.

Better late than never, but honestly, what the hell took them so long?

THIS is what more states need to be doing.  Legalize cannabis, keep vaping legal in general, but regulate better and root out any bad actors in the legitimate market, while cracking down on any remaining illicit market that continues to hawk questionable wares.  In contrast, broad vaping or flavor bans, as well as cannabis prohibition and/or age limits set higher than 18, will only drive more customers to the black market, essentially pouring gasoline on the fire.  And those who foolishly opted for the later strategy while dithering over the real cause now have the blood of over 2000 Americans on their hands.

Of course, Vitamin E Acetate may not be the only culprit.  Other additives may also be to blame, as can perhaps the toxic cadmium fumes from cheaply-made and janky vaping devices and cartridges often made overseas (which can also be true for counterfeit nicotine vapes too, by the way).  And possibly pesticide contamination as well.  But again, in any case regulation would still work far better than prohibition to really get to the root of the problem.

As for the youth vaping epidemic driven by nicotine vapes, which is often disingenuously conflated with the mystery vaping illness, the best way to quash that is to raise the tax on nicotine-containing vape products, cap and phase-down the nicotine content of vape products down to European and Israeli levels, strictly enforce the existing age limit of 18 on vendors rather than raise it to 21, restrict vape advertising to be similar to the way it currently is for combustible tobacco products, and stop hyping this ridiculous moral panic so damn much for once.

So what are we waiting for? 

It's Not Just JUUL: The (Un-)American Vaping Association (And Trump) Also Throws Young Adults Under The Bus

As Trump announced the other day that his administration is looking at, among other things, raising the federal age limit for vaping products from 18 to 21 (which would require an act of Congress), the president of the American Vaping Association, Gregory Conley announced that he (and by extension, his trade group) openly supported the move as an alternative to prohibition.  Such a stance of regulatory appeasement by throwing 18-20 year old young adults under the bus to protect the vaping industry is cowardly at best, and will ultimately backfire as well.

And it is also all the more nonsensical given how the mysterious vaping lung illness that is sweeping the nation is driven primarily by black-market or counterfeit THC cartridges, not legal and legitimate nicotine vapes, and literally on the same day it was announced that they found further confirmatory evidence that the additive Vitamin E Acetate in the rogue THC cartridges is most likely the main culprit in causing this illness.  It is basically a thick, greasy oil that was NEVER meant to be inhaled, and can cause lipoid pneumonia when one does so.  Though likely other additives or contaminants could be causing it as well, such as cadmium fumes from the jankier vape devices themselves, since not all cases are consistent with lipoid pneumonia, and may be cadmium pneumonitis or metal fume fever instead.  And the Trump trade war with China may have led companies to shift to the use of cheaper and lower-quality devices and cartridges from 2018 onwards, ironically.

Thus, we at Twenty-One Debunked hereby excommunicate the American Vaping Association, just as we already did with the quislings at JUUL Labs.  And we can also add Trump 45 to the list as well now.  May their names and memory be forever blotted out.

The Needham, Massachusetts "Miracle", Debunked

Remember when Needham, Massachusetts made history in 2005 by being the first place in the USA to raise the age limit for tobacco to 21 in modern times?  And how the propoents of Tobacco 21 laws used them as an example of how successful such laws supposedly are at reducing teen smoking?  Well, a new article came out that thoroughly debunks that claim.  Scratch that, it debones, slices, dices, and juliennes it, and lays waste to its remains for good.

From 2006 to 2010 (the original study curiously did not include data before 2006), Needham did indeed see a faster drop in smoking rates among high school students compared to surrounding communities which kept the age limit at 18.  But from 2010 to 2012, the reverse was true: surrounding communities that kept it at 18 began to see faster declines in teen smoking rates than Needham.  This inconvenient fact was acknowledged buried in the original study (that went up to 2012) used to sing the praises of Tobacco 21, so it was not simply an oversight by the authors.  And according to the publicly available data that can be gleaned from schools in the surrounding communities, by 2014 the pattern reversed entirely, with the neighboring towns seeing larger net declines in teen smoking (59 to 77% drop) than Needham (40% drop) since 2006.  Hardly miraculous.  And by 2016, we see that some of these other towns raised the tobacco age limit to 21, but without seeing any further decrease in teen smoking (in fact, they saw a slight increase from 2014 to 2016).  If that's "success", we'd really hate to see what failure looks like.

So what explains the short-term success in the first few years in Needham?  Well, it could simply be have been a real but short-lived (and hollow) effect of the policy, just as Miron and Tetelbaum (2009) saw with the 21 drinking age versus traffic fatalities in the 1980s, with the effect being fairly small, dissipating after the first year or two before rebounding later, and further limited to the early-adopting states only (while in the later-adopting, coerced states, it actually had a perverse effect, or at best no effect).  But Needham also increased their enforcement on vendors dramatically, and also had at least some other tobacco laws that surrounding communities lacked.  And the percentage of smokers under 18 who bought their own cigarettes from stores also declined in Needham but not in the other neighboring towns.

Thus, it is very likely that the early decline in teen smoking would have been just as large if not larger had they simply kept the age limit at 18 but stepped up enforcement all the same, ceteris paribus.

Indeed, one should note that Woodridge, Illinois saw a similarly large drop in teen smoking in an even shorter timeframe (just two years) from 1989 to 1991 while keeping the smoking age at 18.  Leominster, MA also saw a drop almost as large from 1989 to 1991 as well.  And NYC, who raised their age limit from 18 to 21 (with no grandfather clause) in 2014, did NOT see teen smoking rates drop any faster than in the nation as a whole from 2013 to 2015.  Thus, the most parsimonious explanation is that Needham's (short) success story was primarily (if not entirely) due to increased vendor enforcement interacting with secular trends, and not the raising of the age limit itself.  In any case, it turned out to be a promise built on sand all along, if not a total statistical mirage.

Tobacco 21 laws, just like the ageist abomination that is the 21 drinking age, clearly belong on the trash heap of history.  And this is the final nail in the coffin.

One Year Later, Canada's Black Market For Cannabis Still Won't Die Quickly

One year after Canada's cannabis legalization went into effect on October 17, 2018, the black market still seems to be alive and well.  This is despite rather modest taxation of legal weed, and the fact that the age limit is 18 or 19 depending on the province, as opposed to 21 in the US states that have full legalization.  So what gives?

Apparently, there are chronic shortages of the herb throughout Canada that persist to this day, with the legal stores often selling out too quickly, and the black market dealers seem to have no difficulty filling the gap, and cheaper.  Why is this happening?  Well, it is clearly not due to any real scarcity, but the artificial scarcity of overregulation.  Most provinces only allow it at government-run stores which are few and far between, while the few privately-run ones are also few and far between due to a limited number of licenses.  The rollout of legal weed has been painfully and deliberately slow so as not to offend the public-health crowd too much, and they did not even sell edibles, beverages, or hashish yet (until this month, October 2019, a whole year after phase-one of legalization began).  So it doesn't take a rocket scientist to see how this would create shortages for illicit dealers to fill, as per the basic iron laws of supply and demand.

Thus, Canada's black market is due to somewhat different reasons (i.e. excessive federal and provincial overregulation causing chronic shortages) than the USA's black market (excessively high age limits and taxes, and a state-by-state patchwork quilt approach in the absence of federal legalization).  Either way, lessons should be learned from both countries.

Best thing for Canada to do?  Accelerate phase-two of legalization yesterday, as it is long overdue.  Consider a tax holiday for a few months, like Oregon did when legalization began there.  Ease up a bit on licensing regulations (and fees) for both producers and retailers.  Allow at least all liquor stores to sell weed alongside their booze, and further consider allowing any store that sells cigarettes to also sell weed as well.  And those provinces that set the age limit at 19 (including Manitoba, despite their drinking and tobacco smoking age being 18) should lower their age limits to 18.  Encourage current black market dealers to "go legit".  And once these things are done, then crack down on the black market.  Problem solved.

Of course, once the black market is dead and gone, then by all means, tax away.  But now is not the time for overtaxation or overregulation.

Remember, there is really no good reason why cannabis needs to be regulated any more stringently than alcohol or tobacco.  After all, while it is not completely harmless for everyone, the fact remains that by just about any objective, rational, scientific measure, cannabis is safer than alcohol, tobacco, most prescription drugs, aspirin, and even Tylenol, while it is less addictive than coffee.   Thus our laws and regulations need to align accurately with reality, since facts > feelings, even in a "post-truth" society.

On the plus side, after a year of legalization the fears of increased carnage on the highways from stoned drivers and stuff like that apparently did not materialize in Canada.  Or any other dire problem for that matter.  But we could have told you that long ago.

Note To Spammers and Advertisers: Stay Off Of This Blog!

To anyone who has been spamming and advertising questionable things in the comments section of our blog posts, we at Twenty-One Debunked are asking you to stop doing so.  Yesterday.  Just because of the subject matter of our blog posts or the fact that they contain certain key words, it does NOT mean that you should take that as an invitation to hawk your sketchy wares here.  Needless to say, I have deleted all of your posts.  Don't let the door hit you on the way out.

HALF Of America Now Has A Smoking/Vaping Age Of 21

As of July 2019, HALF of the American population now lives in jurisdictions with a tobacco/nicotine smoking/vaping age of 21 now.  It is a total of 18 states as of September 2019, and hundreds (if not thousands) of localities, and given the population distribution it adds up at least half of the population living in such places.  And now Pennsylvania, currently 18 statewide (with none of their localities setting it any higher), but soon to be surrrounded on all sides by states with an age limit of 21, unfortunately looks to join them as well.

That is a shame, since Pennsylvania has seen more progress than the national average in terms of reducing teen smoking (and less of an increase in teen vaping) in recent years, while the increase in teen vaping continues unabated nationwide regardless of the states who raised the age limit to 21 in recent years.  Pennsylvania raised their cigarette tax and implement a hefty vape tax on recent years, so that could be part of their relative success story.

UPDATE:  As of November 27, 2019, Pennsylvania raised their smoking age to 21, effective July 1, 2020.  And New York's hike to 21 has just gone into effect in November as well.  Thus, now MORE than half of the American population (and growing!) lives under a Tobacco 21 regime now.

In The UK, Cooler Heads Still Prevail When It Comes To Vaping

With all of this mass hysteria going on in the USA over vaping, we should keep in mind that our friends across the pond in the UK are generally NOT freaking out about it.  So what is so different over there?

First of all, regulation of advertising and promotion of vaping products is stricter in the UK.  Also, the nicotine content of such products is capped at a level significantly lower (as much as two-thirds lower) than the average of today's leading brands in the USA.  Even when those very same brands, most notably JUUL (aka "may their name and memory be forever blotted out"), are sold in the UK, they have to reduce their nicotine levels to be able to sell them there.  That, of course, is an EU-wide regulation, binding on all member states including the UK (at least until Brexit, just to Regrexit, if finalized).  The dose makes the poison, basically, and capping it greatly reduces (though does not eliminate) adverse side effects, not to mention the chances of young experimenters becoming addicted to nicotine so disturbingly quickly.

Also, the age limit is 18 over there (strictly enforced on vendors, just like regular cigarettes and alcohol), and there are no flavor bans either.  If anything, they seem to have an even wider variety of flavors.

Public Health England (PHE) certainly does NOT recommend that non-smokers ever take up the habit of vaping, but they do encourage current adult smokers to switch to vaping if they can't quit nicotine otherwise.  And they caution vapers not to vape any illicit or homemade products or add anything to the legitimate pods or liquid. Overall, authorities and the public health community keep a cool head about vaping, and guess what?  In the absence of moral panic, there does not seem be any real vaping epidemic among young people over there, and while there have been occasional reports of adverse reactions in general, there so far have not been any reported cases of the mystery vaping-related lung illness that the USA is currently grappling with.  (Of course, as we have already noted before, that mystery illness is primarily due to unregulated black-market vape products, especially THC ones, which often contain very questionable additives.)

That’s not to say that nobody is freaking out over there at all.  Every country has its share of that it seems.  But over in the UK at least, it currently seems to be confined to the tabloids for the most part.

We can really learn a lot from our friends across the pond.  So let's be adult about this, shall we?

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.