Alternative nicotine devices linked to deaths

While this story includes the use of cannabis oil vaporisers which research indicates increases lung injury and death, e-cigarettes and vaping are taking a hiding following their linking to three US deaths. A public health warning; nothing in the "harm reduction' debate around alternatives to traditional cigarette, cigar and pipe smoking is certain. It's smoke and mirrors. I naively ran headlong into this murky territory while news editor of the SA Medical Journal. Here's what I wrote in the Izindaba news section in November 2013*; "Can a rechargeable battery, linked to an atomiser and cartridge of liquid nicotine, 'massively' reduce the individual and population risks of traditional cigarette smoking? Or is the increasingly ubiquitous e-cigarette a dubious, poorly-controlled 'aid to quitting', that results in actual dual use with unacceptably high toxin levels? The jury is out scientifically, with South African role players on either side producing evidence for and against the device. Global sales of e-cigarettes are projected to reach R17bn by year end (31st Dec, 2013), which Wells Fargo Securities estimates to be a 240% increase over last year (2012)." Now, ironically it seems, cigarette sales are picking up again in the wake of this scare. Best tip if you're a smoker (of anything)? Go cold turkey; easier said than done, hence the billion-dollar 'new device" industry. – Chris Bateman.People urged to stop vaping following more deaths, hundreds of illnesses.By Brianna Abbott and Jennifer Maloney(The Wall Street Journal) – Health authorities are urging people to stop using electronic cigarettes and other vaping products while they investigate three more deaths from a mysterious illness that federal officials say may have affected over 450 users of the devices around the US. ___STEADY_PAYWALL___.There have been five reported deaths from the severe lung injury associated with the use of nicotine or cannabis vaporisers.."While the investigation is ongoing, people should consider not using e-cigarette products," the federal Centres for Disease Control and Prevention said Friday in a news release. The agency also said people should stop buying vaporisers, cartridges and liquids off the street or modifying vaping products bought legally.Indiana's health department said it had confirmed the death of a state resident "older than 18 years" with the illness on Thursday. Minnesota also reported a death. Its health department said an elderly person, who had a history of lung disease, was hospitalised with a severe lung injury associated with vaping an illegal marijuana-related product and died last month after developing other conditions.Also Friday, Los Angeles County health officials said they were investigating a death in the county that was associated with vaping. The CDC has yet to confirm this death.The latest reports follow the deaths of individuals in Illinois and Oregon after using a vaping device.The cause of the illnesses is a mystery, though health authorities have linked them to the vaping of key marijuana ingredients or nicotine. Most of the cases seem to be cannabis-related, state and federal health officials say.On Thursday, New York state health officials said they identified vitamin E acetate, or oil, in some samples of vaping products linked to several cases and have made it a key focus in their investigation.Late Friday, the Food and Drug Administration announced that people should avoid THC-containing products specifically. Tetrahydrocannabinol, or THC, is a compound in marijuana known for its psychoactive effects and has been associated with many of the illnesses. They also said that most of the THC products tested contained "significant amounts" of vitamin E acetate, echoing the findings in New York.The FDA still cautions that there isn't enough evidence to pinpoint vitamin E acetate as the cause of the illnesses, but people should avoid inhaling the substance. They also warned against buying THC products off the street because consumers can't be sure whether the unregulated products contain vitamin E acetate.There were 35.9 million marijuana vape pens and cartridges sold in the year ended Aug. 31 in licensed recreational marijuana stores in California, Colorado, Nevada and Washington, according to Marijuana Business Daily.Roughly 13.8 million people in the US were users of nicotine e-cigarettes as of June, according to tobacco giant Altria Group Inc. The company estimates that among them more than seven million use e-cigarettes exclusively.A spokesman for Juul Labs Inc., which represents about 70% of e-cigarette sales in stores tracked by Nielsen, said the startup has been closely monitoring the situation."We appreciate the work of the CDC, FDA and other public health authorities and are confident that they will get to the bottom of this issue," he said, adding that Juul's products don't include vitamin E or any compound derived from cannabis.Altria, which owns a 35% stake in Juul, declined to comment. Reynolds American Inc., maker of Newport cigarettes, also owns Vuse, the No. 2 US e-cigarette brand. A Reynolds spokeswoman said: "We are glad to see the CDC has appropriate resources for a fulsome investigation into this issue."A decline in nicotine vaping could lead to increased cigarette sales.Altria is the biggest U.S. cigarette company, and the Marlboro maker's share price jumped following the CDC's announcement before finishing the day little changed. Shares of British American Tobacco PLC, which owns Reynolds American, were up 0.8% in after-hours trading.A CDC spokesman said it is investigating more than 450 vaping cases in 33 states and one US territory, suggesting the number of reports of cases has more than doubled since the agency updated its investigation last week."Although more investigation is needed to determine the vaping agent or agents responsible, there is clearly an epidemic that begs for an urgent response," David Christiani, a Harvard University public-health professor, wrote in an editorial published online Friday in the New England Journal of Medicine.Also on Friday, the medical journal published three reports providing the most comprehensive look at the vaping-injury cases so far. The CDC reported its own findings after looking at a small number of cases.One study looking at 53 patients in Wisconsin and Illinois found abnormalities in the lungs and chests of the patients who were scanned. The researchers believe the inflammation or injury seen in the patients was due to some sort of chemical exposure."What's striking is that, in general, these individuals are young and pretty healthy, and most of them are men," said Jennifer Layden, the chief medical officer at the Illinois Department of Public Health and first author on the study.A second report looked at 19 cases and identified abnormalities in the chest scans of all of the patients. There was no one pattern across all of the scans, leading researchers to believe that the injuries most likely have multiple causes, though all linked to vaping.One potential sign of the injury is fat buildup in the lungs, which was noted in patients studied in the other two reports.The buildup could occur either when people inhale something with oil in it or as a result of inflammation in the lungs from some sort of lung damage, said Sean Callahan, an assistant professor of medicine at the University of Utah Health, an author on one of the reports.Administering steroids or letting the inflammation clear on its own seems to help treat the illness, doctors say. Because the symptoms from the vaping injuries often look like an infection, some patients are first given antibiotics, but many don't improve with the drugs.– Write to Jennifer Maloney at jennifer.maloney@wsj.com

Alternative nicotine devices linked to deaths

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