Public Health

What doctors must know about the vaping crisis

Kevin B. O'Reilly , Senior News Editor

New research shows that 40.5% of high-school seniors have tried nicotine vaping, adding urgency to President Trump’s announcement that the Food and Drug Administration (FDA) will take action to ban the e-cigarette flavorings that have proved so attractive to teens and young adults. Meanwhile, federal health agencies are encouraging physicians to report detailed information on cases of vaping-associated lung illnesses. Here’s what doctors need to know.

Vaping is taking off among kids. A national survey of 42,531 eighth–12th graders finds that 25.4% of high-school seniors have vaped nicotine in the last month, while 20.2% of 10th graders and 9% of eighth-graders have done so.

And while about 40% of 12th-graders have ever used a nicotine e-cigarette, 36.4% of 10th graders have vaped and 20.7% of eighth-graders have used an e-cigarette, says the survey, “Trends in Adolescent Vaping, 2017–2019,” published in The New England Journal of Medicine.

All of these figures have grown dramatically since 2017, the survey found, with past-month nicotine vaping skyrocketing 131% among 12th-graders in just two years.

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Vaping is an epidemic and the FDA must act, physicians say

It’s way past time to eliminate e-cigarette flavorings. The AMA has long called on the FDA “to regulate e-cigarettes, particularly banning flavors and marketing practices that enhance the appeal of e-cigarette products to youth,” said Patrice A. Harris, MD, MA, the Association’s president.

“With soaring numbers of America’s youth using e-cigarette products, we are hopeful that the administration will now speed up e-cigarette regulations and remove all unregulated and unapproved products from the market,” Dr. Harris said.

The AMA House of Delegates has declared the skyrocketing use of e-cigarettes to be an “urgent public health epidemic” and urged the FDA to take action to address it. Dr. Harris also lauded recent actions by Michigan and New York to ban e-cigarette flavorings.

“More stringent policies will help protect our nation’s youth from the harmful effects of tobacco and nicotine use. We will continue to support policies and regulations aimed at preventing another generation of Americans from becoming dependent on nicotine,” Dr. Harris said.

Vaping-related lung illnesses have struck hundreds, killing seven. The Centers for Disease Control and Prevention (CDC) has reported 530 cases of lung injury in 38 states and one U.S. territory. The CDC has confirmed seven deaths in six states: California, Illinois, Indiana, Kansas, Minnesota and Oregon.

While most of the patients affected used e-cigarette products with tetrahydrocannabinol (THC), some of the patients reported vaping only nicotine. The CDC is regularly providing updates on the outbreak.

The CDC and FDA are telling physicians: Report what you see. The CDC says physicians and other clinicians should “report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to your state or local health department.” Learn more by reading the CDC’s health advisory, “Severe Pulmonary Disease Associated with Using E-Cigarette Products.”

The FDA, meanwhile, has developed a portal to report safety problems with tobacco products. The agency says it wants reports from health professionals about tobacco products that are damaged, defective, contaminated, smell or taste wrong. The FDA reviews the reports to identify concerning trends.

And here’s what to tell patients now. According to the CDC advisory, your patients should consider refraining from using e-cigarette products while the agency’s investigation is ongoing. And regardless of the investigation, no one should buy such products off the street or modify e-cigarette products, or add substances to them not intended by the manufacturer.

Also, e-cigarette products shouldn’t be used by children, young adults, pregnant women or people who don’t already use tobacco products. Adult smokers looking to quit should use evidence-based treatments such as counseling and FDA-approved medications.