• Lethal vaping: the mysterious epidemic caused by electronic cigarettes
  • Regulation: US declares war on electronic cigarettes flavored with flavors

Every week, 125 cases of pulmonary lesions derived from 'vaping' are diagnosed in the United States. But, of these, about 106 - 85% - are due not to 'vaping' in itself, but to the fact that products derived from marijuana, normally acquired on the black market, have been 'vaped'. Only 10% of diagnoses are attributable to vaping.

These figures come from a study by the Centers for Disease Control and Prevention (CDC) released on October 25, and reveal a new health problem in the United States and, also, in other countries: drug vaping . Everything seems to indicate that, after several months marked by the concern of public opinion about the multiplication of lung lesions among 'vapers', it is not these devices, but the use that certain consumers make of them. The CDC has identified to date 1,604 cases of injuries , 34 of them fatal. The analysis of the authorities is based on 860 incidents, that is, 54% of all those that have occurred.

Now, vaping has been used in the United States for twelve years, and THC, which is the main psychoactive component of marijuana, has been used in these devices since then. So why is the explosion in the number of cases in recent months? According to Anne Schuchat, the deputy director of the CDC to the Washington Post newspaper, to the use of products "much more dangerous and much more frequently". In other words: THC is increasingly mixed - or, by using the terminology of heroin addicts, 'cut' - with increasingly toxic substances. The heap of vaporized marijuana is usually stronger than that of that drug when smoked. The only problem is that it can kill the consumer.

In fact, in the case of 'vaping', the process of adulteration of the system itself reveals the dangers of the drug. "With nicotine, all the compounds are soluble and, in addition, they vaporize very well at a temperature of 200 degrees Celsius, which is where the steam is inhaled," Roberto Sussmann, director of Pro-Vapeo MĂ©xico explains to EL MUNDO , an organization of users of these systems.

Protesters during a protest over the regulation of vaping in the USA.

With marijuana, the process is much more complex . The two compounds that cause effects on the nervous system - THC and, to a lesser extent, CBD - are oils that, according to Sussman, "have a complex extraction process, so they cannot be obtained at home." Cartridges containing THC and CBD are in fashion in the United States, because their effect is much stronger. The problem is that often these compounds are mixed with substances that are not made to be inhaled . An example of this is vitamin E acetate, a nutritional supplement that is also used in certain creams, and used in the black market to refill cartridges.

Vitamin E acetate can be ingested or distributed to the skin without problems, but it can be dangerous when inhaled. Last Friday, the CDC stated that, in a study of 29 patients admitted for "vaping", the only substance that appeared in all the analyzes was vitamin E acetate. As explained in a teleconference with journalists Anne Schuchat, deputy director of the CDC , that research makes, "for the first time, we have a toxin" that is potentially responsible for the problems.

That is a point of view that the industry shares. Although without going into specific details of what compound can cause the injuries, Moira Cilchrist, vice president of strategic and scientific communication for Philip Morris, "research by health authorities indicates that most cases [of hospitalizations] are linked to the use of cannabioides ", especially tetrahydrocannabinol, which is the main psychoactive component of cannabis.

32% of young people between 16 and 18 years of age acknowledge having ever vaped in the last year.

The problem is complicated, because it combines two trends that are growing in society: 'vaping' and the use of marijuana. The first of these habits has practically replaced cigarettes among teenagers in the United States. According to a survey carried out last December, in 2018 37.3% of young eleventh-year-old Americans - that is, between 16 and 18, approximately - acknowledged having 'vaped' at some point in the previous 12 months , according to the National Institutes of Health (NIH), a public scientific research body. That represents an increase of 34% in relation to the previous year. The figure is even more spectacular if one takes into account that in the United States the minimum age to buy tobacco or derivatives is 21 years.

There are very few markets in which 'vaping' is not expanding rapidly. And, when that happens, it is often for business interests. The most extreme case is that of the largest tobacco market in the world, China , where the state has a monopoly on 'conventional' cigarettes and is not regulated by electronic cigarettes, so the companies that market the latter operate in a framework of extreme legal uncertainty, which, in turn, creates fertile ground for counterfeiting. Something similar, but without reaching that extreme, occurs in Latin America, where countries such as Mexico and Colombia allow 'vaping', but not the sale of products linked to that activity.

As for marijuana, its progressive legalization in the United States for two decades , and throughout Canada since the summer of 2018, has caused an expansion of the use of that drug of such dimensions that there is already talk of a financial 'bubble' of the cannabis in the interest of investors to enter that market.

Illegal Substance Traffic

But legalization has also caused the trafficking of illegal substances and systems to be used for the use of that drug. Only in California, which is the largest marijuana market in the world, the black market linked to cannabis triples the legal one, according to data from the consultant specializing in the Arcview Market Research sector. Illegal products linked to marijuana are not only not controlled, but they are more potent and dangerous than those that are allowed . And, above all, in the United States there has been a considerable increase in the falsifications and adulterations of legitimate brands used in 'vaping', which aggravates the problem.

All this has generated panic among public opinion, because until now the health authorities considered the electronic cigarette much less harmful than the conventional one, and even recommended it as a way to reduce the risk of smoking. And now it turns out that vaping kills mysteriously. The Washington Morning Consult consultancy, which follows the value of 2,000 brands, has found that the main manufacturer of electronic cigarettes , Juul, has gone from having a negative assessment by 6% of Americans in July to 33% in September. In that period, the percentage of citizens of the country who did not know that brand has fallen from 80% to 37%.

That is virtually the definition of a 'perfect storm' in reputational matters: a brand that is only known to the public when it does something wrong. But the effect is also financial. The possibility of Juul going public is in question, and one of the investors in the company, the hedge fund Darsana, has cut its valuation by no less than a third - from 36,000 to 24,000 million dollars, or 21,500 million euros - due to the vaping crisis.

A pro vaping protester in the US.

The reaction of the authorities has been to focus on 'vaping', not on the use of illegal substances. In September, Donald Trump announced in the Oval Office that his Government is working on a new regulation of the electronic cigarette that will include "very hard recommendations", particularly in the case of electronic cigarettes with flavors. "We cannot allow people to get sick," said the US president, who has not smoked or drank alcohol in his life, due to the experience of his older brother, Fred, who died at age 43 as a result of his alcoholism . The use of electronic cigarettes with flavors increases the risk of smoking, especially among the African-American community, where menthol products have always been very popular, but it does not seem to have to do with the surge of injuries, hospitalizations, and deaths in recent months.

Trump's case is not isolated. The state of Massachusetts has instituted a four-month moratorium on the sale of any type of device or substance that has to do with vaping. Rhode Island and Michigan have instituted similar measures, and A&M University, one of the most important in the United States, has banned that activity on its campus.

The problem, however, does not seem to come from both the vaporizers and what is put into them. Now, the results of the CDC investigation could change that approach. The authorities are investigating hundreds of products used in vaping, and they may soon know more precisely what the real reason for this health emergency is.

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