Attitudes towards vaping vary quite significantly between the US and UK, particularly following the worrying hospitalisations in the States that have been attributed to vaping. At the time of writing, there are 450 cases of people being admitted to hospital for breathing difficulties and seven deaths. We’ve understandably been receiving questions from concerned customers regarding the safety of vaping following these unfortunate incidents.
It’s important to note - with the “teen vaping epidemic” in America, there is already heightened concern over the use of e-cigs. The ways in which vaping is regulated varies and how vaping is classified is a major variable between the UK and US. We want to reassure vapers and to clarify a few of the concerns that have been aired in recent weeks.
NO CASES OF THIS ISSUE IN THE UK
The patients in the States have reported symptoms like shortness of breath, chest pain and coughing. Developed symptoms can also include vomiting and diarrhea. Currently, there are no cases in the UK of anyone suffering from comparable symptoms that have been related to the use of an e-cig.
WHAT’S THE LIKELY CAUSE IN THE USA?
There’s been extensive testing put into effect for any devices and e-liquids used by said patients who have been hospitalised. The current commonality between them is the use of counterfeit, black market products - whether those are homebrew e-liquids or THC dab pens. While the method of administration is the same (using an e-cig) it’s the contents of the vape that are the cause for concern - not the vape itself.
Many tests are coming back indicating the cartridges contain an ingredient called Vitamin E Acetate. This ingredient is used in oral and topical applications for dietary reasons and to treat skin conditions. However, by its nature it’s an oil - technically referred to as a “lipid.” Your lungs are made for absorbing gases like oxygen, not oils. When you inhale oils they can get trapped in the alveoli (small sacks in your lungs) that air moves through and enables oxygen to pass into your bloodstream. When these sacks fill up you can suffer from something called lipoid pneumonia(1). The symptoms include things like chest pain, coughing and struggling to breathe.
The other commonality amongst many of the patients was the use of dab pens. These aren’t strictly vapes - they’re usually single use cartridges filled with an oily liquid containing THC. While THC and marijuana products are legal in some states, in most they’re still illegal. This creates an opening for the black market with unregulated products with no quality or safety controls.
When cannabinoids are extracted from hemp or marijuana, it’s common practice for reputable companies to use a CO2 extraction method. This method is generally considered the safest because no solvents are used so there are no residual contaminants on products that will later be inhaled by the end user. Another form of extraction is using solvents like butane. When these extracts are not properly filtered, residual butane, plant pesticides and insecticides can remain. One of the insecticides in particular - myclobutanil - will degrade into hydrogen cyanide when it’s heated like it would be when used in a dab pen.
DIFFERING REGULATION STANDARDS - FDA VS TPD AND MHRA
The FDA (Food and Drug Administration) has had authority to regulate, test and control vaping products on the US market since 2016. The way vaping is currently tested and regulated in the US is very different to the UK. Nicotine in America is available in strengths as high as 50mg (5%) with nic salts being the equivalent to a 5.9% strength.
At present, the FDA is still in the process of testing a whole market of vaping products. Anything released onto the market after the 8th of August 2016, have been subject to compliance policies. However, vaping has been in the US market since 2009, meaning there’s around 7 years worth of product releases that haven’t been regulated or tested. This also doesn’t factor in the illicit market. Individuals mixing up products with no testing, regulation or sanitisation standards are a recipe for issues and products of poor or unsafe quality.
The UK and Europe have an incredibly rigid set of guidelines to adhere to. TPD (tobacco products directive(2)) came into effect in May 2016. These regulations are the authority in the UK are managed by the MHRA (Medicines and Healthcare products Regulatory Agency). When a brand wants to launch a new e-liquid into the UK market, they have to notify the MHRA six months before the product is due to be released. Manufacturers are responsible for testing and submitting reports that prove their products are compliant.
What can go into e-liquids is regulated as far as both ingredients and nicotine strength as well as how they’re packaged and labelled. The UK and Europe have a maximum nicotine strength of 20mg per ml (equivalent to a 2% strength) and they also can’t contain additives like colouring, taurine, diacetyl or caffeine. Any ingredient that makes up more than 0.1% of the final product must also be listed on the ingredients list. Vaping devices themselves are also regulated to ensure they’re safe to use.
While the exact cause of the deaths in America is still somewhat unknown, Public Health England still support vaping as a safer option than smoking. Their previous research indicates that while vaping is not totally risk free, it is generally considered to be 95% safer than smoking(3).
WHAT CAN YOU DO IF YOU’RE CONCERNED?
While there are no long term studies on vaping, the incidents in America have occurred in the space of less than a month. Bear in mind, the vaping industry has been around for about a decade now with no instances of hospitalisations much less and vape related deaths from e-liquids.
If you’re still concerned, you can check the full MHRA(2) list of products that have been approved to see if your usual e-liquids are on there. Only purchasing e-liquids and vaping products from reputable sellers is the best way to go. Many e-cig kits and coils will come with a verification code on the packaging as well, so you can check the legitimacy of your kit on the manufacturer's website.