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According to Oklahoma State Department of Health officials, the first four cases of serious lung injury related to e-cigarettes have been confirmed in the state. Symptoms included shortness of breath, fever, cough, chest pain, vomiting, abdominal pain and diarrhea. Some patients have reported that their symptoms developed over a few days, while others have reported their symptoms developed over several weeks. All the patients have a history of e-cigarette use.  

Nationwide, more than 800 cases of lung injury have been reported, and 40 percent of those patients are under the age of 25.

Although no Oklahomans have died so far, the CDC has currently placed the number of people who have died across the U.S. at 12. Many news outlets and health organizations are reporting as many as 17 or 18 people have died so far.

The recent findings from the investigation into lung injuries associated with e-cigarette use suggest products containing tetrahydrocannabinol (THC) have played a role in the lung injuries. THC is the psychoactive mind-altering compound of marijuana that produces the “high.” 

Some reports have also indicated e-liquids that have been modified in ways not intended by manufacturers might play a role in the serious lung injury outbreak.

What, exactly, is an e-cigarette?

According to the American Cancer Society, e-cigarettes are available in many shapes and sizes and can look like cigarettes, cigars, pipes, pens and USB flash drives among other forms. 

E-cigarettes are known by many different names, including e-cigs, vape pens, vaporizers, vapes and tank systems. Using an e-cigarette product is commonly called vaping. JUUL is one popular brand of e-cigarette.

All e-cigarettes include a battery to turn on the device, a cartridge or tank that holds the e-liquid (also known as e-juice), a heating element that heats the e-liquid to turn it into a vapor, and a mouthpiece or opening used to inhale the vapor. 

There is no Food and Drug Administration oversight of the manufacturing of these products, which means there is no oversight regarding potentially harmful ingredients. The Centers for Disease Control and Prevention says that e-liquid can contain nicotine, THC and cannabinoid (CBD) oils, and other substances and additives. 

The relationship between lung injuries and e-cigarettes: what we don’t know

The CDC, the FDA, state and local health departments, and other public health partners continue to investigate the multi-state outbreak of lung injury associated with e-cigarette use, but the CDC cautions there are still unknowns, such as:

• The specific chemical exposure(s) causing lung injuries associated with vaping remains unknown at this time.
• No single product or substance has been linked to all lung injury cases.
• More information is needed to understand whether one or more e-cigarette or vaping products, substances, or brand is responsible for the outbreak.
  

Current recommendations by the CDC

While the investigation is ongoing, the CDC recommends that people refrain from using e-cigarette products, particularly those containing THC or CBD oils. Other recommendations include:

• If you are an adult who used e-cigarettes to quit cigarette smoking, do not return to smoking cigarettes.
• If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak, see a health care provider.
• If you use e-cigarettes, you should not buy them or any related products, such as e-liquid, off the street. Also, do not modify or add any substances to these products that are not intended by the manufacturer.
  

Young people and e-cigarette use

The popularity of vaping has risen dramatically among teenagers. According to a recent study from the National Institutes of Health, about 37 percent of high school seniors reported vaping in 2018, up from 28 percent in 2017. An estimated 3.6 million middle school and high school students reported using e-cigarettes in 2018. 

Dr. Craig Kupiec, a pediatrician at INTEGRIS, explained why the sharp increase of young people who use e-cigarettes is such a cause for concern. 

“When looking at a cigarette, after all the other ingredients have been burned away, about nine milligrams of nicotine goes down to one milligram. But when looking at a teaspoon of e-liquid, there are typically 12 milligrams (of nicotine) in a teaspoon,” he said. “Who knows how much a person is ingesting when there is an appealing flavor being consumed?”

In fact, e-cigarette manufacturer JUUL itself has admitted that one JUUL pod may contain as much nicotine as a pack of cigarettes, said a report from the American Lung Association.

Kupiec is also concerned by the re-normalization of tobacco products with e-cigarette devices. “More children in society are seeing vaping as a reasonable alternative to cigarette smoking. They are seeing something that a parent is using that has a flavorful odor,” he said.

However, “While it seems benign in the moment, vaping is very harmful and caustic to lungs,” said Kupiec. “The fact is, it is not a reasonable alternative. The FDA has not approved any e-cigarette device as a smoking cessation tool.”

He continues, “We know the harmful effects of nicotine on both adults and especially those under the age of 25, whose brains are still developing. When adolescents consume nicotine products, there is an effect on neurotransmitters in the brain. These transmitters inherently promote addictive behaviors in the future.”

What parents can do

The best way to prevent teenage nicotine use is to get involved and educate your teen. 

• Talk to your teens about vaping. Remind them it is illegal for anyone under the age of 18 to purchase or use nicotine products, including vapes, in Oklahoma.
• Talk to your teens about the health risks of smoking. There are serious consequences if your teen is using e-cigarettes, including long-term health problems and a high probability of addiction. Make sure you children know the risks. 
• If you learn your teen is vaping or smoking, take your child to a health care provider. Get a third party like your family doctor involved to explain how smoking harms the body, perhaps with more graphic information than you can provide. Nicotine addiction is a serious issue and a medical professional can help provide guidance.