VANCOUVER — Alarming headlines and emergency-room pictures of kids hooked up to tubes and respirators because of vaping don’t appear to be having much impact on B.C. teens.
Nicotine vaping has shot past cigarettes, cannabis and drinking alcohol as the most popular drug-delivery system among teens in senior grades.
Armed with a healthy aura — hey, it’s not smoking! — vaping is quickly creating a new generation of addicts just as cigarette smoking appeared to be breathing its last as an acceptable pastime.
Tobacco companies have spent billions of dollars to secure their share of a growing market of young people taking up vaping, who in many cases haven’t had much more than a puff of tobacco in their lives.
“If it was tobacco flavoured, I probably wouldn’t use it. But all the flavours are why I keep it up,” says Sarah, a high school student who has never smoked cigarettes. “It doesn’t worry me at all that people are dying or being hospitalized. I know about that, but it doesn’t scare me enough to stop. It seems pretty safe.”
Other teens say educational films on vaping put them off making it a habit.
The Vancouver school district’s Supporting and Connecting Youth program team is planning classroom education sessions on vaping this school year and offers one-to-one support for students and parents, as well as online resources. Education sessions for students caught vaping are also available.
Sarah and her classmates agree on one thing: Virtually every teen they know has tried vaping.
Data from the 2018 B.C. Adolescent Health Survey found that 21 per cent of teens between 12 and 19 years of age had used a nicotine-laced vaping product in the past 30 days. But the figure jumps to 31 per cent among 16-, 17- and 18-year-olds, says Elizabeth Saewyc, a professor at UBC’s School of Nursing.
By contrast, just seven per cent of B.C. youth smoked a cigarette in the past month. More than 38,000 young people ages 12 to 19 in 58 of B.C.’s 60 school districts completed the survey.
E-cigarettes and vaping wands create a mist that the user inhales, which may contain nicotine, flavouring agents and THC, the psychoactive ingredient in cannabis.
Vaping is so new that the long-term effects of inhaling e-juice ingredients such as glycerine and propylene glycol are unknown.
“We don’t have really good, long-term research about the potential health impacts on adolescents and their growing brains and bodies,” Saewyc says.
You don’t have to look 20 years down the road to see the immediate acute impacts that vaping can have.
Wave of lung failures
American health officials are investigating more than 450 cases of “vaping-related” lung disease across 33 states.
Recently, a 20-year-old outdoors enthusiast was diagnosed with a potentially fatal case of lung failure and ended up on life support after vaping triggered an immune response usually associated with inhalation of mineral oil.
Six people have died from illness related to vaping in the U.S. Michigan is now taking steps to ban flavoured vaping products.
The Canadian Paediatric Society has called for a ban on flavoured vaping products in Canada. Flavoured e-juice is allowed in Canada, but it is not allowed to be “appealing to youth.”
B.C. limits the open display of vaping products to adult-only stores. In an open retail environment, vaping displays and advertising cannot be visible to minors and sale of those products is restricted to people at least 19 years of age.
Vaping giant Juul has marketed its products as a safe alternative to smoking cigarettes and even taken that message to high school students, though it was recently warned to stop doing so. Tobacco conglomerate Altria recently purchased a $17-billion stake in Juul.
Unlike smoking cessation products such as nicotine gum or skin patches, vaping simulates and reinforces every aspect of smoking, right down to inhaling and the rush of the drug.
Nor do e-cigs necessarily wean users from their drug. Nicotine-laced e-juice delivers every bit as much nicotine as tobacco. One vial can contain as much nicotine as a full pack of cigarettes.
Pro-vaping messages easily reach young people through social media, where it is depicted as “safe, tech and cool,” says Saewyc.
“YouTube is becoming a really popular place where young people are talking about the different kinds of e-cigarettes, how they’re modifying them, the different juices and all of the different sorts of equipment, plus showing tricks that you can do with steam,” she says.
Nicotine is one of the most addictive substances known to science and binds to specialized receptors that already exist in the brain. “It fits in the brain really specifically and that’s what makes it so addictive,” says Saewyc.
Governments have spent decades convincing teens that cigarette smoking is harmful and unpleasant, she notes. Now vaping threatens to undo all that work.
“It’s easier to hide because it doesn’t smell of smoke and young people are doing it because they think it’s safer,” she says. “They haven’t gotten the same key messages and the same active campaigns around the risks of nicotine from vaping as they do from tobacco.”
Safety claims unproven
“We know that manufacturers of these products are being controlled by the tobacco industry,” says Marvin Krank, a UBC Okanagan psychology professor. “These are drug-delivery systems that easily replace cigarettes and they are so new that they can say a great deal about them that isn’t true.”
Vaping nicotine might reduce the incidence of cancer compared with tobacco smoking, but it’s far too early to know. “It took 25 years to demonstrate what was going on with cigarettes and the industry resisted every step of the way,” Krank says.
The way manufacturers target children with their products isn’t remotely subtle, he notes. “You can’t tell me that bubble gum and watermelon flavours are going to be used by adults to quit smoking,” he says. “There are a lot of fruit and candy flavours out there in youth-appealing bottles.”
Many of the ingredients being used in e-juice — including in flavoured e-juices that don’t contain nicotine — have been approved for consumption through the digestive system rather than inhalation. “These have never been proved safe for the lungs,” says Krank. “Diacetyl is the stuff that caused popcorn lung in workers that make microwave popcorn.”
Several deaths have been linked to e-cigarettes, along with dozens of emergency-room admissions, some for injuries caused by vaping devices that exploded.
The rising tide of injury and illness is especially concerning given the speed with which young people are taking up vaping.
Krank’s own research with 1,209 students in the Vernon school district found that the number of students who had tried nicotine vaping increased by 50 per cent in each of Grades 8, 9 and 10 between 2017 and 2018. “It’s absolutely ballooning and it’s really sad because we were winning the battle with tobacco,” he says.
Vaping “directly mimics” the way that cigarettes deliver nicotine to the brain, which is likely to encourage addiction, he says.
“Nicotine consumption is on the rise again, nicotine addiction is on the rise again … all with an aura of safety,” he says. “We are watching the creation of a new generation of addicts. I wonder why tobacco companies are so interested in it?”
The Canadian Institute for Substance Use Research warns e-cig vapour may contain substances that can cause cancer. “It will be years before we know the long-term effects of vaping,” Krank says. “But if [harm] is happening acutely, we can only imagine what the cumulative effects are going to be.”
“E-cigarette products often use glycerine, which is an oil that is known to be irritating to the lung,” says Dr. Christopher Carlsten, a professor at the UBC School of Medicine and Canada Research Chair in Occupational and Environmental Lung Disease. “One of the big problems is that e-cigarettes are evolving so quickly, the product is changing faster than anyone can properly test for what’s actually in it.”
Liquids and moist environments are also a terrific medium for microbes, which can thrive in e-juice or e-cigs and vaping equipment. The gear is expensive enough that it is not considered disposable, so people keep them around and reuse them long enough for bugs to grow.
In the U.S. hundreds of people who vape have presented symptoms similar to pneumonia, which include constant coughing, difficulty breathing, fever, fatigue and respiratory failure. Two people have died, in Illinois and Kansas.
There isn’t any data on vaping-related illness in B.C. so far, likely because doctors and health authorities haven’t started to look specifically at vaping as a cause of illness.
Ultimately, Carlsten supports the preventive approach taken by Michigan. “There might be some arguable benefit to vaping for adults who are addicted to nicotine from smoking cigarettes, but there are no redeeming benefits to vaping for anyone else,” he says.