juuling and vaping: what’s next? - nyscha€¦ · substance(s) used: nicotine, cannabinoids...
TRANSCRIPT
JUULing and Vaping: What’s Next?
Leah Berkenwald, MABrandeis University
Christine Johnston, MPHSpringfield College
Learning Objectives1. Participants will understand the language related to vaping and
identify the products used for vaping.
2. Participants will understand the current trends in vape use.
3. Participants will understand the ongoing, changing regulations around vaping.
4. Participants will discuss prevention and intervention strategies to address vaping on campus.
Outbreak of Lung Injury Associated with E-cigarette
Use or Vaping
Tracking the OutbreakLast updated: October 15, 2019
The Centers for Disease Control and Prevention and state agencies have reported 1,479 lung injury cases and 33 deaths linked to vaping.
Source: The New York Times (https://www.nytimes.com/interactive/2019/health/vaping-illness-tracker.html)
The latest from the CDC● As of October 15, 2019, 1,479 lung injury
cases associated with using e-cigarette, or vaping, products have been reported to CDC from 49 states, the District of Columbia, and 1 U.S. territory.
● 33 deaths have been confirmed in 24 states.
● All patients have reported a history of using e-cigarette, or vaping, products.
● Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak.
Sources: The New York Times (https://www.nytimes.com/interactive/2019/health/vaping-illness-tracker.html) and the CDC
Symptoms of Vaping Associated Pulmonary Injury (VAPI)● Patients in this investigation have reported symptoms such as:
○ cough, shortness of breath, or chest pain○ nausea, vomiting, or diarrhea○ fatigue, fever, or abdominal pain
● Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks.
● A lung infection does not appear to be causing the symptoms.
Source: CDC
Flu or VAPI?For the coming flu season, CDC recommends that clinicians strongly consider respiratory infections such as influenza, as well as lung injury associated with e-cigarette use, or vaping, in all patients presenting with respiratory symptoms and a history of e-cigarette use, or vaping.
Source: CDC
For Healthcare Providers1. Report cases of lung injury of unclear etiology and a history of e-cigarette or vaping
product use within the past 90 days to your state or local health department. Reporting of lung injury cases may help CDC and state health departments determine the cause of these lung injuries.
2. Ask all patients who report e-cigarette, or vaping, product use within the last 90 days about signs and symptoms of respiratory illness.
3. Determine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with the local or state health departments.
4. If e-cigarette, or vaping, product use is suspected as a possible etiology of a patient’s lung injury, obtain detailed history.
Source: CDC
For Healthcare Providers - Taking a History1. Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil,
synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances
2. Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids
3. Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)
4. Where the product(s) were purchased
5. Method of substance use: aerosolization, dabbing, or dripping
6. Other potential cases: sharing e-cigarette or vaping products (devices, liquids, refill pods, or cartridges) with others
Source: CDC
VAPI in the MediaWhat are our students seeing about this illness?
11Sources: CNN Health, WebMD, NBC today, Deseret News (Utah)
I realize this is a lot more than what I usually share or post but I wanted to take a moment and show you all what the risks are if you vape or smoke anything THC or vape in general. I was in the hospital for two weeks as I was having trouble breathing, as I got to the hospital my lungs stopped moving all together. The doctors at the hospital had no choice but to put me in coma for 9 days so they can put me on a machine to breathe for me. They warned my mother that things where not looking good for me as my oxygen levels dropped dramatically along with my blood pressure and heart rate. The doctors told my mother to start looking into funeral arrangements. I nearly lost my life for something I thought was completely harmless. I didn’t listen to anyone that told me its dangerous and I never understood why they would tell me that well now I understand why. This is not for sympathy or attention I want all of you to look at this and rethink what you put into your body there are plenty of cases coming out like mine but I was one of the super lucky ones that made it. So please if you smoke vape or anything look at this photo and imagine your loved one or you in this position. This was not comfortable or fun and I’m still recovering so please be cautious of what you put in your body or what you do to your body.#stopvaping#stopsmoking(9 days won’t let me edit)
salazar383412
chanceammirata
This whole experience is absolutely insane and life changing (disclaimer I don’t always look this bad just when I’m glued to the hospital bed for 8 days) I came into this experience completely negative mad at the world , and scared of how things were gonna turn out after my lung collapsed. But I decided to take this negative and completely find another meaning. I decided that spreading my story could help others not have to go through the same thing as me. One by one reading each message from every single one of you explaining how I was able to CHANGE YOUR MINDSET I was able to help you throw out your juul. Makes you realize enough is enough and that nicotine is rotting our brains and destroying our bodies. It overcame me with emotions. I’ve never been happier to make such a difference. My surgery to get my chest tube removed is scheduled in around 2/3 hours and I’m insanely nervous. But I want to make sure my story is always out there. And that the change doesn’t stop. Every day we need to fight to help not only ourselves but the ones we love put down the nicotine. This epidemic has taken enough. We don’t need more evidence telling us just how bad it is. How many more kids are going to have to get hospitalized for us to stop !? None should be the answer don’t take this with a grain of salt. And keep on pushing yourselves to take control of these cravings. I know it’s hard , and I know it will be a long one/2 weeks of getting over the addiction. But 1/2 weeks is so much more worth it than a lifetime of consequences. #lunglove#stopjuul #revolution #wewillmakeachange #wearenotcontrolled edit: hole* reference to third slide
Simah Herman, 18, now advocates against vaping after having a near-death experience.
What is causing this?Short answer: We don’t know for sure!
Initial concerns have focused on the possibility that the lungs were clogged by oils being vaped, like THC oil itself, or other oils like vitamin E acetate that are sometimes used to dilute or “cut” THC for sale.
But Dr. Larsen said the Mayo researchers saw no signs of oil accumulating in the lung tissue. Instead, they saw many immune cells called macrophages with what he described as “the fine, foamy-looking appearance that is characteristic of chemical injuries.”
“So maybe we need to look more closely at the chemical compounds, and not just oils, but the chemical constituents, to figure out which ones are injurious,” Dr. Larsen said.
Chemical compounds
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THC and Dank Vapes
Risks we already know about
What’s in the “vapor”?• Nicotine
• Ultrafine particles
• Flavorings
• Volatile organic compounds
• Known carcinogens
• Heavy metals (chromium, nickel, zinc, and lead)
• Potential for other pharmacologically-active substances
Sources: E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General (2016); Centers for
Disease Control & Prevention; Rubinstein et. at. (2018)
The Problem with Nicotine• Nicotine has negative impacts on adolescent brain development, continuing into the mid-
20s– Detrimental effects on cognition and attention– Deficits in working memory– Some evidence suggesting that there is a causal relationship between smoking and mood
disorders
• Nicotine is toxic to developing fetuses
• Nicotine may have a detrimental effect on cardiovascular function
• Nicotine is HIGHLY addictive, especially for young people. Nicotine may cause changes in the reward and pleasure centers of the brain, increasing the reinforcing effects of other drugs
– Animal modeling suggests that this may be one reason that adolescent smokers have disproportionately high rates of comorbid substance abuse
Source: E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General (2016)
Nicotine Poisoning (when people and animals eat vape pods)● Reported incidents fell sharply between 2016 (which saw more
than 2,014 reports of exposure from children under 12) and 2017 (which saw 1,619 such reports).
● There were 1,913 reports of exposure in 2019.
● Can be absorbed if put in the mouth, swallowed, or on skin, as nicotine can be absorbed via mucous membranes and skin (like a nicotine patch).
● As of 2016, the federal government requires liquid nicotine to be sold in childproof packaging.
● A teaspoon of concentrated liquid nicotine can be fatal for the average 26-pound toddler.
Sources: American Academy of Pediatrics (AAP), www.thatslife.com.au, Rolling Stone
Vaping: The Basics 2.0
What is a JUUL?● A specific brand of closed-system
vape
● The shape is similar to a thumb drive
● Charges using a USB port
● Juice is contained in a replaceable pod and comes in a variety of flavors
● A starter system costs about $50 and pods are 4 for $16
“JUUL-Alikes”
Off-Brand Pods
Dry Herb Vapes vs. Oils vs. Dab Pens● Dry herb vapes are designed for
vaping cannabis in the form of dried buds, stems, etc.
● Vapes for oils are designed to be used with THC (or CBD) oils. They are popular because they don’t smell and they taste good.
● Dab pens (or wax pens) are used specifically for consuming dabs, which are tiny concentrates of THC.
“As health officials grapple with a public health crisis they are struggling to understand, police departments are in the midst of a swift crackdown on vaping products containing THC, the psychoactive ingredient in marijuana. In the Phoenix area, the authorities recently raided three homes over eight days, seizing hundreds of THC cartridges at each. In Wisconsin, detectives arrested two young brothers accused of running a large-scale THC cartridge assembly operation inside a condo. And in Nebraska, sheriff’s deputies found a stash of cartridges in a car parked at a truck stop.”
Source: The New York Times (2019)
Who’s Using?
High School Use Skyrocketing● Last year, at this conference, we shared
that 20.8% of high school students reported using a vape in the last 30 days.
● This year, that number is 27.5%.
● 1 in 14 (~7%) middle school students reported using a tobacco product in the last 30 days - most of these were vapes.
● Fruit, mint, and menthol flavors continue to be the most popular (60% of teens reported using one of these)
Sources: CDC Vital Signs, February 2019, The New York Times
College Student Use is Following Suit
Sources: ACHA-NCHA Spring 2019 Reference Group report and 2019
Monitoring the Future Study
12.6% of college students reported using a e-cigarette in the last 30 days
Perceived use is 83.1%
Political, Legal, and Regulatory Information
Where We Were
● JUUL “Voluntary” actions - November 2018○ Stopped filling retail orders for flavored pods unless
stores could show limited access○ Changed the age to purchase online to 21○ Using age verification software○ Shut down US-based Facebook, Instagram accounts
● FDA Regulations introduced March 2019○ Only tobacco, menthol, & mint flavors available in
stores○ *Unless they restrict access to minors
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Source: Forbes 2018 Slide credit: Student Advocates for Wellness @ Springfield College
A NationalPicture
Source: The New York Times
Massachusetts - Ban on ALL vaping products
Backlash to the Ban
“The temporary clampdown on all e-cigarettes,
whether used for nicotine or marijuana-derived
THC, is a “cause of concern” because it could
“push people into the black market” where
unregulated pipes and oils post the greatest risks,
said Chris Hudalla, founder and chief science
officer of ProVerde Labs of Milton,
Massachusetts.” - New York Post, October 4,
2019
New York and Rhode Island - Ban on Flavored Vapes
Connecticut, Maine, and Vermont - Thinking about it
Meanwhile, in New Hampshire...
Indoor Vaping Bans
Source: Wikipedia
Campus BansAs vaping death toll rises, Texas A&M bans vaping and e-cigarettes on its campus
"This health threat is serious enough that I want to see
the ban include every building, outside space, parking
lot, garage and laboratory within the Texas A&M
System. The ban also should extend to every facility of
our $950 million research enterprise and all System
properties in the 250 Texas counties in which the Texas
A&M System has a presence, " Chancellor John Sharp
wrote in a memo.
Source: NBC News
“We will become a campus that is smoke-free,
vape-free, and nicotine product free on our
property,” Dean of Students Dr. Grant Azdell
said.
Source: NBC12
What are you seeing?
Small group discussions
What are folks are seeing and hearing on their campuses?
Who’s been doing vaping campaigns?
What’s been effective on your campus?
What resources does your campus have for quitting support?
