New state health chief cautions against all e-cigarette use; some recent illnesses aren’t related to black-market THC, but to nicotine

Health Commissioner Dr. Angela Dearinger
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By Melissa Patrick
Kentucky Health News

HAZARD, Ky. — At her first public speaking engagement as state health commissioner, Dr. Angela Dearinger spoke about the high rates of electronic-cigarette and tobacco use in Kentucky, focusing on the recent outbreak of illness related to e-cigs, with a warning that not all of the cases have involved black-market tetrahydrocannabinol, the psychoactive ingredient in marijuana.

“You may have heard that this has only happened to people who use THC products bought on the black market, and that’s not the case. I want to make sure to make that point,” Dearinger said at the fifth annual Appalachian Research Day sponsored by the University of Kentucky‘s Center for Excellence in Rural Health in Hazard Sept. 18.

“We may say that many of them did that, perhaps the majority,” Dearinger continued. “But not every single case of severe lung injury associated with vaping is due to black market THC products.”

She backed that up with numbers, saying that so far 61% of the products associated with vaping-related illness have contained nicotine, 80% have contained THC, and 7% have contained cannabidiol (CBD), a non-psychoactive product of the cannabis plant.

Dearinger said 45% of those products had both nicotine and THC; 38% had only THC; and 17% were nicotine only.

The Centers for Disease Control and Prevention says no specific vaping product or substance has been linked to all of the cases.

As of Sept. 17, the CDC had received reports of 530 cases of lung illness associated with the use of e-cigarette products, and eight people had died from it, the latest a man in his mid-40s from Missouri, according to a Missouri Department of Health news release. The other deaths occurred in California, Illinois, Indiana, Kansas, Minnesota and Oregon.

Graphic is from Health Commissioner Dearinger’s PowerPoint

As of Sept. 20, Kentucky had 12 cases of pulmonary disease associated with e-cigarettes under investigation, with two probable cases and one confirmed, according to the Cabinet for Health and Family Services.

Dearinger said she focused much of her talk on young people because, “This is an illness that is affecting young people, predominantly.”

The CDC has sex and age data on 373 of the cases, showing that 67% of those who have gotten sick are between 18 and 34; 16% are under 18; and 17% are 35 and older. Most are male: 72%.

Patients’ symptoms include cough, shortness of breath and fatigue, with symptoms growing worse over a period of days or weeks before admission to the hospital. Other symptoms may include fever, chest pain, weight loss, nausea, vomiting, abdominal pain and diarrhea.

If you are experiencing any of these symptoms, health officials ask that you refrain from further use of electronic cigarettes, but keep the device for possible further investigation. The U.S. Food and Drug Administration encourages the public to submit detailed reports of any unexpected health issues related to tobacco or e-cigarettes to the FDA through its online Safety Reporting Portal.

Teen e-cig use is rampant

Dearinger pointed out reasons for concern about teen use of e-cigarettes: their rate of use nearly doubled in all age categories from 2016 to 2018.

Data from Kentucky Incentives for Prevention survey; graphic from
Health Commissioner Angela Dearinger’s PowerPoint presentation.

According to the Kentucky Incentives for Prevention survey, 26.7% of the state’s high-school seniors reported they had vaped in the past 30 days in 2018, up from 12.2% in the 2016 survey.

Use by sophomores, or 10th graders, increased to 23.2% from 11.3%; researchers consider the 10th-grade figures to be the better indicator for use by high-school students. Use by eighth graders jumped to 14.2% from 7.3%, and sixth-grader use increased to 4.2% from 2.3% over 2016.

Dearinger spoke at length about teen e-cigarette use, including issues around their high nicotine content, flavorings that are appealing to teens, targeted marketing and dangerous aerosols.

In particular, she pointed out the Lokee Vape products, which she said teens like because they are more affordable than the highly popular Juul brand, while still being just as easy to conceal since they often look like a key fob that can be clipped to a key ring. Further, she said their design is easy to use with THC.

She also reminded the group that Kentucky has the second highest smoking rate for adults in the nation, 25%, adding that they are even higher in the state’s Appalachian region, with rates between 31% and 39%. The national rate is 14 %, according to the CDC.

What can be done?

As for how to decrease smoking and e-cig rates in Kentucky, Dearinger ticked off tried and true tactics: comprehensive smoke-free policies, hard-hitting media campaigns, access to smoking cessation programs and increasing tobacco prices.

“Communities that utilize all of these things have lower rates of smoking than communities that do not,” she said.

She didn’t mention taxes, but they came up in a question-and-answer session, and she said, “It absolutely works. It has been shown to work in other states. It does work.”

And it seems to work in Kentucky, too. The year after the state increased its cigarette tax by 50 cents, to $1.10 per pack, 36 million fewer packs were sold in the state, a drop of about 10%, more than the national drop of 6.1%.

Since the state passed a law to require all Kentucky schools to be tobacco-free by next July 1, unless the district opts out, 148 of the state’s 172 school districts have passed such a policy. Before the new law was passed, only 74 districts had done so.

Dearinger offered kudos to Hazard and Perry County for their recent efforts toward creating a smoke-free community. Perry is the first county in Eastern Kentucky to go smoke-free, and one of only six that have a comprehensive law that includes all workplaces and enclosed public places.

She also spoke about how to decrease teen use of e-cigs.

“When tobacco is expensive, and is not available in every store, and it doesn’t come in kid-friendly flavors, fewer teens will smoke,” she said. “If we have comprehensive smoke-free policies, fewer teens will smoke. If we have countered the marketing and promotion restrictions, fewer teens will smoke. And if we can help teens who want to quit, to quit, they will quit.”

Later, she added, “We need to work together to make this happen . . . so that we don’t have a generation of kids who are addicted to nicotine.”