As U.S. health officials and lawmakers continue to sound the alarm about vaping-related illnesses, Baltimore-area vape shop owners say their businesses have suffered, and they blame what they say is misinformation.
For Mike Becker and Lisa Barkhorn, owners of B&B’s Vape Café in Parkville, selling e-cigarette and coffee products is a second job. In the past five or six months, Becker said business has dropped by at least 20% to 25%.
“When the fear mongering started,” Becker said.
Reports of vaping-related illnesses began over the summer and quickly proliferated, leading the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and state health agencies to issue warnings about vaping devices. Cases have been identified now in 49 states.
The American Vaping Association maintains e-cigarettes are a healthier alternative for tobacco users looking to wean off smoking tobacco products. E-cigarettes were introduced in the United States around 2006 and have grown subsequently in popularity, according to the Consumer Advocates for Smoke Free Alternatives Association.
The long-term bodily effects of vaping are not known, however, and "the arguments [vape advocates] make about safety have never been validated,” said Dr. Panagis Galiatsatos, a lung specialist with John Hopkins Medicine and director of the tobacco treatment clinic at Johns Hopkins Bayview Medical Center.
People assume that because e-cigarettes have less toxins than combustible tobacco products, the product is safer; but “it’s more the quality of the toxin than the quantity,” said Galiatsatos, who currently treats 25 patients experiencing either e-cigarette addiction or negative pulmonary effects from vaping, like worsened asthma.
The true health impacts of vaping won’t be known for years, Galiatsatos said.
Symptoms of vaping-related illness include shortness of breath, pain on breathing, chest pain, wheezing, coughing and coughing up blood, according to the state health department. The CDC dubbed the illness officially e-cigarette, or vaping, product use–associated lung injury, or EVALI.
State health officials say illicit cannabis-derived products in pre-filled cartridges are the strongest factor to date in the lung injuries, according to Maureen Regan, a Maryland Department of Health spokeswoman.
Government investigations also have linked the lung injuries to Vitamin E acetate, an additive found in bootleg vape cartridges containing tetrahydrocannabinol, or THC, a psychoactive component of the cannabis plant, or cannabinoid oil, another cannabis extract.
The acetate has not been found in nicotine-containing liquids, according to a CDC study released in October.
As of Oct. 29, the CDC reported 1,888 cases of EVALI, and most of those patients described a history of using products containing THC.
In Maryland, 43 cases of EVALI had been reported as of Oct. 30, and “people who became ill reported using a range of products, including both cannabis-derived products … and nicotine-containing products,” Regan wrote in an email.
None of those with lung injuries reported exclusively using a product from a licensed Maryland medical cannabis dispensary, Regan said.
“A definitive cause is not yet known, however — and some people who became sick do not report vaping THC or CBD,” she wrote.
The problem for vape shop owners is that federal health officials and news outlets conflated the FDA-approved cartridges sold in legitimate vape shops with black market products, said Elmer Bailey, owner of The Vapor Emporium in New Market, Md.
The resulting “public confusion” over what’s being described as a “mysterious” illness linked to vaping is hitting vape shops hard, Bailey said.
“We’re being killed,” he said. “It’s putting us out of business, it’s putting people back on cigarettes.”
Ask any proprietor of a Maryland vape store, Bailey said, “and they’ll tell you business is down 30%, 40%, 50%.”
Matthew Milby, vice president of the Maryland Vapor Alliance, said many public health officials are not doing their "due diligence” to address the lung injuries by hesitating to pin the blame wholly on black market products. They’re “doing a disservice to public health” at the expense of small businesses, he said.
Black market THC and CBD-containing products are imported from some Asian countries and also can be made by individuals who purchase cheaper ingredients online, said Bob Large, owner of Quality Vapor Source in Taneytown, Md.
Legitimate vape retailers buy vape and e-cigarette products registered with the FDA, Bailey said.
Those products are mostly water-soluble, contain nicotine and are made with propylene glycol and vegetable glycerin, Large said.
The Vitamin E acetate additive is “unique to the [illicit] THC market,” Large said. “If research found [e-cigarettes were] really hurting people … I would have shut the doors. I don’t work to contribute to hurting people.”
Large said he’s noticed an unprecedented drop in business over the past six weeks in his 7-year-old shop. The “negative media attention” is one contributing factor, he said, but if the Maryland legislature passes a bill to ban flavored vaping products, he doesn’t think any vape shop will be left in business.
The state bill may be moot anyway, if President Donald Trump follows through on a potential nationwide ban of flavored vape liquids. Other states have banned flavored e-liquids temporarily despite legal opposition.
The Maryland bill, still being drafted, aims to address vaping among youths, with proponents suspecting teens are drawn to the fruity e-liquid flavors.
A ban won’t curb the use of vaping products, Bailey said; it will only contribute to a larger black market, and “it would be devastating” to vape shops.
“It’s ridiculous to say adults don’t like flavors,” said Bailey, adding that flavor is a deterrent to tobacco smoking.
Vape business owners say it’s still unclear what cartridges a flavor ban would permit, but they suspect it might only allow for tobacco and menthol flavors. Last week, Juul Labs announced it would halt sales of mint-flavored e-cigarettes.
B&B Vape Café's Barkhorn began vaping to quit cigarettes, after smoking “probably a pack, a pack and a half a day” for 38 years, she said.
If the only e-liquid flavors available are tobacco or menthol, “it’s not going to help someone stay off of cigarettes,” and it’s not going to deter teen users, she said. “Trust me, the kids aren’t doing it for the flavor.”
At the Parkville shop, 95% of customers buy the flavored products, said Becker, Barkhorn’s business partner.
“If that flavor ban goes through, it’ll destroy all the shops,” he said. “There won’t be one vape shop open.”
Baltimore Sun Media reporter Cody Boteler contributed to this article.