Maryland state legislators have moved toward banning flavored vaping products, such as those that smell and taste like fruit or candy, and they cite the increased number of e-cigarette, or vaping, product use-associated lung injury (EVALI) cases as evidence that vaping among youth must be stopped. But the current best evidence, released Friday by the CDC, continues to indicate that the strongest risk factors for lung injury are a) vaping pre-filled cartridges b) containing cannabis derivatives like tetrahydrocannabinol (THC), which are c) obtained from an illicit or informal source.

Effective public policy must be built on the best empirical research available to us at the time. Our legislators should be expected to educate themselves using publicly available information on the vaping injury outbreak, rather than spread panic to vilify e-cigarettes and associated legal products. The same could be said for news media who fail to include context and data in their reports.


To be fair, there is some truth to what state legislators like Del. Dereck Davis, who is drafting a bill that would ban flavored vaping product in Maryland, claim. Companies producing tobacco vaping products have been allowed to shamelessly market to adolescents and young adults, and government regulators have failed to act. As a result, a generation of children once driven away from cigarettes by some of the most successful public health campaigns in our nation’s history have been turned back to nicotine. The e-cigarette regulatory vacuum has been allowed exist for too long and must be closed.

Eric Bowersox, manager of the Vape Dojo store in downtown Bel Air, encourages people who vape to look for warning labels, such as those on the bottle shown here, to ensure they are using safe products.
Eric Bowersox, manager of the Vape Dojo store in downtown Bel Air, encourages people who vape to look for warning labels, such as those on the bottle shown here, to ensure they are using safe products. (David Anderson/The Aegis / Baltimore Sun Media Group)

But even in the face of an acute vaping-related health crisis, the evidence is still clear that the economic, medical, social, and human costs of long-term and widespread cigarette use far exceed that of vaping a nicotine distillate. We cannot delude ourselves into believing that banning flavored e-cigarettes is in any way an effective remedy for preventing vaping-related lung injury due to the consumption of by-products in illicit THC distillates. (Importantly, right now there have been no deaths or illnesses connected to Maryland’s medical cannabis program, according to the Maryland Medical Cannabis Commission).

On Friday, the Centers for Disease Control published results of an analysis of lung fluid samples from 29 people hospitalized for EVALI; every sample contained vitamin E acetate. This evidence indicates that vitamin E acetate is a likely adulterant in some illicit vaping fluid and causes significant lung damage when inhaled. The CDC earlier reported that most of those who became ill with EVALI (86%) self-reported vaping THC.

“These findings provide direct evidence of vitamin E acetate at the primary site of injury among EVALI patients ... reinforce CDC’s recommendation that persons should not use e-cigarette, or vaping, products containing THC, especially those obtained from informal sources such as friends or family, or those from the illicit market, where product ingredients are unknown or can be highly variable,” researchers wrote.

Unregulated products sometimes end up in the hands of folks who simply wish to maximize their own profit. To do so, they might mix a THC distillate with a solvent like vitamin E acetate to “stretch” the amount of psychoactive product across a greater volume. Some of these solvents are safe for our delicate lung issue, some are not. If you have any doubts about the source of your THC product, particularly those distillates sold in pre-filled cartridges, stop vaping. If you begin to have symptoms of lung injury, including shortness of breath, talk to a doctor and prioritize describing your symptoms if you’re not comfortable sharing details of your cannabis use.

Most importantly, those officials who we trust to evaluate evidence and draft informed policy must actually seek out the truth from the experts. All the evidence to date clearly demonstrates that the Maryland legislators’ current rhetoric is just smoke and mirrors.

Alexandra Devenport (alexandradevenport@gmail.com) ) recently graduated from the Johns Hopkins Bloomberg School of Public Health with a Master of Science in Public Health.