This is the second episode in a series on Vaping and adolescents. The first was episode 109. If you haven’t listened, I would suggest going back and starting there for some valuable insights for both you and your teens from a young man whose lungs were damaged beyond repair from vaping.

Last week I asked if your teenager vapes. Nicotine or THC or both. You may have said no. But after listening to that episode, I hope you understand that your teen or tween  could be vaping, and you’d never know it unless you ran across a vape they brought home or they told you.

And I hope since then you’ve had an open discussion about vaping with your kids, told them you are not going to be mad, that they will not be punished, and are in a better position to help them if they need it (and we’re going to get to that in a future episode in this series.)

But if you haven’t had that conversation yet, or your teen is not yet convinced that they should stop vaping (or never start), I hope today’s episode will help.

I want to talk to both you and your kids about the very real danger of vaping, what it was that caused Daniel to lose both his lungs, how that particular threat is ongoing and the many other health risks associated with vaping anything. Don’t go anywhere.

This is Speaking of Teens, the podcast that helps parents who are struggling to find peace and connection with their teens. My name is Ann Coleman; I’m an attorney turned parent educator and a mom who has been there - and I’m on a mission to help you build a stronger relationship and decrease the conflict with your kid so you can help them grow into the young adult they’re meant to be.

You know, adolescents don’t feel like they’re invincible – that’s a total myth. They know the risks with most things they do, they can tell you on paper that “yeah, that’s stupid, I wouldn’t do that” – and they totally mean it. The problem is that the way their brain is wired, when they’re with their friends, because of the reward system and the strong need for acceptance and being part of the group and not being odd man out, they will do risky things anyway. It takes a really strong kid, with tons of self-respect and self-esteem and a strong sense of their own values to be the bravest in the crowd – to be the one other kids look to when they want to refuse something.

But they can do this and we’re going to talk about some tools they can use in an upcoming episode. But discussions about values are really important when we’re talking about these risky behaviors.

Additionally, teens don’t necessarily think about their health because they’re healthy. Actually, many of us take our health for granted until something happens, we get sick or injured and then we realize, “oh my gosh, I only have one body and one chance to take care of it and if I don’t, I’m screwed.”

And of course, the older we get the more we realize that. But at 12, 15, 18 years old, it doesn’t enter their mind that you truly have to take care of your body or you can lose functions, lose the opportunity to do what other teenagers do easily. Daniel, for example. He never in a million years thought hitting a vape with his friends could cause him to lose both of his lungs. Who would have ever thought that?

And even seeing that up close wasn’t enough for many of those friends to stop vaping. They have a hard time realizing this could happen to me too – it’s always someone else…until it isn’t.

If you’re a teen or young adult listening, I hope you’ll take this information to heart. I hope you’ll see it as a sign that you either need to ask your parent for help to stop vaping (they will not yell, punish, scold, or get angry – I promise – they just want to help). And if you have never vaped, I hope you take it as a sign to never take a hit off a vape as long as you live.

This is no joke – it’s not just a bunch of adults trying to scare you or treat you like a kid.  This is coming from a place of wanting to make sure you have a full and happy life and that you don’t take chances with the one body you have that has to last you the next 80 years (which by the way, if a freakin’ long time to drag a body around – you know?!)

So, let’s talk about the illness that caused Daniel to undergo such agony and lose the body he once had.

When he got sick in 2019, lots of people were coming down with similar respiratory or lung illnesses that centered around symptoms like shortness of breath, cough, and chest pain. And the more people started showing up in emergency rooms – many of them teenagers – doctors couldn’t figure out what was causing it. So, it was this mystery illness, which has to be reported to the state, and then to the CDC (the Centers for Disease Control) and pretty soon they figured out all of these cases across the US had one thing in common – everyone vaped.

That’s the only common thread that could cause this phenomenon in the lungs making them look totally white and cloudy, where many people had to be put on ventilators or put into induced comas.

They were calling it EVALI, which stands for “e-cigarette, or vaping, product use associated lung injury.”

There’s no specific test for it and no specific clinical guidelines for doctors to determine that’s what it is. But basically, the way the CDC was defining it, in layman’s terms, it’s seeing (stuff in your lungs through an x-ray or a CT scan) that is not supposed to be there, and confirmation that the patient has vaped in the past 90 days and then the ruling out of all other causes for the issue other than the vaping. This definition doesn’t rule in or out any particular chemicals or additives or types of products – it can be from vaping nicotine or THC.

Between the summer of 2019 and February 2020, almost 3,000 people across the US were diagnosed with this disease and 68 died (three quarters of whom were under the age or 34) – Daniel was the only double lung transplant.

For people who did not have as severe a case – perhaps they were only in the hospital for a few days or were even treated and released – it didn’t end there. The damage to their lungs now causes them to get infections often, anything they breath irritates their lungs to the point that they can’t breathe. Many still get out of breath from normal activities – forget running or playing sports. And that will likely never change.

Now – before I tell you about how these cases have actually increased since the CDC stopped recording them back in 2020, let me tell you what they think caused many but not all of these cases and what has and has not been done about it.

Because this issue seemed to crop up so suddenly, and no one could decide why, researchers and the CDC jumped on it fast and started testing people in the hospital and doing autopsies and testing those results against healthy specimens and came to a partial conclusion that something that was added to THC vaping liquid had caused many of the illnesses.

They discovered that vitamin E acetate or VEA had been inhaled into the lungs of most of these patients. This VEA is oily and thick and had stuck to the inside of the lungs and made it so people couldn’t breathe. This same VEA is in a ton of things we ingest or put on our hair or skin – but it’s never been researched or approved by anyone for inhaling!

The experts assumed that the VEA had been used to “cut” or extend the actual vape liquid, so they could use less of the THC and increase profits on the vape – because this VEA cost them less than the THC. Plus, apparently THC oil in it’s natural state is too thick to be vaped so something always has to be added to it – none of which will ever be approved by the FDA, by the way, because the FDA is federal and THC/marijuana, cannabis is against the law at the federal level – so they FDA has nothing to do with it – it's all controlled by state agencies.

So, researchers discovered that most of these folks had at some point recently, vaped THC and that most, but not all, had used a vape that had not come from a legal dispensary – it was a friend’s or they bought it from someone else. But again, some of the vape pens did come from a dispensary and some patients claimed to have not vaped THC at all.

But, as Daniel pointed out in episode 109, these kids are all just “hey, let me hit that vape” and they didn’t purchase it themselves from a store or dispensary, they have no clue what’s in it or whether Kayla’s uncle Johnny made it himself or whether the mango Elf Bar came from a bootlegger in LA or from the factory in China and even if it came from the factory, what the hell is in it. We’re talking the Wild West of slobber swapping vaping who knows what from whom.

So, the bottom line, EVALI seemed to start to decline when the CDC and FDA put out these warnings about VEA and not to be vaping THC at all for a while and especially not from unknown sources. And it was sort of assumed that the actual makers of these vapes got spooked and stopped cutting their vape juice with VEA, which reduced cases.

But again, the CDC never said VEA was the sole cause of EVALI – and because all of this happened and was all over the news right before COVID hit – the CDC stopped tracking cases of EVALI  in February 2020 – they had bigger fish to fry. Again, I’m getting to the new numbers – hang with me, this is important.

Now, let me tell you this too – from what I can tell, only a handful of states “banned” VEA as an additive. Now, that doesn’t mean that they added it to the list of things that the legal cannabis is tested for. It simply means that they made a rule and said – “hey, dispensaries, please make sure the marijuana you sell doesn’t contain VEA – thank you.” There may be a few that now require lab testing for VEA but it’s hard to tell without doing a ton of research that I couldn’t do for this episode – I spent a couple of hours on it and had to give up.

All states where cannabis is legally sold, require lab testing for potency, pesticides, heavy metals, other contaminates like mold. But the states vary as to exactly what they test for. Many labs may now be offering tests for vitamin e but whether it’s actually required or not is a matter of a deep dive into each states regulations.

But Vitamin e acetate aside, EVALI did not suddenly stop being a problem when the CDC stopped tracking cases in 2020.

As a matter of fact, a clinical diagnostic code was implemented for “Vaping-related Disorder” in April 2020 (2 months after the CDC stopped keeping up with the number of illnesses.)

Now, if you don’t know, the international diagnostic code is what medical providers use to categorize illnesses for reporting purposes including to your insurance company for payment. It’s called an ICD-10 number.

The ICD-10 number for Vaping-related Disorder is U07.0 and it’s what medical providers will use if they discover EVALI (used to describe any e-cigarette-related/vaping-related lung damage or injury), or dabbing related lung injury or damage (dabbing is a way to heat up and inhale cannabis) – so vaping or dabbing, whatever the substance – nicotine or THC

So, using this ICD-10 number for vaping-related disorder, my information is that in the last 3 months alone in 2020, there were actually 11,300 cases. In 2021 there were 22,000 and in 2022, there were 31,600 cases.

This is all just in the US. These numbers are from Komodo Heath – a healthcare data analytics company with a comprehensive database of over 330 million US patients including those covered by private insurance and government programs.

Now, Experts are afraid these numbers are just going to keep getting bigger every year because people have just assumed that lung injury is all about VEA. But there are SO many reasons that’s wrong.

An American Thoracic Society Workshop Report from 2022 pointed out that having this one ICD-10 number doesn’t help for tracking any sort of specific lung illness or tracing to see if there’s a specific type of vape product that may be harmful, whether it was THC or nicotine, or which ingredients may be a problem, because you just have one identifying number with all of these vaping injuries lumped together.

Not only that but that same Report points out that there were cases of vaping related acute respiratory syndrome reported prior to the EVALI outbreak that were brought on by vaping THC, but nothing was tested to see if there were additives to the THC. Additionally, there’s an almost endless number of chemicals that could turn up in a vape that could cause breathing problems or lung damage.

But now that the federal government turned this issue back over to the states, there’s just no way to keep up with what’s actually going on, no way to spot case clusters of a certain type, no way to do research across the board, keep up with the after effects of the disease – medical professionals are not even being trained in the issue - it’s just pretty scary.

And as you’ll learn in a future episode, the laws, law enforcement, at the federal or state level, they’re just not protecting people from the chemical cocktails in nicotine vapes and can’t do much about any type of vape cooked up in someone’s basement, if they don’t catch them.

So, I want to dispel the myth that these major lung injuries ended back in 2020 and that as long as there’s no VEA in the mix, everything’s good. That couldn’t be further from the truth. Look at the approximately 65,000 cases that have been recorded by that ICD-10 number since then. There’s much more going on than a vitamin e additive.

Researchers will tell you that trying to figure out specifically what’s going on in all of these different cases is just nearly impossible – there are simply too many variables. There are different types of vapes or delivery systems for one thing: you have the pod systems, the tank systems, disposables, tanks, mods.

And what so many adolescents and possibly parents or adults, seem to not quite understand is that “vapes” are not “vaporizers” and that stuff they’re inhaling is certainly anything but water vapor. Vapor is when something is turned totally into a gas.

But what’s going on in a vape device is that an atomizer (a coil or heating element) is heated up to around 400 degrees Fahrenheit, which then heats up the e-liquid or juice and converts it into tiny airborne liquid droplets that are suspended in a gas – in other words it’s aerosolized. And that’s what goes into your lungs – tiny droplets of chemicals that have been heated to a point that they are actually no longer even the chemical that went into the vape – the heat changes the molecular structure of that juice.

 

So, these e-liquids – they’re going to have 3 different types of chemicals in them; they’ll have the main ingredient (usually nicotine or THC); they’ll have an additive that keeps the liquid, “liquidy” – often this is the PG or VG you may have heard about (propylene glycol or vegetable glycerin) and then you have the flavoring chemicals.

The research conducted when vapes first came on the market (to tell people they were safer than cigarettes) was simply comparing vapes or e-cigarettes (same thing) to regular cigarettes to see if vapes had fewer of the harmful chemical contaminants that were produced from cigarettes – and they did. Here’ a list of the bad stuff that you get when you smoke – how much of that SAME bad stuff comes from vaping? Not a lot. So, vapes had much less of the bad stuff that came from smoking cigarettes. In that sense, yes, they were better for you than smoking a cigarette if you had to choose between the two.

But as we know that doesn’t mean they’re healthy, it simply means as far as those cigarette chemicals are concerned, they have fewer.

But research conducted at Johns Hopkins shows that (nicotine) vape products contain literally thousands of chemicals, that are not in cigarettes.

The researchers tested just the tobacco flavored products to keep it consistent and they tested several different brands. They tested the liquid itself and they tested it after it was heated and aerosolized. They found thousands of unknown chemicals in the liquid, which just multiplied into even more chemical compounds as an aerosol.

Some of the chemicals they could actually identify, included industrial chemicals, a pesticide and potentially toxic flavorings which can cause respiratory irritation.

Something else that concerned them was that they found a particular type of compound that is typically only found during combustion - which is not supposed to be happening in vaping (that’s one of the big selling points.)

Combustion happens when smoking cigarettes – it’s when the tobacco is burned and produces smoke, which happens to be where more than 6,000 harmful chemicals are found.

One of the authors of the study said that with all these unknown chemicals associated with vaping, that no one can possibly know what the health risks are. They added that (quote) “over time, as e-cigarette use continues, experts will gain a better understanding of how vaping affects the lungs.”

Well yes, that makes sense, as more and more kids, teens, and adults get lung diseases, are damaged for life, or lose their lungs or die, they’ll be able to see a pattern, they can conduct more autopsies on their bodies.

Since Danieal had his double lung transplant in 2019, 2 others have been reported due to vaping: a 34-year-old man from Missouri last year - and just over a month ago, a young man from North Dakota.

Back in October 2023, 22-year-old Jackson Allard had some major pain in his stomach so bad that he went to the ER. The ER staff decided he needed to be admitted to the hospital because his oxygen levels had dipped so low.

The doctors diagnosed Jackson, who vaped nicotine daily, with parainfluenza, which is a group of viruses actually, that cause very common respiratory infections like colds, bronchitis and pneumonia – but they generally only cause severe illnesses in the very young, adults over 65 or people with weakened immune systems. Well, you guessed it, he ended up with pneumonia that turned into acute respiratory distress syndrome, which is a deadly build-up of fluid in the lungs, where you have about a 30-50% chance of dying

Jackson, like Daniel was placed on an ECMO device to keep him alive and in early January of 2024, after 70 days on life support, he also received a double lung transplant.

Now, according to the NBC News article, for Jackson to be considered for the transplant, he had to come off sedation and be able to walk and at one point they didn’t that was going to happen – he was given a 1% survival rate. Now my guess is, although they didn’t say it in the article, but he’d been vaping since he was 16 or so and they don’t give smokers/vapers lungs. They give them to people who take care of their bodies and will be most likely to take care of a new set of lungs. I imagine that’s why he had to jump through those hoops.

But, of course, there are several other lung problems caused by certain chemicals in vapes…

One is “popcorn lung” (the official name is bronchiolitis obliterans) – Popcorn lung was first discovered when workers in popcorn factories started getting sick. They figured out that it was the butter-flavoring additive, diacetyl, which is often also added to flavored e-liquid. And inhaling diacetyl can inflame the lungs and cause permanent scarring in the tiny branches of the airways, and it makes breathing really, really difficult. There’s no lasting treatments for this disease– there are only treatments to manage it.

Another lung problem caused by vaping is “vaping-related lipoid pneumonia.” This is what was happening with those patients with the EVALI outbreak – most likely related to VEA added to the THC vapes. So, this isn’t the regular type of pneumonia caused by an infection – this kind is caused from fatty-acids (the stuff that makes up fat – literally) when it gets into the lungs by inhaling these oily substances in e-liquid.

For very mild cases, there’s really not a good treatment other than to stop vaping and let the lungs heal – if they will. And for many cases it’s life support machines like the ECMO, a lung transplant or even death.

And then there’s the possibility of a collapsed lung – and this is kind of crazy. You know you’ve heard of a collapsed lung when someone has a car wreck or maybe stabbed or shot. But with vaping it’s the result of air blisters at the top of the lungs being ruptured.

What happens is that if you experience a growth spurt during adolescence and now you’re tall and thin, you may develop a weak spot – a blister at the top of the lungs. Now, that’s not generally a problem – you won’t even know they’re there unless they rupture. And guess how they can be ruptured? By smoking or vaping. And that rupture then causes the lung to collapse.

Johns Hopkins says they’ve seen a rash of collapsed lungs in young people who vape. You may only need oxygen until it’s healed but sometimes it requires a tube be put directly into the chest to drain leaked oxygen from the body cavity or surgery to repair the hole in the lung.

Then of course there’s cancer. All these chemicals that they haven’t even identified – you have no clue what’s going into your body. Of course, as I said before, it’s going to take years to see what happens so teens are the canary in the coal mine.

Of course, these are not all of the problems vaping can cause. The nicotine alone can cause permanent changes to the structure and function of the adolescent brain. Without going into too much detail, it is extremely easy for the adolescent brain to become addicted to substances (you can go back and listen to episode 4 for more on that), it trains the brain to become more easily addicted to other substances (like cigarettes, for example – studies have shown young adults are 7 times more likely to become smokers if they vape than if they never did), it exacerbates ADHD symptoms, it can increase the intensity of both anxiety and depression, can double the odds of having a depression diagnosis, and can increase stress levels.

 

 

Of course, there are also additional problems caused by vaping THC – some very similar to nicotine. There are increased risks of mental health disorders like anxiety and depression, plus temporary psychosis (imagining things, not knowing what is real and what isn’t), schizophrenia (where people might see or hear things that aren’t there.), addiction, difficulty with the prefrontal cortex executive functions like memory, problem solving, focus. Not to mention all of the related social, legal and family issues it can cause.

And I’m just going to throw this out there – putting your mouth on anything anyone else (not to mention several people) have had their mouth on…ewwww.

The bottom line is, vaping anything is simply not worth the risk to any young person. If someone has never smoked, isn’t trying to quit smoking cigarettes, they shouldn’t start vaping. And frankly, it’s questionable as a mechanism to stop-smoking cigarettes.

Next week I’ll bring you a little bit of a shorter episode on the law and why there are still all these fruity vapes for sale everywhere you look when - aren’t they supposed to be illegal? And I still want to give you as much help as I can on how to help your teen stop vaping if they want that help.

Okay, that’s it for Speaking of Teens today. I really hope you got something out of this episode because frankly, it took me almost 25 solid hours to research it and put it together! But that’s my fault – I get sucked into the abyss so easily – a vaporizer versus an atomizer and a vapor versus an aerosol and how many medical journal articles can one read about the horror that vaping can do to someone’s lungs? Anyway, I hope I didn’t bore you because I thought it was really interesting. And I hope you’ll share it with your teens and have a bit of a discussion about it (no punishment, only help.)

Come join me in the Facebook group and let’s talk about it. The link is at the bottom of the episode description.

Until next time, remember, a little change goes a long way.