Many people, including health professionals, have assumed that e-cigarettes are safer than traditional cigarettes because they use heated liquid vapor (hence the term “vaping”) rather than burning tobacco leaves in a process that has been proved to be carcinogenic. But “safer” doesn’t mean “risk-free.” A troubling increase of acute lung disease among e-cigarette users across 25 states is making the sobering point that there is still a lot we don’t know about the health implications of vaping.

And it seems we are doomed to learn the hard way. Last week, the Centers for Disease Control and Prevention took the unusual step of warning the public to avoid using any electronic cigarette device until the agency concludes a multistate investigation into the mysterious lung ailment and figures out what is causing it. The CDC launched the investigation in mid-August after receiving more than 150 reports of serious respiratory distress among e-cigarette users, many of them adolescents and young adults. Within a couple of weeks, dozens more cases were reported, including the death of one e-cigarette user in Illinois. On Tuesday, health officials in Stanislaus County reported two new cases.

Ultimately, it may turn out that the outbreak of lung disease is caused by the unsanctioned use of cannabis or hash oil in altered or modified e-cigarette devices; many of those interviewed by public health officials so far acknowledged using electronic cigarettes to inhale cannabinoid products such as THC or CBD. If that is in fact what is causing the respiratory problems, then it will be clearer to users what they have to do to protect themselves.

But even so, such a finding would not mean that users of commercial nicotine e-cigarettes can, uh, breathe easier. There are some pretty unpleasant things floating in that liquid nicotine: flavorings, solvents and toxins that may or may not be harmful to our health. One chemical found in liquid nicotine is diacetyl, a flavoring that gives microwave popcorn a buttery taste. It is also associated with “popcorn lung,” a nasty condition that has afflicted workers at factories that process microwave popcorn and has similar symptoms to this new mystery ailment. Nicotine itself is an addictive chemical linked to cardiovascular disease.

For longtime smokers of Marlboros or Camels who are trying to quit, the danger of lung cancer may well outweigh the potential dangers of vaping. But there’s always some risk involved to inhaling chemicals, and if there’s any good to come out of this lung disease outbreak, perhaps it will be to bring that lesson home to teens and young adults considering taking up the e-cigarette habit.

Editorial by the Los Angeles Times

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