The use of e-cigarettes, originally marketed as a safe alternative to cigarettes, has exploded into a full-blown health crisis, due to high levels of nicotine and other ingredients with risks that aren’t fully understood yet, a panel of health-care experts said Thursday.
“I think we’ve got an acute crisis,” said Paul Halverson, dean of the Fairbanks School of Public Health at IUPUI. “We need to face the fact we believe there’s a strong correlation between people who vape and an increase in tobacco. So what started out as an idea of being an alternative is actually a gateway, especially for our kids.”
Halverson and others made their comments at IBJ’s Health Care & Benefits Power Breakfast, which took place Thursday morning at the JW Marriott downtown.
Earlier this month, the Indiana State Department of Health reported the first death of an Indiana resident due to severe lung injury linked to “vaping,” or e-cigarette use. Health officials are investigating 30 cases of severe lung injury linked to vaping. Eight of those have been confirmed—most of them among individuals between the ages of 16 and 29.
Another panelist, Dr. Mary Ian McAteer, an Indianapolis pediatrician, said she has seen patients in their early teens who have been vaping. She said she is concerned by the growing use, because the e-cigarettes often contain dangerous chemicals such as tetrahydrocannabinol, or THC, and cannabidiol, or CBD.
“And the THC concentration can become quite hot,” McAteer said. “The volatile organic chemicals that help create the nice buzz that people like are carcinogenic and they also create lipoid pneumonia, so they get deposited into the membranes of the lungs. And that can cause serious problems.”
An Indiana survey last year found that vaping has increased 387% among high school students and 358% among middle school students since 2012. Nearly 35,000 additional Indiana students began vaping between 2016 and 2018, the state said.
Robin Newhouse, dean of the Indiana University School of Nursing, said the some of the health effects of vaping are still unknown—and could take years to play out. She pointed out the active ingredient in e-cigarettes is nicotine, which is highly addictive. Other ingredients aren’t fully understood yet, she said.
“We don’t even know what that molecule does when inhaled,” she said. “We have decades of adverse effects we could be seeing over the next 40 or 50 years for these children who are vaping.”
Stan Jackson, chief innovation officer for Apex Benefits, said people who vape are winding up in hospitals, sometimes for weeks in critical-care units. That’s going to lead to huge treatments costs, which others could feel.
“That’s going to show up in everybody’s claims data and certainly a very, very severe case of a young person is going to potentially be a high catastrophic claim,” he said.
David Blish, director of health-care consulting for Katz, Sapper & Miller, said vaping-related illnesses and injuries have taken doctors and hospitals by storm, and many are still trying to figure out how to treat severe respiratory diseases linked to e-cigarettes.
“We’re seeing health-care providers struggling to understand and manage this issue and adapt their practices to recognizing it,” he said.
And respiratory problems are likely only the first symptoms of vaping, said Jonathan Nalli, CEO of St. Vincent, an Indianapolis-based health system with 26 hospitals across the state,
“We’re going to see increased issues come about in our outpatient practices as well as within the hospital environment over the next 30, 40, 50 years because of this,” he said.
A related health issue, cigarette smoking, continues to bedevil Indiana, which has one of the highest smoking rates in the nation, Halverson said. In recent years, the Indiana General Assembly has declined to pass any legislation designed to curb smoking, such as raising state taxes on cigarettes, increasing the legal age of buying cigarettes to 21, or repealing the so-called “smoker’s bill of rights.” He said he hopes the General Assembly will finally address the issue in the next year or so.
“I think we haven’t fully made our case,” Halverson said. “The reality is that smoking is the leading cause of preventable deaths in our state. … If you look at what causes our increase in cancer and cardiovascular disease, it’s tobacco use.”