Study Finds Rates of E-Cigarettes, Marijuana Use Not Associated With Vaping-Related Lung Injuries

The results showed higher rates of vaping and marijuana use are associated with fewer EVALI cases per capita.

A new study from the Yale School of Public Health has found that higher rates of e-cigarette and marijuana use did not result in more e-cigarette or vaping-related lung injuries (EVALI) in the United States.

The study estimated the relationship between states’ total reported EVALI cases per capita as of January 2020, and pre-outbreak rates of adult vaping and marijuana use. The results showed higher rates of vaping and marijuana use are associated with fewer EVALI cases per capita.

“If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviors should show a higher EVALI prevalence,” said assistant professor and study author Abigail Friedman in a press release. “This study finds the opposite result. Alongside geographic clusters of high EVALI prevalence states, these findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”

The CDC started a cross-state investigation into vaping-related lung injuries in August 2019, which confirmed more than 2800 cases and 68 deaths. In February 2020, the CDC concluded its national updates and officially classified vitamin E acetate, the additive linked to EVALI and common THC e-liquids, as the “primary cause of EVALI.”

Since the EVALI outbreak, a variety of state and federal legislative actions were passed to restrict sales of nicotine e-cigarettes, including a temporary ban on all e-cigarette sales in Massachusetts in late-2019 and bans on flavored e-cigarette sales in several states and localities, according to the study. The researchers suggest that those policies may have targeted the wrong behavior if the goal was to reduce EVALI risks.

According to Friedman, a negative relationship between EVALI prevalence and rates of pre-outbreak vaping and marijuana use suggests that well-established markets may have crowded-out the use of riskier, informally sourced e-liquids.

The 5 earliest states to legalize recreational marijuana (Alaska, California, Colorado, Oregon, and Washington) all had less than 1 EVALI case per 100,000 residents from 12 to 64 years of age. However, none of the highest EVALI-prevalence states (Utah, North Dakota, Minnesota, Delaware, Indiana) allowed recreational marijuana use.

“If this policy led some recreational marijuana smokers to switch to vaping THC, perhaps in order to avoid detection, it would have increased their likelihood of exposure to contaminated e-liquids when those came on the market. This may have contributed to the higher EVALI prevalence in those states,” said Friedman in a press release.

It may be crucial for policymakers to consider the potential unintended consequences of policies that forbid smokable marijuana while allowing THC e-liquids going forward.

Rates of e-cigarette and marijuana use not associated with larger outbreaks of vaping-related lung injuries, YSPH study finds. Yale School of Public Health. Published August 25, 2020. Accessed August 26, 2020.

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