ATLANTA — The Centers for Disease Control and Prevention (CDC) has taken a general stance against the use of electronic cigarettes as it announced three deaths in three separate states that appear linked to the use of vaping devices.
At a Sept. 6 press conference, CDC officials gathered medical authorities from three states to discuss initial findings and continuing research into the deaths and related cases of pulmonary and respiratory illnesses allegedly stemming from e-cigarettes and vaping.
“While we don’t have all the answers yet, we are getting clearer about the things we should be looking at to understand the situation,” said Ileana Arias, senior scientific adviser and acting deputy director for noninfectious diseases for Atlanta-based CDC. “The focus of our investigation is narrowing, and that is great news, but we are still faced with complex questions in this outbreak that will take time to answer.”
Arias announced the release of several publications describing some of the cases that have been reported, which include an “interim outbreak case definition” to help healthcare providers and state and local public health departments identify and report confirmed and probable cases as the investigation continues.
Meanwhile, in an unrelated move, the U.S. Food and Drug Administration (FDA) issued a warning letter to San Francisco-based Juul Labs for the e-cigarette manufacturer’s marketing practices, alleging that the company made claims that their product was less harmful than other tobacco products, going against agency regulation.
“Based on our review of the information [released to the agency, the] FDA has determined that Juul adulterated its products … by selling or distributing them as modified-risk tobacco products without an FDA order in effect that permits such sale or distribution,” said the Sept. 9 warning letter addressed to Kevin Burns, CEO of Juul.
The letter said Juul needs to comply with FDA rules or face civil money penalties, seizure of product or an injunction, with a request that the company reply to the warning within 15 days of receipt.
A Juul spokesperson issued this response to CSP Daily News: “We are reviewing the letter and will fully cooperate.”
Regarding the CDC announcement about e-cigarettes in general, Dana Delman, the CDC’s incidence response manager, said the agency is working with multiple state health departments on the matter. “While the investigation is ongoing, CDC has advised that individuals consider not using e-cigarettes because as of now, this is the primary means of preventing this type of severe lung disease,” Delman said. “And of course, e-cigarette use is never safe for youth, young adults or pregnant women.”
Several reports were released Sept. 6 that describe lung illnesses associated with the use of e-cigarette products in more than 60 patients in several states, including North Carolina, Wisconsin and Utah, Delman said. Patients reported similar symptoms and displayed similar clinical presentations and findings, and all reported using e-cigarette products in the 90 days prior to developing symptoms, most within a week or so before symptoms developed.
“Many of these patients reported recent use of THC-containing products, and some reported using both THC- and nicotine-containing products. A smaller group reported using only nicotine products,” Delman said, referring to tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis. “No specific e-cigarette device or substance has been linked to all cases, and e-cigarette include a variety of chemical and additives; consumers may not know what these products contain. Particularly, products obtained from social sources or off the street, it is difficult to know what is contained in these e-cigarette products.”
In discussing some of the investigations, another ingredient, vitamin E emerged. To that point, Delman reiterated, “At this time, no one device, product or substance has been linked to all cases.”
Ultimately, Delman said the CDC, states and other partners are actively investigating, but so far, no definitive cause has been established.
Mitch Zeller, director of the FDA’s Center for Tobacco Products, who was also in attendance at the press conference, said, “With these increasing reports, if you’re thinking of purchasing one of these products off the street, out of the back of a car, out of a trunk, in an alley, or if you’re going to then go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice.”
Both the Illinois attorney general and New York Gov. Andrew Cuomo issued similar statements, advising people from their respective states not to use e-cigarettes.
For its part, Juul issued this statement: “Juul Labs, which exists to help adult smokers switch off of combustible cigarettes, has been monitoring the situation closely. To be clear, the ingredients of our products do not include THC, any compound derived from cannabis, or vitamin E compounds like those found in THC products. We appreciate the work of the CDC, FDA and other public health authorities and are confident that they will get to the bottom of this issue.”
Officials with Washington-based Vapor Technology Association said public health departments should fully investigate and release all information about these cases. “Either there’s a legitimate basis to tell people to stop using e-cigarettes or they are feeding the hysteria around a different product to conflate the issues by failing to distinguish e-cigarettes,” said Tony Abboud, executive director of the VTA. “[We] applauds FDA's statement clearly advising consumers to avoid THC-containing vapor products. Even former FDA Commissioner Scott Gottlieb, no friend to the vapor industry, has assigned blame to illegal vapor products containing THC and cannabis. By contrast, CDC’s fear-mongering statement is misguided and will only cause further harm to overall public health.”