With the CDC reporting 26 confirmed vaping-related deaths and over 1,000 cases of vape-related lung injury, vaping has recently commanded the attention of public health experts, scientists, politicians, and consumers alike.
These stats have come as a shock, as most of the public was previously unaware of how quickly the habit could turn dangerous or deadly.
Such tragedies have brought attention to the other potentially detrimental health effects of vaping, and elicited conversation about the vape industry’s targeted marketing of flavored vaping to young people, putting the vaping industry under fire.
But it seems public — and expert — opinion on vaping is mixed. Some argue that vaping can be an effective means of harm reduction for current cigarette smokers.
So that leaves consumers, understandably confused: Is vaping safe? Is it safe for sober folks and those looking to quit smoking? Is it safe for anybody? Here’s what we know so far.
So, how safe is vaping exactly?
Let’s first talk about the known risks of vaping: The FDA has been warning consumers for years that e-cigarettes are not safe.
While it’s tempting to proclaim them a “cleaner” alternative to cigarettes, emerging data show that e-cigarettes, even though their smoke may not produce an odor as obvious as cigarettes, are not without risk.
While toxin composition varies brand to brand, smoke from vaping devices has been found to contain a variety of concerning chemicals, including ethanol (yes, like what’s in alcohol), hydrocarbons, and formaldehyde.
The FDA has been warning consumers for years that e-cigarettes are not safe.
Vaping may also expose users to heavy metals. Researchers have found that e-cigarettes devices can deliver potentially carcinogenic metals and toxins to the lungs and other organs, including the brain, which may lead to serious health risks. Nickel and benzene, for example, both of which are known carcinogens, have been found in e-cigarette smoke. Lead, a neurotoxin, has been found, as well.
And while we’re clearing the air on e-cigarette risks, it seems appropriate to mention that e-cigarettes have been shown to negatively impact indoor air quality, emitting volatile organic compounds (VOCs) polycyclic aromatic hydrocarbons (PAHs), carbonyls, and ultrafine particles, all of which may pose health risks to primary users as well as those who inhale vape smoke secondhand.
A growing body of research also suggests vaping may damage DNA, increasing cancer risks.
All of this is in addition to the recent slew of vaping-related deaths and lung injuries, most of which have been tied to counterfeit THC vape liquids.
But is vaping good for harm reduction?
While risks pervade, many current smokers and some public health professionals believe that e-cigarette use may be a useful means of harm reduction, helping adults break their addiction to tobacco cigarettes.
Advocates say replacing cigarettes with e-cigarettes, which allow users to engage in similar mechanical and ritualistic behaviors while not actually using tobacco products, may make the transition from cigarettes to smoke-free a bit easier.
One person I interviewed stated they started vaping as a way to wean off cigarettes after a multi-decade addiction to nicotine.
Interestingly, this user reports using it for the behavior component of smoking addiction, not for the physical: “I never really got addicted to vaping. I preferred cigarettes so [I] went back to those. Eventually, [I] used Chantix to quit [and] used zero nicotine cartridges in vaping to work on the habit of going out to puff on a cigarette. In that respect, vaping helped but I had already dealt with the physical addiction using Chantix. I no longer craved nicotine but missed puffing on a cigarette. It was not hard for me to stop vaping.”
Few studies have assessed using nicotine-free vaping in combination with other cigarette quitting methods, and thus it’s hard to say how my first interviewee’s experience fits in the large picture.
So while it’s unclear if this method is how most who use vaping to quit cigarettes go about it, scientific data on using vaping as a primary means of harm reduction is mixed.
Scientific data on using vaping as a primary means of harm reduction is mixed.
A study published in 2018 showed that e-cigarette users were 3 times more likely than never e-cigarette users to quit smoking. And some mathematical model analyses have suggested replacing cigarettes with e-cigarettes could avert millions of premature deaths per year.
Furthermore, some advocates believe that decreasing the number of adults who smoke will subsequently decrease the child population who begins smoking, yielding a net benefit for present and future generations.
However, some long term studies show e-cigarette use by smokers is not followed by greater rates of quitting or cigarette consumption at one-year follow-up, meaning many smokers went back to cigarettes or never fully dropped them.
Additionally, some public health experts have expressed concern that e-cigarettes may be more addictive than other smoking cessation techniques, such as the use of prescription medication or nicotine gum.
Indeed, a different subject I interviewed who struggled with nicotine addiction found vaping actually enabled their addiction:
“I can honestly say that addiction is something I have struggled with… for several years. The nicotine addiction enhanced greatly as a result of switching to a vape because of how easy [and] accessible it was to use literally everywhere I went… I believe that vaping is addictive because it makes being a smoker ‘easier’ in a sense and not smelling like cigarette smoke on a consistent basis… I was under the impression that vape was a ‘better’ alternative, which is not the opinion I hold anymore.”
This interviewee returned to cigarettes after the recent vaping deaths. “I do not believe vaping can be a part of a sober lifestyle,” they said.
“I think the idea that we have to be perfect human beings who can’t check out or numb or use anything addictive is harmful to recovery, especially to those who believe in harm reduction.”
But not everyone feels this way. There are those in recovery who would, in fact, consider vaping part of their overall sober lifestyle.
“I think the idea that we have to be perfect human beings who can’t check out or numb or use anything addictive is harmful to recovery, especially to those who believe in harm reduction,” says Lara Frazier, an addiction educator and advocate. “I overcame an addiction to amphetamines, benzos, and opiates that nearly killed me. I quit smoking cigarettes over four years ago. Research from the U.K. indicates that vaping is 94% less harmful than smoking cigarettes.”
There is a long tradition of shaming people in recovery for carving their own path — but that’s neither fair nor anybody’s business, according to Frazier.
“I believe we should all be the makers of our own recovery and ignore the criticism that comes from people who believe that people in recovery should never use anything addictive,” Frazier adds. “Yes, nicotine is addictive and it can be harmful, but it certainly doesn’t do the things that drugs made me do. There is this incessant voice from others that critiques people for their choices. I stick to my own paper and I allow others to move through recovery in their own way.”
What about vaping that targets teens?
Many vaping companies have come under fire for offering flavored vaping cartridges and marketing them heavily towards teenagers. And, it’s worked. An estimated 3.62 million middle and high schoolers considered themselves current e-cigarette users in 2018.
“I got into vaping when I was 19 and I’m 22 now,” said one person who spoke with me anonymously. “I decided to [vape] since I was smoking cigarettes and the juul had no smell and had a stronger head rush… I am trying to wean off with nicotine but nothing is more satisfying than vaping… It’s extremely addictive. I was extremely shocked due to all the news happening right now.”
A 2013-2014 survey found 81% of youth e-cigarette users cited the availability of appealing flavors as their primary reason for use.
The e-cigarette industry’s use of palatable flavors and creative advertisements to intentionally target young people is perhaps one of its greatest dangers, enticing potential lifetime customers by igniting addiction at an early age.
And while flavored e-cigarette flavors are starting to be banned in many places to curb this effect, many of the same places do not have similar bans on flavored tobacco products. For teens looking for a flavored smoking experience, swapping to flavored tobacco cigarettes after a flavored e-cigarette ban is not unfeasible.
Some have also expressed concern that nicotine, found in both cigarettes and most vaping devices, may act as a gateway to cigarettes and other potentially addictive substances.
Ultimately, there’s still much we still don’t know.
The vaping market is a relatively new one and, as products evolve, scientists are challenged to develop new ways to assess their risks. And so far, they’re doing an impressive job keeping up.
Still, since the market is so new, little is known about the potential risks of long-term use.
This alone is concerning, especially considering there is evidence to suggest e-cigarettes are indeed harmful in the short term.
Part of the massive coverage, I think, of these vaping deaths, in particular, is the sudden nature of the death (versus cigarettes, which kill people slowly — more than 8 million people annually worldwide).
There has also been a lot of media coverage surrounding the recent vaping deaths. Part of the massive coverage, I think, of these vaping deaths, in particular, is the sudden nature of the death (versus cigarettes, which kill people slowly — more than 8 million people annually worldwide, according to the World Health Organization).
“I think the media has been ridiculous in their coverage of vaping as they failed to mention that the majority of the deaths and sickness have from black market THC cartridges,” Frazier says. “This is typical drug hysteria which just causes more harm than good. The media wants to paint all vaping in a negative light, which will only cause more harm if vaping is prohibited. People will return to smoking cigarettes and/or make their own black market liquid or products.”
Also, I think because vaping was previously seen as a somewhat “safe” alternative to cigarettes (whereas most people already know about how dangerous cigarettes are), these stories carry some new shock value to those who still carried the impression that vaping was safe.
That said, I think the rapid policy response for eliminating vaping versus cigarettes is very telling of the impact of the industry in public health policy.
The tobacco industry is a powerful monetary and thus, political force. Sadly, this happens a lot in an industry with things like big soda, alcohol, and other industries unhelpful to human health. Even by funding research that casts a shadow of doubt onto science, they can lead the public to believe maybe their products aren’t so bad after all, while lining politicians’ pockets with money to produce favorable policies.
Frazier agrees, adding: “I do believe vaping should be regulated but to threaten a ban on vaping and not a ban on cigarettes seems to be a play from big tobacco. I don’t think we should ban anything. We should be made aware of potential health hazards and the industry should be better regulated, but we shouldn’t be given half-truths to move political agendas forward.”
So, is vaping safe for sober folks? Is it safe for anybody?
As a public health scientist-in-training, I do my best to provide as much educational information needed for people to understand and assess health risks in their own lives.
But if you want my opinion on the subject, when vaping companies may claim they care about their customers, and that they want to keep teens away from their products, I don’t believe them.
With adult cigarette use at an all-time low, it seems convenient that a new market emerged, ready and targeted to profit off 1) young people by getting them addicted and thereby creating lifelong customers, making money at the expense of people’s health and lives, and 2) vulnerable individuals looking to quit smoking by marketing their products as a somehow “safer” or “cleaner” alternative to cigarettes.
I believe if vaping manufacturers really cared about the health of consumers, well, let’s just say, I can think of many preferable ways by which they could improve population health than by creating a potentially addictive product market, and expending little time or resources assessing their safety.
When vaping companies may claim they care about their customers, and that they want to keep teens away from their products, I don’t believe them.
And while I’ve known a select few individuals claim vaping helped them stamp out cigarettes, given the recent risks associated with counterfeit cartridges and the availability of alternative quitting methods, they wouldn’t be my first suggestion over other smoking cessation options for someone trying to release their lives of addiction.
After all, as illuminated by my second interview, cross-smokers run a risk of trading one addiction for another, and the growing body of scientific literature on the health risks of vaping is too much to ignore.
I’m not a physician or addiction counselor, so I don’t feel qualified to make recommendations about what is the best method for individuals to quit cigarettes or other addictive behaviors.
That said, I would urge anyone considering using e-cigarettes as a gateway to quitting cigarettes to speak with their doctor or mental health care provider before picking up a vaping device. And for anyone not currently smoking cigarettes or e-cigarettes, I’d strongly advise you to clear the air and stay smoke-free.