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Lung injuries not linked to higher rates of vaping, cannabis use – Yale

Higher rates of e-cigarette and marijuana use in states in America did not result in more e-cigarette or vaping-related lung injuries – known as EVALI – according to a study from the Yale School of Public Health published in the journal Addiction.

This research from an Ivy League university hammers yet another nail in the coffin of scare stories over the past year about vaping causing lung damage, writes MedicalBrief. Action was taken against vaping products across the United States based on the lung injuries controversy, even though early on it was clear that the problem was related to illegal or homemade cannabis vaping rather than to legitimate vaping products.

The Yale report continues: The study estimates the relationship between states’ total reported EVALI cases per capita as of January 2020, and pre-outbreak rates of adult vaping and marijuana use. Results show that 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 behaviours should show a higher EVALI prevalence,” said Assistant Professor Abigail Friedman, the study’s author, in a Yale article published on 25 August 2020.

“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.”

CDC study of vaping-related lung injuries

The Centers for Disease Control and Prevention began a cross-state investigation into vaping-related lung injuries in August 2019, and has since confirmed more than 2,800 cases and 68 deaths.

In February 2020, the CDC concluded its national updates, and officially classified vitamin E acetate, an additive long linked to EVALI and most common in THC e-liquids that are informally-sourced – that is, purchased off the street or home-mixed – as “a primary cause of EVALI”.

The EVALI outbreak has motivated a variety of state and federal legislation to restrict sales of nicotine e-cigarettes, including a temporary ban on all e-cigarette sales in Massachusetts in late-2019 and bans on flavoured e-cigarette sales in several states and localities.

However, if the goal was to reduce EVALI risks, the study suggests that those policies may have targeted the wrong behaviour.

Fewer risky e-liquids in well established markets

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

Indeed, the five earliest states to legalise recreational marijuana – Alaska, California, Colorado, Oregon and Washington – all had less than one EVALI case per 100,000 residents aged 12 to 64. None of the highest EVALI-prevalence states – Utah, North Dakota, Minnesota, Delaware and Indiana – allowed recreational marijuana use.

Interestingly, Friedman notes that two of the highest-prevalence states’ medical marijuana laws forbid smokable marijuana.

“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.”

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

 

Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States

Addiction journal. Published on 25 August 2020.

Author

Abigail S Friedman

Abstract

Background and Aims

Responses to the 2019 US outbreak of ‘e‐cigarette or vaping product use‐associated lung injury’ (EVALI) ranged from temporary restrictions on nicotine e‐cigarette sales to critiques of state cannabis policies. Yet, if either mass‐marketed nicotine e‐cigarettes or cannabis use per se drove this outbreak, as opposed to an additive in regionally available black market e‐liquids, states’ rates of vaping and/or cannabis use should predict their EVALI prevalence. This study tests that relationship.

Design

Observational study of EVALI data from US states’ health departments

Setting and participants

United States. All US states (N=50)

Measurements

The outcome of interest was each state’s total EVALI cases per 12‐64‐year‐old resident—an age‐group covering most EVALI patients—as reported in the second week of January 2020. Predictors are 2017‐2018 rates of adult e‐cigarette use and past‐month cannabis use, by state.

Findings

The average state EVALI prevalence was 1.4 cases per 100,000 12‐64‐year‐olds. Maps suggest a high‐prevalence cluster comprising seven contiguous states in the northern Midwest. EVALI cases per capita were negatively associated with rates of vaping and past‐month cannabis use, with the preferred specification’s coefficients at ‐0.239 (95% Confidence Interval [CI]: ‐0.441, ‐0.037; P=0.02) and ‐0.086 (95% CI: ‐0.141, ‐0.031; P=0.003), respectively. Robustness checks supported the finding.

Conclusions

In the US, states with higher rates of e‐cigarette and cannabis use prior to the 2019 ‘e‐cigarette or vaping product use‐associated lung injury’ (EVALI) outbreak had lower EVALI prevalence. These results suggest that EVALI cases did not arise from e‐cigarette or cannabis use per se, but rather from locally distributed e‐liquids or additives most prevalent in the affected areas.

 

[link url="https://publichealth.yale.edu/news-article/26879/"]Rates of E-cigarette and Marijuana Use Not Associated With Larger Outbreaks of Vaping-Related Lung Injuries, YSPH Study Finds[/link]

 

[link url="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15235"]Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States[/link]

 

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