Vape, e-cigarettes, Juul, even cannabis—no matter what you're smoking, the news isn't good.

By Dominique Michelle Astorino
November 13, 2019
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"Vaping" is perhaps the most notorious word in our cultural vocabulary at the moment. Few habits and trends have taken off with such explosive force (to the point where we now have verbs created around brands of e-cigarettes) and to the point where medical professionals are deeming its rise a health crisis. But the dangers of vaping haven't seemed to deter JUUL-toting celebrities or American adolescents. Teens are using nicotine products at a rate we haven't seen in decades, with nearly half of high schoolers having vaped in the past year.

Nazir Azhari Bin Mohd Anis / EyeEm/Getty Images

This digitized-form of cigarette smoking is touted as a "healthier" alternative to smoking, with ads insinuating that vaping is safe. But there is a bevy of health risks that come alongside this addictive habit—including death. The Centers for Disease Control and Prevention (CDC) is calling it an "unprecedented outbreak." There have been 39 confirmed vaping-related deaths with over 2,000 reported illnesses. Let's get into the details.

What Is Vaping?

Vaping is the use of an electronic cigarette, sometimes called an e-cigarette, e-cig, vape pen, or JUUL. The Center on Addiction describes it as "the act of inhaling and exhaling aerosol, often referred to as vapor," in the way that one would inhale tobacco smoke. (More here: What Is Juul and Is It Any Better Than Smoking?)

These battery-powered devices heat a liquid (which is sometimes flavored, and contains nicotine and chemicals) to upward of 400 degrees; once that liquid becomes vapor, the user inhales and the drug and chemicals are dispersed into the lungs where they're rapidly absorbed into the bloodstream. As with any nicotine high, some people describe feeling buzzy and lightheaded, others feel calm yet focused. Mood-altering nicotine can be a sedative or stimulant, depending on the dose, according to the University of Toronto's Centre for Addiction and Mental Health.

"One of the main factors in why people vape is for the nicotine chemical and the high contents of nicotine in the vapor," says Bruce Santiago, L.M.H.C., mental health counselor and clinical director of Niznik Behavioral Health. "But research has shown that nicotine is highly addictive." (Even more worrisome: People don't even realize that the e-cigs or vape they're smoking contains nicotine.)

Not all vapes contain nicotine, though. "Some products may market themselves as nicotine-free," said Santiago. "These e-cigarettes still expose the individual to disease-causing toxins, tar, and carbon monoxide." Additionally, some vapes contain cannabis or CBD, not nicotine—we'll get to that shortly. (See: Juul Is Developing a New Lower-Nicotine Pod for E-Cigarettes, but That Doesn't Mean It's Healthier)

Is Vaping Bad For You?

Short answer: Absolutely, 100-percent yes. Vaping is not safe. "No one should consider any form of vaping a benign, safe, recreational activity," said Eric Bernicker, M.D., a thoracic oncologist at Houston Methodist Hospital. "There's much still unknown about the health risks of various chemicals included in vaping liquids. What we do know is that e-cigarettes are a toxic product designed to foster nicotine addiction, and that's dangerous for our brains and bodies."

That's right—it doesn't help you quit smoking, it fosters addiction. To boot, "it's also not an FDA-approved cessation tool," he says.

These electronic cigarette companies are preying on impressionable youth who have yet to see the effects of nicotine in the long term. "We are in danger of seeing a major reversal of smoking cessation gains made over the past few decades in this country," said Dr. Bernicker. "Flavored liquids are marketed specifically to young people who have never smoked, as the flavors are more palatable than nicotine." (You can find vape flavors like strawberry, cereal milk, donuts, and icy bubblegum.)

Are All Vapes Bad? What About Vaping Without Nicotine?

"Vaping without nicotine has numerous health risks, namely general toxicity," says Dr. Bernicker. "The most worrying aspect of this is that we still don't know the full effects of these various chemicals other than that they're toxic to our bodies." We need more research before vaping of any kind can be deemed remotely safe—or to truly understand all the dangers of vaping.

"Both nicotine and flavored chemicals can lead to heart problems in those who vape, as well as those who are exposed to it second-hand," says Judy Lenane, R.N., M.H.A., chief clinical officer at iRhythm Technologies, a digital healthcare company that specializes in cardiac monitoring. (More Here: Juul Launched a New Smart E-Cigarette—But It's Not a Solution to Teen Vaping)

What About CBD or Cannabis Vaping?

When it comes to cannabis, the jury is still out, but some doctors believe it's a safer alternative to something like a JUUL or a nicotine-fueled e-cig—if you're using a product from a safe and legitimate brand, that is.

"Overall, THC and CBD are safer than nicotine," said Jordan Tishler, M.D., a cannabis specialist and instructor at Harvard Medical School. "However, at the moment, there are many tainted cannabis [vaporizing] products causing acute injury, so I'd advise avoiding cannabis and CBD oil pens." Instead, Dr. Tishler suggests vaporizing cannabis flower, as a safer alternative.

Vaporizing the cannabis flower means "putting the ground botanical material into a device designed for it, liberating the medicine from the woody parts of the plant material," he says. "Amongst other things, doing this avoids further human processing, which can lead to additional errors like contamination."

Even some CBD vendors are holding back when it comes to vapes, even though it's an extremely lucrative industry (and these vendors stand to make a fortune). "Although vaping is considered one of the better-known methods to administer and maximize CBD's benefits, the risk to consumers' health is still an unknown," said Grace Saari, cofounder of SVN Space, a hemp-focused website and shop. "We carry a variety of products to administer CBD, but vaping CBD is not a category we are investing in until further research validates the safety profile for those products." (Related: How to Buy the Best Safe and Effective CBD Products)

The Health Risks and Dangers of Vaping

Several doctors shared the health risks associated with vaping, many of which are deadly. "Research has shown that nicotine is highly addictive and can harm the developing brains of teens, kids, and fetuses in women who vape while pregnant (according to the American Heart Association)," says Santiago. "Vapes also contain harmful substances such as diacetyl (a chemical linked to a serious lung disease), cancer-causing chemicals, volatile organic compounds (VOCs), and heavy metals such as nickel, tin, and lead." Keep reading for more specific details on the dangers of vaping.

  • Heart attack and stroke: "Recent data conclusively links increased heart attacks, strokes, and death with vaping and e-cigarettes," said Nicole Weinberg, M.D., cardiologist at Providence Saint John's Health Center in Santa Monica, CA. "Compared with non-users, vaping users were 56 percent more likely to suffer a heart attack and 30 percent more likely to suffer a stroke. Initially touted as being a safer alternative to regular cigarettes, we now see that they increase heart rate, blood pressure, and ultimately increase plaque rupture which causes these dangerous cardiovascular events."

  • Stunted brain development: Among many of the "avoidable" risks that vaping poses, the National Institute of Health shared that the use of vape pens and e-cigs can cause "long-term harm to brain development." This is more specific to youth users but can affect learning and memory, self-control, concentration, attention, and mood.

  • AFib (Atrial Fibrillation): AFib is "a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications," according to the American Heart Association. And though AFib is typically seen in older populations (65 and older), "with the continuing trend of vaping among teens and young adults, we may someday be looking at younger and younger populations of people (even high schoolers) being diagnosed with AFib unless we can stop this now," said Lenane.

  • Lung disease: "Vaping can cause acute lung injury, potentially chronic lung injury, and vascular disease as well," said Dr. Bernicker. And if you've seen reports about popcorn lung, it's rare but possible: "Flavors [including diacetyl] have been implicated in the development of popcorn lung disease," says Chris Johnston, M.D., chief medical officer at Pinnacle Treatment Centers in New Jersey. Popcorn lung is the nickname for the condition bronchiolitis obliterans, which is a condition that damages your lungs' smallest airways and makes you cough and feel short of breath The more likely result of vaping, when it comes to your lungs, is currently classified as "e-cigarette- or vaping-associated lung injury" and is both incurable and fatal; The CDC has been calling this EVALI. The National Institutes of Health reported that "patients diagnosed with this illness have reported symptoms such as: cough, shortness of breath, or chest pain, nausea, vomiting, or diarrhea, fatigue, fever, or weight loss." The CDC reports that "no specific test or marker exists for its diagnosis," but most clinical assessment looks for lung inflammation and elevated white cell count. Continued vaping when you've been diagnosed with vaping-associated lung injury can result in death. Your compromised lung health can also leave you susceptible to pneumonia, which can also be deadly.

  • Addiction: "Addiction is the most serious long-term side effect," says Dr. Johnston. "The earlier in life someone is exposed to an addictive inhaled drug, the greater the chance of being diagnosed with a substance use disorder later in life." (See: How to Quit Juul, and Why It's So Damn Hard)
  • Dental disease: Orthodontist Heather Kunen, D.D.S., M.S., co-founder of Beam Street has seen an uptick in nicotine-related problems in her young patients. "As a dentist who caters mostly to the young-adult patient, I've become acutely aware of the popularity of the vaping trend and its consequences on oral health," says Kunen. "I find that my patients who vape suffer from a higher incidence of dry mouth, cavities, and even periodontal disease. I warn my patients that while vaping seems somewhat innocuous and a healthier alternative to cigarette smoking, this is not at all the case. The extremely high concentration of nicotine in e-cigarettes has significant mal-effects on oral health that should not be ignored."

  • Cancer: Similar to traditional cigarettes, e-cigs can potentially lead to cancer, says Dr. Bernicker. "We do not have enough information to fully gauge cancer risks yet, but data from mice is starting to become available," he says. "Use of cigarettes and other nicotine products remains the leading cause of lung cancer. As an oncologist, I strongly encourage people that are currently vaping to reconsider for the benefit of their health."

  • Death: Yes, you can die from vaping-related illness, and there have been nearly 40 reported instances so far. If it's not from the aforementioned lung diseases, it can be from cancer, stroke, heart failure, or another heart-related event. "Short-term damage from vaping includes respiratory failure and death," said Dr. Johnston.

If you know a teen who is struggling with vaping and JUUL, there's a program called This is Quitting—a first-of-its-kind program to help young people quit vaping. The goal is to give "youth and young adults the motivation and support they need to ditch JUUL and other e-cigarettes." To enroll in This is Quitting, teens and young adults text DITCHJUUL to 88709. Parents can text QUIT to (202) 899-7550 to sign up to receive text messages designed specifically for parents of vapers.

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