ACMT Position Statement: Limiting Harms of Vaping and E-cigarette Use

Summary & key facts

This is a position statement from the American College of Medical Toxicology about the risks of vaping. The authors reviewed published papers and public health reports and explained that vaping has grown quickly, can cause nicotine addiction and other harms, and that a recent outbreak of severe lung illness (called EVALI) has been linked mainly to THC vape cartridges from informal sources. They note vitamin E acetate is a leading suspect in that outbreak but more study is needed. The statement lists actions for governments, manufacturers, and doctors, and it recommends counseling people — including teens and pregnant women — to avoid vaping.

Key facts:

• Vaping means inhaling vapor from an electronic device to get nicotine or cannabis; devices include e-cigarettes, vape pens, disposable pods, and wax pens.
• Vaping became much more common among young people: by 2018 about 20% of high school students and about 5% of middle school students reported e-cigarette use, up from very low numbers earlier in the decade.
• Vaping liquids often contain nicotine plus flavorings, oils, and solvents such as glycerin or propylene glycol; some flavor chemicals have been linked to lung damage in other settings.
• Concentrated nicotine liquid can poison young children and has caused deaths when they swallowed it by accident.
• Beginning in 2019 there was an outbreak of severe lung illness called EVALI with thousands of reported cases; most patients reported using THC-containing vape products, often from informal sources like friends or illicit sellers.
• Investigators found vitamin E acetate in lung fluid samples from a sample of 29 EVALI patients, making it a strong suspect as a cause, but it is not yet proven to be the only cause.
• Many people with EVALI needed to be hospitalized. Some needed machines to help them breathe, and one person had a lung transplant.
• Corticosteroid medicines (drugs that lower inflammation) seem to help some patients with EVALI, but the best dose and how long to give them are not yet known.
• The ACMT recommends stronger surveillance to find the cause, better labeling and regulation, removal of vitamin E acetate from products, limits on flavored vapes that appeal to teens, child-resistant packaging, and that doctors ask about va

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