The Vaping Crisis Explained

New numbers from the Centers for Disease Control show vaping-related illnesses and deaths around the country continue to rise. In Massachusetts, one person, a woman in her 60s, has died from vaping. And there are more than 100 suspected cases of illness connected with the disease in the state. What makes all these numbers scarier is we don't seem to have a handle on exactly what is happening. Two experts — New York Times Health Reporter Denise Grady and Dr. Hasmeena Kathuria, pulmonologist and associate professor of medicine at Boston University — spoke with WGBH Radio’s Arun Rath about vaping. The transcript below has been edited for clarity.

Arun Rath: First, as we try to break this down, let's start with the basics. This phrase “vaping-related illness” — it’s so vague. What exactly are we talking about? What exactly are people coming to their doctors presenting?

Denise Grady: It's an unusual presentation with some of them, because not in every case, but a lot of them seem to start out with these stomach problems. They come in, they've got nausea, vomiting and other gastrointestinal problems for a few days. And most of them think they have the flu or a stomach bug or something, they try to wait it out. And then what generally brings them into the emergency room is that they start being not able to breathe, having a lot of coughing, but really, just short of breath and cannot catch their breath.

Rath: People have been vaping in various forms for over a decade now. Is it reasonable to assume that there's something new going on that's causing these problems getting reported now, like in the last year or so?

Grady: It does seem to be. An awful lot of these people, the majority of them, say that they have been vaping THC, which is the ingredient in marijuana that gets you high. And some of them have been vaping both THC and nicotine. Very few say only nicotine. But what the CDC and state officials are really looking at is some of these THC products that are illicit or kind of black market THC products that are just kind of flooding the market, and nobody knows who makes them or where they come from or even what's in them or even if they're all the same. And they may not be, because they come with flavorings, and they may be diluted or cut with other, different chemicals to extend the supply.

Rath: There's so many complicating factors. But still, we have this idea that maybe it's not really real, but the people, the scientists who study diseases, people who work for say, the CDC, they're really good at the detective work of sleuthing out, going back to finding patient zero. Is there a reason why this one seems to resist analysis, or am I just being impatient?

Grady: I think that the problem with this is that there are so many products out there and nobody knows, again, where they're coming from or who's making them. When you see the lists that have been compiled by doctors in Illinois and Wisconsin of what their patients were vaping, there are more than a dozen different THC products. And a number of them have these labels on them like “Dank Vapes” or “Off White,” and some of these aren't really a real product. They are packaging that people selling THC can buy off the Internet and then they can put those labels on anything they want. So nobody knows what's in it or who's sending this stuff out.

Some of these transactions are going on on the dark web, so they're encrypted transactions. There are some people who are buying this stuff online with bitcoin. So it's really quite a mess.

Rath: This has been such an unregulated, wild west kind of market with these devices and substances. It seems like it just makes it so much harder to figure it all out.

Grady: It does. And the questions are even coming up about the flavorings that are in some of these things. Some of the sellers say, 'Well, these are food flavoring so they're safe — we know that people can eat them.' But just because you can eat something doesn't mean that it's safe to inhale. You know, it's not like your digestive tract. Your lungs don't have enzymes to break down these flavorings or oils that may be in the THC that people are vaping.

Rath: As a reporter, what are some of your biggest unanswered questions when it comes to this illness?

Grady: I would like to have an understanding of whether or not there is anything to be concerned about with nicotine. There are a lot of fingers being pointed at these different THC products, and yet there's still concern about whether the nicotine products are safe.

And then another question that came up was, when you buy THC or these other things that you can buy from dispensaries in states where it's legal and they're licensed, could that be safe? At the last briefing that the Centers for Disease Control gave, someone asked that question — is it OK if you get it from a dispensary? And a doctor who was overseeing the whole thing said, 'I don't know what safe is anymore.'

Rath: Denise, thank you so much.

Grady: Thank you.

Rath: That was Denise Grady, health reporter from the New York Times, who's been covering the ongoing story of the mysterious illness tied to vaping.

Joining us now to give a local perspective and a view of what doctors on the ground are facing is Dr. Hasmeena Kathuria. She's a pulmonologist and an associate professor of medicine at Boston University. Thanks for being here, doctor.

Hasmeena Kathuria: Thank you.

Rath: So I've seen that you've come out and called these vaping related illnesses "terrifying," and obviously as a pulmonologist, lungs are your business. So I'd like you to explain exactly what's terrifying doctors about this illness?

Kathuria: What's terrifying us is every week we're hearing from the CDC that there are more reported cases of lung injury. So every Thursday, a new report comes out and now it's up to 1,299 cases, and we haven't seen a peak. This is very different than the normal landscape that we see of combustible cigarettes. Now we're seeing adolescents dying from this, and it's frightening.

Rath: Have you seen patients with confirmed or suspected vaping related illness?

Kathuria: We have seen one case. Interestingly, we saw this before the reported epidemic, so it was about a year ago, where a 24-year-old came in with acute shortness of breath and was diagnosed eventually with pneumonia, which our team thought was related to vaping.

Rath: And in those situations, if someone comes in and they're not able to breathe and they say, 'I have asthma' or some other condition, you would have a course of treatment. If it's this vaping-related illness, what do you suggest people do?

Kathuria: So hospital-wide, we’re making a lot of efforts to one, increase awareness of this. We're having clinicians get a better vaping history. So for instance, what type of vaping device is being used? What products are in that device? Is it nicotine? Is it THC? Is flavor being used? And a more in-depth history sort of about the cartridges or pods — are they reused? Are they filled with homemade products? Unlicensed products? Commercially licensed products? Was a product concentrated? We also have on our website very valuable information, like what type of history to ask. We've introduced a vaping clinic that's composed of our team, which is the nicotine and tobacco treatment team, as well as adolescent and adult pulmonologists that can look at these cases as they come in. All of those things are really important steps that many health systems are starting to do.

Rath: Do you support this recommendation that people who are vaping should stop vaping, at least until this is figured out?

Kathuria: A question that’s being asked to me and to others is why now? These products have been on the market since 2006. There are a lot of questions that are unanswered. So I think until we know more, banning using these products makes a lot of sense.