United States: does pneumonia come from electronic cigarettes?

«Dangers du vapotage», «le vapotage est-il dangereux?», «Vapoter est-il dangereux?». In the wake of the lung disease epidemic in the United States, the French general-interest media have almost forgotten that cigarettes cause 80,000 deaths a year in France. But above all, they've got the wrong subject.

What's happening in the United States?

We have of course already but in view of the way the subject has been treated, we feel it's worthwhile to take stock again. Hundreds of cases of pneumopathy, causing at least twelve deaths, have appeared since the end of August in the United States. Cannabis was initially blamed. But anyone in their right mind and/or involved in any way with this product knows that cannabis alone has nothing to do with it. Everything around it does, potentially.

And therein lies the complexity of the situation: no single product has been identified as the cause of these illnesses. The common denominators are, in the majority of cases, THC cartridges bought on the black market. Not all products meet this criterion: we've also seen synthetic CBD or cannabinoid-free liquids. Three culprits have been implicated, with no single one present in all cases:

• a solvent used to fluidize THC oil, notably vitamin E acetate
• synthetic cannabinoids
• heavy metals released when cartridges heat up too cheaply

The success of vape pen in the United States can be summed up in 3 points: discretion, practicality for microdosing, no combustion.

Are electronic cigarettes dangerous?

At a time when a youth smoking crisis is raging in the United States, the debate has subtly shifted from illicit and adulterated cannabis-based products to e-cigarettes, one of the main risk-reduction tools for nicotine smokers.

Is it legitimate? If electronic cigarettes and vape pen may share the same operating principle, the products they consume are quite different.

The e-liquids used in electronic cigarettes in France are made up of Propylene Glycol and Vegetable Glycerine (PG and VG), flavors suitable for inhalation and nicotine or CBD. E-liquids are bought in bottles that fill and refill the tanks of e-cigarettes.

THC cartridges are composed of THC oil (usually distillate or Clear), from terpenes (often natural and derived from fruit, rarely from cannabis, but sometimes synthetic) and sometimes a fluidifier to bind it all together. Cartridges are screwed onto the battery of the vape pen and are not rechargeable.

Are electronic cigarettes risk-free? Perhaps not, as there is no scientific consensus on the total harmlessness of the PG/VG blend. Has it caused pneumopathy in the United States? Absolutely not. Should we go back to combustion? The choice is yours (one smoker in 2 dies from smoking).

Are electronic cigarettes dangerous in France?

France is the world's third-largest market for electronic cigarettes, with sales of $820 million. in 2018. Health authorities keep a close eye on the products placed on the market, and strictly supervise the formulations that manufacturers are required to register. E-cigarettes helped reduce the number of smokers by 1.4 million in 2017, more than any other public health policy.

And if we wanted to find fault with electronic cigarettes, we'd have to look more closely at accidents linked to e-liquids containing synthetic cannabinoids. K2, Spice or Buddha Blue, the names are different but the effects are the same: paralysis, tachycardia, hallucinations, respiratory distress... Here too, tainted products sold under the table. But that's no reason to call into question e-liquids sold in stores and made with natural CBD.

What impact have the French media had on companies selling e-liquid? Lionel Jean-Marie, Director at Greeneo, explains:

«Of course the vape industry as a whole suffers from the controversies coming out of the US.

When it comes to CBD, we're getting more and more questions about the provenance of raw materials and the composition of liquids. Professionals and consumers alike need to be reassured, and that's normal. We demonstrate a high level of transparency by making our product safety data sheets and CBD / THC analyses available. The buyer, whether a store or a consumer, must have documents drawn up in France and meeting the requirements of French legislation.

We also ensure that our raw materials are of organic origin: no synthetic CBD, no synthetic cannabinoids. Our liquids are composed exclusively of PG, VG, controlled organic CBD and natural terpenes.

We're still in a new market, and many «products» arrive in France without necessarily conforming to the imposed specifications. Our strategy today, and I'm speaking on behalf of many French manufacturers, is to open up dialogue between all parties in the market to show that our products are FRENCH, manufactured and bottled in France, in compliance with strict, rigorous specifications.»

Insofar as electronic cigarettes and their e-liquids are not responsible for American respiratory diseases, why do the French media equate them with adulterated products? Is it too hard to verify information? To contact people in the know? I've no idea. But Professor Dautzenberg, a tobacco specialist and former lung specialist, sums up the treatment of the subject.

A man heated rat poison in a saucepan and drank it all. The headline might read «Death by rat poison», but the afp would headline «Death by casserole». Such a headline would be as stupid as headlining death by vapotage when the US cases are linked to tampered products. pic.twitter.com/XtBtJN1Unm

- Pr . B Dautzenberg (@PrDautzenberg) October 5, 2019