A marijuana-related vaping disease outbreak gave the Trump administration the perfect opportunity to tackle another public health problem: teen e-cigarette use.
But the two aren’t directly related.
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One of the crises largely involves pot, the other nicotine. One is driven by illicit marijuana vapes, the other by fruity-flavored nicotine vapors.But the epidemic of deadly lung sickness this summer created an opportunity that officials seized, with President Donald Trump’s Oval Office announcement this week banning the flavored vapes that have lured millions of teens.
Trump gave no indication he understood the distinction between the two substances when he announced the ban on Wednesday. “People are dying with vaping,” he said. “A lot of people think vaping is wonderful, it’s great. It’s really not wonderful.”
His comments conveniently merged the alarming growth in teen vaping with the outbreak of lung disease that states officials have mostly linked to vaping products that contain THC, the main psychoactive component of marijuana. The administration took one crisis and used it to stamp on another that had steadily captured Washington’s attention.
The White House action against flavored e-cigarettes won’t have any effect on marijuana vape regulations, which is up to the states where marijuana has been legalized. But the FDA and lawmakers have long had flavored vapes in their sights because of their role in a jarring increase in teenage nicotine use over the past two years after decades of decline.
The administration’s sleight of hand infuriated lobbyists for vaping companies, who are leery of federal regulation, while encouraging marijuana companies, which want more of it.
“It’s like having salmonella in Romaine lettuce and calling to ban peanut butter. It is literally public health malpractice,” said Mike Hogan, a lobbyist for the Smoke-Free Alternatives Trade Association. Critics like Hogan say Trump’s focus on e-cigarettes completely ignores the early state-level data that links cases of lung disease to cartridges containing THC.
An early report from Illinois and Wisconsin found that 84 percent of their lung disease cases were linked to marijuana vapes. New York state officials pointed to vitamin E acetate in THC oils as a primary culprit. California and Oregon each reported a death linked to marijuana vape cartridges.
The administration’s flavor bans were propelled by sobering national survey figures showing teen vaping is rising. Former FDA Commissioner Scott Gottlieb railed against flavored e-cigarettes during his tenure and supports the ban.
But the mystery lung illnesses is a different challenge, he said, and “you really need to separate both these issues.”
The administration’s action contrasted with the cautious approach federal officials have taken to linking the vaping illnesses to any one product or substance until their investigation is complete.
FDA’s acting Commissioner Ned Sharpless and CDC Director Robert Redfield have urged consumers to avoid street products and THC oil, although Redfield took it a step further by suggesting that all e-cigarette users should “consider not using [e-cigarette] products.”
Some public health officials see these two strategies as different strands of a flawed policy.
“CDC has hyped up the risks of vaping so much that they have literally said nothing about youth vaping of marijuana,” said Michael Siegel, a public health and tobacco control research at Boston University. “They almost want to blame this on run-of-the-mill e-cigarette products to say ‘I told you so.'”
FDA said its investigations of the epidemic “involve the broader use of vaping products — including those being used with substances like THC.” It has emphasized that the flavored ban was intended to keep e-cigarettes out of teens’ hands — not necessarily off the market entirely.
And a CDC spokesperson cautioned that not all the lung illnesses were definitively caused by a marijuana-derived product. “Most, but not all, patients have reported using e-cigarettes containing THC. Many report using THC and nicotine. Some report using nicotine containing products only.”
Under federal law, the government could raid state-licensed dispensaries and remove all vape products, but even the White House cannot create new oversight of marijuana products beyond what is outlined in the Controlled Substances Act. To change that, Congress would have to reclassify marijuana — a measure far less likely to reach the president’s desk than laws targeting the e-cigarette industry.
Many lawmakers already had e-cigarettes in their sights. After Trump’s action, congressional Democrats active on the issue talked past the evidence that the lung disease outbreak is linked to marijuana vapes much more than e-cigarettes in general.
E&C Oversight subcommittee chair Diana DeGette, who plans a hearing on the lung disease outbreak and the safety of e-cigarettes later this month, said pulmonologists in her pot-legal state are unwilling to attribute the disease wholly to weed vapes.
DeGette’s announcement for the hearing makes no mention of marijuana. Neither does a letter from 23 Democratic senators demanding that federal agencies answer questions about the health impacts of e-cigarettes. One of the senators, Sen. Jeff Merkley (D-Ore.), has pushed for e-cigarette restrictions since 2009 — without ever mentioning pot. A vape product from a legal Oregon marijuana dispensary is linked to one of the lung disease deaths.
Merkley’s spokesperson said “the details are still murky” on the death, adding that the senator expects FDA, once its research is finished, to take action against offending products, “regardless of whether they contain nicotine, THC, both, or neither.”
“You have to go into schools, you have to pass state laws,” said Rep. Donna Shalala (D-Fla.), a Clinton-era HHS secretary who has introduced sweeping legislation to ban e-cigarette flavors and restrict sales. “Everybody has got to do something.”
The federal prohibition of marijuana means that decisions to change or issue new regulations on marijuana vape cartridges are entirely up to the 33 states that have legalized marijuana for medical or adult use.
California’s state legislature was considering regulating e-cigarettes, but not marijuana vape cartridges. In Massachusetts, Cannabis Commissioner Shawn Collins called for all vape cartridges to list every ingredient, including additives or thickening agents. New Jersey State Senate President Steve Sweeney, a Democrat, said he wants legislation banning all vape products, both tobacco and marijuana. And in Oregon, the AP reported that authorities will ask marijuana dispensaries to review their inventories and post warnings about potential vaping dangers.
In the absence of federal oversight or guidance, Collins said, Massachusetts and other states must consult among themselves on appropriate policies.
“That is the legalized cannabis environment, you know; states are kind of left to their own devices in a lot of ways,” he said.
Many of the marijuana-related health concerns have been linked to unlicensed marijuana vapes obtained on the black market, according to the National Cannabis Industry Association. One death in Oregon, however, has been reportedly caused by a cartridge purchased at a legal dispensary.
But there has been no real call to action for marijuana-legal states to revisit existing regulations.
States are sending marijuana vapor samples to FDA labs for testing, but since marijuana is federally illegal, there is no baseline against which to test samples. And without standardized packaging and ingredient lists, it’s difficult for the agency to know what to look for.
“There is a regulatory gap here. The states have legalized cannabis but they don’t have any infrastructure to properly regulate it,” Gottlieb said. Meanwhile, the market has filled with regulated and unregulated THC, as well as cannabidiol, or CBD, another marijuana derivative, which recently was partly legalized.
The federal marijuana prohibition limits the FDA’s ability to regulate marijuana, even as vaping products like CBD have seemingly boomed in popularity, Gottlieb said.
“It’s not fair to say this is the FDA’s fault,” he said. “It might not be within FDA’s grasp.”
Paul Demko contributed to this report.