The history of America’s vaping problem

By Miriam Fauzia
BU News Service

BOSTON — Teddy M.’s story began with long-standing chronic pain.

“People have always offered me advice,” said Teddy, a BU undergraduate studying linguistics who declined to give their last name for privacy reasons. “They’re like, ‘you should try this thing or that other thing.’”

But then one day nearly a year ago, Teddy discovered a JUUL pod lying on the floor in a dorm room. They came from a family of smokers and had an intrinsic apprehension of cigarettes. Yet in that moment, spying this object they had no idea how to use, Teddy took the pod as a chance to experiment.

“I found [that JUUL pod] helped me more than any other pain management in my life,” they said. Vaping marijuana, from that point onward, became their linchpin, their go-to therapy.

JUUL does not sell any THC products, but the company and black-market THC products that are compatible with JUUL’s devices have been at the center of an outbreak of vaping related illnesses. The FDA announced in October that the public should stay away from any and all THC-containing vaping products amid numerous reports of vaping-related lung injuries and deaths.

The first vape-related death occurred in Illinois on Aug. 23, followed by 17 more deaths in 15 other states. As of Oct. 15, the CDC has received reports of 1,479 lung injury cases associated with vaping from 49 states and 1 U.S. territory including Massachusetts, which as of Sept. 30, has had 83 reported cases.  

These illnesses have presented a new problem with which the government and medical community must grapple, but vaping has been around for quite some time. The first historically documented reference to e-cigarettes was a patent filed by Joseph Robinson in 1930 for a device he called “Mechanical Butane Ignition Vaporizer.” While the patent was approved, Robinson never took the product to market.

In the early 1960s, young Korean War veteran Herbert A. Gilbert had the idea to create a non-combustible cigarette. He, too, filed a patent in 1963 and built several successful prototypes, but failed to find companies willing to commercialize.

More was done to advance the technology in the eighties and nineties. Phil Ray, one of the pioneers of computers, worked with his personal physician Norman Jacobson to create the first commercialized e-cigarette and introduced the verb “vape” to the common parlance.

It was not until a 52-year-old Chinese pharmacist based in Beijing, Hon Lik, created the device in 2003 after his father, a heavy smoker, died of lung cancer. After several failed ideas, he patented a system which used a piezoelectric ultrasound element to vaporize nicotine solution in a cigarette-like device. Within a year of patenting, the product took off in the Chinese market and Lik’s company, Golden Dragon Holding, changed its name to Ruyan (“like smoke”) and started shipping globally.  

By April 2006, e-cigarettes were introduced worldwide, first to Europe and then to the United States. Touted as a healthier, potentially less harmful alternative, e-cigarettes found acceptance amongst reforming smokers as an alternative to typical tobacco cessation with nicotine patches.

However, in more recent years, young people have been turning to e-cigarettes. A 2018 Youth Risk Behavior survey, conducted by Emerson Hospital and an aggregate of school districts across Massachusetts, found that while smoking has rapidly declined since the first survey in 2002, the number of students who vape has doubled since 2016.

Amongst 2,484 Acton-Boxborough students interviewed, 19% admitted to vaping. Survey results also demonstrate a steady increase of users starting in eighth grade and peaking at twelfth grade. 

News of the outbreak and deaths was not lost on Teddy or their peers. In emergency rooms across the country, patients presented symptoms ranging from shortness of breath, chest pain and coughing to nausea, vomiting, diarrhea, fever, abdominal pain and weight loss.

“Most of my friends [who vape] have completely stopped,” Teddy said.

Teddy has not been completely deterred due to their chronic pain, but has tried to cut down. They said they use legal cartridges from a company called SAUC Vapor that are compatible with the JUUL device.

“I do [vape] but less, because, like, I’m scared,” they said. “Naturally, I’m thinking, ‘maybe if do it a little bit less, I have less of a chance it will happen.’” 

With the uptick in the number of vaping-related illness cases, Massachusetts Governor Charlie Baker announced a four-month ban on sale of all vaping products—including those containing tobacco and marijuana—on Sept. 24. The governor stated this ban would provide time for medical experts to collect information to better understand the dangers posed by vaping both nicotine and cannabis.

While this has been considered a bold move by the state, those whom this ban is meant to protect are skeptical of its efficacy.

Teddy said young people are unlikely to reach out to healthcare professionals or pursue tobacco cessation therapy.

“Most of the people who [vape] got themselves addicted wanted to be addicted,” Teddy said. “They are people who reject traditional, prescription drugs. They feel like they don’t have enough access to therapy.”  

Dr. Peter Grinspoon, a doctor at Massachusetts General Hospital as well as a cannabis and addiction expert, agreed.

“It would be wonderful to get people to quit [vaping],” Grinspoon said. “I’m still a little bit skeptical. It’s very hard, as a primary care doctor, to get people to stop smoking and stop using nicotine. Hopefully, a certain percentage will stop, but again, there’s no data and I’m not convinced.”

There have been concerns circulating of an unregulated, underground market emerging as a result of the ban. Grinspoon also fears young people will turn to illegal, unlicensed vape cartridges.

“The problem [has] been mostly with illegal vape products. No one is getting sick from vaping flower, grinding the marijuana flower and vaping. You’re only getting sick from the cartridges which have some kind of adulterant in them,” he said.

While opposed to a blanket prohibition of all vaping products, Grinspoon urges young people to consider tobacco cessation therapy or medical marijuana, if of age, for treating chronic pain or anxiety in lieu of vaping.         

Much remains unknown about the underlying disease mechanism, but new research has emerged. In findings published to the New England Journal of Medicine on Oct. 2, Mayo Clinic doctors discovered that tissue damage from vaping nicotine or marijuana products resembled chemical burns.

These injuries, seen on lung tissue samples collected from 17 patients, appeared akin to “injuries…seen in people exposed to poisons like mustard gas,” Dr. Brandon T. Larsen, a surgical pathologist of the study, told the New York Times.

For Teddy, the future is uncertain.

“Honestly, I’m concerned for my short-term health at this point,” they said. “Would I like to live a long life and be in pain or live a short life painlessly?” 

Until they come across a better pain treatment, Teddy said vaping will remain very much part of their life.

Presently, the Massachusetts Department of Public Health is offering four-weeks of free nicotine replacement with patches, gum or lozenges. Individuals over the age of 18 can visit www.makesmokinghistory.org or call the Massachusetts Smokers’ helpline at 1-800-QUITNOW (1-800-784-8669). The helpline is a free and confidential service for all Massachusetts residents and includes an over-the-phone quit coach, online tools and other resources.