New Study Demolishes Vaping’s Links to EVALI

A new study in the Drug and Alcohol Review has dismantled claims that vaping was responsible for EVALI. While many people in the vaping world have known this for a while, the effects of initial false reports still echo around the public consciousness.

A new study released in the Drug and Alcohol Review has tackled the question of the links between vaping and EVALI. The paper, written by Dr. Colin Mendelsohn, is called “Nicotine vaping was not the cause of e-cigarette, or vaping, product use-associated lung injury in the United States.”

Dr. Mendelsohn is a very sensible voice in the Australian vaping community. He frequently writes about vaping in his excellent blog. Additionally, he came out strongly against a recent paper commissioned by the Australian Department of Health, pulling no punches and 

What was EVALI?

EVALI was an outbreak of lung disease that happened between late 2019 to early 2020. Early newspaper reports suggested that vaping was the culprit. But by the time the CDC set the record straight, the genie was out of the bottle.

Most people in the vaping industry knew the claim was bogus. However, if you go to the CDC website’s article on the outbreak, they suggest that “Evidence is not sufficient to rule out the contribution of other chemicals of concern.” 

Another thing is the name itself. EVALI stands for E-cigarette, or Vaping, product use-Associated Lung Injury. For anyone taking a cursory glance at the issue, it would be easy for them to make the association between the two.

Whatsmore, according to ASH’s SmokefreeGB survey conducted in 2020, news about EVALI caused a jump in the number of people who wrongly believed that vaping is as harmful or more harmful than smoking tobacco.

Mendelsohn’s paper aims to settle the controversy once and for all. Here are some of the key points made in the report.

#1. 14% of EVALI cases reported using nicotine only. 

These reports were used to support claims that nicotine can cause EVALI. However, as the paper points out, self-reporting on these issues isn’t always reliable. 

There is still a stigma around THC use. Additionally, some patients were probably conscious of job loss and violation of health insurance that could result from using illegal products.

The paper suggests that later interviews and biological tests showed that some people who initially denied using THC were later shown to have consumed the chemical.

#2. Vitamin E acetate (VEA) 

The CDC concluded that VEA was strongly linked to EVALI. However, VEA is not soluble in nicotine juice and has never been found in nicotine juice.

#3. Nicotine products remain unchanged, but EVALI rates have dropped

Pretty simple logic here. E-liquid products are still being made in the same way. But EVALI rates are down. If nicotine was causing EVALI, surely we would expect the rates to have stayed consistent.

As the paper notes, the elimination of VEA corresponds to a drop in EVALI cases. 

#4. Geographical factors

EVALI cases were almost exclusively observed in North America over a specific time period. If e-liquid was at fault, we should expect cases to occur everywhere that vapers live and over a longer stretch of time.

Because things didn’t happen like that, it’s fair to assume that these factors are more consistent with a “contaminated supply chain for illicit THC products.”

Dr. Mendelsohn concludes the paper by stating that EVALI was caused by black-market THC oils mixed with VEA. Initial links to e-liquid were likely caused by patients misreporting their use of THC oils “for fear of legal or social consequences.”

Finally, he suggests that the media and health authorities need to correct the continued misrepresentation of EVALI. If smokers are being put off vaping because of false news stories, it could legitimately harm public health.