Long Island hospitals are seeing an increasing number of e-cigarette users with serious lung problems, including two men who nearly died, as federal and state officials ramp up warnings against vaping.
The U.S. Centers for Disease Control and Prevention has confirmed more than 450 cases of lung illness nationwide that may be associated with e-cigarette products containing nicotine or tetrahydrocannabinol, known as THC, the ingredient in marijuana that creates a high.
Long Island hospitals said they are aware of at least 19 cases here over the past few years that are believed to be associated with vaping, most in the last several months — but hospital representatives said the numbers probably are not complete. Nationally, there reportedly have been six deaths linked to vaping, all this year.
As the number of cases of lung damage linked to e-cigarettes mount, doctors like Patrick O’Shaughnessy, chief clinical officer for Catholic Health Services of Long Island, which operates six hospitals, believe that “until we understand more about what’s going on, I think they should be banned."
“We don’t know the long-term effects,” added O’Shaughnessy, who said his call for a ban is a personal, rather than a Catholic Health Services, position. “Certainly we’re beginning now to really understand the short-term effects, which can be horrific.”
E-cigarettes are battery-operated devices that heat a liquid typically containing nicotine or THC, along with chemicals and sometimes flavoring, into an inhaleable aerosol. Their popularity has skyrocketed in recent years, including among young people.
Jon Doneson, 52, of Roslyn Heights, said he began occasionally vaping THC — though THC vape products are illegal in the state except for authorized medical reasons — about a year ago to help relieve the stress of co-owning a new business and eventually started doing so daily.
A few months ago, he began having night sweats, and then fevers of up to 103 degrees and coughing fits, said Dr. Mina Makaryus, a pulmonologist at Northwell Health who treated Doneson. He ended up at North Shore University Hospital in August for five days. At one point, his wife was presented with a “do not resuscitate” order.
“I thought it was relaxing me,” Doneson said of vaping during a news conference Thursday at North Shore hospital. “It wasn’t. It was killing me."
An 18-year-old Nassau County man who nearly died was recently at NYU Winthrop Hospital for more than three weeks, including one week in a medically induced coma, said Dr. Melodi Pirzada, a pediatric pulmonologist at the hospital. He was diagnosed with acute respiratory distress syndrome and had to use a ventilator to help him breathe, she said. A vaping cartridge found at his home contained THC, and doctors believe the vaping caused his respiratory problems. It’s unclear how long the man had been vaping, she said.
Another man, who is 19, was hospitalized at NYU Winthrop with nodules — masses of tissue — in his lungs. He acknowledged vaping cannabis oil daily for three months and suffered from chest pain, shortness of breath, weight loss and other problems, Pirzada said.
Although vaping cases have surged in recent months, there previously had been isolated cases reported, said Makaryus, who co-authored a 2017 report on a Long Island man with lung damage from vaping cannabis oil.
“I don’t understand why all of the sudden now” there are far more cases being reported, he said, but “there clearly are multiple causes of the injuries we’re seeing” because there are different types of lung injuries and illnesses, depending on the patient.
Until more is known about the health risks of vaping, "as humans using these products, we are essentially experimenting on ourselves," said Dr. Annamaria Iakovou, a pulmonologist at North Shore.
Most of the cases reported on Long Island and statewide were of people who vaped THC, although some used both THC and nicotine, or just nicotine. The CDC said it does not have a breakdown of which cases nationally involve THC and which involve nicotine — or both.
“I think the main culprit will be the [other] ingredients [in vape products], not the nicotine or the THC,” Pirzada said. “They have their own problems, but right now I’m thinking this acute lung injury seems to be due to the ingredients.”
The state is investigating whether vitamin E acetate, which was found in high quantities in most e-cigarette samples of New Yorkers with lung problems who vaped THC, could be a culprit.
State officials are advising New Yorkers to stop vaping while the investigation continues. Gov. Andrew M. Cuomo and President Donald Trump this week called for the banning of e-cigarette flavors — some of them sweet — that critics contend attract kids to vaping. Cuomo on Thursday directed the state health department to work with state education officials to develop vaping prevention materials for local school curriculums. And a health department panel Thursday ordered stores that sell e-cigarette products to post signs warning about the dangers of vaping. Cuomo in July signed legislation that will raise the age to buy vaping products and tobacco from 18 to 21 by November.
Dr. Rachel Boykan, an associate professor of clinical pediatrics at the Renaissance School of Medicine at Stony Brook University, said there are several substances in e-cigarettes that could cause harm, including heavy metals like copper, flavorings that have been shown to cause respiratory irritation and tiny toxic particles in e-cigarette aerosol. Use of e-cigarettes is too recent to establish whether they may cause cancer in the long term, she said.
Boykan said one reason for the popularity of vaping is that “I think in general the public, including teenagers, thinks it’s safe. That’s largely because they’ve been freely marketed as a safe alternative to cigarettes.”
The U.S. Food and Drug Administration on Monday accused JUUL Labs, which has most of the U.S. e-cigarette market, of having “ignored the law” in marketing its products as less harmful than cigarettes, even though it hasn’t provided evidence to back that up. The FDA also said JUUL’s marketing appears to have led children to use its products.
JUUL spokesman Austin Finan said in an email Thursday that the company is reviewing the FDA letters and “will fully cooperate.” Finan said the company does not want customers who do not use nicotine. “JUUL Labs exists to help adult smokers switch off combustible cigarettes,” he said.
But health officials said e-cigarettes are not primarily used to stop smoking. Boykan said that, to the contrary, kids who vape are much more likely to start smoking cigarettes.
In New York State, the number of high school students who use e-cigarettes has sharply risen in recent years, to 27 percent, as the percentage of high schoolers smoking tobacco plummeted from 27.1 percent in 2000 to 4.3 percent in 2016, according to the state health department.
Several students interviewed at Farmingdale State College on Wednesday said many of their friends vape nicotine, THC or both — and almost none of the nicotine users previously had smoked tobacco.
Gianna Conetta, 18, a liberal-arts major from Massapequa, said a lot of people who vape nicotine or THC “think it’s cool. They’re trying to fit into the crowd. They don’t realize what it’s going to do to them."
Conetta, who said she does not vape, added that reports of vaping-related hospitalizations and warnings in recent days have scared friends, and some are vowing to quit.
“I’ve seen my friends who’ve been varsity athletes in high school and now they can’t even run a mile because of their lungs,” she said.
Desiree Kelly, 22, a business management major from Greenlawn who doesn't vape, said friends who vape believe it’s safer than smoking tobacco or marijuana, but “they’re definitely not looking into the health risks."
Some have told her they are trying to quit vaping nicotine, a highly addictive substance — but can’t.
Steven May, 22, a business management major from Plainview, vapes nicotine. He said he uses vaping oils he believes are less harmful, vapes only about 20 minutes a day and believes there is no evidence that vaping nicotine is a major health issue — only vaping THC.
But Boykan said there is no evidence that vaping nicotine is less dangerous than vaping THC, and no conclusive evidence that certain types of oils are less harmful than others.
HOW DO E-CIGARETTES WORK?
Most electronic cigarettes have four components:
- A cartridge holds a liquid that contains nicotine, other chemicals and sometimes flavorings. Some contain THC, the ingredient in marijuana that causes a high.
- A heating element.
- A power source, usually a battery.
- A mouthpiece that is used to inhale the aerosol.
SOURCE: National Institute on Drug Abuse
BY THE NUMBERS
- More than 450: Confirmed lung illnesses nationwide that may be associated with e-cigarettes.
- 49: Severe pulmonary illnesses in New York State linked to vaping reported to the state health department. All but two required hospitalization.
- 14 to 57: Age range of New Yorkers with the severe illnesses.
- 19: Number of lung illnesses and injuries linked to vaping that Long Island hospital officials are aware of.
SOURCES: Centers for Disease Control and Prevention, New York State Department of Health
NOTE: State officials said some lung illnesses may not have been reported to the health department; Long Island hospital officials said the estimate of Island vaping-linked illnesses is likely low.