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Questions about vaping? Forum seeks to clear the air in wake of illnesses, deaths
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The Georgia Department of Public Health issued an advisory Wednesday, Oct. 9, urging people not to vape after a second vaping-associated death was confirmed.

As of Tuesday, Oct. 8, there have been 14 vaping-associated illness cases identified by the Department of Public Health in Georgia, including the two deaths. Other potential cases are still being reviewed.

“The increasing numbers of vaping-associated lung injury and death are clear indications of the need for people to follow the Centers for Disease Control and Prevention’s recommendations and not vape,” said DPH Commissioner Kathleen E. Toomey in a statement. “The Georgia Department of Public Health is working closely with Governor (Brian) Kemp and the Georgia Department of Education to provide education and awareness about the imminent health risks of vaping and e-cigarette use, especially among adolescents.”

About this story

With a recent spate of deaths and illnesses tied to vaping, many people have more questions about the practice. The Times has been following the issue since local officials began examining how to regulate the industry. For these articles, The Times spoke with government and health officials and vape shop owners, and drew information from the CDC, the Department of Public Health and national reporting from the Associated Press.

No outright ban on the practice or products has been issued, but local authorities have put a moratorium on more shops opening as they study how to regulate the industry.

In an effort to better inform the public about vaping, the Partnership for Drug Free Hall is hosting a forum tonight in the First Baptist Church’s banquet hall on Green Street in Gainesville.

Merrill Norton, a professor at the University of Georgia pharmacy college, will present on the medical side of vaping. Northeast Georgia Health System governmental affairs executive director Deb Bailey and Gainesville Police Chief Jay Parrish are also slated to speak. 

A preview of Parrish’s remarks regarding law enforcement was not available

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Planet X Smoke & Vape Gainesville manager Trevor Comeaux holds a typical vaping device Wednesday, Oct. 9, 2019. Gainesville has placed a 120-day moratorium on new vape shops while city officials work on regulations for these businesses. The Hall County Board of Commissioners has also issued a moratorium on vape shops through December. - photo by Scott Rogers
The Truth About Vaping

What: Community forum about vaping risks

When: 6-8 p.m. Thursday, Oct. 10

Where: First Baptist Church banquet hall, 751 Green St., Gainesville

How vaping works, and the risks

Almost all e-cigarettes and vape devices have a liquid storage area, a battery and a way to heat the liquid.

The liquid often combines nicotine, flavorings and other chemicals to create an aerosol when heated, according to the CDC. The vapor is then inhaled into the lungs.

Long touted as a safer alternative to smoking tobacco, that claim is being called into question.

“E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes,” according to the CDC. “However, e-cigarette aerosol is not harmless.”

The CDC said the potentially harmful substances outside of nicotine may include: “ultrafine particles that can be inhaled deep into the lungs,” volatile organic compounds, cancer-causing chemicals and heavy metals.

One area Norton will discuss tonight is bronchiolitis obliterans, a disease that restricts the airways and is often called “popcorn lung.” The popcorn association comes from past instances of manufacturers using the chemical diacetyl as a buttery flavoring in popcorn and other products.

“When you heated it or vaporized it, it created irritations in the employees inside of that industry,” Norton said.

Diacetyl has been found in some e-cigarette flavoring.

Norton also points to a rapid rise in chronic obstructive pulmonary disease, or COPD, which is used to describe a number of lung diseases.

According to the COPD Foundation, it occurs mostly in people older than 40 who have smoked, but now it’s hitting vapers quickly.

“What we’re seeing is early signs of that kind of process within 90 days of people beginning to vape,” Norton said.

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Hemp based vaping luiquids on display Wednesday, Oct. 9, 2019, at Planet X Smoke & Vape Gainesville. The City of Gainesville has placed a 120-day moratorium on new vape shops while city officials work on regulations for these businesses. The Hall County Board of Commissioners has also issued a moratorium on vape shops through December. - photo by Scott Rogers
Rapid spread

The CDC said 1,080 confirmed and probable cases of vape-related illness have been reported in 48 states and one U.S. territory as of Oct. 1. That count includes 18 deaths in 15 states.

More than a third of patients are under age 21, but the deaths have been older adults who apparently had more difficulty recovering. The ages in the Georgia cases range from 18 to 68, with 71% being men.

Recently, 275 cases have been added to the national tally each week, and about half of the newest batch were people hospitalized in the last two weeks.

“Unfortunately, the outbreak … is continuing at a brisk pace” and there’s no sign of it slowing, the CDC’s Dr. Anne Schuchat said.

“Cases experienced severe respiratory symptoms including cough and shortness of breath. Cases also reported experiencing fever, fatigue, chest pain, nausea, vomiting, and diarrhea,” according to the Department of Public Health.

The CDC said it is unknown what “specific chemical exposures (are) causing lung injuries associated with e-cigarette use,” but use of liquid containing THC, the main psychoactive element in marijuana, has been frequently reported.

“Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak,” according to the CDC.

THC vape products are illegal in Georgia but often are sold on the black market, where it can be impossible to know what’s in the liquid.

Complicating the investigation are apparently conflicting medical reports about what’s been seen in the lungs of different patients. Some doctors suggested patients’ lungs are being clogged and inflamed by oils from vaping liquids, but a report published by the New England Journal of Medicine pointed to the kind of chemical burns that might come from poisonous gases.

“We’re probably going to have 10 times the reports that we have now, because the physicians are just now getting into the system to be able to report what kind of injuries we’re seeing,” Norton said.

Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak
Calls for action, information

With cases rising and progressing so rapidly, more governments — including Hall County and the city of Gainesville — are looking into regulating the vaping industry.

Brian Walters, the director of operations at Georgia-based store chain Big Bang Vape, said the industry as a whole has already had regulations in place to keep its products out of younger people’s hands.

“Let’s be honest, kids from 18 to 25 are gonna still be kids,” Walters said. “Any of them could open a device and slip some drugs in there, then boom, it’s not a vaping product anymore, it’s an illegal drug product. Our warnings pretty much state Big Bang deals with manufacturers directly or through distributors that deal with manufacturers directly and to be mindful when vaping someone else’s product that they could have altered it and not to do such a thing.”

Norton said he wants to separate what has been scientifically proven from the myths and misconceptions so people can have an accurate understanding of the issue.

“People make a choice if they want to smoke or not, but I want them to have the appropriate information to sit down with their adolescents, their young adults and let them know what this is, because a lot of this information is just now coming to light,” Norton said.

With obtaining accurate information being a focus of tonight’s forum, Laurelwood business development manager Adam Raulerson will run a portion called “Start the Conversation,” which will focus on communication skills about serious topics.

“What I’m seeing in my work with families is families just aren’t really communicating about important topics such as suicide, vaping, drug use in general. We’re kind of acknowledging the fact that we’re not doing a good job as families with those communications, so it’s going to be how do we have those difficult conversations in an effective way,” he said.

Much of this will be geared toward parents talking with their children or other young people.

“With vaping, how do we have the difficult conversations about the truth about vaping without creating defensiveness in the young people who just see it as parents trying to control them?” Raulerson asked.

The skills discussed at the forum will include active listening and using “I” statements, which focus on expressing the emotion felt by a certain action.

“The use of ‘I’ statements helps break down some of the defensiveness, because you don’t feel accused,” Raulerson said.

Raulerson said he hopes people will leave with the skills and a conversation plan on how to start the dialog.

Kenneth Hucks and the Associated Press contributed to this report.