Read other stories in this series at gainesvilletimes.com/cancer.
Eric Williams took his first drag on a cigarette at 9 years old.
Williams, who lives in Dahlonega, spent the majority of his adolescence smoking cigarettes. For just under a decade it became a regular habit, and while Williams said the long-term effects of smoking cigarettes didn’t concern him at first, the damage it was doing to his body eventually caught up with him.
“It just snapped,” he said. “My wife Stacey saw that I was hacking and coughing all the time — almost every 10 minutes. That’s when it pretty much snapped and we knew something had to change. My wife wanted me to stop, and I just felt like crap all the time. But I genuinely felt that it could help me and it did.”
At the request of his wife, Williams switched to vaping products at 18, and he said the changes were almost immediate — his breathing was easier, his sense of taste improved and he doesn’t get winded after moderate exercise.
But recent news is casting a shadow on one of the nation’s most popular tobacco-replacement products.
With hundreds of illnesses in dozens of states attributed to vaping, regulators at the state and federal level are moving to tighten restrictions on the industry or outright ban flavored e-cigarettes altogether.
Defenders of the products and the industry argue recent illnesses have been attributed to vaping products that include THC derived from marijuana, and they also say that federally regulated products are still safe.
President Donald Trump on Sept. 11 announced plans to implement a ban on flavored e-cigarettes based on reports of lung illnesses and even deaths believed to be related to vaping.
The proposed ban would remove flavors other than tobacco flavors in hopes of deterring the use of vaping products, especially among teens.
Critics of the move to ban flavored vape products say the light is being cast on the wrong culprit, and that the ban will only deprive people looking for a less harmful alternative to cigarettes, which have been proven to cause myriad illnesses, including lung cancer and other cancers.
Vape products bought at regulated stores are registered with the FDA, but homemade or bootleg products proliferate the market.
The number of vaping-related illnesses in the nation has increased to more than 800, and both experts and industry advocates warn it’s important for people using vapes to buy from respectable sources.
Especially worrisome are vaping products that include THC, the psychoactive component of marijuana. Vaping products that include THC have been shown to contain high levels of Vitamin E acetate, which the FDA and the Centers for Disease Control suspect could be the source of the illnesses in the United States.
Vaping was introduced as a safer alternative to traditional cigarettes, allowing users to get a nicotine fix without the thousands of harmful chemicals found in cigarettes — but that doesn’t mean they’re considered risk-free.
Angie Caton, the assistant manager of Oncology Services at Northeast Georgia Medical Center, said her research suggests e-cigarettes can help those with nicotine addiction avoid known illnesses related to traditional cigarettes, as well as satisfy oral and hand fixations associated with the act of smoking.
But vapes are only a better alternative to cigarettes as long as users know what’s in the product they’re using.
“For the adult smoker that is very addicted to nicotine, it may be a way that they could look to reduce the amount of smoke that they’re exposed to,” Caton said. “But with that said, and with all the stuff that’s been in the news, that unless we know what is in an e-cigarette, the vapor and liquid that fuels them, those things might be harmful.
“If it’s (just) nicotine, we would know that nicotine is addictive, but it doesn’t cause cancer.”
Meanwhile, there’s still not enough data to know exactly what their long-term effects could be. Caton believes definitive evidence about how vaping will affect personal health in the long run is probably another five to 10 years away.
But in the short term, vaping has already been proven to alleviate symptoms like weaker lung capacity, poor dental health and loss of senses like smell and taste caused by frequent cigarette use.
It can also be a more effective replacement for smoking. Caton said she believes the act of vaping — holding the vape itself, inhaling, exhaling and the amount of nicotine provided — can make it a more effective replacement to smoking than nicotine gum and patches, especially when the withdrawal symptoms for nicotine can be too bothersome to those looking to quit.
“There are several products out there, and it sometimes takes a combination,” Caton said. “Everybody is different as far as their addiction to nicotine and their ability to cope when they’re withdrawing. The withdrawal symptoms of nicotine are so powerful and so uncomfortable that that’s when a lot of people relapse.
“You think you’ve got your plan, you’re gonna do it, but then you start to get irritable and sweaty and anxious. Then you get instant relief when you smoke your cigarette. Those symptoms just go away.”
But as Caton and others emphasize, while nicotine gum and patches have been proven safe, the long-term effects of vaping on the lungs and body are still being studied.
Even so, many people have used e-cigarettes to wean themselves off of tobacco cigarettes, which is why American Vaping Association President Gregory Conley became an advocate for the products.
“I was a dedicated smoker in law school,” Conley said. “I tried multiple times to quit with the gum, the patch, lozenge and kind of resigned to the fact that I would smoke for many more years, then I saw the very early versions of e-cigarettes.
“I actually failed to quit with them but got a better product in 2010, quit with it, and saw that there were state governments, as well as the FDA, trying to essentially ban these products while real cigarettes remained freely available.”
The American Vaping Association’s advocacy for vaping the industry has reached a fever pitch in recent weeks as news has spread about illnesses and even deaths that have been connected to vaping.
When the news began weeks ago, it was unclear what sort of vaping was involved in a wave of illnesses in about three dozen states. In September, investigations discovered that all of the cases involved people vaping marijuana-derived THC oil.
Initial reports following the uptick in lung illnesses attributed to vaping by the CDC warned consumers to avoid vaping products altogether.
Conley argues that’s foolhardy.
“Very quickly it started to become apparent that this was going to be relating to amateur-made, street-bought THC cartridges,” Conley said. “The type of lipoid pneumonia that is being most commonly associated with these illnesses can’t actually be caused by propylene glycol or vegetable glycerine, the two main bases used in nicotine vapor products. You need to have an oily, fat substance, and that’s what the THC cartridges are, they are oil.”
While the illnesses and deaths being attributed to vaping products have sparked a proposed ban at the federal level and in a few states, the FDA suspects the illnesses are being caused by vaping products bought through unregulated or illegitimate channels.
“Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores,” states a warning on the FDA website.
The headlines about illness and potential crackdowns have local businesses worried about what the future holds for the market.
Brian Walters, the director of operations at Georgia-based store chain Big Bang Vape, said the company’s stores have a few ways of ensuring they’re only selling FDA-registered products, like working directly with manufacturers so they know exactly what’s on their shelves.
The company also works to prevent minors from buying any vaping products or liquid — called “juice” in the industry — from their stores, even going beyond what is technically required for stores with age-gated goods.
“We have third-party ID readers in all of our stores to make sure that when we scan an ID it’s not a fake. We pay for that monthly,” Walters said. “We pay for those services because all eyes are on us.”
As for how these devices still manage to end up in the hands of kids under 18, Walters said some gas stations don’t check IDs. Some kids will buy gift cards that will let them purchase vaping equipment online, but according to Walters, one of the most common ways kids get vaping products is through friends, parents or other family members buying for them.
“We know how to spot it,” Walters said. “When you have a parent that comes in with a minor, or at least someone that looks under 18, you’ll watch them come up to the cabinet, take a look at what we have, then turn to their son or daughter, whatever the case may be, and say, ‘Which one did you want?’”
Walters said the company’s stores require ID cards for everyone present for the purchase and refuse a sale when the intended recipient is under 18.
Instances like this have become so widespread that Big Bang has made it policy to check IDs for anyone who comes into its stores at the door.
When it comes to informing customers about the dangers and benefits of vaping compared to cigarettes, American vaping stores’ hands are tied, as The Deeming Rule enforced by the FDA in August of 2016 prevents them from discussing the differences between vaping and smoking cigarettes and labeling products as “lower risk” or “less harmful.”
But Big Bang has added warnings about the dangers of home-made products and buying or using products that don’t come through official channels.
“The only thing we can do is inform our customers,” Walters said. “In every single one of our retail locations, because of that scare, we made a point to put at our point of sale a piece of paper that has a big warning on it to let our customers know to be sure that where you’re buying your products that you’re buying legitimate products, and to be mindful that you should never vape someone else’s equipment not knowing where they’ve bought their products or if they modified.”
Advocates like Conley are fighting to offer some perspective amid the recent news of illnesses among people who vape — a frustrating task as more regulators set their sites on the products.
As early as 2014, the CDC estimated 3.7% of the United States population used vaping products, or more than 9 million people.
At the start of fall, the number of people made ill by vaping tallied to more than 800. At the same time, there are more than 480,000 smoking-related deaths each year in the United States, according to the CDC.
That’s about 1,300 deaths each day, and Conley argues that cracking down on vaping will push more people back to cigarettes, which would remain on the shelves.
And that could be bad news for people like Dahlonega’s Eric Williams, who used flavored vaping products to quit smoking on the grounds that, if studies show that there are long-term consequences to vaping, it would still be better than cigarettes by the pack.
“I can taste things more than I have in the last 10 years,” Williams said. “My breathing is a lot better. I don’t feel winded if I run for more than 30 seconds. I feel significantly healthier on vaping than I have with smoking. Ever.”