About Department of Health

STATE OF HAWAI‘I
DEPARTMENT OF HEALTH

Health Advisory — October 7, 2019

Update and recommendations on e-cigarettes and vaping for the public

Injuries and deaths are associated with e-cigarettes and vaping
The Centers for Disease Control and Prevention (CDC) and health departments across the nation, including Hawai‘i, are investigating hundreds of lung and stomach injuries associated with the use of e-cigarettes and vaping products (also referred to as “vaping devices”). As of today, more than one thousand cases have been reported in 48 states, including 18 deaths reported in 15 states. One case has been reported in Hawai‘i involving a minor.

Vaping involves inhaling substances using a wide variety of products
As supported by statements from CDC and other sources, vaping involves inhaling aerosol from a device that heats a liquid containing nicotine, marijuana (THC), cannabidiol (CBD) or other substances. These devices come in all shapes and sizes, including colorful vape pens, modified tank systems, and devices that can look like USB flash drives, cell phones, credit card holders, and highlighters. They are frequently referred to as e-cigarettes, e‐cigs, vapes, vape pens, electronic vaporizers, pod mods, or pod systems.

The investigation of injuries and deaths associated with vaping is ongoing
No one type of vaping device has been positively identified as a common cause of the lung injuries and illnesses reported nationwide. In approximately 77 percent of the identified cases, patients reported using marijuana (THC) vaping products. Some patients reported vaping only nicotine products. Others reported some combination of nicotine and cannabis products. Many of the products used are believed to be sold on the street, over the internet, or were homemade. While the investigation is still ongoing, all the reported cases have a common history of vaping and include individuals of all ages with the majority between the ages of 13 to 34 years.

Recommendations for the public

Until the cause of vaping-associated illnesses is determined, the Hawai‘i Department of Health advises the following:

• Do not use e-cigarettes or vaping devices of any kind. If you don’t use vaping devices, don’t start. If you are using a vaping device, stop.
  E-cigarettes and vaping products are unsafe and unregulated. While there are claims that vaping devices help smokers kick their cigarette habits, not enough time has elapsed, nor has testing been done, to verify this claim or the potential for other health impacts. If you are an adult using vaping devices with medical cannabis products, consider changing to another form of medical cannabis.
• If you choose to continue using vaping devices, do not use off-market products. Caution is especially advised regarding the use of off-market THC containing liquids. “Off-market” products are those available through the internet, purchased from persons on the street, and those which are homemade. Homemade products often involve modifying or adding substances to products purchased at retail stores. While evidence points to a higher incidence of negative health impacts among users of off-market THC products, some patients suffering negative health impacts report using only nicotine products or products obtained on the market.
• Pregnant women should not use e-cigarettes and vaping products of any kind at any time during pregnancy.

• Children and youth should never use e-cigarettes and vaping devices.
  The act of selling to anyone under the age of 21 is illegal in Hawai‘i. It is also illegal for anyone under the age of 21 to purchase, use, and possess these products. Vaping devices were never intended to be used by children or youth and should not be used by them.
• If you have recently used a vaping device and are experiencing symptoms including coughing, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever, or abdominal pain, see a healthcare provider. You may also call the Hawai‘i Poison Hotline at 1-800-222-1222 at any time 24 hours a day, 7 days a week.
• If you are an adult using vaping devices to kick a cigarette habit, do not return to smoking cigarettes. Consult your doctor, pharmacist, or call the Hawai‘i Tobacco Quitline at 1-800-QUIT-NOW (1-800-7848-669). This is a free and confidential call.

Download a PDF version of the public health advisory here.

Resources for Clinicians
Hawai‘i clinicians and medical providers looking for instructions on how to report possible vaping-related illness cases to the department should visit the Disease Outbreak Control Division’s clinician page. Resources, including the official medical advisory on vaping and the preliminary vaping case report form, are available along with appropriate phone numbers for additional assistance.

Additional Resources
For more information about ongoing investigations of vaping associated illness in Hawai‘i and additional resources for the public and clinicians, visit the Disease Outbreak Control Division’s investigation page. Get the latest updates on the national outbreak investigation from the Centers for Disease Control and Prevention (CDC) here.

Vaping prevention resources for parents and educators can be found at www.HawaiiNoVape.com.