News Releases from Department of Health

HONOLULU – The Hawai‘i Department of Health (DOH) recently confirmed two additional cases of lung injury related to the use of e-cigarette or vaping products and has received other reports for investigation. This brings the current number of confirmed cases in the state to four, with one individual confirmed in each county. Two of the individuals are adolescents and two are adults. All were hospitalized and have recovered.

The department continues to advise everyone to stop vaping, no matter the substance or source, until current nationwide investigations are complete.

“E-cigarettes and vaping products are not safe,” said Director of Health Bruce Anderson. “The public should refrain from using these products, regardless of whether they contain nicotine or THC.” 

As of Nov. 13, 2019, the Centers for Disease Control and Prevention (CDC), reports 2,172 confirmed and probable lung injury cases associated with use of e-cigarettes or vaping products reported by 49 states, the District of Columbia, Puerto Rico, and the Virgin Islands. This includes 42 deaths confirmed in 24 states and the District of Columbia.

FDA and state health laboratories have detected vitamin E acetate (a synthetic form of vitamin E) in a sample of vaping fluids also containing tetrahydrocannabinol (THC), the main active compound in marijuana. In a sample of lung fluid from 29 ill patients:

• All 29 were positive for vitamin E acetate.
• Twenty or 69 percent of these patients stated they were vaping marijuana. 
• Other patients using nicotine, or a combination of nicotine and THC have also developed symptoms.

Although there may be a link between THC and vitamin E, the exact cause of the vaping injury and deaths is unknown. DOH recommends that persons should not use e-cigarettes of any kind (marijuana or nicotine) and especially those containing vitamin E acetate. People should be concerned about using vaping products containing THC, particularly those obtained from informal sources such as friends or family, or from the illicit market, where product ingredients are unknown or can be highly variable. Until the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette or vaping products.   

DOH has issued an updated Medical Advisory to physicians to assist in identifying patients who may have lung injury related to e-cigarettes and vaping. New tools for clinicians are available online at https://health.hawaii.gov/docd/vaping-resources-for-clinicians/. Healthcare providers in all settings are advised to educate all patients on the risks associated with vaping nicotine and other products. E-cigarettes should never be used by youth, pregnant women, and adults who currently do not use tobacco products.

DOH, in partnership with the Hawai‘i Community Foundation and using Tobacco Prevention and Control Trust Funds, recently conducted three different sets of vaping prevention workshops for administrators, staff, and faculty teams for the Department of Education, State Charter School Commission, and the Hawai‘i Association of Independent Schools.

“Prevention is the best strategy,” said Alvin Bronstein MD, medical toxicologist, and Emergency Medical Services branch chief. “E-cigarettes are not safe, and we do not know the long-term effects for youth and adults who vape.” 

DOH is working daily with local physicians and federal authorities to investigate and report cases related to the national outbreak of lung injury. At this time, no one compound, or product has been identified as the cause of the injuries, and there may be more than one cause of the outbreak. DOH therefore recommends 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. CBD products in retail locations other than through the licensed state dispensaries are not on the market legally, and vaping products especially should be avoided. 

• Pregnant women should not use e-cigarettes and vaping products of any kind.

• Children and youth should never use e-cigarettes and vaping devices.

Parents are urged to talk about the hazards of vaping with their children. Visit HawaiiNoVape.com for more information on e-cigarettes and tips on starting the conversation. Nicotine is highly addictive, and one vaping pod smaller than the diameter of a quarter can contain nicotine equivalent to 41 sticks of cigarettes. 

The act of selling tobacco products, including e-cigarettes, 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.

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PDF: DOH confirms additional cases of lung injury associated with the use of vaping products