Higher rates of e-cigarette and cannabis use did not lead to more e-cigarette or vaping-related lung injuries (EVALI), a US study has found.
Researchers from the Yale School of Public Health have found that higher rates of vaping and marijuana use are associated with fewer EVALI cases per capita.
Published in the journal Addiction, the study estimates the relationship between states’ total reported EVALI cases as of January 2020 and pre-outbreak rates of adult vaping and marijuana use.
Author of the study, Assistant Professor Abigail Friedman said: “If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviors should show a higher EVALI prevalence. This study finds the opposite result. Alongside geographic clusters of high EVALI prevalence states, these findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”
The Centers for Disease Control and Prevention began a cross-state investigation into vaping-related lung injuries in August 2019, and has since confirmed over 2,800 cases and 68 deaths.
In February 2020, the CDC concluded its national updates, and officially classified vitamin E acetate, an additive long linked to EVALI and most common in THC e-liquids that are illicitly-sourced as a ‘primary cause of EVALI’.
The EVALI outbreak has motivated a variety of state and federal legislation to restrict sales of nicotine e-cigarettes, including a temporary ban on all e-cigarette sales in Massachusetts in late-2019 and bans on flavored e-cigarette sales in several states and localities.
However, if the goal was to reduce EVALI risks, the study suggests that those policies may have targeted the wrong behavior.
The five earliest states to legalize recreational marijuana—Alaska, California, Colorado, Oregon and Washington—all had less than one EVALI case per 100,000 residents aged 12 to 64.
None of the highest EVALI-prevalence states—Utah, North Dakota, Minnesota, Delaware and Indiana—allowed recreational marijuana use.
Friedman notes that two of the highest-prevalence states’ medical marijuana laws forbid smokable marijuana.
She added: “If this policy led some recreational marijuana smokers to switch to vaping THC, perhaps in order to avoid detection, it would have increased their likelihood of exposure to contaminated e-liquids when those came on the market. This may have contributed to the higher EVALI prevalence in those states.”
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