Celebs have made 'Juuling' a trend — but new reports should make you think twice. Here, the health risks of all vape pens you need to know about.

By Rachael Schultz
Oct 03, 2019 @ 5:30 pm
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In 2018, Juuls appeared to be as essential as dad sneakers and fanny packs to a certain young-Hollywood set. Bella Hadid, Sophie Turner, Dua Lipa, Miley Cyrus, Kate Moss — plenty of your faves were seen carrying one. But mark Fall 2019 as the death of the toking trend: E-cigarettes and weed vape pens have now been linked to more than 805 hospitalizations and 12 deaths (and counting), according to the Centers for Disease Control and Prevention, effectively killing their cool. 

Trump is now considering outlawing flavored e-cigarettes. Michigan, New York, and Massachusetts (among other states) have flat-out banned sales of all e-cigarettes for at least the next few months. And, even though the problem is beyond one brand of e-cigarettes — and beyond tobacco products themselves — the CEO of Juul stepped down amidst widespread criticism over the brand’s targeting of teenagers and young adults in their marketing.

There’s a lot of chaos and questions surrounding the mysterious lung illness epidemic — what vapes are we supposed to stay away from, which ones are safe, and why exactly are people ending up in hospitals? Here, everything you need to know about whether e-cigarettes like Juul are safe. 

Are all vape pens the same?

There is a foundational similarity in the devices themselves: Vape pens are battery-powered — usually small, sleek, and discreet — and are comprised of four main parts: a battery; sensor software to help power it; an oil cartridge that contains substance you're trying to inhale (usually THC or nicotine), along with carrier oils and potentially flavorings and other compounds; and a small heater called an atomizer that converts the liquid oil into tiny droplets for you to inhale.

Beyond the basics of construction, all vapes are definitely not the same. For starters, we have two main categories: weed vape pens and e-cigarettes. Cannabis oil vape pens sometimes contain CBD, but usually contain THC, the psychoactive substance that produces the “high” associated with smoking marijuana. The CDC reported last week that about 77 percent of people hospitalized with the mysterious pulmonary illness had used a THC vape in the past 30 days. 

This is causing most everyone to point the finger at weed vapes — and some of that flak is warranted. "The world of cannabis vapes is largely an unregulated space, which means you can have unscrupulous people cutting the products with who knows what," says Ray Niaura, Ph.D., professor of social and behavioral sciences at NYU and former president of the Society for Research on Nicotine and Tobacco. (Among those questionable compounds is vitamin E acetate, which was found in many of the pens that belong to hospitalized folks then tested by the CDC).

But 16% of the people hospitalized with vaping-related illnesses exclusively used nicotine e-cigarettes. Plus, a large percentage of the patients vaped both THC and nicotine — and that points to an issue that goes beyond THC or nicotine itself, and instead is tied to the vaping devices themselves (e.g.., how hot they get) and extraction process (namely, the carrier oils in the cartridge), says Stanton Glantz, Ph.D., director of the Center for Tobacco Control Research and Education at the University of California San Francisco. 

“We don’t know what the exact culprit is just yet, but I think they’ll conclude that more than any risk of nicotine or cannabis, most of the compounds used as carriers in these products are not good for your health,” Glantz says. (More on that later.)

Lastly, we have the difference among e-cigarettes themselves, which is mainly around how clean the formula is for the vape oil, and how hot the device is able to get. "Most of the carrier compounds in an e-cigarette become formaldehyde when they are heated too high. And the hotter it heats, the more breakdown of all the compounds you're going to get," says Glantz. One pro for Juul compared to other brands is their pens have more advanced technology that prevents it from overheating and combusting, Niaura points out.

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What is a Juul anyway?

Juul is hands-down the most popular brand of e-cigarettes. In fact, it’s likely the only brand most people could name. But every e-cigarette isn’t a Juul and, even though it, like all e-cigs, isn’t regulated by the FDA, the more advanced Juul technology and public exposure makes it one of the safest forms of e-cigarettes, says Niaura. (More on why it’s considered ‘safer’ below.)

Are e-cigarettes safer than regular cigarettes?

Yes. E-cigarettes were created for and are marketed as products for current smokers trying to quit. And in that context, they’re definitely healthier: Ditching traditional smokes for the electronic variety reduces your exposure to some toxicants and carcinogens, says a 2018 study in JAMA. They help you quit better than nicotine patches, and a lot of ex-cigarette smokers say they feel less dependent on e-cigarettes than they remember being on the traditional stuff, according to a 2015 paper from Penn State. Meanwhile, European researchers found that former smokers who switched over to e-cigs exclusively experienced less nicotine withdrawal and less exposure to toxic cigarette smoke after two years.

So, are e-cigarettes safe?

Unless you’re using them to  try to quit smoking, e-cigarettes can only harm your health. For one, they often still contain nicotine, which is highly addictive; and they have been linked to serious long-term side-effects.

We know traditional cigarettes are terrible for your heart and lungs, but a huge study review in the Annual Review of Public Health found that e-cigarettes increase the risk of lung and cardiovascular disease at similar rates. Other research found they increase your chances of chronic bronchitis. The electronic variety ups your chances of having a heart attack and, since most who puff on e-cigs also still use traditional sticks, dual-users' risk of a heart attack is actually five times higher than people who don't smoke at all.

The flavorings are another huge issue. For starters, it’s the feature authorities blame on enticing so many teenagers into picking up the e-sticks. But the compounds used to make e-cigarettes taste better are also really, really bad for teens and adults alike.

Harvard researchers analyzed 24 different flavored e-cigarette brands on the market in 2017 and found all of them had at least one aldehyde or chemical on FEMA’s “High Priority Chemicals” or the FDA’s Harmful and Potentially Harmful Constituents lists. Meanwhile, more than 60 percent of the samples contained diacetyl, a chemical known to tear up your respiratory system and cause “popcorn lung” (that's a condition that damages your smallest airways and makes you cough and feel short of breath all the time).

What about 'black-market' vaping products?

You may have heard that the only danger is with 'black-market' vape cartridges. But in reality, nothing is currently regulated by the FDA (while they’ve had the authority to oversee e-cigarettes since 2016, they have yet to enforce any guidelines or approve products like Juul as safe for use; and cannabis is still illegal at the national level). That means all weed vape pens (other than those sold at a dispensary, which are at least regulated by the state) and e-cigarettes are actually black market purchases. In other words: The FDA is not checking any vape products for safety, so there is no inherent trust in brand names you recognize.

Why the real issue is vaporizing itself:

The main issue with vape pens is the actual process of aerosolizing. "Aerosolizing creates tiny microparticles about one-hundredth the size of a human hair that are small enough to enter the alveoli, the tiny air sacs in your lungs,” Glantz explains. Those particles that are entering your lungs are the substances from the vape oil itself.

Which leads us to the second biggest problem — and likely part of the reason we’re seeing all these pulmonary issues now: the questionable compounds used as carriers in both nicotine and THC vape pens, like vitamin E acetate, propylene glycol, and vegetable glycerin.

Niaura points out these last two compounds — propylene glycol and vegetable glycerin — are in the foods we eat every day, so we know they’re safe to consume. But that says nothing of how safe it is to heat up these substances to extremely high temps and breath them in as vapor.  

What we do know: The CDC hasn't officially labeled the mysterious pulmonary illness yet, but some of the cases are being diagnosed as lipoid pneumonia, a condition where the lungs become inflamed because fat particles enter the lungs. In this case, that fat is oil from a vape pen, Glantz says. Tissue samples of one of the men who died in St. Louis showed cells stained with oil, the New York Times reports. And cases of lipoid pneumonia from e-cigarettes have been turning up in England as well, one of which last year involved a young woman who was hospitalized for a serious cough and respiratory failure. A biopsy revealed she had vegetable glycerine from e-cigarettes in her lungs.

The bottom line on vape pens:

In short: Until the FDA starts regulating vape pens across the board, we have no guarantee the compounds used in the oils are safe when heated and aerosolized. What’s more, we know that unless you’re trying to quit traditional cigarettes, the electronic variety will only harm your health (jury’s still out on whether that applies to weed vape pens or not). And even if you’re using them to quit, you are substituting one harmful habit for another, and quitting entirely is the best bet.

The silver lining, as Niaura points out, is that this epidemic is motivating major e-cigarette companies, including Juul, to obtain FDA approval for use as a smoking cessation aid, which means the products will  have to be proven safe for that use to be approved (and that could take well into 2020 to happen). The takeaway for now? While e-cigarettes are healthier than the traditional kind, and one of the best options to help you quit smoking (and Juul may be one of the safest brands available), they’re still not guaranteed to be safe. No matter what your favorite celebs are up to.