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The US vaping flavour ban: twenty things you should know




















The secret weapon against smoking – facing an existential threat from zealous regulators

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CDC and State Health Departments are Wrong to Inform the Public that Some Case Patients Used Only Nicotine E-Liquids

Because the CDC and state health departments have deliberately been conflating the respiratory disease outbreak with the general problem of youth vaping, they have not been clear in communicating the scientific evidence regarding the type of products that are most likely causing the outbreak. Because of the confusion they have created, a large number of state officials, health practitioners, and media outlets have been incorrectly reporting that a substantial proportion of the outbreak case patients used only nicotine-containing e-cigarettes.For example, in its legal brief opposing a temporary restraining order against its emergency order banning the sale of vaping products, the state of Massachusetts claimed that "17% [of outbreak case patients] used only nicotine."As another example, one chest physician told the public that about 15% of outbreak case patients: "used only nicotine-based products." Another physician writing for UpToDate claimed that 15% of case patients "used products with nicotine but not THC."Newsweek reported that about 16% of case patients "used only nicotine." Yahoo also reported that a subset of the case patients "used only nicotine-containing products."NBC News, too, reported that: "16 percent [of case patients] used only nicotine products."The Rest of the StoryThese statements are simply not true, or at least they are not backed up by solid evidence. It is not the case that 15% of case patients used only nicotine products. The evidence is actually that 15% (it's now down to 11%) of case patients did not admit to using products other than nicotine-containing e-liquids. The difference between these claims might sound minor, but it has immense public health implications.A story published today out of Indiana illustrates why this distinction is so important. The article reports that a young male in Indiana developed vaping-associated respiratory illness and claimed to have only used nicotine-containing products. But it turns out that he really didn't know what was in the product because it was given to him, and he just assumed it was a nicotine-based product because "that’s what is mostly in vapes." Subsequent testing of the e-liquid in question revealed that it actually contained THC. But the patient had no idea that he was vaping THC oil.What the CDC and many state health department officials don't seem to realize is that youth are not obtaining their vaping products by purchasing them at stores. They are mostly obtaining them from friends or school distributors, off the internet, or from street shops or dealers. For this reason, many youth vapers really have no way to know what is in their e-liquids. Moreover, as the Indiana story illustrates, even if a youth knows they are vaping THC oil, there is a strong incentive not to report it. The youth in question was expelled from school indefinitely and his mother is fighting the school system to have him reinstated. Furthermore, the CDC - until very recently - did not recommend that physicians conduct THC drug screens on patients, which ensured that it would not be possible to link all of the cases to the use of THC. To the best of my knowledge, the CDC has not confirmed a single outbreak case who tested negative for THC use. In light of this, I think it is irresponsible for physicians or other health practitioners or groups to report that a certain percentage of patients "did not use" THC vaping products.The lack of understanding of youth vaping culture also explains why proposals to ban flavored e-cigarettes are misguided and will be ineffective and why claims that it is the flavors that are responsible for teen vaping are too simplistic. Youth are not vaping because they like flavors. They are vaping because they like vaping. Vaping is what's cool, not the particular type of e-liquid that you are vaping. Moreover, youth will vape whatever cartridges are being supplied by the kids who serve as the distribution channels in their schools. The majority of kids are not making autonomous decisions about what to vape. They are vaping what's available. The supply is largely determined by a small number of distributors. All the kids in a school know who those distributors are. The distributors essentially control the supply. This is why flavored e-cigarette bans will not necessarily get rid of the problem of youth vaping. What these bans will do, however, is: (1) facilitate a transition towards the use of THC oils; and (2) facilitate a shift towards the distribution of black market e-liquids. It is precisely these types of products that are causing the outbreak in the first place. This is why banning flavors will do nothing to curtail the outbreak but may make it much worse. And it will likely lead to more serious problems in the future.A final possibility that needs to be considered is that some patients may actually be using nicotine-containing products, but contaminated THC oils may still be the reason for their illness. This is because there are bootleg, adulterated, and counterfeit products on the market in which a nicotine e-liquid is mixed with THC oil. In fact, lab testing of products recovered from case patients in two states has detected the presence of adulterated cartridges that contain both nicotine and THC.We are still a long way from concluding that any cases of this outbreak have been caused by nicotine-only e-liquids and we are even further away from concluding that any cases have been caused by traditional nicotine-containing e-liquids sold by retail stores. In that light, bans on the sale of electronic cigarettes - even just flavored ones - are a terrible public policy that will do little to protect youth but will do a lot to put them at substantially higher risk of severe harm.Original author: Michael Siegel
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Why I Think the FDA's Imminent Ban on Flavored E-Cigarettes is Unlawful

I expect the FDA to announce soon that it is banning the sale of all flavored e-cigarettes, with the exception of tobacco and probably mint and menthol as well.As you know, when an executive agency issues a regulation, it is required by the Administrative Procedures Act (APA) to go through a formal rule-making process, which at a minimum requires that the agency publish the proposed rule in the Federal Register, allow public comment on the rule, and then respond to the comments before actually issuing the rule. This process can take one to two years.The question you may be asking is: How can the FDA ban flavored e-cigarettes without issuing a rule that bans flavored e-cigarettes and that goes through the required APA process?I expect that the FDA is going to use its enforcement authority, rather than a formal rule-making process, to "promulgate" a de-facto ban on the sale of most flavored e-cigarettes, exempting only tobacco, mint, and menthol flavors.I believe they will attempt to escape the required public input and due process requirements of administrative rule-making by issuing a "guidance" regarding its enforcement of the pre-market tobacco application (PMTA) requirement, whose enforcement it is currently holding off on until May 2020.So what the FDA will likely do is to issue a guidance announcing that it is going to use its enforcement authority to enforce the PMTA requirement "immediately" for all flavored e-cigarettes. This means that any flavored e-cigarette that has not yet submitted a PMTA (which is every flavored e-cigarette) will have to be taken off the market until they submit and gain approval of a PMTA (which will be never for almost all companies except for the cigarette companies and perhaps a few of the largest independent companies). So not only will most flavored e-cigarettes have to come off the market but what does remain of the market will be handed over to the tobacco companies.So the following question arises:Is It Legal for the FDA to Ban Flavored E-Cigarettes By Issuing a Guidance and/or Using Its Enforcement Authority Regarding PMTAs?The answer, I believe, is no, for three major reasons.1. Such a guidance would violate the Executive Order on Promoting the Rule of Law Through Improved Agency Guidance Documents and the Executive Order on Promoting the Rule of Law Through Transparency and Fairness in Civil Administrative Enforcement and AdjudicationOn October 9, 2019, the president issued an executive order that requires for any significant guidance document:"a period of public notice and comment of at least 30 days before issuance of a final guidance document, and a public response from the agency to major concerns raised in comments, except when the agency for good cause finds (and incorporates such finding and a brief statement of reasons therefor into the guidance document) that notice and public comment thereon are impracticable, unnecessary, or contrary to the public interest."The rationale for this executive order seems to perfectly describe what the FDA is doing here and why it is not appropriate or legal:"Agencies may clarify existing obligations through non binding guidance documents, which the APA [Administrative Procedures Act] exempts from notice-and-comment requirements.  Yet agencies have sometimes used this authority inappropriately in attempts to regulate the public without following the rulemaking procedures of the APA.  Even when accompanied by a disclaimer that it is non-binding, a guidance document issued by an agency may carry the implicit threat of enforcement action if the regulated public does not comply.  Moreover, the public frequently has insufficient notice of guidance documents, which are not always published in the Federal Register or distributed to all regulated parties.Americans deserve an open and fair regulatory process that imposes new obligations on the public only when consistent with applicable law and after an agency follows appropriate procedures.  Therefore, it is the policy of the executive branch, to the extent consistent with applicable law, to require that agencies treat guidance documents as non-binding both in law and in practice, except as incorporated into a contract, take public input into account when appropriate in formulating guidance documents, and make guidance documents readily available to the public.  Agencies may impose legally binding requirements on the public only through regulations and on parties on a case-by-case basis through adjudications, and only after appropriate process, except as authorized by law or as incorporated into a contract."An "enforcement authority"-imposed ban on flavored e-cigarettes also appears to violate a second emergency order, also issued on October 9 of this year.That executive order states that:"When an agency uses a guidance document to state the legal applicability of a statute or regulation, that document can do no more, with respect to prohibition of conduct, than articulate the agency’s understanding of how a statute or regulation applies to particular circumstances.  An agency may cite a guidance document to convey that understanding in an administrative enforcement action or adjudication only if it has notified the public of such document in advance through publication, either in full or by citation if publicly available, in the Federal Register (or on the portion of the agency’s website that contains a single, searchable, indexed database of all guidance documents in effect)."Since I do not believe that the FDA notified the public of this new enforcement approach through publication, it seems that it would violate this executive order. 2. Such a guidance and/or new policy on enforcement action would violate the Congressional Review Act.The Congressional Review Act (5 U.S. Code 801-808) requires that a federal agency submit any rule to Congress prior to its issuance. Congress has an opportunity to disapprove the rule via a joint resolution. While it may seem that a guidance or a new policy on enforcement action is not a "rule," the definition of "rule" in the Congressional Review Act is quite broad, being defined as:"the whole or a part of an agency statement of general or particular applicability and future effect designed to implement, interpret, or prescribe law or policy."In addition, this past April the Office on Management and Budget issued a memorandum explaining that in its view: "The CRA applies to more than just notice-and-comment rules; it also encompasses a wide range of other regulatory actions, including, inter alia, guidance documents, general statements of policy, and interpretive rules."The imminent ban on flavored e-cigarettes would appear to fit under this definition.3. Such a guidance and/or new policy on enforcement action would violate the Administrative Procedures Act because it represents "Rule-making by enforcement."I believe there is a legitimate argument that what the FDA is attempting to do represents rule-making by enforcement action. It is generally held that rule-making by enforcement is not permissible because it circumvents due process.Finally, even if it were lawful for the FDA to promulgate a rule banning flavored e-cigarettes merely by announcing a new enforcement action policy, I do not think it is an appropriate action. A policy of this magnitude, which is going to affect the national economy in a major way, is going to shut down almost an entire industry, is going to create new black markets, and is going to cause severe public health consequences, should not be implemented by enforcement action, but by a formal rule-making process.Original author: Michael Siegel
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I Expect FDA to Announce Flavor Ban This Week, But Vapers Save Mint and Menthol E-Cigarettes

Due to the outcry from the vaping community, it appears that mint and menthol will be excluded from a ban on flavored e-cigarettes that I expect the FDA to announce this week. I also do not expect menthol cigarettes to be included, since that would actually cause a decline in cigarette consumption (while a flavored e-cigarette ban will increase cigarette consumption, and therefore, federal government revenue). Moreover, it is easy to take a stand against the weak vaping industry but takes actual political courage to stand up to the large cigarette companies.The only reason why I think mint and menthol will be excluded from the ban is that vapers have loudly made their voices heard, shared their experiences, and let politicians know that e-cigarettes have saved their lives and that they rely upon flavored e-liquids to stay off real tobacco cigarettes. This has apparently convinced the Trump administration that a more comprehensive flavor ban would alienate the vaping community and could give him problems in the 2020 election. The votes of the vaping community are widely acknowledged to have played a role in the close 2016 election victory of Senator Ron Johnson in Wisconsin.The Rest of the StoryWhile this would be a victory for public health, it would only be a small victory. There are still hundreds of flavored e-cigarettes that would have to be taken off the market, and the public health consequences of even this "watered down" flavor ban would be devastating.The ban would still:Cause many ex-smokers to return to smoking;Deter many current smokers from trying to quit in the future;Create a new, unregulated black market for flavored e-liquids; andCreate a shift in youth use of vaping products towards the use of black market THC oils (the precise ones that are causing the current outbreak of severe respiratory illness).Allowing mint and menthol e-cigarettes to remain on the market is better than banning all flavors other than tobacco, but it is only marginally better.Why is the FDA interested in creating an unregulated black market for e-liquids, rather than simply directly regulating the safety of these products. If the current outbreak teaches us anything, it is that when you have a large black market, you can expect much more dangerous products being consumed and if a dangerous product does enter the market, it becomes almost impossible to control its manufacture, distribution, and use.Original author: Michael Siegel
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Heads Up – News – Updates 11.1.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Sales Data Show that Massachusetts Vaping Product Ban Has Already Caused Severe Harm as Vapers Migrate to Smoking in Large Numbers

Sales data reported by PiperJaffray for the four weeks ending October 20 (when the Massachusetts emergency ban was in effect for 25 of the 28 days) and the four previous weeks (mostly before the ban went into effect) were compared to sales data for the previous year. The PiperJaffray analysis revealed that there has been a substantial shift from vaping to smoking in the state. This indicates that as I predicted, ex-smokers in Massachusetts who were reliant on e-cigarettes to stay smoke-free are now returning to smoking in large numbers.Nationally, there was very little difference in the rate of decline in cigarette sales between these two time periods from 2018 to 2019. The rate of decline decelerated by 0.3 percentage points (from -7.8% to -7.5%). However, in Massachusetts, the rate of decline decelerated by a massive 5.7 percentage points (from -9.8% to -4.1%).Another way of expressing this is that in September 2019, national cigarette sales were 92.5% of what they were in September 2018, and in October 2019, they were 92.2% of what they were in October, 2018. Thus, there was little change in the rate of decline.However, in Massachusetts, while cigarette sales in September 2019 were 90.2% of what they were in September 2018, in October 2019, they were 95.9% of what they were in October 2018, a substantial lowering of the rate of decline in cigarette sales.The Rest of the StoryWhat these sales figures mean is that the emergency ban on the sale of all vaping products in Massachusetts has resulted in an increase in cigarette consumption, most likely due to large numbers of vapers going back to smoking.Because cigarette consumption is roughly linearly related to smoking-related disease and death, this means that unless the state reverses course, the vaping products sales ban is going to result in a substantial increase in disease and death.The state is justifying causing this known harm to the public's health based solely on pure speculation that although 90% of outbreak cases admit to vaping THC purchased off the black market, store-bought e-cigarettes are causing a substantial proportion of these cases. This assumes that the 10% of case patients who didn't report using THC: (1) know exactly what the ingredients were in the products they used even though the vapes may have been given to them by friends or purchased off the street or the internet; (2) know that the products are not counterfeit or tampered with; and (3) are not under-reporting their THC use even though we know that a huge proportion of youth who present in emergency rooms do under-report their THC use to physicians.These known negative health consequences are also occurring in the absence of any documentation that a substantial proportion of confirmed case patients who reported using nicotine-only products tested negative for THC in a urine drug screen.And furthermore, these known adverse health outcomes are occurring without any finding that a single nicotine-containing e-liquid sold by a retail store was contaminated with a chemical that could be causing the respiratory failure observed in outbreak case patients.The principle tenet of all public health practice is "Do no harm." As a central principle, we try to avoid doing known harm to the public's health. In this case, states that are banning e-cigarettes (or flavored e-cigarettes) are violating this principle because they are knowingly causing substantial harm to the public's health while producing no known benefits in terms of helping to curtail the outbreak. And, on top of this, they are likely going to make the outbreak worse.Original author: Michael Siegel
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U.S. Military’s Misbegotten Message to Troops: Cigarettes Are Safer Than Vape Products




With regard to tobacco products, the U.S. Department of Defense isn’t serving the health interests of those who serve. As I have documented many times (here, here, hereand here), in pursuing a tobacco-free fighting force, DOD has grossly misinformed American service members about the relative safety of smokeless tobacco and e-cigarettes.  David Sweanor recently posted the photo at left from an Army and Air Force Exchange Service store.  Even worse is this Military Times article from September 24, about the removal of vaping products from Army, Air Force and Navy exchanges by October 1, owing to “the outbreak of mysterious vaping-related lung injuries.”  Actually, that mystery has been solved.  CDC Principle Deputy Director Dr. Anne Schuchat said on October 25, “The vast majority of patients with [lung injuries] including those who died…, had a history of use of e-cigarette, or vaping, products that contained THC.” DOD removed products that we now know did not kill 34 Americans who were instead vaping contaminated marijuana liquids, yet DOD continues to sell cigarettes, which have, in fact, killed 380,000 Americans so far this year. In this case, military intelligence is an attribute of our proud troops, but not of their health officers or administrators.  The Military Times notes: “Vaping now appears to be more common in the military than smoking regular cigarettes, according to results of the most recent Defense Department Health-Related Behaviors Survey of Active-Duty Service Members. The results of that survey, conducted in 2015, showed 11.1 percent of troops said they were daily e-cigarette users, compared to 7.4 percent who said they smoked cigarettes daily.  In the junior enlisted ranks, nearly 20 percent said they were current e-cigarette smokers.” The troops have made the switch to vastly safer smoke-free tobacco at far higher rates of use than are seen in the general U.S. population.  So far, the Marine Corps, which at 16% has the highest prevalence of vaping among the military branches, continues to permit the sale of vaping products, signalling semper fidelis to harm reduction.  The Army, Air Force and Navy exchanges should immediately reverse their egregious decision and return e-cigarettes and vaping products to their shelves. Original author: Brad Rodu
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Heads Up – News – Updates 10.28.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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FDA Awards “Modified Risk” Status to General Brand Snus Products from Swedish Match



“The U.S. Food and Drug Administration announced [on October 22] that, for the first time, it has authorized the marketing of products through the modified risk tobacco product (MRTP) pathway. The authorizations are for eight Swedish Match USA, Inc. snus smokeless tobacco products sold under the ‘General’ brand name” (from the FDA press release).  The FDA authorization allows Swedish Match to use this statement: “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”  The approval will be in place for five years, but the agency can remove it at any time if it decides that it “no longer benefits the health of the population as a whole.” It took the FDA over five years (during which 2.56 million American smokers died prematurely) to approve this truthful statement that I have documented for 25 years.  Note, however, that the tobacco control act stacked the deck against harm reduction by mandating the term “modified risk” instead of the more accurate “reduced risk.” The FDA announcement received favorable media attention, with one analyst calling it a “gamechanger.”  While that may be true, there are some important things to remember. 1. The company filed its original application in 2014 to change the FDA’s mandated but grossly inaccurate smokeless tobacco warning labels.  The FDA, using flawed analysis, rejected that application in December 2016, and signaled that it would not jettison the required warnings, “cause mouth cancer” and “not a safe alternative to cigarettes.”  Swedish Match then filed an amended application with the statement that was approved. 2. The approved warning refers to “lower” risk of disease, which implies that risks are still present, when, in fact, snus has no risk for mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.  Even worse, the FDA’s “not safe alternative” warning covering a large part of the package and advertisements annuls the “lower” risk statement from Swedish Match.  3. Swedish Match’s success was supported by a wealth of published epidemiologic research demonstrating snus’s negative impact on smoking and smoking-related diseases among Swedish men.  While Swedish boys use snus just like their fathers, use among American youth is nearly nonexistent.  These factors set a high standard of evidence for other current MRTP applications from Philip Morris International (IQOS), Reynolds (Camel snus) and and US Tobacco (Copenhagen moist snuff).    IQOS heat-not-burn tobacco.  Years of extensive research demonstrate that IQOS vapor is vastly less hazardous than smoke.  However, there is no epidemiology on the health effects of IQOS use, and there won’t be any for at least two decades.  In other countries, PMI sells IQOS devices only to adult smokers in special stores, so youth don’t have access.  PMI’s FDA application is now almost three years old (corresponding to 1.44 million dead smokers).Camel snus.  Produced in the same manner as Swedish snus, Reynolds’s Camel product should qualify for MRTP status with similar labeling, but Reynolds has no epidemiology for a product introduced in the U.S. around 2005.  The MRTP application is two and a half years old (1.24 million dead smokers).Copenhagen moist snuff.  The U.S. Smokeless Tobacco Company took a minimalist approach in its FDA MRTP application for this statement: “Switching completely to this product from cigarettes reduces risk of lung cancer.”  Still, the FDA, concerned with under-age use of dip products, claimsthat 350,000 “youth under 18 years of age use smokeless tobacco for the first time” yearly.  The agency will likely cite the youth issue to deny any statement about vastly lower risks, including lung cancer.  The MRTP application is one year, seven months old (760,000 dead smokers).E-cigarettes and vapor products.  The chances of these products getting an MRTP are approximately zero.  Research at American universities funded by the federal government is focused only on risks, epidemiologic studies are nonexistent, and federal officials consider vape products to be the cause of an exaggerated teen epidemic and mischaracterize them as the cause of lung injuries and deaths.  Manufacturers must first navigate widespread flavor and product bans, and then complete Premarket Tobacco Product Applications, a feat accomplished only by Swedish Match for General Snus and PMI for IQOS.  Swedish Match should be commended for establishing a precedent for successfully navigating the Reduced (not merely modified) Risk Tobacco Product Pathway.  Original author: Brad Rodu
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Heads Up – News – Updates 10.24.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Analysis Reveals that 44% of State Health Departments are Not Explicitly Warning Youth Not to Vape THC and Three States are Committing Public Health Malpractice



This is part 1 of an analysis of the health warnings that state health departments are issuing to the public regarding the outbreak of vaping-associated respiratory illness. Here, I analyze the warnings issued by the first 25 states (Alabama through Montana).For each state, after briefly summarizing the warning, I categorize the warning based on three criteria:Is there an explicit warning not to vape THC?Does the warning inform the public that THC vape cartridges are playing a major role in the outbreak?Does the warning mention THC at all?Based on the warning and these three criteria, I then classify the state health department warnings into six rating levels:Excellent: There is an explicit warning not to vape THC, the state informs the public that THC is playing a major role in the outbreak, and the state goes beyond CDC by not undermining its warning about vaping THC Good: There is an explicit warning not to vape THC and the state goes beyond CDC by not undermining this warning, but the state either fails to inform the public that THC is playing a major role in the outbreak or issues too vague a warning.Fair: There is an explicit warning not to vape THC but the state undermines that warning by emphasizing that no single product has been associated with all cases.Poor: There is an explicit warning not to vape THC but it is undermined by a vague warning or the failure to acknowledge that THC plays a major role in the outbreak.Very poor: There is no explicit warning not to vape THC.Public health malpractice: There is no mention of THC in the warning. My rationale for this classification is that at this point, it is very clear that THC vape cartridges are playing a major role in the outbreak and both CDC and the FDA have now acknowledged that. Given that fact, it is imperative that state health departments issue an explicit warning to the public, and especially to youth, not to vape THC (at least black market THC products). Finally, this message should not be undermined by other statements in the warning. Here are the results of my analysis:The Rest of the StoryThe most striking finding of this analysis is that 3 states - Alabama, Illinois, and Kentucky - are committing public health malpractice by not even mentioning THC at all in their warnings. This is inexcusable and puts the lives and health of residents, especially youth, at risk.The second most striking finding is that 11 of the 25 states (44%) are not explicitly warning the public not to vape black market THC cartridges. These states are (in addition to the 3 states above): California, Georgia, Idaho, Indiana, Kansas, Louisiana, Massachusetts, and Montana.In only 3 states are the warnings rated as excellent: Connecticut, Maine, and Minnesota.Links to the warnings for each state that I used in the analysis are provided below: Alabama Arizona Arkansas California Connecticut Colorado Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Original author: Michael Siegel
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Heads Up – News – Updates 10.23.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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New CDC Report Out Today Makes it Even Less Likely that Store-Bought Nicotine E-Cigarettes are Playing Any Role in the Outbreak

A new report published today in the MMWR summarizes the results of the most detailed investigation to date of cases of the outbreak of vaping-associated respiratory illness, focusing on the 83 confirmed cases occurring in the state of Utah. The key findings of the report are as follows:92% of the patients for whom product use was ascertained admitted to using THC vapes (only 3 out of 53 - 6% - did not).Of the THC products tested, 89% contained vitamin E acetate oil.No abnormalities were found in any of the nicotine e-liquids tested.The report concludes that “unregulated THC-containing cartridges play an important role in this outbreak.”Another interesting and important finding was that: "Use of three brands of prefilled THC-containing cartridges was reported frequently by patients; these included Dank Vapes (21, 40%), Rove (19, 36%), and Golden Gorilla (11, 21%)."The Rest of the StoryIt is critical to note that as the investigation progresses, the proportion of cases that are being associated with THC vaping cartridges is steadily increasing, while fewer and fewer cases are being linked to the exclusive use of nicotine-containing products.Over the last three CDC updates, the proportion of cases reporting using nicotine only has decreased from 17% to 13% to 10%. In the states that have released data in the past two weeks, the proportion of case patients who admitted to using THC is in the range of about 92% and higher. And now, in the most comprehensive investigation to date, the proportion of patients who admitted to using THC vaping cartridges is 92%, with only 3 patients not admitting to THC use (and no toxicology testing results were reported on those patients).Moreover, there were no contaminants found in any of the nicotine e-liquids tested, while it appears that vitamin E acetate oil was detected in THC cartridges used by every THC-using case patient from whom product was obtained. This is consistent with the reported results from testing in New York State and nationally. So far, vitamin E acetate oil has been present in most of the THC vape cartridges recovered and no contaminants have been detected in any of the nicotine e-liquids tested.The finding that 92% of patients admitted to vaping THC is quite striking, especially since young people (particularly young males) are highly likely to under-report their use of marijuana. In a 2006 study of male emergency room patients ages 18-24, only 25.8% admitted to marijuana use, but drug testing revealed that 48.1% had used marijuana. Given this huge degree of under-reporting, it is not at all unlikely that 3 of 53 patients might not admit to THC use even though they actually did use THC.In other words, it is entirely possible that the outbreak is a result of contaminated THC vaping cartridges, period. It appears that it is not necessary to invoke nicotine e-liquids, but especially those purchased in brick-and-mortar retail stores, in explaining the outbreak. Nevertheless, there is still some chance that there are some black market nicotine-containing products that are either counterfeit or otherwise adulterated and which could be contaminated with vitamin E acetate oil and therefore involved in the outbreak. For example, one of the e-liquids samples recovered from a Utah patient contained both nicotine and THC, suggesting that a nicotine e-liquid had been adulterated with THC oil.At any rate, it is being more and more clear every day that the actions of the CDC and many state health departments as well as policy makers in multiple states is putting the lives of the public at risk. The irrational obsession with going after legally sold e-cigarettes at vape shops and other stores while completely ignoring the distribution and use of black market THC vape cartridges is irresponsible and is almost certainly causing more outbreak cases than we would be seeing if health agencies would simply tell the public the truth and address the actual cause of the outbreak, rather than continuing to demonize electronic cigarettes and the businesses which sell them.Original author: Michael Siegel
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Heads Up – News – Updates 10.21.2019

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CASAA – Weekly Heads Up Round Up – 10.20.19

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Heads Up – News – Updates 10.18.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Tennessee Department of Health Appears to Have Deliberately Blamed E-Cigarettes for a Death It Knew Was Caused by THC Carts

Yesterday, I revealed that the Tennessee Department of Health reported its first death from vaping-associated respiratory illness as follows: "The Tennessee Department of Health has reported one death in a patient with serious respiratory disease associated with use of electronic cigarettes or other vaping devices. This is the first such death reported in Tennessee."As it turns out, it appears that this death was not caused by electronic cigarettes, but by THC vape carts. I suggested that the health department's reporting of the death as being associated with the use of "electronic cigarettes or other vaping devices" would be like reporting a death from contaminated lettuce by saying: "The Tennessee Department of Health has reported one death in a patient with severe Salmonella poisoning associated with the consumption of lettuce or other vegetables."However, I realize that this analogy is not actually correct. More precisely, it would be like reporting a death from contaminated lettuce by saying: "The Tennessee Department of Health has reported one death in a patient with severe Salmonella poisoning associated with the consumption of artichokes or other vegetables."The Rest of the StoryIt seems to me that one wouldn't report a death associated with the consumption of contaminated lettuce as being "associated with the consumption of artichokes or other vegetables" unless you were intentionally trying to deceive the public into thinking that artichokes were responsible for the death.Wouldn't you just report the death as having been associated with the consumption of contaminated lettuce? By adding in a product that you know was not responsible for the death, it has the appearance of:deliberately trying to mislead the public;trying to undermine the public's connecting of the death with contaminated lettuce; andintentionally trying to blame artichokes for something you know was not associated with artichokes.While it does appear that the Tennessee Department of Health has deliberately misled the public, I still believe that the CDC bears some responsibility for the failures in communication that are coming from many state health departments because it continues to undermine the demonstrated connection between the outbreak cases and the vaping of THC.Even the name that the CDC is using for the disease is an indication of an intentional attempt to attribute the outbreak to electronic cigarettes rather than THC vape carts. Originally, the CDC called this "vaping-associated respiratory illness" (VARI). But they have now changed the name to "e-cigarette or vaping product use associated lung injury."I am quite sure that if 90% of the patients reported using nicotine and only 10% reported exclusively using THC, they would not be calling this "THC or vaping product use associated lung injury." It seems clear that in the very name itself, the CDC is trying to primarily blame e-cigarettes for an illness that they know is predominantly linked to THC vaping products.Original author: Michael Siegel
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Tennessee Department of Health Tragically Misleads the Public in Order to Falsely Blame a Death on E-Cigarettes

Sadly, Tennessee recently experienced its first death from vaping-associated respiratory illness.Here's how the Tennessee Department of Health reported it: "The Tennessee Department of Health has reported one death in a patient with serious respiratory disease associated with use of electronic cigarettes or other vaping devices. This is the first such death reported in Tennessee."So which one was it? Was it the use of "electronic cigarettes" or was it the use of "other vaping devices." If the Tennessee Department of Health truly wants to prevent further cases of this illness, it is incumbent upon the agency to inform the public which of these two products it was. They are completely different products so it makes a world of difference for the public to know which one it was.The Rest of the StoryIt turns out that this tragic death was associated with the use not of electronic cigarettes, but of THC and CBD vape cartridges. The rest of the story, that the health department is hiding from the public, is that this patient died from vaping THC. And it was most likely black market THC carts because marijuana use is not legal in Tennessee for either recreational or medicinal purposes.Why, in describing the product associated with the death, would the health department intentionally lump electronic cigarettes into the mix, knowing that it was THC vaping that caused the death?It would be like reporting a death from contaminated lettuce by saying: "The Tennessee Department of Health has reported one death in a patient with severe Salmonella poisoning associated with the consumption of lettuce or other vegetables."Clearly, that would be irresponsible. The only conceivable reason why the health department would lump other vegetables into the picture would be to intentionally deceive the public so that the connection in their minds between consumption of lettuce and Salmonella poisoning would be completely undermined.In other words, the Tennessee health department is intentionally deceiving the public in order to undermine the connection in their minds between THC vaping and the severe, acute respiratory disease outbreak. I can hardly think of anything that could be so irresponsible.I just don't understand why so many state health departments and the CDC are trying so hard to undermine the connection between THC vaping and the outbreak. It is as if they are trying to protect illegal marijuana drug dealers by switching the focus over to legal, responsible, vape shops. And it is as if they don't actually want to prevent further cases of the disease.Frankly, if they truly wanted to prevent further cases of the disease, if they truly wanted to honor the memory of this incredible individual whose life ended tragically because of contaminated THC vape carts produced by an illicit drug operation, the health department would clearly communicate to the public that there was a death in the state associated with vaping THC and nobody in the state should even touch a THC vape cart. If you need THC, then just smoke a joint. Right now, it is simply much too dangerous to be vaping THC in the state of Tennessee since there is no legal supply of safe THC vaping products. Original author: Michael Siegel
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Heads Up – News – Updates 10.17.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Heads Up – News – Updates 10.15.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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