Berkshire health officials on vaping: 'Do we know it's safe? Absolutely not.'

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With six people dead and hundreds sickened nationwide from a vaping-associated lung illness, Berkshire health officials are doubling down on the message that they have been sending for years: We don't know what's in the vapor.

"One of the real preconceived notions that's out in the community is that vaping is safer than cigarettes," said Kimberly Kelly, who runs community outreach programming at Berkshire Health Systems. "We've been saying for a really long time: red flag, red flag; this is really, really dangerous."

Massachusetts has had 10 suspected cases of vaping-associated pulmonary disease, but none of them has been confirmed, according to the Department of Public Health. In August, the Pulmonary Department at Berkshire Health Systems saw one case of lung injury that is suspected to be caused by vaping, and it reported that case to the Massachusetts Department of Public Health.

E-cigarettes and vaporizers, or vapes, commonly are used to ingest nicotine or THC. This year, 25 percent of Berkshire County students who participated in a youth assessment survey said they used the devices in the previous 30 days.

As of Sept. 6, the Centers for Disease Control and Prevention had received reports of more than 450 possible cases of lung illness associated with e-cigarette or vaping products from 33 states and the U.S. Virgin Islands. As of Tuesday, there had been six confirmed deaths.

While state and federal health officials have not yet isolated the cause of the illness, all patients had a history of vaping, most of them having used THC products. Some of the patients reported using just nicotine products, and many reported using both, according to the CDC. Symptoms included an array of respiratory issues, including coughing, shortness of breath and chest pain.

The CDC recommends that everyone concerned about the health risks refrain from using e-cigarettes or vaping products, and emphasized not buying the products off the street, as their cartridges can be tampered with during manufacturing.

"What I would be saying to people, if you have used a vape and you're experiencing any unexplained shortness of breath, fatigue, weight loss, to really go to your primary care physician," Kelly said. "That's what I would say to anyone who is experiencing any kind of respiratory issues."

What's safe?

Vapes, which took Berkshire County schools by storm in 2016, have been marketed as less harmful than smoking because their cartridges allegedly have fewer chemicals than cigarettes.

Marketing of the products has not only led to some adults using the devices in an attempt to quit other tobacco products, but also has convinced some parents that they shouldn't be concerned that their children are using them, according to Joyce Brewer, the Tobacco-Free Community Partnerships manager for Berkshire County.

Brewer and other local health officials have been working to get the word out that it is too soon to know the long-term effects of the oil in vape cartridges.

"Do we know it's safe? Absolutely not," Brewer said. "We smoked in this country for centuries, and it wasn't until 1964 when the surgeon general came out and said, `You know what, we can link it to cancer.' "

Brewer receives weekly updates from the CDC about the investigation into the vape-related illness, and she is hesitant to speak about the potential causes while the facts are unknown.

"What we do know is that the number is rising, and the number of deaths is going up," she said. "And we do know that the e-cigarettes or vaping comes into play when people are talking about this."

While there is no identified culprit for the disease, the New York state Department of Public Health has identified vitamin E acetate — it has been used as a thickener in primarily black-market vape cartridges — as a key focus of its investigation.

Vitamin E is safe as a vitamin pill or to use on the skin, but inhaling oily vitamin E droplets into the lungs can trigger pneumonia.

"A lot of these vape liquids have just a real big cocktail of chemicals, and people are mixing these chemicals in their garages," Brewer said.

Berkshire Health Systems has been working to direct patients looking to quit smoking away from vaping and toward other methods, Kelly said.

"For many years, we have been saying: Don't do it," Kelly said of vaping. "We're really trying to promote other [Food and Drug Administration]-approved nicotine therapy. If you're trying to quit smoking, we've got a whole plethora of options."

Enforcement

In response to the growing diagnoses, the FDA announced this week that it was finalizing a plan to crack down on the sale of flavored e-cigarettes, products that opponents say are marketed toward children.

Last year, Juul, a major manufacturer of vaping products, voluntarily stopped shipping flavored pods to stores nationwide, after the FDA threatened to take action. Other companies still sell the products.

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Nine Berkshire County towns already have limited the sale of flavored tobacco products to adult-only establishments, according to James Wilusz, who runs the Tobacco Awareness Program of the Berkshires through the Tri-Town Health Department, which represents Lee, Lenox and Stockbridge.

Currently, 14 towns participate in the program, which provides outreach, policy assistance and training to boards of health, and unannounced inspections of local stores, Wilusz said.

"Some towns have been quite aggressive, while other towns are kind of just getting their feet wet in tobacco control," Wilusz said.

Of the towns that are participating in the program, the number of illegal sales to minors has skyrocketed from fiscal years 2018 to 2019. The increase could be attributed partly to several new towns joining the program and their clerks being unfamiliar with the compliance checks, Wilusz said.

The program employs three Berkshire County minors who are trained to go several times a year into stores that sell tobacco and try to buy products without an identification. If the individuals, who are younger than 21, are sold a tobacco product, the store and clerk face a fine.

Stores also have signed on to additional regulations, like tobacco permit caps and required training for all clerks before they can sell the products.

Even with these regulations in place, minors are buying vape products in Berkshire County.

Wilusz is urging boards of health in these towns to be stricter about enforcing the regulations that already are in place.

"Stores are still selling this stuff to people under the age of 21," Wilusz said. "I think some boards of health are doing a really good job. I think we need to do more. It's really important that these regulations that are in place, that we're holding retail stores accountable when there are illegal sales to a minor."

Additives

While the CDC and state health departments are warning individuals to avoid vaping tobacco and cannabis products until more is known about the illness, New York is focusing its investigation on additives that primarily are used as "thickening agents" in black-market THC products.

Some marijuana dispensaries have been trying to get the word out that their vape products are safe and free of potentially dangerous additives.

On Wednesday, Theory Wellness, which has a retail marijuana shop in Great Barrington, released a statement to customers that their vape cartridges are made to resemble the cannabis flower as closely as possible and are free from any noncannabis additives or cutting agents. Only cannabis and terpenes extracted from cannabis grown at Theory's facilities are in the oil, Theory CEO Brandon Pollock told The Eagle.

"This points to why we should have a regulated marketplace," Pollock said. "There are no real regulations around cartridges. Companies that are operating legitimate businesses have the resources and knowledge to implement best practices."

The Boston Globe recently reported that the "state's otherwise-strict cannabis regulations" have no oversight on additives in regulated marijuana cartridges sold in stores.

In response, the commission voted Thursday to require that cannabis extract and concentrate manufacturers disclose all ingredients in vape cartridges sold in licensed stores.

While additives primarily are used in black-market cartridges, the Globe reported that they also can be found in some inexpensive vape pens sold in licensed Massachusetts stores.

Most Berkshire County retailers have posted public statements confirming that their cartridges are additive-free, signaling increased concern from customers about the popular products.

At Theory Wellness, cannabis flower is the No. 1 seller, but vape cartridges are No. 2, Pollock said.

Over the past week, the most common question from customers at the Great Barrington shop has been, "What is in the cartridges?"

"We haven't seen any material impact on sales," Pollock said. "I would not be surprised if sales increased in the next couple of months as people start to move away from illegal unregulated products."

Information from the Associated Press was used in this report.

Haven Orecchio-Egresitz can be reached at horecchio@berkshireeagle.com, @HavenEagle on Twitter and 413-770-6977.


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