Dr. Kevin Most: Vaping Injury Now Has Official Name
In the world of Medicine, you rarely want to lead the nation, unless it is in screening and prevention. Unfortunately Illinois leads the nation in Vaping Illnesses. With close to 1500 cases in the US, Illinois leads the nation with Over 150 cases and a second death last week. There has been a recent spike in the number of cases as we are more aware of the illness and looking for it. The exact cause has still not been identified, however it does appear to be linked with tainted THC vials in many of the cases. All individuals using e cigarettes should be very caustious and using only approved vials and to not use any illicitly obtained THC based vials. These vials are made and marketed on the black market and appear to be the cause of the vast majority of these cases.
Individuals will use E cigs to smoke marijuana as it has the ability to hide the normal odor and can be used in public without any scrutiny at all.
Congress is very unhappy about the pace of identifying the issue and correcting it. The CDC has officially named the illness, it is termed EVALI. This stands for E cigarette Vaping Associated Lung Injury, EVALI. It also gave insight into recommendations for assessment, criteria for hospital admission and treatment. Initial evaluation includes testing to eliminate other possible infectious causes. Treatment is showing early use of steroids is key. 82% of those who were given steroids early on showed improvement, the problem is that steroids are often contraindicated in some infections, so eliminating the possibility of an infection quickly is the key. Patients presenting with lung issues must have infections ruled out first as they are the most common with over 1.5 million individuals hospitalized for this conditions and millions more treated in the outpatient setting each year.
The CDC continues to evaluate each of the cases as the exact cause is still unknown, there have been 35 related deaths in 21 states as of last week. It is also calling for people to stop vaping completely any product that contains THC, some states are looking to completely ban vaping 100%. Colorado is taking a different stand, it understands that the majority of the cases have been associated with THC, which is legal in Colorado. They are looking at the additives that are used to help vaporize the THC oil which is very thick. They are looking at restricting the additives that they find are carcinogens when heated or that may vaporize when heated but condense back when cooled in the lungs. The regulated cannabis market in Colorado, where components known to cause injury could be banned and monitored appears to be the best solution to a problem that probably will not go away any time soon.
The other big concern is that even when the CDC identifies the offending component, halting its use is easy from the regulated or approved vials but obviously they have no control of those vials containing THC that are made illegally. CDC is now testing fluids from the lungs of those affected in the hope of identifying the compound causing the injuries.
Six states have taken some form of action from complete banning to tighter restrictions.
Opioids- technology for overdoses
Let’s put this in perspective in Illinois alone last year we had over 2,200 deaths due to drug overdoses in 2017. Across the country we had 70,200 drug overdose deaths, with 28,000 of them related to fentanyl and other synthetic opioids. A study in Massachusetts showed that less than 2 % of the overdose victims who died last year had active prescriptions for these medications. The focus by the federal government to decrease the supply of prescription opioids appears to be overshadowed by the need for more rehabilitation services as the vast majority of overdoses are coming from illicit sources.
We need to keep in our minds that the battle over drug overdoses is equally or more important than the battle against vaping injuries. Last week it was shared that a researcher at Northwestern received a $10 million dollar federal grant to develop technology which would call first responders and deliver Narcan to an individual when low oxygen levels were noted. John Rogers is one of the top researchers in the world in materials science and is based her in Chicago at Northwestern University. We have discussed other products he has designed including the fingernail patch that monitors your sun exposure and the patch that tracks electrolyte loss in athletes.
His latest device is an implantable device that would notice when oxygen levels drop to dangerous levels, when individuals overdose from opioids the drug essentially tells the brain that it does not need to breathe and the individual dies from a lack of oxygen. Narcan is a drug that binds tightly in the brain to the drug receptors and blocks the opioid from reaching that part of the brain. It works very quickly and can reverse the impact of the opioid and if given soon enough can take an individual from an unresponsive state to awake in minutes. The power of the drug is amazing but it must be given soon after the overdose. This is the reason that police and paramedics have Narcan with them. It is delivered via a nasal spray or injection and the impact is lifesaving.
This same implantable device would also trigger a call to first responders via the 911 system. Now do people think this is a good idea? Do they think it is ethical? Does it allow drug addicts to push to the edge? I look at it as an opportunity to save a life and perhaps get them the help they need to quit.
Soft Drinks- heart and digestive deaths
Do you drink soft drinks? How many? Some recent studies may change your intake of these popular drinks. Studies that came out last month showed that both regular as well as diet drink consumption had health related issues that we should be aware of. The studies are observational and cannot show an actual cause and effect. It has been impossible to find a specific artificial sweetener that is causing the health related issues of heart disease or obesity. The recent study published in JAMA found that individuals who drink 2 or more diet sodas a day had a higher risk of dying from heart disease when compared to those who did not drink these sodas.
The study came out of Europe, from a larger study that we have discussed before. This study is the European version of what we are trying to do here with the “All Of Us” study that is starting now in the US, please consider joining. The study has 450,000 individuals that it has been following for the past 20 years, over the 20 years 40,000 individuals have died. They take the information they have captured and compare it against others in the study. This group has allowed us to track the impact of many illnesses as well as social and environmental issues. The US is trying to get a similar study up and running now with the “all of Us “ project.
For those of you drinking non-diet drinks, let’s make sure we explain how the study defined use. Participants who drank 2 glasses of soda a day were consider high users and low users were defined as one glass of soda a month or none.
The study showed that those who were considered in the high user cohort and drank sugar sweetened soft drinks had a much higher risk of dying from digestive related disorders, while those who drank diet sodas had a much higher risk of dying from cardiovascular related diseases. The volume of individuals they had to study, allowed them to remove or neutralize other risk factors we all may think of. The study does admit that they have no smoking gun as to why but that the findings are observational and only show association not cause.
This study reinforces the findings that we have seen in other studies that show the health impact of sodas are pretty much all negative. We have studies that have shown the negative impact on the rates of obesity and Type 2 diabetes, we know there are chemicals in soft drinks that are tough on our kidneys as well as our bone growth.
So what should we do? Certainly cutting back is the correct thing to do but this may not be as easy as one would think. Just like vaping where the body is addicted to the nicotine the body can also become addicted to the caffeine in soft drinks. Many suggest that cold turkey may not be the best way to quit, cutting back by 1-2 servings a day until you get down to one a day, then go every other day and continue to stretch out the time until you have quit. Replacing it with non-sweetened seltzer water or plain water is what is suggested. Breaking the craving for sweets is difficult as well, and substituting for natural sweets is preferred. Fruit infused water is another great substitute, and they now have fruit infuser water bottles so you can make your own.