The nicotine salt formulas allow for much higher levels and efficient delivery of nicotine with less irritation compared to earlier generations of e-cigarettes - prompting questions about the use, purpose and safety of this novel form of nicotine.The most recent generation of e-cigarettes on the market, which include pre-filled pod systems like JUUL, refillable systems like Suorin Drop and Kandypens, and disposable systems like Puff Bar, use nicotine salts in the e-liquids. Older generations of e-cigarettes used a form of nicotine called free-base nicotine.The CDC states, “it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants.” It continues to advise non-smokers to avoid vaping of any variety and especially products purchased “off the street.” While cases of EVALI have decreased since the initial outbreak, the California Department of Public Health reported eight cases of EVALI in April 2020, the first cases reported to them since February 2020.Because 82% of the cases with specific substance use information available involved individuals who reported using THC-containing products, the FDA has recommended that consumers avoid purchasing vaping products of any kind on the street, using THC oil, or modifying store-bought products. Vitamin E acetate was present in bronchoalveolar-lavage (BAL) fluid in 48 out of 51 EVALI patients from 16 states, but it was not found in BAL fluid from the comparison group of 99 healthy individuals. Data from a February 2020 study linked EVALI cases to vitamin E acetate, an additive in THC-containing vaping products.
As of February 18, 2020, a total of 2,807 hospitalized EVALI cases had been reported to the CDC in the U.S. In August 2019, cases of e-cigarette or vaping use-associated lung injury (EVALI) sharply increased, afflicting e-cigarette users with respiratory and other symptoms, peaking in September 2019.A recent study found that e-cigarette users are five times more likely to test positive for COVID-19 than those who do not use tobacco products, and that dual users of cigarettes and e-cigarettes are nearly seven times more likely to test positive for the disease. There is growing evidence that using e-cigarettes can harm lung health and puts users at greater risk of contracting COVID-19.Thus, their health consequences are not well known when consumed in this manner. While many of the flavorings and humectants used in e-liquids have been approved by the Food and Drug Administration for oral consumption, they have not been approved for inhalation.Solutions, sometimes called e-liquids, almost always include nicotine, flavoring and a humectant, such as propylene glycol, to retain moisture and create the aerosol when heated.E-cigarettes are devices that operate by heating a liquid solution to a high enough temperature so that it produces an aerosol that is inhaled.
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