What happened to “EVALI”?

Blog Post created by dr_hays on Mar 4, 2020

The news cycle happens very fast in this country. What is hot news one day can be back page news or completely out of sight the next.  This has happened with a condition known as EVALI, or “E cigarette or vaping associated lung injury.”  In some ways it is good news that this problem has become less newsworthy in the last few months because this means the epidemic of vaping associated lung problems is declining.  What we now know is that the lung problems appear to be mainly associated with vaping liquids that contained THC (the chemical in marijuana that causes the “high” feeling) and a chemical known as vitamin E acetate that was being used to thicken (very thin liquids are harder to vape) and dilute the THC.  Although the exact cause of the lung problems has not been determined, chemical changes of the vitamin-E acetate caused by the heating in electronic cigarettes seems a likely cause for the lung problems that occurred.  The epidemic appears to have peaked in around September of 2019 and now is declining.  This is probably because of all of the press this problem received and the public education that was quickly provided.  People across the country got the message and stopped using vaping devices and liquids that came from “casual” sources.


So where does this leave us with regard to the safety of electronic cigarettes in general?  Unfortunately, we are left still very uncertain about the safety of e-cigarettes and how useful they might be in helping people quit smoking tobacco cigarettes.  I still advise people who smoke and want to quit smoking to use the proven safe and effective methods of behavioral therapy and approved medications. 


Another reason that we are in a tight spot is because the groups who own the technology and best science in support of electronic nicotine delivery devices are the big tobacco companies.  The epidemic of EVALI probably set back the opportunity to develop safe electronic cigarettes and market them to help adult smokers quit by years.  My hope is that in time we will be able to see truly safe electronic nicotine delivery devices in the market place and move to a future where no one smokes tobacco and no one suffers from the long-term health effects of chronic tobacco smoking.  There seems little doubt that we in the public health and medical care communities will eventually have to make an uneasy peace with the tobacco companies who are working on developing safe electronic nicotine delivery devices.


If we can get to a point where we have a proven safe electronic cigarette (no matter who makes it), then we might achieve a future where no one smokes.  Wouldn’t that the great to see tobacco cigarettes go “poof” in a cloud of vape!


Dr. Hays