Vaping in the United States has become a public health crisis, with 2172 cases reported this year, as of November 2019. With vaping-related illnesses are at an all-time high, staying on top of the news and counseling patients properly are some ways that pharmacists can help fight the epidemic, according to a session at the ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition in Las Vegas.

The session, entitled “Up in Smoke: Fact and Fiction Surrounding Vaping,” discussed the dangers of e-cigarettes, and the tips that pharmacists can use to continue to educate the public on the crisis. Presenter Amy L. Stump, PharmD, FASHP, BCPS, BCACP covered an overview of what vaping entails, such as device terminology, device safety, and how the pen works to create the smoke effect.

Stump compared the importance of educating our youth on vaping to how we educate about alcohol consumption. “Because these pens can be taken apart, I feel like we have to start teaching our youth that it’s kind of like the old adage when you go to a party,” Stump said. “You always pour your own beer, you always make your own drink, you always open your own can…so you always vape your own vape pen. Because you don’t know what could be in it. What somebody hands to you, it could have anything in it. And if you don’t know what’s in it, you could inhale a substance that’s kind of scary.”

The attractions of vaping is what is drawing in children and adults to start, such as colorful skins to decorate the vape, “fun” flavors to choose from, and the marketing of the pen being “nicotine free.” Numbers recorded by the CDC and DEA in a 2018 survey have proven that these attractions work to draw in users. The CDC found 20.8% of high school students use vapes, while the DEA found 37% of 12th graders reporting to have used a vape in the year of 2018.

Vaping related illness, now called 'Evali', is defined as an e-cigarette- and vaping-associated lung injury. As of September 2019, 530 cases were reported with 7 deaths in 38 states and 1 US territory. Symptoms to look for include respiratory and gastrointestinal findings, fever, less or more fatigue, and weight loss.

Although many states and local areas are attempting to take executive action towards the ban of these products, it is still crucial to have an important role in your patients’ lives as a pharmacist, according to Miranda R. Andrus, PharmD, FCCP, BCPS. “You gotta know about it to do anything about it and stay up to date with information as much as possible,” Andrus said. Being informed, screening each patient, and educating as many people you can are 3 steps Andrus recommends.

When it comes to counseling points about e-cigarettes, Andrus emphasized how most of these pens contain addictive nicotine, how the vapor contains harmful substances, and the questionable status on its reputation of being “less toxic” than cigarettes. In addition, the long-term risks are still completely unknown in the medical field. “If you think about tobacco related illnesses…we see COPD and other effects much after in people that start smoking in their teens,” Andrus said. “E-cigs have only been around for a decade, so we really have no idea the long-term effects.”

Even with the uncertainty, the CDC recommends the public follows guidelines, including:
  • Do not use vaping products with THC
  • Do not use a vaping product from unreliable sources
  • Do not modify e-cigs or add anything
  • Don’t start if you are not a current smoker
  • Monitor for symptoms

However, even with guidelines currently in place to restrict promotion of vaping, Andrus still feels there is a problem since some of these products are useful for smoking cessation. “I agree with all of this. But the problem with this is that this is not very practical for me as a clinician,” Andrus said. “Because these are so readily available, and the patient already has them in their hand when they come to see me. So, it’s not that they are asking me about using e-cigs to quit smoking as their first line of defense.”

REFERENCE

Stump A, Andrus M. Up in smoke: the facts and fiction surrounding vaping. Presented at: American Society of Health-System Pharmacists 54th Midyear Clinical Meeting and Exhibition; Las Vegas, Nevada: December 11, 2019.