Pleasant Grove • When he was 18, Orem resident Ben Webb picked up what he calls a “social” cigarette habit from his co-workers, which ultimately swelled to smoking one or two packs a day over the course of eight years.
He attempted to quit multiple times — chewing on sunflower seeds, sucking hard candies — but without success.
“Anything that I tried," Webb said, “I’d eventually fall back within a month or two.”
Then, a little more than two years ago, a friend persuaded Webb to try vaping. He says he hasn’t touched a cigarette since.
“I was amazed," Webb said. "But, yeah, it was that simple.”
In recent months, a nationwide outbreak of lung illnesses and deaths that appears to be linked to vaping has hospitalized thousands and led to dozens of deaths, including one death in Utah. State and national health officials have warned vapers to stop, and political leaders are pushing new regulations that could ban products or increase the minimum legal smoking age.
Many Utahns who vape say they are skeptical of the perceived dangers, and see the reaction to the lung disease outbreak as misplaced, misguided or disproportionate. Several vapers who spoke to The Salt Lake Tribune acknowledged a risk associated with vaping products — particularly the lack of information on long-term health effects — while arguing that risk pales in comparison to the known harms of other legal activities like smoking tobacco or drinking alcohol.
“It could end up being — in the long run — really bad for us, but I just don’t see it as likely,” Webb said. “If you want to [vape], then I just don’t really see anything wrong with it.”
And like Webb, several of the vapers contacted by The Tribune said their initial use of electronic nicotine and marijuana products was motivated by a desire to quit, or decrease, their use of traditional cigarettes and cannabis.
The efficacy of e-cigarettes as a tobacco-cessation tool has come under scrutiny as recreational vaping has grown in popularity among adult and teenage users. And the Utah Department of Health is considering new restrictions on the sale of flavored e-cigarette liquids with the goal of deterring minors from vaping.
But Webb — who recently began mixing his own refill liquids, or “juice” — said vaping is safer and costs significantly less than his former smoking habit and that the ability to reduce his nicotine intake over time could help him to finally kick an addiction that started roughly a decade ago.
“I’m hoping by the time my kid is born I’m going to be nicotine-free," he said.
‘Nicotine is nicotine’
Andrew McLay, of Salt Lake City, said he was not quite 18 when he started smoking. He took a trip to Spain and thought cigarettes would be a fun, temporary, European experiment and would make for better vacation photos.
“Before that," he said, “I didn’t even have friends who smoked.”
That trip led to McLay becoming a smoker, but he said he hates the smell of cigarettes and would brush his teeth every time he smoked. He initially was skeptical of vaping, but was drawn to the convenience of disposable pods — like those made by the e-cigarette giant Juul — and ultimately abandoned traditional cigarettes.
McLay said he was “freaked out” when he started hearing news stories of people being injured, or killed, after vaping. He tried to quit, going nicotine-free for a month, but ultimately returned to vaping after seeing Juul pods on sale.
“It’s just as addictive [as cigarettes],” McLay said. “Nicotine is nicotine in any form.”
Now, McLay says, he still wants to quit vaping but is less concerned about the threat of lung illness. He said most of those cases appear to be linked to vaping THC — the primary psychoactive element of marijuana — while McLay vapes only nicotine.
The Centers for Disease Control and Prevention and the Utah Department of Health report that lung injuries appear to be most strongly — but not exclusively — correlated with THC vaping.
While his concern for lung injury has lessened, McLay worries about the prevalence of vaping, particularly among underage smokers. And some legislation to better regulate the products, he said, could be appropriate.
“It shouldn’t be easy to get. It shouldn’t be something that’s just readily available,” McLay said. “But I also think there’s a fine line between that and adults being able to make their own decisions.”
Ogden resident Riley Murray said she was never a traditional cigarette smoker and didn’t start vaping for any particular reason. She has followed the reports of lung injuries and deaths and said she doesn’t feel 100% safe vaping but added that there are bigger issues to worry about, like drunken drivers or the quality of the air in Utah that she breathes into her lungs.
“I don’t wake up in the morning and say, ‘This might kill me,’ but then again, I don’t get in my car and say the same thing either,” Murray said. “Every day there’s so many things that you are doing to put yourself in harm’s way. I guess, in my mind, it’s like what’s one more thing?”
Murray said she’d like to quit vaping but not because of the health risks. It’s an expensive habit, she said, costing her and her boyfriend roughly $100 combined each month.
And while she also sees a need for regulation, she worries that the reaction to the lung illness outbreak is creating a double standard in which vaping is at risk of an outright ban while the much deadlier cigarettes remain legal for adult purchase.
“You make cigarettes fine and legal and you can buy those at the grocery store or the gas station across the street,” she said. “But people who choose to vape instead of smoking cigarettes are now paying the price for something that is not doing nearly as much damage.”
Oils and additives
As of Dec. 10, 2019, the CDC reports 2,409 cases of vaping-related lung injury and 52 deaths in the United States. The CDC also states that cigarette smoking is responsible for the deaths of more than 480,000 Americans each year.
In Utah, health officials have confirmed one death and 115 cases of lung injury related to vaping. The Utah Department of Health says that THC cartridges are the likely driver of the outbreak and has recommended that Utahns stop vaping THC — which is illegal in the state — until more information is available.
Ryan Bartlett, a media coordinator with the Utah Department of Health’s Tobacco Prevention and Control program, said one of the main culprits behind the lung injury outbreak is vitamin E acetate, an additive and thickening agent used in some THC vaping products.
“You’re not just vaping THC,” Bartlett said. “They have to put a liquid in there — some type of oil.”
But Bartlett added that some lung disease patients have reported using only nicotine products, and not THC, prior to their injuries.
“We definitely don’t want people to think that just because we’ve issued a warning against THC that vaping other products is necessarily safe,” Bartlett said.
Utah’s smoking rate is the lowest in the nation, Bartlett said, and has generally trended down. But recent years have seen a leveling off in that rate, he said, and a potential uptick as the rate of Utah adults who smoke went from 8.7% in 2016 to 9.2% in 2018.
The rate of Utah adults who vape also climbed, to 5.6% in 2018, up from 2% in 2012, the first year the Utah Department of Health began tracking use of vaping products.
(Christopher Cherrington | The Salt Lake Tribune)
Bartlett said people should not lose sight of that fact that regular smoking is detrimental to their health and that they should quit if they smoke.
“We just advise all people of all ages not to use any type of tobacco products," Bartlett said.
Webb said he feels 100% confident that he’s safe from the lung injury outbreak. People have only recently started getting sick, he said, despite vaping products being widely available for years.
He said he plans to stick to purchasing the same products that he always has, without incident and will likely transition fully to using his homemade vaping juice. He experiments with different flavors — his favorite is a stuffed French toast recipe that includes hints of Bavarian cream, peaches and strawberry — and said mixing his own refills is cheaper, leaves him prepared in the event of a ban on vape sales and helps him to know exactly what is going into his body.
“I trust most of the companies that I buy from," he said, “but [homemade juice] is a foolproof way to know what you’re vaping.”
Better than smoking?
One man, who requested anonymity to discuss his use of THC vaping products, said he stopped vaping for 64 days after hearing about the lung disease outbreak. And while he went back to vaping, he said he used to vape two or three times a day but now vapes mostly on the weekends and once or twice during the week.
The THC helps with a sleeping disorder, he said, and mitigates his anxiety.
“It helps me get through my day and do my job the best that I can,” he said. “I actually get my sleep in and my stress is gone, so I can actually function better with it than without it.”
He said he started vaping roughly a year ago due to complaints from neighbors and family members about the smell of marijuana. Vape pens keep down the smell, he said, and are more convenient, allowing him to take small amounts of THC throughout the day without wasting cannabis.
He used to buy from a dealer in Utah, but now travels to Colorado — where recreational marijuana is legal — to purchase products, which he says are of noticeably higher quality.
“I don’t trust any local distributor out here,” he said.
He believes the public reaction to the lung disease outbreak is potentially overblown and overly politicized. While he expects there to be some negative side effects to putting something besides air in his lungs, he said additional research would be more effective than prohibitions.
“It warrants an argument to fully legalize [marijuana]," he said, “so we can study it more accurately.”
In October, an emergency rule banning the sale of flavored e-cigarette products at Utah grocery and convenience stores was struck down in court.
The state had argued that flavors attract youths to a vaping culture that subsequently leads to the use of illicit, and potentially harmful, THC products. But 3rd District Judge Keith Kelly ruled that nicotine sales do not pose an imminent peril that warrants emergency restrictions.
While Kelly’s ruling allowed the sale of flavored e-cigarettes to resume, state health officials are drafting new policies that, after a public comment period, could again restrict vape sales in the state.
Webb was critical of the move to ban flavored vape sales. He agrees that teen vaping is a problem but suggested that prohibiting legal sales will make vapers move to other sources, like the black market, for cartridges.
“We don’t want to push them there,” he said, “so a ban is the wrong way to do things.”
Juul, the largest e-cigarette company, has stopped making flavored products, but competitors fiercely oppose a government-imposed ban, arguing it will shutter thousands of small retailers and cost more than 150,000 jobs.
Asked what he’d think if his soon-to-be-born child were to take up vaping down the road, Webb said we may know more about potential harms by then, but for now he’s not worried about that prospect.
“My reaction to that would be, it’s better than smoking,” he said.
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