In the wake of mounting illnesses and deaths, including another in California, the California Department of Public Health and the American Medical Association called for everyone to refrain from vaping and e-cigarette use, no matter the substance or source, until the cause of vaping-associated lung disease is known.

Vaping and e-cigarette use have been linked to an outbreak that has caused more than 2,000 illnesses and over 40 deaths across the country, according to the AMA.

In September, the Stanislaus County Health Services Agency were notified of two local cases of a lung ailment associated with vaping cannabis or cannabis oils. Both the individuals were hospitalized and both had recently vaped cannabis.

The recommendation comes as health officials narrow in on one suspected cause of the outbreak. A report released Nov. 8 by the Centers for Disease Control and Prevention  named Vitamin E acetate as a potential chemical of concern in the severe breathing problems and lung damage associated with vaping. While this finding represents progress in the investigation, it does not rule out other causes or ingredients.

The CDPH said the only way to assure that people are not at risk is to refrain from the use of all e-cigarette or vaping products. Those individuals who choose to use cannabis products should purchase them only from a licensed retailer and be sure to read the ingredient label and avoid products containing Vitamin E acetate. People should avoid all products from unlicensed entities as the ingredients are unknown and may contain Vitamin E acetate and other potentially harmful ingredients. Be aware that most of the illnesses are associated with THC products purchased from unlicensed entities and other informal sources such as friends, family, and in-person or online dealers.

“It is tragic that yet another person has died from this cause in California and people continue to fall ill. We are working closely with the U.S. Food and Drug Administration, CDC, other state health departments, and local health departments across California, investigating every case and testing products, and we’ll continue until this vaping associated outbreak is over,” said State Public Health Officer and Director of CDPH Dr. Sonia Angell. “Until that time, we urge everyone to stop vaping, especially products from informal sources.”

Since August 2019, the Department of Public Health has collected reports on 161 people in California who have a history of vaping and were hospitalized for severe breathing problems and lung damage. Four people have died. In the past week alone, 10 new cases in California have been identified.

At the Interim Meeting of the AMA House of Delegates, physicians, residents, and medical students from across the country voted to adopt policies building on the AMA’s longtime efforts to prevent people from becoming dependent on nicotine.

The new policies include:

• Urgently advocate for regulatory, legislative, and/or legal action at the federal and/or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those approved by the FDA for tobacco cessation purposes and made available by prescription only;
• Advocate for research funding to study the safety and effectiveness of e-cigarette and vaping products for tobacco cessation purposes;
• Call for immediate and thorough study of the use of pharmacologic and non-pharmacologic treatment strategies for tobacco use disorder and nicotine dependence resulting from the use of non-combustible and combustible tobacco products in populations under the age of 18;
• Actively collaborate with health care professionals, particularly pharmacists and other health care team members, to persuade retail pharmacies to immediately cease sales of tobacco products;
• Advocate for diagnostic codes for e-cigarette and vaping associated illnesses, including pulmonary toxicity

“The recent lung illness outbreak has alarmed physicians and the broader public health community and shined a light on the fact that we have very little evidence about the short- and long-term health consequences of e-cigarettes and vaping products,” said AMA President Dr. Patrice A. Harris. “It’s simple – we must keep nicotine products out of the hands of young people and that’s why we are calling for an immediate ban on all e-cigarette and vaping products from the market. With the number of young people using e-cigarettes spiking it is not only critical that there is research into nicotine addiction treatments for this population, but it is imperative that we continue efforts to prevent youth from ever using nicotine.”