The Hazy Future of Vaping

Cigarette smoking kills almost half a million Americans every year. It killed Deanna Sampson’s father, sickened her, and nearly claimed her husband, too. It gave Matt Culley oral cancer at just 30 years old, and it led a 37-year-old Ryan Bliss to develop “the cardiovascular system of an 80-year-old.” It is still the leading cause of preventable death in the United States, even decades after Americans were first made aware of the myriad health risks associated with smoking.

Bliss, Sampson and Culley are all now ex-smokers, which they say would have been impossible had they not discovered electronic cigarettes before it was too late. They are among the millions of people around the world who use electronic cigarettes, or vaping, many in an effort to wean themselves from and eventually break an addiction to nicotine. But they are just one piece of a complicated puzzle that has spilled out into the public consciousness as an outbreak of illnesses associated with vaping has become national news, and calls for more regulation and outright vaping bans have intensified.

The puzzle includes the smoking cessation advocates, butting heads with the Montana Department of Public Health and Human Services (DPHHS), which says plainly: “E-cigarettes are not a legitimate smoking cessation tool.” Then there are the skyrocketing numbers of underage boys and girls vaping, and claims by anti-tobacco groups that the companies manufacturing e-cigarettes are creating flavors and designing packaging specifically to target kids and breed a new generation of nicotine addicts. There, too, is the vaping of cannabis-based oils, either CBD, which is legal around the country, or THC, the chemical in marijuana that produces a high, and which can be sold legally in only a handful of states and on the black market everywhere else.

Then this summer, the first cases of what is now being called Vaping Associated Pulmonary Illness (VAPI) started popping up, initially in geographical pockets and now in 49 different states, including Montana. As of Oct. 8, the Centers for Disease Control and Prevention (CDC) had received reports of 1,299 cases nationwide, and attributed 26 deaths spanning 21 different states to VAPI. In the wake of that news, the Trump administration announced last month that it was preparing to ban flavored vaping products nationwide, although no formal action had been taken as of Oct. 14.

And last week, it was Gov. Steve Bullock who waded into the morass, using emergency administrative rules to announce that the state of Montana would become the sixth to ban the sale of flavored vaping products, beginning on Tuesday, Oct. 22 for a term of 120 days, the longest period permitted through executive action. The ban includes flavored liquids derived from tobacco and cannabis, and has drawn cheers from groups like the Montana Chapter of the American Academy of Pediatrics (AAP), who hailed “Bullock and his plan to help us fight the epidemic of vaping that has consumed our children and our schools.”

In other corners of the state, however, the reaction has been vastly different. The American Vaping Association called Bullock’s ban “senseless” and panned it as “a rash and unfounded move.” Vape shop owners, including in the Flathead Valley, are struggling to find ways to save their businesses, and smokers trying to quit cigarettes have been stocking up on as much e-liquid as they can ahead of the ban taking effect. Culley, an outspoken vaping advocate and popular YouTube personality, believes some vapers will likely return to traditional cigarettes. The stakes, he says, are nothing less than life and death.

“For a lot of these people, they could not quit smoking for decades and they feel like that product is giving them extra years that they didn’t have,” Culley said. “They’re freaking pissed, man. They’re trying to take away something that helped (them) add years to (their) life and that’s what radicalizes people, and makes them more politically active.”

The first e-cigarettes were introduced in the United States in the mid-2000s, when Culley was a young cigarette smoker. He smoked for 14 years, ending in 2013 when he first noticed a growth on his lip where he placed his cigarette. It was oral cancer, caught early enough that it has not returned but still scary enough to push the then 30-year-old to search for a new way to quit smoking after failing with other methods. Culley bought his first e-cigarette as an impulse purchase at a gas station cash register, and by February 2014 he was making YouTube videos for a channel he called Suck My Mod.

More than five years later, Suck My Mod has 286,000 subscribers and Culley, who lives in Kalispell, is a veritable celebrity in the vaping world. His videos today cover everything a vaper could want, and in recent weeks he has become one of the most visible advocates of the practice, appearing in stories everywhere from the Washington Post to CNN, and traveling to Washington, D.C. to visit Montana’s congressional delegation.

In the years since he quit smoking and started vaping, the amount of nicotine in Culley’s e-liquid has slowly decreased, and the same is true for Ryan Bliss, who opened The Vapor Depot in Evergreen in 2011. Bliss smoked a pack-and-a-half a day at the height of his 22-year addiction before being introduced to e-cigarettes, and after only one use he ditched his smokes for good. Deanna Sampson beat her longtime cigarette habit seven years ago and opened her store, D’s Vapor Plus in Evergreen, around the same time, to share the tool that had made such a big difference in her life.

All three ex-smokers had tried other methods to quit, like nicotine gum, patches and prescribed medications, but say only vaping worked. The hand-to-mouth action mimics cigarette smoking in a helpful way, they say, and the sensation of smoke entering the body also replicates the sensation their body had come to crave.

Science to back up their claims, however, at least in the U.S., is hard to find. The Food and Drug Administration (FDA) has not approved e-cigarettes as a device to be used for smoking cessation and the Montana DPHHS staunchly denies any connection, saying those trying to quit “should use evidence-based strategies.” The United Kingdom, though, has taken a different approach, with public health officials viewing e-cigarettes as a healthier alternative and two English hospitals even agreeing to allow vape shops to open on their premises earlier this year.

Even so, no group claims that vaping is without its own health risks. The safest amount of e-liquid or cigarette smoke for anyone to consume is zero, a fact even vapers acknowledge. Culley calls vaping “a harm reduction tool” that helps ex-smokers decrease the amount of nicotine they consume while cutting out some of the carcinogens found in cigarettes.

Dr. Bethany Weiler, a pulmonary and critical care doctor at Kalispell Regional Healthcare who speaks to local parent groups about the dangers of e-cigarettes for teenagers, says that while vaping may be a healthier alternative to cigarettes, it is far from a recommended practice.

“There are inherent risks to smoking anything,” Weiler said. “The lungs are not intended to inhale anything but clean air. We know that a lot of the damage that people get is actually very similar to the damage they get from smoking … It’s very, very hard to know. Right now the evidence is telling me that (vaping) is less harmful, but before I start recommending it (for smoking cessation) we need to see some long-term studies.”

Other parts of the Montana medical community are less generous.

“One of the most insidious untruths about vaping is that it is safe. It certainly is not,” the Montana Chapter of the AAP said in a statement.

Where vaping has done the most harm, just about everyone agrees, is among young people. This year’s release of the semi-annual Montana Youth Risk Behavior Survey of high school students around the state found that 58.3 percent have used an electronic vapor product in their life despite e-cigarette sales restricted to people 18 and older, and that 12.7 percent of teens have used a vaping product at least 20 times in the last 30 days, a more than 200 percent increase from 2017. Most people who vape, young people included, use flavored products, and anti-vaping groups claim some of those flavors, like cotton candy and bubble gum, are specifically going after underage customers.

“E-cigarette use is an epidemic among Montana youth,” the Montana DPHHS wrote in a statement to the Beacon. “The dramatic increase of e-cigarettes, or vaping, by youth is driven in large part by flavored e-liquids, and flavors are a principal reason that youth initiate and maintain e-cigarette use.”

Once again, those who are pro-vaping do not entirely disagree. Bliss said his store has made the deliberate choice to not carry flavors that target kids or any product that comes in cartoonish packaging that would be more enticing to a teenager. But vapers trying to quit smoking say they have their own reasons for preferring flavored liquids.

“It helps you disassociate from the whole taste of tobacco,” Culley said. “And also the variety of it; somebody wants a fruit flavor one week and then they go onto a dessert flavor a month later. Part of why I think vaping was so successful was the variety, and keeping it enjoyable.”

The many disagreements came to a head during this summer’s outbreak of VAPI, the origins of which are still being studied. The CDC and FDA have been careful not to identify or discount any potential sources of the outbreak, but the CDC did acknowledge on Twitter, “To date, national and state data suggest that products containing THC are linked to most of the cases and play a major role in the outbreak.” In recent weeks, black-market operations have been uncovered in a few states, and illegally purchased liquids have been connected to many of the VAPI illnesses reported so far, a point advocates have seized on.

Culley placed blame for the outbreak on black-market sellers who dilute THC e-liquid to increase their profits. Culley believes it is these diluting agents that are causing vapers to suddenly report major illness after more than 10 years without a similar outbreak.

Gov. Bullock said that while the cause of the outbreak is not entirely clear, he made his announcement of the flavor ban in Montana out of an abundance of caution and with young vapers in mind.

“Young Montanans are using e-cigarettes at an alarming rate, while officials investigate the possible causes of a national outbreak of e-cigarette-related injury and death, leaving us at a crossroads,” he said. “Today, I choose action.”

That same line of thinking, though, has caused people like Culley to draw a different connection.

“It’s Reefer Madness 2.0,” Culley said. “It’s public hysteria. Everyone’s in a tizzy, and the low-hanging fruit is banning flavors.”

The American Vaping Association went even further.

“Prohibition has never worked in this country and it will once again fail miserably in Montana,” George Conley, the association’s president, wrote. “These bans will only serve to hinder the ability of Montana’s 150,000 smokers to quit. These bans will cost lives by forcing some vapers back into smoking.”

The practical implications of the ban will be felt in other ways, too. An online rallying cry of “We Vape, We Vote” is pushing vapers to pressure government officials, and Culley says a national rally in Washington D.C. is planned for November.

Closer to home, people like Bliss and Sampson are preparing for the worst and scrambling to adapt their businesses on short notice. Bliss will focus on sales of unflavored CBD and nicotine products during the 120-day ban, and is considering adding other revenue streams to his operation, while Sampson, who works her one-woman shop by herself out of a small storefront adjacent to her house, is facing a more dire future.

“My whole purpose was not to get rich,” she said. “(The ban) will literally put me out of business.”

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UPDATE (Oct. 21, 9:15 a.m.): After this story was published, a judge in Ravalli County signed a temporary restraining order preventing the state’s flavored vaping ban from taking effect on Oct. 22. A follow-up hearing to further consider the ban is scheduled for Oct. 30.