ACMT Position Statement: Limiting Harms of Vaping and E-cigarette Use

Summary & key facts

This is an American College of Medical Toxicology (ACMT) position paper about the harms of vaping and a recent outbreak of severe lung injury called EVALI. Vaping use has grown, including large increases among teenagers. Thousands of cases of EVALI were reported to public health authorities, many patients used THC-containing products from informal sources, and vitamin E acetate was found in lung fluid from a CDC sample and is a leading suspect. The statement reviews known hazards, clinical features, and gives recommendations for government, manufacturers, and clinicians to improve surveillance, regulation, product testing, and patient reporting.

Key facts:

• In 2017, an estimated 2.8% of U.S. adults used e-cigarettes.
• From 2011 to 2018, e-cigarette use rose from 1.5% to 20.8% among high school students, and from 0.6% to 4.9% among middle school students.
• The CDC received thousands of reported cases of e-cigarette or vaping product use-associated lung injury (EVALI).
• A large majority of reported EVALI patients said they had used THC-containing vaping products, often those obtained from informal sources (friends, online suppliers, or illicit dealers).
• In a CDC convenience sample of 29 EVALI patients, vitamin E acetate was detected in bronchoalveolar lavage fluid from all 29 patients; this chemical became a leading suspect but investigators said more study is needed.
• Patients with EVALI commonly had respiratory symptoms (shortness of breath, cough, chest pain) and many also had gastrointestinal symptoms (abdominal pain, nausea, vomiting, diarrhea).
• Chest imaging in EVALI often showed bilateral infiltrates and ground-glass opacities, with no clear infectious cause identified.
• Many EVALI patients were hospitalized; some required mechanical ventilation or extracorporeal membrane oxygenation (ECMO), and one patient received a bilateral lung transplant.
• The ACMT statement notes known vaping hazards beyond EVALI: nicotine is addictive and can harm the developing brain; concentrated nicotine liquid exposures have caused severe toxicity and death in children; some flavoring chemicals (for exa

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Global Public Health Policies and Epidemiology Smoking Behavior and Cessation

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