Feds announce much tougher e-cigarette, cigar rule

 and , USAToday 7:09 p.m. EDT May 5, 2016

New federal rules announced Thursday have the potential to upend the multibillion-dollar electronic cigarette industry just as it is attempting to position itself as an alternative to traditional cigarettes. (May 5) AP

Electronic cigarettes will now be regulated much like tobacco cigarettes and their sale to children banned, according to a new federal rule issued Thursday.

Under the rule, the U.S. Food and Drug Administration would have to approve all tobacco products not currently regulated that hit stores after February 2007. The e-cigarette industry was virtually non-existent before then.

Premium, hand-rolled cigars, as well as hookah and pipe tobacco, are also included in the new regulation, which federal officials call ”historic.” The rule prohibits selling ”covered tobacco products” to people younger than 18, and buyers must show photo ID. It also requires health warnings be displayed on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements; and bans free samples and the sale of covered products in vending machines not located in adult-only facilities.

The Tobacco Control Act of 2009 sets Feb. 15, 2007, as the latest date by which all tobacco products would have to have to be grandfathered in. Mitch Zeller, head of the FDA’s Center for Tobacco Products, has said publicly that he couldn’t choose a later date, although industry officials disagree.

That means nearly every e-cigarette on the market — and every different flavor and nicotine level — would require a separate application for federal approval. Each application could cost $1 million or more, says Jeff Stier, an e-cigarette advocate with the National Center for Public Policy Research and industry officials.

An amendment to appropriations legislation working its way through the House would change the date so more e-cigarettes would be grandfathered in. White House Press Secretary Josh Earnest said Thursday that President Obama ”takes a very dim view of attaching ideological riders to appropriations bills,” but stopped short of threatening a veto of any legislation.

The proposed rule was released more than two years ago, in April 2014, and the final rule gives the industry two additional years to comply. The industry will have had “plenty of time to submit their applications,” says Robin Koval, CEO of the Truth Initiative, an anti-tobacco health group.

However, stores have to comply with the rule in about three months (90 days from its publication May 10), and Zeller says contractors tasked with enforcement will be ready to “hit the ground running” on Day 91.

Koval says “it’s perfectly reasonable” that people should know what’s in something that “you inhale into your lungs.”

Ellen Hahn, a professor at the University of Kentucky College of Nursing and co-chair of the UK Tobacco-free Task Force, said the new rule is a good first step toward controlling e-cigarettes. “From a health perspective, to reduce the social acceptance of them is good because frankly, it’s the wild, wild West out there,” she says. “Vape stores are everywhere.”

She says so-called “vaping” can get kids hooked on nicotine and threatens to prolong “the tobacco epidemic.” E-cigarette use has been rising steadily, especially among youth. According to the U.S. Centers for Disease Control and Prevention, e-cigarette use among high school students rose from 1.5% in 2011 to 16% in 2015. Federal health officials estimate that about 3 million middle and high school students use e-cigarettes.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, says the rule announced Thursday falls short in protecting children because it doesn’t restrict the use of sweet e-cigarette flavors such as gummy bear and cotton candy even though the FDA’s own data show flavors play a big role in youth use.

Industry experts say treating e-cigarettes, which don’t contain tobacco, the same as cigarettes could lead to such onerous and costly approval that all but the largest tobacco companies would be forced out of the market — and possibly those companies, too. Zeller says he expects consolidation in the number and type of products and vape shops.

The Tobacco Control Act requires the FDA to use science to weigh the potential benefits of e-cigarettes against any potential health risk for both individual users and the whole population, which Stier says would be all but impossible.

That could force e-cigarette smokers back to regular cigarettes, he says.

E-cigarettes help people trying to quit smoking, says Patricia Kovacevic, general counsel and chief compliance officer at e-cigarette manufacturer Nicopure. She and other e-cigarette advocates cited a Royal College of Physicians’ report last week that showed e-cigarettes’ benefits.

Department of Health and Human Services Secretary Sylvia Burwell says, ”There are many other cessation tools available.”

But Russell Major, an e-cigarette user and store manager of 723 Vapor in Louisville, Ky., says e-cigarettes were the only thing that helped him quit a 13-year tobacco habit. The 33-year-old former Marine says he also tried nicotine patches and gum, to no avail. Major says he doesn’t think e-cigarettes should be regulated like tobacco cigarettes.

“To me, we don’t really understand the long-term health risks. We don’t know if there are health risks,” he sais. But he adds:”I can support the ban on the sale of e-cigarettes to minors. … I have kids of my own.”

Lawmakers have to address the possible adverse health effects of e-cigarettes, Kovacevic says, but the rule doesn’t account for the comparative benefits of e-cigarettes over regular tobacco products for improving overall public health.


FDA announces rules restricting e-cigarettes and cigars

Koval agrees that e-cigarettes “are dramatically less harmful” than regular cigarettes.
“But they’re not without harm,” she says. “It would be hard to make a product more harmful or toxic than cigarettes.”

Contributing: Gregory Korte

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California raises smoking age starting today, Thursday, June 9, 2016


, USA TODAY 5:59 p.m. EDT June 8, 2016


A new California law that takes another bold step to limit smoking goes into effect Thursday, raising the age limit to buy tobacco products from 18 to 21.

Another new law bans e-cigarettes from public places such as schools, restaurants and hospitals.

California will be the second state in the nation after Hawaii to have an age requirement of 21 to purchase tobacco — a feat which state Sen. Ed Hernandez, author of the bill, says he is excited about. He predicts a “significant drop” in tobacco use.

“I think California is taking a leadership role in curbing tobacco use and tobacco products,” Hernandez, a Democrat, said in an interview. “Hopefully, all states in the United States will eventually move to 21 and reduce smoking even more.”

Hernandez said there could be some backlash or slightly more illegal underage tobacco use, though he thinks it will deter far more potential users. The Institute of Medicine found that if all states required a minimum age to purchase tobacco 21, it would lead to a 12% drop in smokers.

The bills were backed by an advocacy group, the Save Lives California coalition, made up of doctors and healthcare workers from the American Lung Association, the California Medical Association, the American Cancer Society and other organizations.

“I think tomorrow is a proud example of California taking the lead to protect our kids and stand up to big tobacco,” said Mike Roth, spokesperson for Save Lives California.

California e-cigarette smokers will also see restrictions after Thursday. All e-cigarette and vapor products will be reclassified as traditional tobacco products in the law. This law is opposed by the Smoke-Free Alternatives Trade Association – a lobbying group for vapor products—which calls the provision a “step backwards.”

“Stigmatizing vapor products, which contain no tobacco and treating them the same as combustible cigarettes opens the door to excessive taxation that will economically penalize smokers looking to make the switch to vaping.,” said Josh Krane, president of the California chapters of the SFATA.

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Can we please stop pretending marijuana is harmless? The truth is it can indeed mean trouble, especially for young people.

By Dr. Sushrut Jangi   

These days, it’s become fairly square to criticize marijuana and its rush toward legalization. Twenty-three states have condoned the drug in some form, with four permitting recreational use, and Massachusetts is set to vote on permitting it next year. The proposed federal CARERS Act of 2015 would let states legalize medical marijuana without federal interference and demote pot from a Schedule I drug — one with high abuse potential — to Schedule II. The path toward nationwide decriminalization is looking unobstructed.

But underscoring the incredible momentum to legalize marijuana is the misconception that the drug can’t hurt anybody. It can, especially young people.

The myth that marijuana is not habit-forming is constantly challenged by physicians. “There’s no question at all that marijuana is addictive,” Dr. Sharon Levy tells me. She is the director of the Adolescent Substance Abuse Program at Boston Children’s Hospital, one of a few programs designed to preemptively identify substance use problems in teens. At least 1 in 11 young adults who begin smoking will develop an addiction to marijuana, even more among those who use the more potent products that are entering the market.

Levy speaks of an 18-year-old patient who had started smoking marijuana several times a day in 10th grade, dropped out of high school, and been stealing money from her parents. “She and her family were at their wits’ end trying to find appropriate treatment in a health care system that doesn’t consider addiction to marijuana a serious problem,” Levy says. “We are simply not prepared for the fallout of marijuana legalization.”

Such perspectives have been obfuscated by those who might gain from legalization. “People strongly defend marijuana because they don’t want legalization to be derailed,” says Jodi Gilman, an assistant professor at Harvard Medical School with the Center for Addiction Medicine.

An insistence on the banality of the drug is especially dangerous among younger smokers, a population with an epidemic level of pot use. According to the most recent National Survey on Drug Use and Health, the use of tobacco and alcohol among 12-to-17-year-olds has fallen in the past year, but habitual use of marijuana among those 12 and up is increasing.

“If you go into a high school and ask the classroom, ‘Are cigarettes harmful? Is alcohol harmful?’ every kid raises their hands,” Gilman says. “But if I ask, ‘Is marijuana harmful?’ not a hand goes up.”

To bring balance to a narrative driven by pro-legalization campaigns, Gilman and others are interested in leveraging data to show pot’s real effects. Last year, Gilman published research on 18-to-25-year-olds that showed differences in the brain’s reward system between users and non-users. (“I got a lot of hate mail after that,” Gilman says.) And data supporting the hazards keep accumulating. Recently Gilman found that in a group of college students, smokers had impaired working memory even when not acutely high.

Physician concern for marijuana’s acceptance isn’t because doctors are a stodgy bunch — their skepticism is rooted in science and in history. In the 1950s, nearly half of Americans smoked tobacco, a level of adoption that rendered its health hazards invisible. Meanwhile, the corporate forces that drove cigarette smoking to its ascendancy actively subverted those that governed public health.

While marijuana has not been definitively shown to cause cancer or heart disease, its harmful cognitive and psychological effects will take time to capture in studies. The underlying biochemistry at work suggests deeply pathologic consequences. Tetrahydrocannabinol (THC) in marijuana attaches to receptors in the brain that subtly modulate systems ordinarily involved in healthy behaviors like eating, learning, and forming relationships. But THC — which has been increasing in potency in legal products being sold in places like Colorado — throws the finely tuned system off balance.

“Smoking pot turns the volume on this system way, way up,” says Jonathan Long, a research fellow at the Dana-Farber Cancer Institute.

Each hit of THC rewires the function of this critical cognitive system: Early evidence in mice has shown that repeated exposure to THC causes these receptors to disappear altogether, blunting the natural response to positive behaviors and requiring higher doses to achieve the same effect. Marijuana exploits essential pathways we’ve evolved to retrieve a memory, to delicately regulate our metabolism, and to derive happiness from everyday life.

Medical science at its best operates independently of forces that drive the market and its associated politics. It was science that eventually curtailed the power of Big Tobacco and prevented nearly 800,000 cancer deaths in the United States between 1975 and 2000. As marijuana marches toward the same legal status as cigarettes, its potential hazards will require equal attention by science.

The argument here isn’t whether marijuana should be legal. There are champions on either side of that debate. Instead, should the drug become widely available, it’s to our detriment to blindly consider marijuana’s legalization a victory worthy of celebration. We must be cautious when societal shifts can affect health, especially among our most vulnerable populations.

More coverage:

• Marijuana dispensary opens in Brockton

• Demand soaring at state’s lone marijuana dispensary

• Different strategies for groups pushing legal marijuana

• Could medical marijuana alleviate the state’s drug epidemic?

Dr. Sushrut Jangi is an internist and instructor in medicine at Beth Israel Deaconess Medical Center. Send comments to magazine@globe.com.

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Tobacco Laws and Protecting Youth

Study Finds America is Ready for 21-and-Older Tobacco Laws

A study released this week by the University of North Carolina at Chapel Hill and East Carolina University found that in all nine regions of the country, a majority of adults supported increasing the minimum legal age for tobacco product sales to age 21.

Researchers reported their findings in the American Journal of Preventive Medicine.

In the study, researchers surveyed 4,880 adults aged 18 or older to learn their views on raising the minimum age of tobacco sales to 19, 20 or 21.

“With these findings, policy makers and public health advocates can move forward knowing that people in their states support raising the minimum legal age for selling tobacco products, and that this is an issue that is not viewed as partisan,” said Dr. Adam O. Goldstein, a University of North Carolina Lineberger Comprehensive Cancer Center member and professor in the UNC School of Medicine Department of Family Medicine, in a news release. “It seems to cross political lines, and it is one policy measure that the majority of those surveyed can agree on.”

The study comes as two states have recently moved to increase the legal age of tobacco sales to 21. Hawaii became the first U.S. state to make the change Jan. 1, and California followed suit earlier this year.

“With the strong support indicated in our data, I think we will continue to see strong momentum,” Goldstein said. “It appears likely that increasingly, lawmakers are going to be interested in doing this.”

The study was funded by grants from the National Institutes of Health, National Cancer Institute and the Food and Drug Administration Center for Tobacco Products.


FDA Finalizes its Authority on all Tobacco Products

CADCA’s Geographic Health Equity Alliance

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SAMHSA Newsletter: Marijuana & Youth

Although marijuana use among youth poses a risk to health, nationally only 1 in 5 adolescents perceived it as such. According to SAMHSA’s 2014 National Survey on Drug Use and Health, this misperception among youth exists at a time when marijuana concentrates continue to become more potent, which is cause for public concern. This demonstrates the need to educate young people about various forms of marijuana and their related health consequences and harms. 

Marijuana Use

According to SAMHSA’s Short Report, “State Estimates of Adolescent Marijuana Use and Perceptions of Risk of Harm from Marijuana Use: 2013 and 2014,” in the 12 to 17 age group, approximately 1.8 million youth reported using marijuana in the past month.

Health risks associated with youth marijuana use include poorer education/employment outcomescognitive problemsincreased likelihood of vehicle crashes, and increased addiction risk.

Marijuana Concentrates

The Drug Enforcement Agency describes marijuana concentrate as a substance containing highly potent THC (tetrahydrocannabinol, the psychoactive component of marijuana). This concentrate is often referred to as oil or “710” (“OIL” spelled upside down and backwards). THC levels in this oil could range from 40 to 80 percent, which is about four times stronger than what is found in a “high grade” marijuana plant.

Using marijuana concentrates is different from smoking marijuana in several ways:

  • Oil is harder to detect. When marijuana is smoked it causes a distinctive smell. But when oil from the marijuana plant is extracted and concentrated, it is odorless, making it harder to detect, for example, in e-cigarettes or foods. Because of this particular characteristic, it could be harder for parents, teachers, and law enforcement to know when marijuana is being used.

“Vaping is much easier to conceal and it is harder to tell if kids are vaping and getting high,” said David Dickinson, M.A., SAMHSA’s Region 10 Administrator. “Teachers may not have a full awareness of what’s happening and THC overdose is a real concern.”

Street Names for Cannabis Extracts & Oils

  • ■ Hash Oil
  • ■ Butane Honey Oil (BHO)
  • ■ Shatter
  • ■ Dabs
  • ■ Honeycomb
  • ■ Honey Oil
  • ■ Budder
  • ■ Crumble
  • ■ Sap
  • ■ Ear Wax
  • ■ Pull-and-Snap or Snap-and-Pull
  • ■ Black Glass
  • ■ Errl
  • ■ 710 (“OIL” spelled upside down and backwards)
  • Oil can be mixed into other products. Oil is also sometimes mixed with other drugs including alcohol, cocaine, methamphetamine, and phencyclidine (PCP), creating an even stronger psychoactive response. It is also commonly added to sweet drinks and foods like brownies that appeal to youth, which can lead to high levels of exposure and can have toxic consequences when accidentally ingested.

“It’s not just smoking that concerns us, edibles and drinkables are also really popular with teens and young adults,” said Charles Smith, Ph.D., SAMHSA’s Region 8 Administrator. People eating a brownie containing marijuana, vaping the oil from an e-cigarette, or mixing it with other drugs may not fully realize the potency or effects until they are feeling unwell or even at a point of crisis from overdose.

There are other problems with marijuana use to consider as well:

  • Additives and other chemicals may be toxic. According to Charles LoDico, MS, F-ABFT, a chemist in SAMHSA’s Division of Workplace Programs, marijuana concentrate can be extracted by using liquid butane, which is a highly flammable carcinogen. In many cases, trace butane remains and, when inhaled, can lead to long-term cognitive impairment and can affect nervous system functioning. And butane isn’t the only potential chemical exposure – pesticides used when growing the plant are also cause for concern. 

The Need for More Research

Jon Perez, Ph.D., SAMHSA’s Region 9 Administrator, said “In the case of marijuana, the science lags behind policy and access. That means we do not yet have a full understanding of the health consequences of marijuana, hash concentrates, or what happens when it’s consumed through e-cigarettes.”

Douglas Tipperman, M.S.W., SAMHSA’s Tobacco Policy Liaison, noted that the record growth of smoke shops in recent years coincides with the emergence of the e-cigarette and the legalization of marijuana. He said, “While research is still needed to fully understand the health effects of e-cigarettes at the individual and population level, we also need to consider how marijuana concentrates in e-cigarettes may also pose additional significant health risks.”

Although more data are needed on the impact of marijuana concentrates, it is clear that in order to prevent use by youth, public education and awareness of the potential health risks are critical.

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On an Average Day…College Students…

New Report Reveals 1.2 Million Full-Time College Students Drank Alcohol

On an average day, 1.2 million full-time college students in the U.S. (ages 18 to 22) drank alcohol and 703,759 smoked marijuana, according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA).  The report also shows that on an average day, 239,212 part-time college students (ages 18 to 22) drank alcohol and 195,020 used marijuana.  The report differentiated full-time and part-time college students by their college enrollment status.

The report also sheds light on how many of America’s 9 million full-time and 2 million part-time college students’ start using substances on an average day.  For example, on an average day, 2,179 full-time college students drink alcohol for the first time and 1,299 start using marijuana. In addition, on an average day, 649 full-time college students start using hallucinogens, 559 start the non-medical use of prescription pain relievers, and 447 start using cocaine.

In addition, the report shows that on an average day, 453 part-time college students drink alcohol for the first time, 153 start using marijuana, 129 start the non-medical use of prescription pain relievers, 117 start using hallucinogens and 80 start using cocaine.

Full-time college students who used alcohol in the past month drank an average of 4.1 drinks per day on the days which they drank; while part-time college students who used alcohol in the past month drank an average of 3.8 drinks per day on the days which they drank.

“Substance misuse at any age can jeopardize one’s health and long term well-being, but college students may be particularly at risk because of the pressures they face at this critical juncture of their lives,” said SAMHSA’s Center for Substance Abuse Prevention (CSAP) Director Frances Harding.  “College administration, faculty, and staff; students; parents; and the surrounding community must work to ensure that college students get the effective prevention programming and treatment services they need.”

The report, “A Day in the Life of College Students aged 18 to 22: Substance Use Facts,” highlights the substance use behavior among full-time and part-time college students. It was drawn from combined 2011 to 2014 National Survey on Drug Use and Health (NSDUHs) data and analyzed by SAMHSA’s Center for Behavioral Health Statistics and Quality.

“These numbers are not new to us but they are alarming,” CADCA’s Gen. Arthur T. Dean told USA Today in an article that appeared about the report today. “We need to somehow change the social norms related to alcohol. Most young people believe that drinking is a rite of passage and that one has to drink to drink to fit in, but we know that it is not appropriate.”


NIAAA Releases Comprehensive Resource to Help Address College Drinking

CADCA-Community Anti-Drug Coalitions of America  cadca.org

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World No Tobacco Day 2016

World No Tobacco Day 2016: Get Ready for Plain Packaging

Every year, on May 31, the World Health Organization and partners mark World No Tobacco Day, highlighting the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption.

For World No Tobacco Day, WHO and the Secretariat of the WHO Framework Convention on Tobacco Control are calling countries to get ready for plain (standardized) packaging of tobacco products.

Plain packaging is an important demand reduction measure that reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of tobacco advertising and promotion, limits misleading packaging and labelling, and increases the effectiveness of health warnings, WHO representatives say.

get involved in World No Tobacco Day and its plain packaging initiative.

CADCA-Community Anti-Drug Coalitions of America
Building drug-free communities.

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High School Senior Shares Reasons to Celebrate Sober

As prom and graduation season approaches, this is a time when students, and their parents, celebrate their accomplishments.  The following was written by a graduating senior of Mercer Island High School.  It reminds parents that, while their children are graduating and entering adulthood, they still need your encouragement and reminders about why it is so important to keep making healthy decisions.  

By Sarah Stewart
As the end of our senior year in high school approaches, I have noticed a different kind of buzz in the air. Suddenly getting the mail becomes more than a chore, and cheering at sports games – varsity or not – is extremely important. The sun comes out and flowers bloom as our senioritis flourishes.

Words like second-semester and fourth-quarter paired with senior have never sounded more valid as an excuse for almost any behavior. Facebook is littered with positivity and people proclaiming their future homes: colleges, universities, jobs and gap years of adventure.

What we call “promposals” are happening every day, and despite all of the drama, people are excited. Everything seems a little bit easier… especially not opening your backpack all weekend. However, mixed into the good energy is a palpable fear. The fear of being rescinded from your dream school, the fear of dropping grades, the fear of final exams, and not being allowed to be a part of graduation.

This time of year is filled with simultaneous firsts and lasts. These next few weeks are ones to take advantage of, and that is why I am staying sober. Prom and graduation are nights to be remembered, not nights to be wasted. As the school year winds to a close and the celebration begins, remind yourself that the majority of seniors don’t drink and don’t use drugs.

Sure, there will always be the isolated group that chooses to drink before prom or that shows up high on the last day of school, but that is not the norm. Most people find ways to celebrate and unwind after 4 long years of high school that don’t involve substances. You can, too.

Surround yourself with friends who are staying sober then “sober-party” it up whenever possible. You deserve to celebrate! Go for a swim, drink soda, have a bonfire, eat as many donuts as you can, slick your hair back or put on your favorite dress, and throw your graduation caps as high as possible. Enjoy the end of high school, and enjoy it when you are really yourself: sober.

Take a moment and remember opening your college acceptance letter. I remember deciding where I am headed next fall. I remember the butterflies and excitement. I remember the four years of working hard in high school. I know choosing to use drugs and alcohol can take all of that away from me.

If I were caught using substances, I may be suspended, unable to attend prom, and not allowed to participate in graduation. So, it is clear: the risk far outweighs the appeal. This is a time in our lives of endless opportunity. With great opportunity comes great responsibility. Stay excited, keep buzzing with anxious energy, but don’t ever stop working hard and remembering what it took to get you here. You are so close to the end. Celebrate sober!

Congratulations class of 2016!

Sarah Stewart is a graduating senior of Mercer Island High School. She is the founding member of the school’s Super Awesome Fun Events Club (S.A.F.E.) and is an outspoken advocate on substance abuse prevention issues.


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E-cigarette poisonings in kids skyrocket, study finds

By Sandee LaMotte, CNN  Updated 7:54 AM ET, Mon May 9, 2016

(CNN)The number of children under 6 poisoned by nicotine in e-cigarettes rose by nearly 1,500% between 2013 and 2015, and one child died, according to an analysis of calls to the National Poison Data System published in the journal Pediatrics.

More than 90% of the children swallowed the nicotine-laced liquid, known as e-juice, that is smoked inside e-cigarettes. Nearly half of the exposed children were under the age of 2.
The number of children exposed to e-cigarette products each month rose from 14 in January 2012 to 223 in April 2015.
“On average, every three hours, a poison center receives a call about a young child exposed to an e-cigarette or liquid nicotine,” said the study’s senior author, Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. “That’s more than seven children each day.”
The numbers of accidental poisonings skyrocketed because of the explosive popularity of e-cigarettes, Smith said. Their use among U.S. adults doubled between 2010 and 2013, and tripled among high school students from 2013 to 2014. That trend continues: Total sales are predicted to top $10 million by 2017.

E-cigarette exposure is more harmful, analysis finds

The study looked into calls about exposure to nicotine and tobacco products in children under 6 between January 2012 and April 2015. It compared e-cigarettes with tobacco cigarettes and other tobacco products, mostly snuff and chewing tobacco.
“This is the first comprehensive multiyear study of exposures among young children using a national database,” Smith said. “Over the 40-month study period, more than 17,500 children were exposed to cigarettes, and more than 4,000 children were exposed to e-cigarettes or liquid nicotine.”
While the number of children who came into direct contact with e-cigarettes was much smaller, the outcomes were more serious. Children in contact with e-cigarettes were 5.2 times more likely to be admitted to a health care facility and 2.6 times more likely to have a severe reaction than those exposed to traditional cigarettes.
“Liquid nicotine is very concentrated and easily absorbed into the body,” Smith explained, “and can cause serious poisoning and death among young children after even small doses.”
Once nicotine enters the body, it rapidly affects the heart and circulation system, as well as the gastrointestinal and nervous systems.
“In this study,” Smith said, “children exposed to e-cigarettes and liquid nicotine more commonly experienced severe clinical effects, such as seizure, coma and respiratory arrest, than children exposed to cigarettes.”

Easy access, enticing packaging and flavors

Smith said the analysis discovered that children were often able to get to the products because they were improperly stored or left out in the open — in some cases during use by an adult.
“We take this very seriously,” said Ray Story, founder and CEO of the Tobacco Vapor Electronic Cigarette Association. “We already tell users to refill their devices away from children and store all e-cigarette products in a safe, childproof place. These are irresponsible adults who are not handling the product with care.”
“This is not primarily a parenting problem,” Smith said. “The best parent in the world cannot watch their child every second. Rather, this is another example of a highly dangerous product being introduced into the places where young children live and play without adequate regard for child safety.”
To a child, the small, colorful bottles in which e-juice is sold can be enticing. It comes in a rainbow of colors and flavors, mimicking candy and desserts: bubble gum, gummy candy, marshmallow, chocolate, fruit flavors, even glazed doughnut and pie crust flavors.
Critics of the industry have called for manufacturers to limit or change flavors, packaging and labeling so that they are less appealing to youngsters. Story said his association has advocated since 2009 for a changes in the law that would require age verification and restrict sales to minors, as well as childproof bottles.
But as for limiting choice? “Nicotine without flavoring is odorless and tasteless. This is an adult product, and therefore the adult has a right to choose his or her flavor,” Story said. “We strive to provide the adult user with a vastly less harmful alternative to conventional tobacco. We hope that these adults handle the products with care.”
“It is unacceptable,” Smith said, “that children are being rushed to emergency departments in coma, with seizures or breathing failure, and dying. Child safety should be put first.”
Join the conversation

See the latest news and share your comments with CNN Health on Facebook and Twitter.

Concerns over a mostly unregulated industry prompted the Food and Drug Administration to announce that it is extending its authority over e-cigarettes and other tobacco products like hookahs and cigars. However, in its final rule (PDF), the FDA declined to limit flavorings, saying it would address the issue in the future.
Parents and caregivers can protect their children, Smith said, by following these tips:
  • Store e-cigarettes and refill products where children cannot see or reach them; in a locked location is best.
  • Use and refill alone. Do not use e-cigarettes around children. Because children want to imitate adults, using e-cigarettes and refilling them with children nearby could lead to dangerous exposure.
  • Store the national Poison Help Line number (1-800-222-1222) in your cell phone and post it near any home phones. Call it in case of accidental exposure.
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Marijuana Increased in 2014 as a Factor in Deadly Crashes


Olympia, WA – Newly released data from the Washington Traffic Safety Commission (WTSC) shows that marijuana is increasing as a factor in deadly crashes. The number of drivers involved in deadly crashes who tested positive for marijuana increased 48 percent from 2013 to 2014.

“We have seen marijuana involvement in fatal crashes remain steady over the years, and then it just spiked in 2014,” said Dr. Staci Hoff, WTSC Data and Research Director.

From 2010-2014, nearly 60 percent of drivers involved in fatal collisions were tested for drugs. Among these tested drivers, approximately 20 percent (349 drivers) were positive for marijuana.

However, just testing positive for marijuana doesn’t necessarily indicate if a driver was actually affected by the drug at the time of the crash since marijuana can be detected in a person’s blood for days (possibly weeks) after a person uses the drug. This new data is able to distinguish between drivers who test positive for THC, the impairing substance in marijuana and those who have residual marijuana in their system from prior use which may have occurred days ago.

The number of drivers testing positive for active THC increased, from 65 percent (38 of 60 drivers) in 2013 to an alarming 85 percent (75 of 89 drivers) in 2014. Approximately half of these THC-positive drivers exceeded the 5 ng/ml THC per se limit (A “per se” limit is the amount of a substance in a person’s blood that according to Washington law makes the person DUI notwithstanding other evidence.)

“With this data we are finally able to see who was high during the crash versus which drivers had used marijuana in the past few days,” said Hoff, “The answer in 2014 is most of them were high.”

According to the new data, the driver with the highest THC level was tested at 70 ng/ml.  Half of these THC-positive drivers were also under the influence of alcohol, the majority of those also exceeded the alcohol per se limit of 0.08 BAC.

The largest increase in THC-positive drivers were among males ages 21-25, from only 6 in 2013 up to 19 in 2014 – the most significant increase among any other age group.

The WTSC Research and Data Division, in collaboration with the WA State Patrol Toxicology Lab, abstracted drug types and levels for drivers in fatal crashes back to 2008. The full report and complete analysis of this data is expected to be released in September.

“This study is a step towards answering the myriad of questions we have about the impact of legalized marijuana on driving. We will continue to explore the implications of this information,” said Hoff.

A new law prohibits drivers and passengers from using marijuana while driving. It also prohibits anyone from keeping marijuana in the vehicle unless it is in its original sealed packaging or is stored in the trunk or some other area of the car not normally occupied by people.

“This data shows why this new law is so important,” said Darrin Grondel, WTSC Director, referring to the new statute passed during this year’s legislative session.

From 2008 through 2014, more than 1,100 people died in impaired collisions in Washington. Impaired driving is involved in nearly half of all traffic deaths and more than 20 percent of serious injury collisions. The highest percentage of these deaths occurs during the summer months.

That is why the WTSC participates in the National Drive Sober or Get Pulled Over campaign. From now through Labor Day, the Commission is letting the public know that extra officers will be out across the state at times and locations where DUI is a problem.

“It is our hope that by publicizing these extra patrols more people will plan ahead if they will be drinking or using marijuana,” said Grondel. “Don’t risk getting arrested for a DUI, or causing a life-changing tragedy. Designate a sober, drug-free driver.”

Over 100 law enforcement agencies including all districts of the Washington State Patrol will be teaming up and participating in the extra patrols all across the state.

These extra patrols are part of Target Zero—striving to end traffic deaths and serious injuries in Washington by 2030. For more information, visit www.targetzero.com.


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