Why blaming e-cigarettes for deadly EVALI is not just wrong, but dangerous

Was the much-trumpeted rise in youth vaping responsible for last year’s outbreak of vape-related lung injury (EVALI) in the US?

The short answer can be given loud and clear in one word: NO. The longer answer has important implications for legislators and media commentators everywhere.

While a great many jurisdictions – not just across the US but all over the world – have used the EVALI episode as a reason or pretext for clamping down on e-cigarettes, it is now clearer than ever how inappropriate that is.

The science is now in. A study from the Yale School of Public Health, published in the journal Addiction, makes it plain: “Higher rates of e-cigarette and marijuana use in US states did not result in more e-cigarette or vaping-related lung injuries (known as EVALI).”

The study’s author Abigail Friedman explains: “If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviours should show a higher EVALI prevalence. This study finds the opposite result.

“These findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”


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    Increased likelihood of exposure


    Beyond just ruling out increased levels of vaping as leading to more lung injury cases, putting state-by-state case figures alongside information on marijuana laws demonstrates the dangers inherent in over-eager prohibition of all kinds.

    The first five states to legalise recreational marijuana – Alaska, California, Colorado, Oregon and Washington – all had less than one case of EVALI per 100,000 residents aged 12-64, the age range covering most cases. The five states with the highest per-capita prevalence of vape-related lung injury – Utah, North Dakota, Minnesota, Delaware and Indiana – all ban recreational marijuana.

    “If this policy led some recreational marijuana smokers to switch to vaping THC, perhaps in order to avoid detection, it would have increased their likelihood of exposure to contaminated e-liquids when those came on the market. This may have contributed to the higher EVALI prevalence in those states,” Friedman said.

    In other words, preventing legal use of cannabis led directly to the use of illegal, unregulated – and, as it turned out, potentially deadly – alternatives.

    The conclusion to be drawn from that needs to be taken seriously by anyone involved in legislating not just on marijuana but on vaping too.

    Photo: Saeed Moin 

    Author default picture

    Aidan Semmens