In recent months, you may have heard the news about multiple lung injuries associated with the use of electronic cigarettes (e-cigarettes) or vaping products. In late August of 2019, the CDC released recommendations for health care providers naming the disease EVALI or E-cigarette, or Vaping, product use Associated Lung Injury. 
In October 2019, the FDA and CDC reported that the only commonality among all EVALI cases found at that time was that patients report the use of e-cigarette or vaping products. It was thought that the recent spike in EVALI cases was due to more than one cause.
As a result, the FDA and CDC investigated many different substances and product sources. At that time, data suggested that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family members, or illicit dealers), were linked to most of the EVALI cases and played a major role in the outbreak. In a more recent update published in the New England Journal of Medicine, research strengthened prior CDC and FDA finding that linked Vitamin E acetate and EVALI. [1, 2]
According to a CDC study, those at increased risk of rehospitalization due to EVALI tend to be patients that have a history of chronic conditions such as heart disease, respiratory conditions, and diabetes. And, according to the same study, those EVALI patients who died after hospital discharge were more likely to be 50 years or older. 
Current recommendations from the CDC and the FDA to prevent EVALI 
- CDC and the FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online sellers.
- Vitamin E acetate should not be added to e-cigarette or vaping products. Additionally, people should not add any other substances not intended by the manufacturer to products, including products purchased through retail establishments.
- While it appears that vitamin E acetate is associated with EVALI, there are many different substances and product sources that are being investigated. There may be more than one cause. Therefore, the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.
- Adults using e-cigarettes or vaping products as an alternative to cigarettes should not go back to smoking; they should weigh all available information and consider using FDA-approved cessation medications. They should contact their healthcare provider if they need help quitting tobacco products, including e-cigarettes.
- Adults who continue to use e-cigarette or vaping products should carefully monitor themselves for symptoms and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak.
The CDC warns that regardless of the ongoing investigation: 
- E-cigarette, or vaping, products should never be used by youths, teens, young adults, or women who are pregnant.
- Adults who do not currently use tobacco products should not start using e-cigarette or vaping products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
- THC use has been associated with a wide range of health effects, particularly with prolonged and frequent use. The best way to avoid potentially harmful effects is not to use THC-containing e-cigarette or vaping products.
- People with ongoing problematic marijuana use that causes significant impairment or distress should seek evidence-based treatment by a healthcare provider.
 Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019. MMWR Morb Mortal Wkly Rep 2019;68:919–927. DOI: http://dx.doi.org/10.15585/mmwr.mm6841e3
 CDC Newsroom. New Cases in Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) On the Decline. December 20, 2019. Retrieved from https://www.cdc.gov/media/releases/2019/p1220-cases-EVALI.html on Jan 16, 2020.
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.
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Published February 5, 2020, on AddictionHope.com
Reviewed by Jacquelyn Ekern, MS, LPC on February 5, 2020