The number of North Carolina cases of severe lung injury associated with e-cigarette use or vaping continues to rise, with 61 cases in people ranging in age from 13 to 72, reports the North Carolina Department of Health and Human Services in a media release.

The North Carolina cases are among a rising outbreak reported by the Centers for Disease Control and Prevention of 1,604 cases and 34 deaths in the United States and the U.S. Virgin Islands as of Oct. 22. The acute lung injury cases have occurred in the context of a rapid rise of e-cigarette use by young people.

Lung injury cases are being reported in younger adults and teenagers. Approximately 79 percent of patients are under 35 years of age, 40 percent are 18-24, and 14 percent are younger than 18.

All patients reported a history of using e-cigarette or vaping products, with most reporting a history of using THC-containing products. THC is the primary psychoactive component in cannabis.

Eighty percent of North Carolina cases interviewed reported vaping THC; 75 percent of North Carolina cases interviewed reported vaping flavors, 70 percent vaped nicotine, 50 percent vaped THC and nicotine and 30 percent vaped cannabidiol, or CBD. No single product or source has been linked to all lung injury cases.

NCDHHS has joined the CDC’s efforts to urge people to consider not using e-cigarette or vaping products, especially e-cigarette or vaping products that contain tetrahydrocannabinol or THC.

“Those who use e-cigarettes or vaping products should not obtain them through informal sources and should not modify or add any substances,” said Dr. Zack Moore, state epidemiologist.

The acute lung illness outbreak is occurring on top of rapidly rising rates of e-cigarette use among youth. The biennial 2017 North Carolina Youth Tobacco Survey found that although cigarette smoking was the lowest ever recorded among high school students at 8.9 percent, e-cigarette use increased 894 percent since 2011.

E-cigarettes have become the most commonly used tobacco product among youth in North Carolina and 9.6 percent of high schoolers report having vaped cannabis. This rate is expected to rise.

“This severe lung disease epidemic and the rise in youth use of e-cigarettes is deeply troubling,” said Dr. Elizabeth Tilson, state health director and chief medical officer for DHHS. “As a pediatrician, I know that nicotine can harm areas of the brain that influence attention, learning, mood and impulse control. Nicotine use at a young age can also rewire pathways in the brain, priming it for future addiction – to nicotine and other substances.” Dr. Tilson testified Sept. 25 before a U.S. House Committee on Commerce and Energy on the topic.

The North Carolina Division of Public Health (DPH) and Department of Public Instruction (DPI) Healthy Schools initiatives have worked together to help implement 100 percent tobacco free schools policies, considering this new and challenging e-cigarette epidemic, and to increase awareness among youth of nicotine levels in e-cigarette products.

DPI and DPH also promote measures to help students, parents and staff recognize youth e-cigarette use as an addiction and to provide evidence-based prevention and tobacco treatment education and counseling, rather than to suspend students who are addicted to nicotine. CATCH My Breath is an evidence-based tobacco use prevention curriculum that addresses middle and high schoolers’ use of e-cigarettes. The curriculum is available free of charge to NC schools. Fifty-six schools in NC have implemented this curriculum serving more than 17,000 students since 2017, and demand is growing.

Another resource, the Truth Initiative, serves as a further resource and has expanded its quit-smoking resources to include a first-of-its kind e-cigarette quit program. To access TRUTH’s new e-cigarette quit program, users can text “DITCHJUUL” to 88709. QuitlineNC (1-800-QuitNow or 1-800-784-8669) is also available 24/7 with online, text and telephone programs to help young people addicted to any tobacco product, including e-cigarettes.

New clinical guidance for managing acute lung injury from the CDC and NCDHHS also urges people to receive a flu shot to protect against a combination of the flu and lung injury from vaping.

NCDHHS will continue to monitor this outbreak and report any new information weekly at tobaccopreventionandcontrol.ncdhhs.gov/ecigs.

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