Doctors expect more people to die of vaping-related illnesses in North Carolina. 

The first North Carolinian died of vaping-related lung illness at Cone Health in Greensboro on Thursday, Sept. 26. Vaping-related illnesses have hit the Tar Heel State hard. Though it has been spared the severity of the outbreaks in California and Texas, North Carolina is home to at least 40 cases of vaping-related illness. 

Nationally, more than 800 people have vaping-related lung injuries, and at least 13 people have died. 

The Centers for Disease Control and Prevention suspects THC — the psychoactive ingredient that produces the high in marijuana — is tied to the outbreak. Almost 80% of patients self-reported vaping THC products, but doctors believe the number may be higher. 

The illness makes patients weak and short of breath. Many need supplemental oxygen; some need ventilators to keep them alive until their lungs recover. 

In the most severe cases, patients’ lungs were so damaged they required an ECMO oxygenator — the most extreme form of life support, in which a device breathes for the patient by pumping oxygen directly into the bloodstream. [See Editor’s note below.]

“Similar to what other people are seeing across the country, we’ve started to see young people in their 20s — otherwise healthy adults without any significant medical history — that are presenting with respiratory failure or symptoms that look similar to pneumonia that are requiring life support,” said Dr. Peter Miller of Wake Forest Baptist Health. 

Most of the patients were 18-34 years old, but more than a third of them were younger than 21, the CDC reports. 

Just as uncertainty surrounds the cause of the outbreak, it also clouds patients’ futures. Doctors don’t yet know the consequences for patients’ long-term health. 

“We don’t know if this is going to cause permanent lung damage, or greater risk for cancer, or other long-term issues,” Miller said. “It’s hard. Vaping has been accepted in society as the safer alternative to smoking cigarettes. And it’s turning out that that might not be true.”

President Trump plans to slap a federal ban on vape flavors, and he’s not alone. 

Michigan proposed outlawing all flavors but tobacco. New York, the District of Columbia, and Washington plan similar bans. Details vary from ban to ban, and from day to day, but all attack vapers’ ability to access the 7,000 flavors on the market today. 

But harm reduction advocates fear flavor bans would unleash unintended consequences. They say bans could drive vapers back to smoking cigarettes, which can be lethal. The CDC has warned consumers against switching to cigarettes. 

And they say flavor bans won’t solve the problem. 

“It is a knee-jerk reaction that is trying to solve the problem of vaping illnesses that has nothing to do with flavors. You’re putting a solution to something that is not the problem,” said Carrie Wade, R Street Harm Reduction Policy Director. “People might start adulterating their e-cigarettes, or buying illegal, unregulated products on the black market, or going back to smoking. And none of these are good outcomes.”

Vaping advocates blame the CDC for failing to accurately represent the nature of vaping-related illnesses.

“The public policy ideas are hysterical, panic driven, and feeding into the feedback loop where media likes to have sensationalism,” Cato Institute Senior Fellow Dr. Jeffery Singer said. “As far as we can tell, almost every case of vaping-related illnesses that we’ve seen are related to people using bootleg products.”

If Trump’s flavor ban goes through, doctors also worry about nicotine withdrawal. Because some vaping devices deliver astoundingly high doses of nicotine — one Juul pod contained as much nicotine as a pack of cigarettes — doctors expect an ugly withdrawal process. 

“With every ban, there are unintentional consequences. History has shown us that, that’s not rocket science,” said Dr. Julie Casani, medical director of Student Health Services at N.C. State University. “I’m worried on both sides. Some people might turn towards cigarettes, and I have concerns about nicotine withdrawal. Though there are plenty of products on the market, they might not be as easy for some students to get to, and for others, it’s just not the thing.”

And then there are the fears that flavor bans will drive consumers toward embracing the black market, where vaping cartridges contain unknown, sometimes lethal chemicals. 

“They’re already getting it illegally, so banning it won’t make them not continue to get it. But banning will make sure that 100% of the flavored vaping products they get will be bootlegging products,” Singer said. “You’re virtually guaranteeing driving up vaping-related illnesses and deaths.”

Editor’s Note: This article was corrected after initial publication.