Georgia could ban most flavored vape products in 2020. What effects will that have?

Terry Clements, the manager of two Macon Vape & More stores in the area, immigrated to the United States five years ago from England. Now, he’s waiting to see what will happen to shops like his.

He’s already seen traffic at his stores decline significantly over the past week following news of more than 1,000 vape-related illnesses and at least 19 confirmed deaths nationwide. The numbers of those affected continue to grow.

Attempts to limit use and access to certain e-cigarette products are moving forward as well. Two Georgia state representatives have announced they will introduce a bill during the 2020 legislative session which could include a ban on flavored products.

But flavor bans like the ones currently being discussed by the Trump administration and at the state level, Clements said, would destroy businesses like the ones he manages.

“I thought America was the land of the free,” he said. “How can you take people’s businesses away? … That’s not right.”

Georgia’s governor and congressional representatives in the central and western parts of the state have said little about potential vaping legislation. Politicians, medical experts and vapers are evaluating what the health concerns mean for former smokers, teens who shouldn’t be able to purchase the products — but do — and vape shop employees trying to make a living.

What local, state lawmakers are saying

As of Oct. 1, the CDC confirmed 18 people have died nationwide as a result of vaping-related lung injury. The Georgia Department of Public Health confirmed a second death in Georgia on Wednesday — which would bring the death count to at least 19.

The state’s first death was a man over the age of 35, and he did not live in the metro Atlanta area, according to a report from the Atlanta Journal-Constitution. He had a history of heavy nicotine vaping but no history of vaping THC, the substance that produces the “high” associated with marijuana.

The second patient had a history of nicotine vaping but the case is still being reviewed to determine if other substances were used.

One way e-cigarette manufacturers attract young users is with appealing flavors with fanciful names. Getty Images

A total of 14 vape-related illnesses have been reported across the state, according to the most recent data from the Georgia Department Public of Health. None were reported in Macon.

Patients affected in Georgia were 18 to 68 years old — with an average age of 31 — and 71% are male.

Efforts to address the illnesses and youth vaping are taking place at both the federal and state levels. President Donald Trump announced in September that he wants to ban the sale of most flavored e-cigarette products.

In Georgia, state representatives Bonnie Rich, R-Suwanee, and Gerald Greene, R-Cuthbert, announced Thursday they will introduce legislation during the 2020 session to address vaping and e-cigarette use.

The legislation hasn’t been completed, but Rich told The Telegraph in an email that her main goal is to limit minors’ access to vape products.

“I’m proposing requiring ID and signature for residential vape product deliveries in the same manner as required for residential wine deliveries in Georgia,” she said. “I’m also proposing that retailers of vape products be licensed, so as to cut down on the underage sales. The FDA’s investigation showed the vast majority of underage sales came from gas stations and convenience stores, not from licensed smoke shops. Finally, I would like the prohibition of flavored tobacco to extend to flavored nicotine juices, for the same reasons the flavored tobacco is restricted.”

If Congress addresses the sale of flavored vape and e-cigarette products before January, that issue won’t be addressed in Georgia’s legislation, Rich said.

Efforts in other states have already begun. New York, Michigan, Rhode Island and Massachusetts have all issued a ban of some sort, Time Magazine reported.

Some of those bans have been challenged in court with mixed results so far. In Massachusetts, a federal judge upheld that state’s fourth-month ban for now, the AP reports. In New York, a state appellate court is currently preventing that state from enforcing its ban, the Wall Street Journal reports.

A federal lawmaker who represents Georgia, though, told the Telegraph that he believes any legislation should not focus solely on banning flavors.

“I worry the focus on flavors ignores the reality that it needs to be harder for underage people to obtain these products in the first place,” said U.S. Rep. Sanford Bishop, a Democrat whose district includes portions of Columbus and Macon. “Many of the people who have died from vaping-related illnesses were using counterfeit products not regulated by the FDA, which needs to be investigated. Any legislation regarding flavor bans needs to take into account the adults who are fighting a very real and deadly addiction to cigarettes, many of which are flavored as well.”

A cloud of smoke from a vape pipe at a local vape shop in Richmond, Virginia., Friday, Jan. 18, 2019. Tobacco-friendly Virginia is preparing to raise the age limit on buying traditional and electric cigarettes from 18 to 21. Steve Helber AP

Republican U.S. Sen. David Perdue is a co-sponsor of the “Preventing Online Sales of E-Cigarettes to Children Act” which would mandate online age verification for the sale of tobacco products, including e-cigarettes. But he did not say if he would support a flavor ban.

“Senator Perdue considers this to be a very broad, multi-faceted issue that will require input from researchers and the public health community,” according to a statement from Perdue’s spokesperson.

Gov. Brian Kemp did not respond to questions from The Telegraph on whether he would consider a flavor ban or any other action regarding vaping in Georgia. He also did not comment on the vaping legislation that could be brought before the Georgia General Assembly during the next session.

However, Kemp, along with the state Department of Public Health, issued a health advisory Wednesday on the risks of vaping and e-cigarette use following the second confirmed death in the state. The state is urging people to not use vape or e-cigarette products while the CDC continues its investigation into the deaths and illnesses nationwide, according to the news release.

“The safety of Georgians is my top priority,” Kemp said in a statement. “I applaud the Centers for Disease Control and Prevention and Georgia Department of Public Health for their tireless work to conduct research and inform the public about this serious issue. This public health advisory will notify Georgians of the potential hazards associated with adolescent vaping and encourage youth to take proactive steps to safeguard their health and well-being. We are asking convenience stores, vape shops, and leaders in communities throughout Georgia to join us in raising awareness.”

Other state lawmakers have not yet weighed in on vaping, including Republican U.S. Sen Johnny Isakson, his spokeswoman said. Attempts to contact U.S. Rep. Austin Scott, a Republican whose district includes Warner Robins and portions of Macon, were unsuccessful.

What bans mean for local vape shops, customers

Clements, the Macon Vape & More manager, said he doesn’t understand the point of a ban on e-cigarette products. He points to CDC data that shows the use of THC has played a role in the outbreak of vaping-related illnesses.

“From a vaper’s point of view, why are you trying to ban something that has been proven to be safer,” he said. “It’s not 100% safe. Nothing is. But it’s been proven. ...I could understand you want to protect the children. I do get that. But they are going to do whatever they want regardless.”

A flavored product ban would hurt smokers trying to give up cigarettes, he said.

“There are these people out there that are desperate to get off cigarettes, and you take way their alternative, they’re going to go back to cigarettes. Not all of them, but the majority will,” Clements said.

E-cigarette use is not approved by the U.S. Food and Drug Administration as an aid to quit smoking, but Harvard Health Publishing cites a February 2019 study that supports the idea that vaping may help some smokers quit.

Ambrose McDonald, 23 of Columbus, first took up vaping as a teenager to help his dad stop smoking cigarettes.

His father put down cigarettes for good, and eventually, he stopped vaping too. But the younger McDonald kept at it.

Now, he’s sponsored by two vaping product companies and his roughly 700 Instagram followers can watch him blow vapor rings or show off his fancy equipment. If customers use his promotional codes to buy vape juices online, he gets paid.

But he said plans to stop vaping in the next six months, just before his daughter turns one. His reasoning for stopping, he says, has nothing to do with the recent illnesses and deaths. McDonald pointed to the CDC’s statement that many of those sick used THC products.

Still, he said vaping is something he wants to give up.

“I don’t want to make her feel like it’s the cool thing to do because it’s not,” he said. “It’s an addiction that needs to be kicked.”

Dr. Sebastian Montgomery, a second-year internal medicine resident at Coliseum Health System in Macon, said it took decades to see the damage associated with smoking cigarettes and decades more to change people’s perception of smoking. There’s still not a lot of data on vaping.

“The vape products have only been on the U.S. market since 2006 and it wasn’t really until about 2010 that it became more popular for use,” Montgomery said. “Overall, the truth is — we don’t know enough.”

Noemi Griffin uses a Juul electronic cigarette while on a quick break at work Wednesday. Jason Vorhees jvorhees@macon.com

The biggest concern to many in the medical community is the resurgence in smoking among young adults and teenagers, Montgomery said.

The FDA reports that e-cigarette use increased 78% among high school students (from 11.7% to 20.8%) and 48% among middle school students (from 3.3% to 4.9%) from 2017 to 2018. A 2013-2014 survey reports that 81% of youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.

“Teens are more susceptible to many of the impacts of toxic substances as their bodies are still in development,” Montgomery said. “They are perhaps, more importantly, more susceptible to the pressures of those around them. ... What we are seeing is in direct contradiction to the years prior to vape introduction to the market. Teens were turning against smoking cigarettes. It was no longer ‘cool.’ Vaping has changed this.”

The Bibb County School District prohibited the use of vapes and e-cigarettes in their student code this year, reports 13WMAZ. Several schools in the district have not had issues with students using the products at school, according to the district.

“I’ve heard back from a handful of secondary principals and they’ve noted this has not been an issue this year,” said Stephanie Hartley, a spokesperson for the school district.

What are some health risks?

For older people who were smokers, it’s possible that vaping could be healthier for them over smoking cigarettes. But the data just isn’t there yet, Montgomery said.

“A 60-year-old who was smoking cigarettes for years and has now taken up vaping likely has disease already proven to be caused by their cigarette use,” he said. “Vape-caused disease is not only hidden in these patients, but also potentially — and much more research is needed into this before we know enough to make any convincing statements — a safer alternative to cigarettes smoking.”

Teens and young adults, however, should stay away, Montgomery advises.

“Teens, on the other hand, are not smoking cigarettes and suddenly taking up vaping flavored and other adulterated pods. The end results are disease we would otherwise not be seeing in these individuals with few other medical conditions, making it easier to see the direct effect of the vaping on the patients,” he said.

Initially, the prevailing thought was that nicotine vaporized products were a safer alternative to smoking traditional cigarettes because there’s no tar, the particulate matter that is the main cause of cancers and lung damage, Montgomery said.

But there are concerns from recent data, he said:

  • Nicotine has known carcinogenic effects and can damage blood vessels over time.

  • Flavoring could be pooling up in a user’s lungs, causing pneumonia.

  • “Second-hand aerosol” could affect people who are around vapers.

“Generally speaking, your lungs were made to breathe in clean air and anything that isn’t clean air is or has the potential to be damaging to your lungs,” Montgomery said. “Studies of these vape products have still found carcinogens in them. ...They’ve still found things like heavy metals … that’s not where your body can process it.”

A cloud of smoke from a vape pipe at a local vape shop in Richmond, Virginia., Friday, Jan. 18, 2019. Tobacco-friendly Virginia is preparing to raise the age limit on buying traditional and electric cigarettes from 18 to 21. Steve Helber AP

Investigations into the vaping-related illnesses nationwide are being conducted by the CDC, the FDA and state health departments, according to the CDC.

Findings suggest products containing THC plays a role in the recent outbreak but no single product or substance has been linked to all lung injury cases.

“This complex investigation spans many states, involves hundreds of patients, and involves a wide variety of substances and e-cigarette, or vaping, products,” the CDC writes.

The CDC recommends that users consider refraining from using e-cigarette or vaping products. Anyone who uses an e-cigarette or vapes should not buy products off the streets or add substances to products.

By the numbers

As of Oct. 1, 1,080 cases of lung injury associated with the use of e-cigarette or vaping products have been reported to Centers for Disease Control and Prevention from 48 states and 1 U.S. territory. There have been at least 19 confirmed deaths as of Oct. 9, and more deaths are under investigation.

The CDC has complete sex and age data on 889 cases.

  • 70% of cases are male.

  • 81% of patients are under 35 years old.

  • The median age of sick patients is 23 years old and ranges from 13-75.

  • The median age of all deceased patients was 49.5 years and ranges from 27-71.

The CDC has information on substances used in e-cigarette or vaping products in the 3 months prior to the onset of symptoms in 578 cases.

  • About 78% reported using THC-containing products; 37% reported exclusive use of THC-containing products.

  • About 58% reported using nicotine-containing products; 17% reported exclusive use of nicotine-containing products.

Nick Wooten is the Southern Trends and Culture reporter for McClatchy’s South region. He is based in Columbus, Georgia at the Ledger-Enquirer but his work also appears in The (Macon) Telegraph and The Sun Herald in Biloxi.Before joining McClatchy, he worked for The (Shreveport La.) Times covering city government and investigations. He is a graduate of Mercer University in Macon, Georgia.