Is Vaping Safe? Yes. Then Why Try to Force It Out of Existence?

Smoking is bad for you, but is vaping safe?

What is vaping, you ask? Vaping is a substitute for cigarettes. Individuals suck the vapor out of an e-cigarette whose primary ingredient is a liquid made from vegetable glycerin or propylene glycol (PG), a synthetic compound used in massage oils, injectable Diazepam, hand sanitizers, and a bunch of other products.

The Food and Drug Administration (FDA) has “generally recognized as safe” pharmaceutical grade PG, which is what is used in vaping.

The vaporized liquid is thicker than smoke, though it isn’t smoke. There’s no tobacco in the liquid or any of the tar, carbon monoxides, or other dangerous toxins found in cigarettes. In fact, in many cases the liquid doesn’t even have nicotine, which is the addictive ingredient in cigarettes, and is often the draw in using e-cigarettes to get off smoking cigarettes. Vaping usually smells good because the liquid is infused with fruit, mint, or other flavorings.

Vaping has risks, but it’s way safer than cigarettes — like 95 percent safer!

So why has the FDA been trying to treat e-cigs like cigarettes? Usually, you have to follow the money. In this case, there’s the added bonus of following the moralists who equate vaping to tobacco and think that smoking is evil, no matter the product. It doesn’t hurt the moralist argument that the cigarette companies are now getting in on vaping as a recovery point for the dying tobacco industry.

Drug and addiction specialist Sally Satel explained what the FDA is doing.

In the spring of 2016, the FDA issued a “deeming rule” bringing e-cigarette devices and associated nicotine liquids under the jurisdiction of the Tobacco Control Act and requiring each product to be authorized by FDA.

It was clear from the outset that the cost of filing an application for approval would be excessive. FDA itself estimates application costs of between $286,000 and $2.6 million for devices and between $182,000 and $2.0 million for liquids – and there are tens of thousands of devices and liquids.

The FDA could flip its position and keep the industry alive while it proves itself, if its new commissioner, Scott Gottlieb, a former colleague of Satel’s, would delay regulatory rules that require the vaping industry to undergo the “unrealistic and unnecessary demands” that will put 90 percent of the industry out of business.

Since vaping is safe, but the regulatory regime is harsh, the threat of vapes being taken off the shelf is real. And that would undermine the vaping industry’s huge successes in getting people off cigarettes. Product standards are one means to regulate, but driving people back to using a deadly product seems counterproductive to the FDA’s stated goals.

Learn more about vaping from Satel.

Deaths of Despair: Opioid Abuse Devastates America. There Is a Solution

Low-income poorly educated whites between the ages of 45-54 are dying too soon. Unlike every other age, ethnic and racial, education, and income group, this group’s longevity is decreasing. Why? Opioid abuse.

That’s right, prescription painkillers, heroin, Fentanyl, and other opiate derivatives killed more than 33,000 Americans in 2015. That’s about four times the number of opioid-related drug overdose deaths than in 1999.

Nearly half of those overdoses come from prescription painkillers. But the number of prescriptions written for opioids has been on the decline since 2011. That may explain the rise of heroin and Fentanyl, as substitutes for legal opioids. But the turn toward heroin and Fentanyl now exceeds painkillers for the number of deaths each year.

These drugs are extremely potent. Fentanyl, which was created to relieve pain in end-of-life cases, is about 50 times more potent than heroin, but people can survive it because they build up a tolerance.

The related costs associated with this national epidemic total about $77 billion.

That seems shockingly high, but consider some of the tentacles of the epidemic. The foster care system is overwhelmed. West Virginia, which has the highest overdose death rate in America, has run out of funding for funeral burial benefits. Ohio has started building portable morgues because coroners’ offices are full. The state of Arizona recently concluded that on average, more than two Arizonans die every day in 2016 due to opioid-related overdoses.

To put it bluntly, the United States has a killer problem on its hands.

Christopher Caldwell, a senior editor at The Weekly Standard and author of an essay entitled, “American Carnage: The New Landscape of Opioid Addiction,” recently spoke at a conference about the massive growth in opioid-related deaths. It’s a problem that began long ago.

The specific problem of opioids, I think, has to do with the confluence of three things in the 19th century: In the start of the 19th century, scientists were able to isolate morphine, the chemical in opium poppies. In the 1850s, we invented the hypodermic needle, and in the 1860s, we fought the bloodiest war in the history of the planet, and a lot of people came home with what we now call chronic pain, and the ability of, the uses of this drug were just infinite.

It was over-prescribed. You know what happened, or you can predict what happened. A lot of mothers and teachers, and like, pillars of the community, got addicted and died.

It wasn’t until soon before the first World War that the first drug laws were passed. Drugs became taboo, but after Vietnam, drug use started rising again, and with that, so did drug deaths. The use of crack in the 1980s began elevating the death rate. But the spike in recent years is a whole different animal.

So can something be done? Well, resources seem to be moving in the right direction, and in one of those rare good news stories, federal money is being directed toward actual solutions.

For instance, drug courts have expanded access to medication-assisted treatment (like methadone), and residential treatment programs, as opposed to jail, are helping addicts recover, not languish in prisons.

Harold Pollack, a professor in the School of Social Service Administration at the University of Chicago and a contributing researcher to the National Drug Abuse Treatment Systems Survey, which tracks drug addiction and substance abuse treatment programs nationwide, says there is also some movement among lawmakers “who are looking at a map of the nation, and seeing the problem is everywhere.”

“Antiquated behavioral health systems” are being given new life with federal funding. Ironically, the source of these solutions are being funded in part by one of the most controversial assistance programs out there – Medicaid.

“Medicaid is kind of the ball game on the service side. It’s so much more important than the (21st Century) Cures Act or anything else that people are going to talk about,” Pollack said.

Pollack said that as lawmakers figure out how to replace the Affordable Care Act, one of the issues that isn’t on the chopping block is mental health parity in health care, which includes addressing the symptoms that lead to drug addiction.

What’s striking is ACA-Medicaid expansion is kind of the quiet model for successful bipartisan health policy. Nobody really wants to talk about it, but that’s what is happening on the ground. When you call up someone in a random state … the conversation is about the work, it’s not about the politics.

And in fact, when we ask people you know there’s just been an election, does that change anything, the most common answer we here is, ‘We’ve been told from our governor just do the work, don’t pay attention to what’s happening in Washington, just keep doing. And I actually find that very encouraging. Democrats and Republicans around the country are governing and they’re really trying hard to deal with this because they see this map, and they don’t want people to die.

Pollack notes that Medicaid expansion has been good and bad, and when it comes to addressing the drug crisis, and policymakers “know less than we should about what’s happening out there.” Fortunately, he said, the problem is finally being taken seriously, though it’s unfortunate the conditions that had to arise before it did.

The crack epidemic, the HIV  work, when the drug problem was much more black and brown in its public conception than it is now, that’s a welcome change. I must say I feel a certain sense of sadness at seeing the difference in public reaction but it’s a good thing that people are responding with empathy and compassion.

Watch more about the opioid epidemic.

Treating Opioid Addiction: A Holistic Approach to Recovery

Dr. Sally Satel is a psychiatrist who has spent more than 25 years treating patients with opioid addiction. She has seen highs and lows that would make a roller-coaster jealous. But she also sees light on the horizon when it comes to treatment.

With public attention and resources now closely trained on the opioid epidemic, there is a real opportunity for enlightened systems of care. Never before in the history of addiction management have there been so many different therapeutic elements to apply in combination to promote recovery. But we can’t afford to focus on just one set of these tools under the false idea that addiction is a disease like any other.

Why not just treat addiction like a “chronic illness”? As Satel explains, it is much more involved than just a medical diagnosis and prescription plan.

But first, we must acknowledge the problem, and it’s big. In the U.S. today, opioid use is skyrocketing. Some shocking statistics reveal its impact.

With an estimated 2.6 million people addicted to opioids—including heroin, fentanyl and oxycodone—the toll is daunting. Fatal opioid overdoses have risen from around 8,200 in 1999 to 33,000 in 2015, according to the Centers for Disease Control and Prevention, making them a leading cause of accidental death. Last year, deaths from heroin slightly edged out gun homicides for the first time since the government began keeping such data.

The CDC reports that deaths from heroin overdoses quadrupled between 2002 and 2013. Heroin use spans the gamut; its use is rising among men and women, all age groups, and all income levels.

Statistics on treating opioid addiction.

So what needs to be considered when dealing with addiction?

  1. Medical treatment: Opioids are combated with anti-opioid medications. Many people have heard of methadone, but other options, like buprenorphine, or “bupe,” have been rising in popularity. With it come hazards: proper dosage and handling of anti-opioids is critical to preventing abuse. Monitoring patient dosage is a matter requiring close attention.
  2. Causes of Relapse: Satel notes that 40-60 percent of addicts drop out of treatment before they’re done. This is partly due to ambivalence on the part of the addict, partly because of the overwhelming pull of addiction, and partly because treatment plans are conducted by the wrong doctor in the wrong environment. In addition, often times, the treatment plan is too rapid or doesn’t address the triggers that cause people to return to drugs.
  3. Restoration: Addiction doesn’t just ravage the addict’s body, its impact is savage toward everyone around. Not just treating the cause, but looking at ways to cope with the future is imperative. Without it, the toll continues on an addicts’ and their families, their ability to work, their social networks, and their ability to find satisfaction through something other than drugs.
  4. Enforcement: In the desire to not overwhelm the public health or criminal justice systems, drug courts are looking for ways to influence addicts without destroying the possibilities of their being able to live a drug-free future. This means ruling with degrees of consequence like community service or “flash incarceration,” and providing other carrots and sticks, including expunging the record of someone who completes treatment.

Managing the situation of dealing with an addict is not easy, Satel notes.

I speak from long experience when I say that few heavy users can simply take a medication and embark on a path to recovery. It often requires a healthy dose of benign paternalism and, in some cases, involuntary care through civil commitment. Many families see such legal action as the only way to interrupt the self-destructive cycle in which their loved ones are caught. Users sometimes want it, too.

With an explosive rise in addiction, appropriate government policy can help. Satel says Donald Trump’s blueprint during the election was consistent with the Comprehensive Addition Recovery Act that passed Congress this summer, though is only partially funded.  The bill calls for expanding addiction treatment access, funding for diversionary programs such as drug court, and funding for naloxone (the opioid antidote that instantly reverses the respiratory suppression of overdose), among other things. This is heading in the right direction, she says.

If you deal with addiction in your family, it’s important to get help.  You can call 1-800-662-HELP (4357) or check out the Substance Abuse and Mental Health Services Administration for resources.

Read Sally Satel’s article on treating opioid addiction.

Get more statistics on America’s opioid epidemic.