I was recently interviewed by the Bermuda Broadcasting Company on the topic of vaping on the island. To prepare for the interview, I conducted research to uncover the dangers and possible benefits of vaping. After the interview and my extensive research, I am convinced that Bermuda needs to take action on setting regulations around vaping.

To ensure the safety of people who vape and those who may decide to vape in future, the Government needs to enact regulations around several key areas. There are three areas to consider for regulating vaping: nicotine content, manufacturing safety of the products in regards to the heating source; added ingredients in the pens.

First, the nicotine content of vape pens and vape cartridges must be limited. We know that a nicotine dose of 26mg can be fatal when consumed by a child. Nicotine content needs to be clearly stated on the products. Nicotine needs to be monitored. One cigarette distributes 1mg of nicotine to the smoker. Vapers need to be made aware of the toxicity of nicotine at high doses. One vape cartridge may have up to 50mg of nicotine. It is easy to overuse the vape pens and have toxic effects of the overdose of nicotine.

Second, the vape pens and vaping units must be sourced from reliable distributors. Researchers in Australia, at the University of Woogalo, discovered that all unregulated vapes contain nicotine — even when they claim to be nicotine-free. As well, the nicotine cartridges were found to contain heavy metals, including arsenic, chromium and mercury.

These toxins are dangerous to the functions of the brain, and are even more damaging to the developing brains of children. Often it is the heating elements of these vapes that can increase the toxic content of the vape aerosol. These must be carefully controlled. The high temperatures of vaping devices can actually increase the release of more toxic elements from within the device. Inhaling the aerosolised “vape” smoke that has been passed across these high-temperature heating devices will create even more toxic elements to be released from the materials within the device.

The tobacco in a cigarette is burnt or combusted at temperatures between 400C and 900C. The higher the temperature of a nicotine-containing vape cartridge, the more vape smoke that will be created. This needs to be heated to a very high temperature to create the vape smoke.

Along with the concern of toxins being released by the heating elements of the vape pens, there is also a worry around the added content of the vape cartridges. Vape cartridges themselves contain substances that are deemed “safe” for consumption as food. However, when these substances are heated, the content is not predictable, nor has it been regulated, monitored and tested.

The flavour additives have been found to be dangerous to the lungs when heated to high temperatures. The flavours may even create toxic metals. Thus the flavourings and other food-safe products — including vegetable glycerin and propylene glycol — within the cartridge are being consumed in an unregulated manner. In fact, the THC-containing vape products that caused “popcorn lung” among more than 60 young users in 2019 contained a food-grade additive called vitamin E acetate. These were tainted, unregulated, off-market products.

As a food additive, vitamin E acetate is safe. However, when it is smoked, the consequences are deadly. The surface tension of the lungs was altered when the viscous additive came into contact with the small air sacs — the alveoli — of the lungs. This caused the lungs to collapse, preventing the users from being able to breathe.

There is much discussion within the health and vaping communities about the advantages of vaping over smoking. Many smokers believe that switching to vaping is a better and safer option. This is partly because the vape smoker is seen as less toxic. In fact, the term “vaping” implies that the smoke is water vapour. However, the vape smoke is actually an aerosol, a conglomerate of particles suspended in the air.

As I mentioned in my interview, this aerosol is more like a hairspray, and is not water. The damaging potential of vape smoke has not been conclusive owing to the habits of the users. Most vapers are also smokers. Thus it has been difficult to isolate the consequences of vaping versus the effect of smoking cigarettes on the lungs, although smokers have claimed that vaping can reduce smoking of cigarettes.

In fact, most smokers who try to quit vaping end up adding vaping along with smoking to their addictive habits. Vaping is not non-addictive. The nicotine in the vape pens is an addictive substance. The flavoured vape products that young people often purchase thinking there is no nicotine have been found to contain nicotine. Although nicotine has been successfully used medicinally — for dementia, Parkinson’s disease and attention deficit hyperactivity disorder — this use cannot be assured when there are unregulated products in the market.

As well, because studies have shown that the high temperatures used to combust tobacco during the smoking of a cigarette also produce many toxic by-products, vapes are believed to be safer. Cigarettes also contain many additives that are toxic to the body. However, there are few studies that have been able to determine the isolated dangers of vaping. This is because the users of vapes are most often co-users; that is users of both cigarettes and vapes.

A study from January last year was able to compare the inflammation in lungs of each of non-smokers, smokers and vapers. This study out of the University of Pennsylvania’s Perelman School of Medicine found that the lungs of vape users contained inflammatory markers that were not present in the lungs of the smokers or the non-smokers. This study is ground-breaking in proving that vaping does not have the clean bill of health that some are supposing.

It is important that we face this concern head-on in Bermuda. We cannot deny that these products are being used by people here. As well, they are being used by children as young as 9. By making these products illegal, we would increase the likelihood that these products will be sold on the black market. As well, products become more appealing when they are seen as dangerous and off-limits.

All the black-market products studied in Australia were found to contain toxic metals. A recent discovery in Britain of black-market vape pens were also found to contain metals that are dangerous to the tissues of the lung. These included arsenic, chromium and lead.

Let’s accept the reality that vaping is on the rise. And let’s create regulations around these products in order to avoid the consequences of black-market products.

• Katherine Dale, ND, is a licensed naturopathic doctor providing natural and alternative primary healthcare. She has been practising for more than 20 years