U.S. e-cigarette policy and related reports roundup
As of September 18, 2019, the United States had reported 530 confirmed and suspected cases of lung disease associated with e-cigarette or vaping product use, including seven deaths. This prompted heightened attention in the U.S. toward e-cigarettes and va
As of September 18, 2019, the United States has reported 530 confirmed and suspected cases of lung diseases related to the use of e-cigarettes or aerosol products, with 7 deaths. This has caused the United States to attach great importance to e-cigarettes and aerosol products. From congressional hearings to states and e-cigarette manufacturers, they are paying close attention to relevant developments and issuing attitudes and statements one after another. In particular, flavored e-cigarettes have attracted much attention because of their strong appeal to young people. The FDA announced on September 12 that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan announced a ban on the sale of flavored e-cigarettes, and other states are also paying attention to and even preparing to ban the sale.
So far, officials still cannot explain the relationship between e-cigarettes and aerosol products and lung diseases. The reason is still under investigation. Only the CDC said that most cases are related to illegal cigarette liquids (containing THC), so it is speculated that the source of the disease is related to THC. However, from the perspective of the market, the reaction is strong. On the one hand, the health of e-cigarettes is again questioned, consumers have generated a certain panic, and the sales of related cannabis atomization products have declined; on the other hand, due to the fact that e-cigarettes and atomization products have a certain correlation with cannabis, THC, etc., the market is worried that the impact of future e-cigarette related policies will continue to the cannabis industry, thus affecting the development of the cannabis industry. We believe that the e-cigarette market can only return to stability after the final FDA policy is issued and the relationship between e-cigarettes and lung disease is confirmed.
The following are important contents of recent reports:
On September 24, the United States held a congressional hearing on e-cigarettes
Preliminary results from the CDC survey show that about 80% of patients report using tobacco oil containing tetrahydrocannabinol or THC, about 60% report using tobacco oil containing nicotine, and about 10-20% report using only nicotine-containing products. Although the specific source of the disease has not yet been determined, it can be clearly related to chemical exposure.
Illinois initially envisages banning the sale of flavored nicotine products.
The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% from 2018, and an increase of 135% from 2017. The main reason why teenagers use these products is the appeal of candy and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes.
U.S. states have banned or are preparing to ban the sale of e-cigarettes
On June 25, the San Francisco City Supervisory Board unanimously passed a comprehensive ban on the sale of e-cigarettes.
On September 15, New York State said it would ban flavored e-cigarettes, but keep the mint flavor.
On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, which took effect immediately.
On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out of inventory.
On September 24, Massachusetts suspended sales of all e-cigarette-related aerosol products for four months.
E-cigarette manufacturing company issued a statement
British Tobacco: 1) has never added tobacco oil containing THC and vitamin E acetate to its aerosolized products;2) For the four VUSE products planned to be launched in the United States, the company is confident that it will submit PMTA before May 2020.
Japan Tobacco International: Among the Logic series of nicotine-containing products, we do not provide THC tobacco oil or hemp oil. Also, we confirmed that vitamin E acetate is not used as an ingredient in Logic's tobacco oil.
Market share and sales of marijuana-related aerosolized products declined
Comparing the sales ratio data of marijuana-related aerosol products in the recreational cannabis product market on August 19 and September 16, the proportion shows a downward trend. Among them, California: dropped from 32.8% to 29%; Colorado: dropped from 19.2% to 14.5%; Nevada: dropped from 22.3% to 19.2%; Washington: dropped from 17.8% to 14.6%.
Among licensed marijuana stores in Massachusetts, total sales of marijuana-related fogging products peaked at $919,776 for the week of August 11 - 17, while total sales dropped to $689,924 for September 9 - 15, a drop of 25%.
Risk warning: New tobacco policy changes risk, sales fall short of expectations; industrial cannabis should be strictly distinguished from intermediate cannabis and recreational cannabis/drugs, and the legalization of recreational cannabis and other products should be resolutely opposed.
Zhengwen
As of September 18, 2019, the United States has reported 530 confirmed and suspected cases of lung diseases related to the use of e-cigarettes or aerosol products, with 7 deaths. This has caused the United States to attach great importance to e-cigarettes and aerosol products. From Congressional hearings to states and e-cigarette manufacturers, they are paying close attention to relevant developments and issuing attitudes and statements one after another. In particular, flavored e-cigarettes have attracted much attention because of their strong appeal to young people. The FDA announced on September 12 that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan announced a ban on the sale of flavored e-cigarettes, and other states are also paying attention to and even preparing to ban the sale.# p #pagination title #e #
So far, officials still cannot explain the relationship between e-cigarettes and aerosol products and lung diseases. The reason is still under investigation. Only the CDC said that most cases are related to illegal cigarette liquids (containing THC), so it is speculated that the source of the disease is related to THC. However, from the perspective of the market, the reaction is strong. On the one hand, the health of e-cigarettes is again questioned, consumers have generated a certain panic, and the sales of related cannabis atomization products have declined; on the other hand, due to the fact that e-cigarettes and atomization products have a certain correlation with cannabis, THC, etc., the market is worried that the impact of future e-cigarette related policies will continue to the cannabis industry, thus affecting the development of the cannabis industry. We believe that the e-cigarette market can only return to stability after the final FDA policy is issued and the relationship between e-cigarettes and lung disease is confirmed.
In order to allow everyone to have a clearer understanding of recent U.S. reports on e-cigarettes, we have sorted out important contents including congressional hearings, FDA, CDC, and relevant statements issued by states and e-cigarette manufacturers for reference.
1. Statement by relevant US agencies
1.1. Congressional Hearing (2019/9/24)
1.1.1. Speech by Anne Schuchat, M.D.(CDC, Principal Deputy Director, Department of Health and Human Services)
On August 1, 2019, Wisconsin notified the Centers for Disease Control and Prevention (CDC) for the first time of a series of lung diseases that have appeared among young people since July 2019. As of September 18, 2019, 530 confirmed and suspected cases of lung diseases related to the use of e-cigarettes or aerosolizing products have been reported in 38 states and 1 region in the United States, and 6 states (California, Illinois, Indiana, Kansas, Minnesota and Oregon) have died. These tragic deaths add to the urgency of the CDC and FDA jointly investigating the cause and providing states with the necessary resources to address this emerging public health issue. The CDC established a case investigation team in August and launched the Emergency Operations Center on September 16, allowing it to devote more resources to the investigation.
1) Case summary
Investigating the causes of lung damage associated with the use of e-cigarettes or aerosolizing products is challenging for a variety of reasons. a. The investigation involves many states;b. The diversity of the market for e-cigarettes or aerosolization products, the wide variety of products, wide range of ingredients and links to potentially illegal substances such as marijuana complicate the investigation. Consumers do not know what is contained in their e-cigarettes or aerosolized products, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street or through social channels.
Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, the majority of patients (about 80%) reported using tobacco fluid containing tetrahydrocannabinol or THC (the psychoactive compound of marijuana), and half (about 60%) reported using tobacco fluid containing nicotine, while about 10-20% reported using only nicotine-containing products. But no e-cigarette or aerosol product, brand or specific substance has a clear link to the epidemic.
The CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old.
The lung damage observed in this incident did not appear to be caused by infection, and pathological findings and non-infectious diagnosis suggest that the cause of the disease was related to exposure to chemicals. Patients first show signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products. Before hospitalization, they gradually develop symptoms such as difficulty breathing, tachypnea or chest pain. Some patients develop mild to moderate gastrointestinal disease, and other symptoms include fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds linked to all cases.
2) Data on youth e-cigarette use
Preliminary data from the 2019 National Youth Tobacco Survey show that the use of e-cigarettes among young people continues to rise. Data shows that in 2019, more than a quarter of high school students currently (in the past 30 days) used e-cigarettes, a significant increase compared with 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products.
3) Hazards associated with cannabis use
The CDC is committed to monitoring cannabis use, identifying associated health effects, and improving the surveillance capabilities of the CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or aerosolized products containing THC, indicating the need to understand the health impact of increasing cannabis use and the changing market in the United States as states work to legalize cannabis for medical or recreational use. In 2018, an estimated 16% of the population aged 12 and over used cannabis.# p#pagination title #e#
4) CDC recommendations for manufacturers, states and the public
The CDC recommends that members of the public who are concerned that e-cigarettes or aerosol products can cause lung disease should consider avoiding using e-cigarettes or aerosol products. Teenagers, pregnant women or non-smokers should not use e-cigarettes. Anyone who uses e-cigarettes or aerosol products should not buy these products on the street and must not modify or add ingredients on their own.
1.1.2.NgoziO. Ezike's speech (Director, Illinois Department of Public Health)
Sixty-nine people in Illinois developed severe respiratory diseases after using e-cigarettes or nebulizing products, and one person died. The patient's age ranged from 15 to 42 years, with a median of 22 years, and most of them were male. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people.
Illinois began an investigation after learning about respiratory diseases related to e-cigarettes in residents on July 31, 2019. On August 2, it issued an alert to the Health Bureau and cooperated with the CDC to investigate the prevalence of e-cigarettes among young people and the habit of smoking e-cigarettes, and carried out measures such as youth education, case studies and relevant legal research.
Despite this, on the one hand, the number of people sick every day is still increasing, with more than 90% hospitalized, 72% of whom are sent to the intensive care unit, and nearly 30% require medical equipment to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. Surveys show that 1) 68% of young people used flavored e-cigarettes in 2019, compared with 61% in 2017;2) a 2017 survey found that 63% of teenagers did not know that the JUUL products they use contain nicotine;3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes.
Focus groups found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of smokers among Illinois high school students in the total tobacco market dropped from 21% to 5%, but from 2016 to 2018, the proportion of e-cigarettes used by high school students increased from 18.4% to 26.7%.
The current preliminary idea is to ban flavored nicotine products and study the short-and long-term health effects of atomized products. Illinois 'governor supports a legal provision in the October legislative session to ban the sale of flavored atomized products specifically targeted at young people.
1.1.3.AlbertA. Rizzo's speech (Chief Medical Officer of the American Lung Association)
Our country is currently experiencing two different e-cigarette crises. The first is the prevalence and increasing popularity of e-cigarettes among young people; the second is the recent outbreak of lung diseases caused by aerosol products among adults and teenagers.
According to the 2019 National Tobacco YouthSurvey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% from 2018 and an increase of 135% from 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days. 12% of 12th graders, 7% of 10th graders and 2% of 8th graders said they do this regularly.
A 2018 CDC study showed that the main reason why teenagers use these products is that candy and fruit flavors appeal to them, while their friends and family are using them, and they believe that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to act quickly to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes.
There are many misconceptions about the health hazards of e-cigarettes, partly due to the high proportion of teenagers using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly states that the use of e-cigarettes can be harmful to health, increase the chances of children and teenagers starting using e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is substantial evidence that if young people use e-cigarettes, the likelihood of using traditional cigarettes is also increased. A study in the journal Pediatrics also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not.
According to a 2015 study published in the Journal of the American Medical Association, 81% of young people have used tobacco products based on flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes, with 65.9% of children using fruit-flavored e-cigarettes and 63.9% using mint or menthol e-cigarettes. The taste in e-cigarettes is created through a combination of chemicals that carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including flavors such as marshmallow, bubble gum and cupcake, and found that 47 of the flavors were associated with at least one chemical associated with respiratory diseases.# p#pagination title #e#
E-cigarettes are not a smoking cessation product. Smokers who switch to e-cigarettes may also be using traditional cigarettes. A study in the Annals of Internal Medicine found that the probability of using e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who use e-cigarettes quit smoking after six months, compared with 26.6% of smokers who do not use e-cigarettes.
1.2. FDA plans to ban the sale of flavored e-cigarettes (2019/9/12)
On September 12, the FDA stated that in order to reduce the use of e-cigarettes among teenagers, it would issue a policy to ban the sale of flavored e-cigarettes (including mint flavors) within a few weeks.
1.3. CDC releases its opinion on the causes of e-cigarette deaths (2019/9/19)
The latest report from the U.S. Centers for Disease Control and Prevention (CDC) stated that the number of people suffering from lung diseases due to e-cigarettes has recently soared to 530 people in 38 states, and 7 people have died so far, causing the governor of Indiana to pay attention to the ban on flavored e-cigarettes, or corresponding measures will be taken.
The CDC is currently unable to determine the specific cause, but they believe it is caused by chemical exposure. Most cases are related to illegal cigarette liquids, which contain THC components. These products come from the black market rather than formal e-cigarette stores. But even so, e-cigarette retailers will also be greatly affected.
The American Association for Lung Research believes the country should take action as soon as possible, hoping to remove flavored e-cigarettes from the shelves before further research is carried out.
2. U.S. states have banned or are preparing to ban the sale of e-cigarettes
2.1. San Francisco becomes the first city to ban the sale of e-cigarettes (2019/6/25)
On June 25, the San Francisco City Supervisory Board unanimously passed a comprehensive ban on the sale of e-cigarettes, which stipulates that unless e-cigarettes have been reviewed by the FDA's PMTA, the sale of e-cigarettes will be banned. The regulation is scheduled to be fully implemented in six months.
2.2. New York State will ban the sale of flavored e-cigarettes but retain the mint flavor (2019/9/15)
Cuomo signed an executive order on September 12 requiring e-cigarettes to be included in anti-smoking activities in New York.
Cuomo's office said, 1) State Health Commissioner Dr. Howard Zucker will recommend this week that the state Public Health and Health Planning Commission issue emergency regulations that could take effect as soon as two weeks. 2) Como has instructed the New York Police and the Department of Health to strengthen law enforcement efforts, and retailers selling e-cigarettes to minors may face criminal penalties; in addition, Como plans to promote legislation to ban deceptive marketing of e-cigarettes to teenagers and children, but the decree will not affect tobacco-based and mint-flavored e-cigarettes.
Trump said last week that the federal government plans to ban the sale of thousands of flavors in e-cigarettes because a health bureau investigation found hundreds of cases of respiratory diseases among consumers who use e-cigarettes. Although many of the cases involve cannabis smoking, the problem with the devices, ingredients or additives has not yet been identified.
2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18)
On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but merchants still have a 14-day buffer period and the ban will last for six months, but the governor has the right to extend the period.
2.4. Wal-Mart stops selling e-cigarettes (2019/9/20)
On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After selling current stocks, it would stop selling e-cigarettes in Wal-Mart stores and Sam 's Clubs. In July, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21, and has said it is stopping selling fruity and dessert-flavored e-cigarettes.
E-cigarettes are mainly sold through e-cigarette specialty stores, with approximately 115,000 specialty stores in the United States. The e-cigarette business only accounts for a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart stores +Sam's Clubs have more than 5000 stores in the United States. Wal-Mart's suspension of sales will reduce the opportunities for direct contact between e-cigarettes and consumers. It is also difficult to find replacements for this huge sales channel.
2.5. Massachusetts suspends sales of all e-cigarette-related atomization products (2019/9/24)
Massachusetts has decided to suspend the sale of all e-cigarette-related aerosol products for four months (as of January 25 next year). 1) This emergency suspension is mainly to work with expert doctors to find out the cause of the disease;2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of lung disease in the patient has not yet been determined.
3. E-cigarette manufacturing company statement
3.1. British American Tobacco
3.1.1. Response to the U.S. FDA announcement on nebulizing products (2019/9/9)
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Dr David O Reilly, director of scientific research at British American Tobacco, said company toxicologists carefully examined each individual ingredient in the company's nebulizing products to see if they were suitable for nebulizing. And the company has never added tobacco oil containing THC and vitamin E acetate to its atomized products. This tragic incident occurred because the tobacco oil was not purchased from well-known manufacturers and contained ingredients that the manufacturers did not use (including THC and vitamin E acetate). The company supports the FDA's view that users of aerosolized products should always purchase smoking utensils and smoking fluids from reputable manufacturers, and should avoid modifying or adding substances to the products they purchase, and should use these products as the manufacturer intends.
3.1.2. Statement on support for strong product quality standards, measures to prevent use by U.S. teenagers, and readiness to apply for PMTA (2019/9/12)
1) The company said it shares the FDA's concern that the marketing of certain flavored products will attract the attention of teenagers. At the same time, the role of flavored products in helping adult consumers move from combustible products to alternative tobacco and nicotine products is hard to overestimate. The company has procedures in place to ensure that its products are only sold to adult smokers and users of aerosolized products.
2) For the four VUSE products planned to be launched in the United States, the company is confident that it will be able to submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Renault Tobacco will be able to continue to sell its VUSE branded atomized products within the new regulatory framework in the United States.
3.1.3. Statement on the need for strong and effective supervision of atomized products (2019/9/20)
The company said that recent e-cigarette lung disease cases did not involve products developed or produced by British American Tobacco, supports investigations by relevant agencies, and hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting of the ingredients used in cigarette oil of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations. Only through effective supervision and law enforcement, Only then can consumers maintain confidence in the harm reduction effect of using atomized products compared to traditional tobacco.
3.2. Japan Tobacco
3.2.1. Regarding response to lung disease case in the United States (2019/9/13)
To date, the U.S. Health Bureau is investigating 450 cases of lung disease that may be related to e-cigarette use. Currently, there is little information about the products involved and potential causes. We are not aware of any Logic products linked to these cases and are under investigation.
We learned from media reports that many patients admitted to using e-cigarettes containing THC tobacco oil. In addition, vitamin E acetate, a chemical related to cannabis oil, was reportedly found in many relevant samples analyzed by authorities. In our Logic line of nicotine-containing products, we do not offer THC tobacco oil or hemp oil. Also, we confirmed that vitamin E acetate is not used as an ingredient in Logic's tobacco oil.
At JTI we know exactly what Logic is composed of: all Logic tobacco fluids undergo a strict product management plan, including toxicological assessments and quality control of all ingredients used. Logic Tobacco Oil can only be sold after a comprehensive inspection. Nebulizer users should not use tobacco oil produced by manufacturers that have not been strictly inspected for safety and quality. Smoking utensils and cigarettes that can be used together after being designed and tested should always be paired with each other.
4. Market share and sales decline of marijuana-related aerosolized products
Since the first e-cigarette-related death was reported on August 23, the proportion of sales of marijuana-related fogging products in the recreational cannabis product market has declined. Comparing sales data for August 19 and September 16, California: 32.8% dropped to 29%; Colorado: 19.2% dropped to 14.5%; Nevada: 22.3% dropped to 19.2%; Washington: 17.8% dropped to 14.6%. (Report time: 2019/9/12)
Among licensed marijuana stores in Massachusetts, total sales of marijuana-related fogging products peaked at $919,776 for the week of August 11 - 17, while total sales dropped to $689,924 for September 9 - 15, a drop of 25%. (Report time: 2019/9/19)
#p#Pagination Title #e#
So far, officials still cannot explain the relationship between e-cigarettes and aerosol products and lung diseases. The reason is still under investigation. Only the CDC said that most cases are related to illegal cigarette liquids (containing THC), so it is speculated that the source of the disease is related to THC. However, from the perspective of the market, the reaction is strong. On the one hand, the health of e-cigarettes is again questioned, consumers have generated a certain panic, and the sales of related cannabis atomization products have declined; on the other hand, due to the fact that e-cigarettes and atomization products have a certain correlation with cannabis, THC, etc., the market is worried that the impact of future e-cigarette related policies will continue to the cannabis industry, thus affecting the development of the cannabis industry. We believe that the e-cigarette market can only return to stability after the final FDA policy is issued and the relationship between e-cigarettes and lung disease is confirmed.
The following are important contents of recent reports:
On September 24, the United States held a congressional hearing on e-cigarettes
Preliminary results from the CDC survey show that about 80% of patients report using tobacco oil containing tetrahydrocannabinol or THC, about 60% report using tobacco oil containing nicotine, and about 10-20% report using only nicotine-containing products. Although the specific source of the disease has not yet been determined, it can be clearly related to chemical exposure.
Illinois initially envisages banning the sale of flavored nicotine products.
The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% from 2018, and an increase of 135% from 2017. The main reason why teenagers use these products is the appeal of candy and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes.
U.S. states have banned or are preparing to ban the sale of e-cigarettes
On June 25, the San Francisco City Supervisory Board unanimously passed a comprehensive ban on the sale of e-cigarettes.
On September 15, New York State said it would ban flavored e-cigarettes, but keep the mint flavor.
On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, which took effect immediately.
On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out of inventory.
On September 24, Massachusetts suspended sales of all e-cigarette-related aerosol products for four months.
E-cigarette manufacturing company issued a statement
British Tobacco: 1) has never added tobacco oil containing THC and vitamin E acetate to its aerosolized products;2) For the four VUSE products planned to be launched in the United States, the company is confident that it will submit PMTA before May 2020.
Japan Tobacco International: Among the Logic series of nicotine-containing products, we do not provide THC tobacco oil or hemp oil. Also, we confirmed that vitamin E acetate is not used as an ingredient in Logic's tobacco oil.
Market share and sales of marijuana-related aerosolized products declined
Comparing the sales ratio data of marijuana-related aerosol products in the recreational cannabis product market on August 19 and September 16, the proportion shows a downward trend. Among them, California: dropped from 32.8% to 29%; Colorado: dropped from 19.2% to 14.5%; Nevada: dropped from 22.3% to 19.2%; Washington: dropped from 17.8% to 14.6%.
Among licensed marijuana stores in Massachusetts, total sales of marijuana-related fogging products peaked at $919,776 for the week of August 11 - 17, while total sales dropped to $689,924 for September 9 - 15, a drop of 25%.
Risk warning: New tobacco policy changes risk, sales fall short of expectations; industrial cannabis should be strictly distinguished from intermediate cannabis and recreational cannabis/drugs, and the legalization of recreational cannabis and other products should be resolutely opposed.
Zhengwen
As of September 18, 2019, the United States has reported 530 confirmed and suspected cases of lung diseases related to the use of e-cigarettes or aerosol products, with 7 deaths. This has caused the United States to attach great importance to e-cigarettes and aerosol products. From Congressional hearings to states and e-cigarette manufacturers, they are paying close attention to relevant developments and issuing attitudes and statements one after another. In particular, flavored e-cigarettes have attracted much attention because of their strong appeal to young people. The FDA announced on September 12 that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan announced a ban on the sale of flavored e-cigarettes, and other states are also paying attention to and even preparing to ban the sale.# p #pagination title #e #
So far, officials still cannot explain the relationship between e-cigarettes and aerosol products and lung diseases. The reason is still under investigation. Only the CDC said that most cases are related to illegal cigarette liquids (containing THC), so it is speculated that the source of the disease is related to THC. However, from the perspective of the market, the reaction is strong. On the one hand, the health of e-cigarettes is again questioned, consumers have generated a certain panic, and the sales of related cannabis atomization products have declined; on the other hand, due to the fact that e-cigarettes and atomization products have a certain correlation with cannabis, THC, etc., the market is worried that the impact of future e-cigarette related policies will continue to the cannabis industry, thus affecting the development of the cannabis industry. We believe that the e-cigarette market can only return to stability after the final FDA policy is issued and the relationship between e-cigarettes and lung disease is confirmed.
In order to allow everyone to have a clearer understanding of recent U.S. reports on e-cigarettes, we have sorted out important contents including congressional hearings, FDA, CDC, and relevant statements issued by states and e-cigarette manufacturers for reference.
1. Statement by relevant US agencies
1.1. Congressional Hearing (2019/9/24)
1.1.1. Speech by Anne Schuchat, M.D.(CDC, Principal Deputy Director, Department of Health and Human Services)
On August 1, 2019, Wisconsin notified the Centers for Disease Control and Prevention (CDC) for the first time of a series of lung diseases that have appeared among young people since July 2019. As of September 18, 2019, 530 confirmed and suspected cases of lung diseases related to the use of e-cigarettes or aerosolizing products have been reported in 38 states and 1 region in the United States, and 6 states (California, Illinois, Indiana, Kansas, Minnesota and Oregon) have died. These tragic deaths add to the urgency of the CDC and FDA jointly investigating the cause and providing states with the necessary resources to address this emerging public health issue. The CDC established a case investigation team in August and launched the Emergency Operations Center on September 16, allowing it to devote more resources to the investigation.
1) Case summary
Investigating the causes of lung damage associated with the use of e-cigarettes or aerosolizing products is challenging for a variety of reasons. a. The investigation involves many states;b. The diversity of the market for e-cigarettes or aerosolization products, the wide variety of products, wide range of ingredients and links to potentially illegal substances such as marijuana complicate the investigation. Consumers do not know what is contained in their e-cigarettes or aerosolized products, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street or through social channels.
Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, the majority of patients (about 80%) reported using tobacco fluid containing tetrahydrocannabinol or THC (the psychoactive compound of marijuana), and half (about 60%) reported using tobacco fluid containing nicotine, while about 10-20% reported using only nicotine-containing products. But no e-cigarette or aerosol product, brand or specific substance has a clear link to the epidemic.
The CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old.
The lung damage observed in this incident did not appear to be caused by infection, and pathological findings and non-infectious diagnosis suggest that the cause of the disease was related to exposure to chemicals. Patients first show signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products. Before hospitalization, they gradually develop symptoms such as difficulty breathing, tachypnea or chest pain. Some patients develop mild to moderate gastrointestinal disease, and other symptoms include fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds linked to all cases.
2) Data on youth e-cigarette use
Preliminary data from the 2019 National Youth Tobacco Survey show that the use of e-cigarettes among young people continues to rise. Data shows that in 2019, more than a quarter of high school students currently (in the past 30 days) used e-cigarettes, a significant increase compared with 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products.
3) Hazards associated with cannabis use
The CDC is committed to monitoring cannabis use, identifying associated health effects, and improving the surveillance capabilities of the CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or aerosolized products containing THC, indicating the need to understand the health impact of increasing cannabis use and the changing market in the United States as states work to legalize cannabis for medical or recreational use. In 2018, an estimated 16% of the population aged 12 and over used cannabis.# p#pagination title #e#
4) CDC recommendations for manufacturers, states and the public
The CDC recommends that members of the public who are concerned that e-cigarettes or aerosol products can cause lung disease should consider avoiding using e-cigarettes or aerosol products. Teenagers, pregnant women or non-smokers should not use e-cigarettes. Anyone who uses e-cigarettes or aerosol products should not buy these products on the street and must not modify or add ingredients on their own.
1.1.2.NgoziO. Ezike's speech (Director, Illinois Department of Public Health)
Sixty-nine people in Illinois developed severe respiratory diseases after using e-cigarettes or nebulizing products, and one person died. The patient's age ranged from 15 to 42 years, with a median of 22 years, and most of them were male. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people.
Illinois began an investigation after learning about respiratory diseases related to e-cigarettes in residents on July 31, 2019. On August 2, it issued an alert to the Health Bureau and cooperated with the CDC to investigate the prevalence of e-cigarettes among young people and the habit of smoking e-cigarettes, and carried out measures such as youth education, case studies and relevant legal research.
Despite this, on the one hand, the number of people sick every day is still increasing, with more than 90% hospitalized, 72% of whom are sent to the intensive care unit, and nearly 30% require medical equipment to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. Surveys show that 1) 68% of young people used flavored e-cigarettes in 2019, compared with 61% in 2017;2) a 2017 survey found that 63% of teenagers did not know that the JUUL products they use contain nicotine;3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes.
Focus groups found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of smokers among Illinois high school students in the total tobacco market dropped from 21% to 5%, but from 2016 to 2018, the proportion of e-cigarettes used by high school students increased from 18.4% to 26.7%.
The current preliminary idea is to ban flavored nicotine products and study the short-and long-term health effects of atomized products. Illinois 'governor supports a legal provision in the October legislative session to ban the sale of flavored atomized products specifically targeted at young people.
1.1.3.AlbertA. Rizzo's speech (Chief Medical Officer of the American Lung Association)
Our country is currently experiencing two different e-cigarette crises. The first is the prevalence and increasing popularity of e-cigarettes among young people; the second is the recent outbreak of lung diseases caused by aerosol products among adults and teenagers.
According to the 2019 National Tobacco YouthSurvey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% from 2018 and an increase of 135% from 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days. 12% of 12th graders, 7% of 10th graders and 2% of 8th graders said they do this regularly.
A 2018 CDC study showed that the main reason why teenagers use these products is that candy and fruit flavors appeal to them, while their friends and family are using them, and they believe that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to act quickly to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes.
There are many misconceptions about the health hazards of e-cigarettes, partly due to the high proportion of teenagers using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly states that the use of e-cigarettes can be harmful to health, increase the chances of children and teenagers starting using e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is substantial evidence that if young people use e-cigarettes, the likelihood of using traditional cigarettes is also increased. A study in the journal Pediatrics also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not.
According to a 2015 study published in the Journal of the American Medical Association, 81% of young people have used tobacco products based on flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes, with 65.9% of children using fruit-flavored e-cigarettes and 63.9% using mint or menthol e-cigarettes. The taste in e-cigarettes is created through a combination of chemicals that carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including flavors such as marshmallow, bubble gum and cupcake, and found that 47 of the flavors were associated with at least one chemical associated with respiratory diseases.# p#pagination title #e#
E-cigarettes are not a smoking cessation product. Smokers who switch to e-cigarettes may also be using traditional cigarettes. A study in the Annals of Internal Medicine found that the probability of using e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who use e-cigarettes quit smoking after six months, compared with 26.6% of smokers who do not use e-cigarettes.
1.2. FDA plans to ban the sale of flavored e-cigarettes (2019/9/12)
On September 12, the FDA stated that in order to reduce the use of e-cigarettes among teenagers, it would issue a policy to ban the sale of flavored e-cigarettes (including mint flavors) within a few weeks.
1.3. CDC releases its opinion on the causes of e-cigarette deaths (2019/9/19)
The latest report from the U.S. Centers for Disease Control and Prevention (CDC) stated that the number of people suffering from lung diseases due to e-cigarettes has recently soared to 530 people in 38 states, and 7 people have died so far, causing the governor of Indiana to pay attention to the ban on flavored e-cigarettes, or corresponding measures will be taken.
The CDC is currently unable to determine the specific cause, but they believe it is caused by chemical exposure. Most cases are related to illegal cigarette liquids, which contain THC components. These products come from the black market rather than formal e-cigarette stores. But even so, e-cigarette retailers will also be greatly affected.
The American Association for Lung Research believes the country should take action as soon as possible, hoping to remove flavored e-cigarettes from the shelves before further research is carried out.
2. U.S. states have banned or are preparing to ban the sale of e-cigarettes
2.1. San Francisco becomes the first city to ban the sale of e-cigarettes (2019/6/25)
On June 25, the San Francisco City Supervisory Board unanimously passed a comprehensive ban on the sale of e-cigarettes, which stipulates that unless e-cigarettes have been reviewed by the FDA's PMTA, the sale of e-cigarettes will be banned. The regulation is scheduled to be fully implemented in six months.
2.2. New York State will ban the sale of flavored e-cigarettes but retain the mint flavor (2019/9/15)
Cuomo signed an executive order on September 12 requiring e-cigarettes to be included in anti-smoking activities in New York.
Cuomo's office said, 1) State Health Commissioner Dr. Howard Zucker will recommend this week that the state Public Health and Health Planning Commission issue emergency regulations that could take effect as soon as two weeks. 2) Como has instructed the New York Police and the Department of Health to strengthen law enforcement efforts, and retailers selling e-cigarettes to minors may face criminal penalties; in addition, Como plans to promote legislation to ban deceptive marketing of e-cigarettes to teenagers and children, but the decree will not affect tobacco-based and mint-flavored e-cigarettes.
Trump said last week that the federal government plans to ban the sale of thousands of flavors in e-cigarettes because a health bureau investigation found hundreds of cases of respiratory diseases among consumers who use e-cigarettes. Although many of the cases involve cannabis smoking, the problem with the devices, ingredients or additives has not yet been identified.
2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18)
On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but merchants still have a 14-day buffer period and the ban will last for six months, but the governor has the right to extend the period.
2.4. Wal-Mart stops selling e-cigarettes (2019/9/20)
On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After selling current stocks, it would stop selling e-cigarettes in Wal-Mart stores and Sam 's Clubs. In July, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21, and has said it is stopping selling fruity and dessert-flavored e-cigarettes.
E-cigarettes are mainly sold through e-cigarette specialty stores, with approximately 115,000 specialty stores in the United States. The e-cigarette business only accounts for a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart stores +Sam's Clubs have more than 5000 stores in the United States. Wal-Mart's suspension of sales will reduce the opportunities for direct contact between e-cigarettes and consumers. It is also difficult to find replacements for this huge sales channel.
2.5. Massachusetts suspends sales of all e-cigarette-related atomization products (2019/9/24)
Massachusetts has decided to suspend the sale of all e-cigarette-related aerosol products for four months (as of January 25 next year). 1) This emergency suspension is mainly to work with expert doctors to find out the cause of the disease;2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of lung disease in the patient has not yet been determined.
3. E-cigarette manufacturing company statement
3.1. British American Tobacco
3.1.1. Response to the U.S. FDA announcement on nebulizing products (2019/9/9)
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Dr David O Reilly, director of scientific research at British American Tobacco, said company toxicologists carefully examined each individual ingredient in the company's nebulizing products to see if they were suitable for nebulizing. And the company has never added tobacco oil containing THC and vitamin E acetate to its atomized products. This tragic incident occurred because the tobacco oil was not purchased from well-known manufacturers and contained ingredients that the manufacturers did not use (including THC and vitamin E acetate). The company supports the FDA's view that users of aerosolized products should always purchase smoking utensils and smoking fluids from reputable manufacturers, and should avoid modifying or adding substances to the products they purchase, and should use these products as the manufacturer intends.
3.1.2. Statement on support for strong product quality standards, measures to prevent use by U.S. teenagers, and readiness to apply for PMTA (2019/9/12)
1) The company said it shares the FDA's concern that the marketing of certain flavored products will attract the attention of teenagers. At the same time, the role of flavored products in helping adult consumers move from combustible products to alternative tobacco and nicotine products is hard to overestimate. The company has procedures in place to ensure that its products are only sold to adult smokers and users of aerosolized products.
2) For the four VUSE products planned to be launched in the United States, the company is confident that it will be able to submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Renault Tobacco will be able to continue to sell its VUSE branded atomized products within the new regulatory framework in the United States.
3.1.3. Statement on the need for strong and effective supervision of atomized products (2019/9/20)
The company said that recent e-cigarette lung disease cases did not involve products developed or produced by British American Tobacco, supports investigations by relevant agencies, and hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting of the ingredients used in cigarette oil of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations. Only through effective supervision and law enforcement, Only then can consumers maintain confidence in the harm reduction effect of using atomized products compared to traditional tobacco.
3.2. Japan Tobacco
3.2.1. Regarding response to lung disease case in the United States (2019/9/13)
To date, the U.S. Health Bureau is investigating 450 cases of lung disease that may be related to e-cigarette use. Currently, there is little information about the products involved and potential causes. We are not aware of any Logic products linked to these cases and are under investigation.
We learned from media reports that many patients admitted to using e-cigarettes containing THC tobacco oil. In addition, vitamin E acetate, a chemical related to cannabis oil, was reportedly found in many relevant samples analyzed by authorities. In our Logic line of nicotine-containing products, we do not offer THC tobacco oil or hemp oil. Also, we confirmed that vitamin E acetate is not used as an ingredient in Logic's tobacco oil.
At JTI we know exactly what Logic is composed of: all Logic tobacco fluids undergo a strict product management plan, including toxicological assessments and quality control of all ingredients used. Logic Tobacco Oil can only be sold after a comprehensive inspection. Nebulizer users should not use tobacco oil produced by manufacturers that have not been strictly inspected for safety and quality. Smoking utensils and cigarettes that can be used together after being designed and tested should always be paired with each other.
4. Market share and sales decline of marijuana-related aerosolized products
Since the first e-cigarette-related death was reported on August 23, the proportion of sales of marijuana-related fogging products in the recreational cannabis product market has declined. Comparing sales data for August 19 and September 16, California: 32.8% dropped to 29%; Colorado: 19.2% dropped to 14.5%; Nevada: 22.3% dropped to 19.2%; Washington: 17.8% dropped to 14.6%. (Report time: 2019/9/12)
Among licensed marijuana stores in Massachusetts, total sales of marijuana-related fogging products peaked at $919,776 for the week of August 11 - 17, while total sales dropped to $689,924 for September 9 - 15, a drop of 25%. (Report time: 2019/9/19)
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