India has banned the sale of electronic cigarettes or e-cigarettes. The ban is the latest and possibly biggest move against vaping.
Vapes are electronic devices that heat liquid into a cloud of vapor that users breathe in. Most users vape with a liquid that includes the drug nicotine, several other chemicals and flavoring.
The ban cuts off a huge market for e-cigarette makers such as Juul Labs and Philip Morris International. Both companies planned to expand in India.
India’s health ministry said the products are “novel,” attractive and come in many flavors, but said their use has increased very quickly “in developed countries, especially among youth and children.”
The ban comes at a time when public officials in other countries are raising questions about the safety of vaping.
Last week, the United States government announced plans to remove flavored e-cigarettes from stores. Federal officials warned that sweet flavors were leading millions of children into nicotine addiction.
Health and Human Services Secretary Alex Azar made the announcement during an appearance with President Donald Trump. A few state governments are also taking action. The state of Michigan banned the sale of flavored e-cigarettes on Wednesday.
The Michigan Department of Health and Human Services said the ban was effective immediately. It gave dealers including online sellers two weeks to obey the measure. On Tuesday, New York officially became the first state to ban e-cigarettes when officials approved a series of emergency rules.
India reportedly has 106 million adult smokers. That number is second only to China in the world.
Indian Finance Minister Nirmala Sitharaman announced the ban Wednesday at a news conference. She showed different kinds of products to the media, including a Juul vaping device that looks like a USB flash drive.
Juul had plans to launch its e-cigarette in India and has hired several top-level officials in recent months. Reuters had reported that Philip Morris also plans to launch its smoking device in India.
The Indian ban will be imposed through an executive order.
The order calls for a jail term of up to one year and a fine of about $1,400 for people who break the law for the first time. A repeat violation could mean a jail term of up to three years and a fine of up to $7000, the government said.
The ban would apply to the manufacture, importation, sale, advertisement for or distribution of e-cigarettes.
Such executive orders are usually given as an emergency measure when India’s parliament is not meeting. The ban could end if it is not approved when lawmakers return to parliament. The next parliamentary term will likely be held in November.
Vaping in the United States
Health officials are investigating 530 confirmed and probable cases of pulmonary illness in the U.S. The illnesses are spread across 38 states and one U.S. territory, and seven people have died.
Many doctors and health officials are urging people to stop vaping during the investigation. President Trump has said the administration plans to ban all non-tobacco-flavored vaping products from the market. Here is what health officials know so far about the condition:
What are the symptoms?
Patients have an array of respiratory symptoms, including coughing, shortness of breath and chest pain. Many also have gastrointestinal symptoms such as nausea, vomiting or diarrhea. Fever, fatigue and weight loss also have been reported. Sometimes symptoms rapidly develop over a few days, or they could build slowly over several weeks. Most patients also have a high white blood cell count, a sign that the body’s immune system is on high alert.
Why are these symptoms occurring now? Is this illness new?
Health officials think that the majority of cases have occurred within the past several months. It is possible the condition has occurred before and is only now being recognized as related to vaping, but many investigators believe it is likely caused by something new, such as an additive or toxin in the products or devices.
How severe are these lung illnesses?
Patients can recover after a few days or weeks, but many also require ventilation or intubation, meaning they have a tube inserted to help them breathe. Of 53 cases reported in Wisconsin and Illinois, 94% of patients were hospitalized, and 32% of patients required intubation and medical ventilation, according to a report in the New England Journal of Medicine. Some patients have even required extracorporeal membrane oxygen, or ECMO, which involves using a machine to pump blood outside of the body to allow the heart and lungs to rest.
What’s causing it?
While the specific cause is still unclear, doctors say some sort of chemical exposure related to vaping or e-cigarette use may be causing inflammation or injury in the lungs.
Many of the illnesses have been linked to cannabis-related products, specifically THC, or tetrahydrocannabinol, a chemical in marijuana known for its psychoactive effects. Many patients report using both nicotine and THC-containing products, and some patients reported vaping only products with nicotine.
Both the New York State Department of Health and the U.S. Food and Drug Administration say that many of the THC-products contained significant amounts of vitamin E acetate, which is an oil potentially being used as a thickening agent for the vaping liquid without affecting the flavor or odor.
Health officials, however, haven’t linked any specific substance or products to the illnesses, and no single product has been associated with all of the cases. The inflammations and injuries themselves also aren’t identical, leaving some physicians to believe that the related illnesses may have several causes related to vaping.
What is lipoid pneumonia, and how is it related to the vaping illness?
Lipoid pneumonia is an inflammatory response that occurs after someone inhales a fat or oil. A hallmark of the condition is fat buildup in the lungs, which has been found in some of the patients, including the patients in North Carolina that were included in a CDC report. All five patients were diagnosed with acute lipoid pneumonia. All of the North Carolina patients also reported recently using marijuana oils, such as THC-containing oils, and three of them also reported vaping nicotine e-cigarettes.
Not all patients studied, however, have had the fat buildup associated with pneumonia. Fat buildup in the lungs may also be a result of inflammation due to some sort of lung damage, says Sean Callahan, an assistant professor of medicine at the University of Utah Health, and not necessarily a sign of inhaling a fat or oil.
How are the illnesses being treated?
The symptoms look like an infection or pneumonia, so physicians sometimes first put the patients on antibiotics to clear it up. Antibiotics don’t help with the symptoms, however, and physicians typically discover that the patients don’t actually have an infection.
For some patients, halting vaping and letting the inflammation clear on its own seem to help. Doctors also say they have seen success after administering steroids, which are commonly used to reduce allergic reactions and other inflammations.
Should I stop using my vape device or e-cigarette?
The CDC recommends that people consider stopping the use of vaping devices altogether, while the FDA is urging people to avoid using THC-containing products specifically. Both agencies urge people not to buy any illicit vaping products or modify products purchased legally. Several states, cities and health organizations have also warned the public to stop vaping or using e-cigarettes.
I’m using THC vaping products from a state-licensed medical marijuana dispensary for a serious health problem. Should I halt my treatment?
You may want to ask a health professional about an alternative. While many of the illnesses have been linked to illegal products, one person who died in Oregon had purchased cannabis from two licensed marijuana retailers.
n New York, there have been no adverse events related to the regulated medical marijuana program, but the state health commissioner urged patients using medical marijuana to consult with their health-care providers and potentially find alternatives to vaping while the investigation is ongoing.
Could I develop the vaping illness if I quit vaping months ago?
Patients so far reported vaping within the past 90 days before developing symptoms. If you have vaped within the past 90 days or continue to vape, you should monitor your health for symptoms.
I’ve been diagnosed with pneumonia. Should I tell my doctor I vape?
Yes, if you are experiencing any pneumonialike symptoms, it is important to inform your health-care provider about your medical history, including vaping or e-cigarette use.