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December 14th, 2016:

Vapers experimenting with illegal drugs bought on the dark web

MILLIONS of people worldwide use e-cigarettes or vaping equipment instead of smoking tobacco. But nicotine isn’t the only drug people are vaping.

Some vapers are experimenting with recreational drugs, mixing them into the e-liquid that goes into vapes and sharing their experiences online. This, along with advances in vaping technology, has led to an increase in drug-based e-liquids advertised for sale on dark web marketplaces.

Cannabis is a common choice but vendors on dark web marketplace Alphabay also sell e-liquid containing cocaine, morphine, MDMA (ecstasy) and temazepam, a drug sometimes prescribed for insomnia. There are even listings for fentanyl, a potent opiate responsible for thousands of fatal overdoses in recent years.

Michelle Peace at Virginia Commonwealth University is leading a project that examines drug use and abuse involving vaping, with a view to educating the public and providing information to law enforcement, medical examiners and forensic scientists. Her team is investigating which substances these e-liquids contain and whether they can be vaporised. The project is supported by grants from the US National Institute of Justice.

“The users believe they are experiencing better drug delivery,” says Peace. “Part of our work has been to understand why they think that is the case.”

Peace and her colleagues tested e-liquids containing everything from legal substances such as nicotine, vitamins and caffeine to illicit drugs, including cannabis, heroin and methamphetamine. They used mass spectrometry to see what is actually contained in e-liquids available for sale on the dark web. For instance, they have found synthetic cannabinoids in some liquids that weren’t labelled as containing any drug other than nicotine but were suspiciously expensive.

“Vaping e-liquids that contain drugs could make already dangerous drugs even more dangerous”

They also tested how effectively different drugs vaporise. To do this, they used a machine that “inhales” the e-liquid and then analyses which chemicals are present in the vapour.

The researchers haven’t yet published their results, but Peace says it seems that many drugs can be vaporised. Tests with methamphetamine, for example, showed the drug was present in the vapour.

Vaping recreational drugs poses public health concerns. As drug delivery via the lungs is generally more effective than some other methods, says Peace, vaping could make “already dangerous drugs even more dangerous”.

There are other risks, too. The lungs are a sensitive organ and drugs or other constituents of these e-liquids could cause inflammation, says John Britton at the University of Nottingham, UK.

But vaping could also have legitimate medical applications. “If the pharmaceutical industry can figure how to control dosing, it may be an effective tool to deliver therapeutic pharmaceuticals in the future,” says Peace.

FDA denies Swedish Match request on tobacco warning label changes

In its first action on so-called modified-risk tobacco products, the U.S. Food and Drug Administration on Wednesday rejected a company’s request to remove some health warning labels from a smokeless product called snus.

Swedish Match, a Swedish-based tobacco company with its North American headquarters in Richmond, applied to the FDA in 2014 to have its snus product designated as modified risk, meaning it could be less risky to health.

Snus (pronounced snoos), is a smokeless tobacco sold in small pouches that the user places between the cheek and gum.

It has been popular in Scandinavian countries for many years, and Swedish Match, which sells snus under the brand name General in the United States, argued in its application to the FDA that it is a less-risky alternative to cigarettes and other tobacco products.

The company said it submitted about 120,000 pages of documents to the FDA to back that claim, including scientific and consumer studies conducted over the past 30 years in Norway and Sweden.

The company wanted to remove mandatory, rotating warning labels on snus packages that say it can cause gum disease, tooth loss and mouth cancer.

It also wanted to change the wording on a warning label that says snus is “not a safe alternative to cigarettes.” The company wanted it to read: “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

The company did not seek to change a warning that says smokeless tobacco is addictive.

The FDA said it denied the request to remove the gum disease and tooth loss warnings because, based on the scientific evidence, “the products can cause gum disease and tooth loss.”

However, the agency deferred a final decision on the mouth cancer warning and the wording change, giving Swedish Match up to two years to amend its application. The FDA said the application “could be amended to support issuance of modified-risk orders.”

Under a 2009 federal law that gave the FDA authority to regulate tobacco products, companies can apply to the agency to market novel products as modified risk if there is evidence they are less risky to health.

The FDA has not yet authorized any tobacco products as modified risk. In reviewing such requests, the agency has to consider a product’s potential impact on both individual users and the population as a whole.

“The lessons learned through these first applications provide key insights moving forward,” said Mitch Zeller, director for the FDA’s Center for Tobacco Products, in a statement. “For example, companies should carefully consider how they plan to present and substantiate a modified-risk claim.”

“While the FDA is not authorizing modified-risk orders for these products at this time, our guidance to the company will enable it to amend its applications if it chooses,” Zeller said.

Swedish Match called the FDA decision encouraging and noted that the agency previously found that snus contains “significantly lower levels of harmful constituents compared to over 97 percent of the smokeless products on the U.S. market.”

The FDA decision leaves open the possibility that other warning label changes could be approved for snus products eventually, or that Swedish Match could propose other ways of communicating the lower risks of the product, said Jim Solyst, Swedish Match’s vice president for federal regulatory affairs.

“I think there are various ways of looking at this decision,” Solyst said. “Certainly, there are positive elements to the correspondence we received from the FDA. They would like to continue the dialogue. They have given us more guidance as to what is possible.”

Some public health and tobacco-control groups opposed changing the warning labels on snus. For instance, during the FDA’s review of Swedish Match’s application, the American Dental Association urged the agency to make no changes to warning labels without more research on whether smokeless tobacco is “a gateway” to cigarette smoking.

The FDA is considering other applications for modified-risk tobacco products.

Earlier this month, tobacco company Philip Morris International said it submitted an application to the FDA to market a new type of cigarette that heats tobacco instead of burning it as potentially less harmful than conventional cigarettes.

If the product, called iQOS, gets clearance, Henrico County-based Altria Group Inc. — parent of top U.S. tobacco company Philip Morris USA — would have exclusive rights to sell it in the United States under a licensing agreement between the companies.

As pot becomes legal, head shops can drop the smoke screen

Of course it was for marijuana. All of it. The cheapo metal one-hitters that are supposed to look like a cigarette. The glass shelves lined with pocket vaporizers. The $175 Magic Butter machine. All of it.

And at 12:01 a.m. on Thursday in Massachusetts, as recreational marijuana became legal, the shops that have been selling all this paraphernalia could finally end their long public wink, take down the “for tobacco use only” signs, and admit that their glass cases have always been filled with toys for getting high.

“I’m so sick of telling customers they can’t say bong, or marijuana. And I’ll be so glad to not have to say ‘tobacco’ anymore,” said Zelda Feinberg, throwing up huge, dramatic air quotes around the word “tobacco.” Feinberg is one of the cofounders of Buried Treasures, a “smoke shop” that has been pretending it had no idea what you were talking about with this weed stuff in various locations in Boston and Cambridge since 1983.

The “it’s for tobacco” deceit was a thin and often ludicrous charade carried out for decades by shops all over the state. With names like the Trippy Hippy, The Hempest, and Wild Side Smoke Shop, it’s unlikely anybody was fooled. But Massachusetts laws were clear — no sales of drug paraphernalia — and the penalties for violating them stiff, up to two years in prison or fines up to $5,000. So retailers strictly enforced the rules.

Customers who dared drop the “tobacco” ruse at her shop would usually get a warning, Feinberg said, and then the door. No talk of weed. And no using the “b word” — “bong just feels like a drug word,” Feinberg said. Customers were asked to call it a “water pipe” and pretend they were asking about the 4-foot, 4-inch chambered glass tower because they just weren’t getting enough out of their cigarettes.

“Now I don’t care what you call it. Call it a bong. Call it whatever you want,” said Feinberg, who said she stopped pretending about all of it after the ballot measure passed in November. For the first time in the shop’s 33-year history, they brought in apparel featuring the marijuana leaf. “Having that stuff in here feels like a big deal. We always had to be so careful.”

Upholding the “for tobacco use only” façade has always meant that it is somehow plausible that the product be usable for tobacco or some other legal pursuit. Could you use a glass pipe for tobacco? Most definitely. Could you eat a cookie made with tobacco butter? Technically, probably. Could you use the carbon-lined odor-absorbing messenger bag on sale at Buried Treasures for something other than transporting marijuana? Sure. Are there scenarios in which you’d want to disguise a cigarette by using a metal cigarette? Maybe so. And on and on. That has been the drill: Just pretend the items sold by the shop were for tobacco and everything was fine.

And now, well, it’s over. Right? Everyone can drop the act on Thursday? Just up the street from Buried Treasures in Allston, Richard Lamoretti, the owner of Fast Eddie’s Smoke Shop, still wasn’t ready to budge. “I’ve got a copy of the old laws around here somewhere,” he said, sifting through binders behind the counter. “The section on paraphernalia is like four pages long and whoever wrote it was good.”

He asked a Globe reporter to read him the new law, twice, which states that it is not a crime “for possessing, purchasing or otherwise obtaining or manufacturing marijuana accessories or for selling or otherwise transferring marijuana accessories to a person who is 21 years of age or older.”

His face continued to make clear that he was not sold.

“My current story is that this is all for tobacco use only,” he said.

On Thursday, would that change? Would he admit that nearly everything in his shop was for weed?

“You just told me that I can, right?” he asked, still with the suspicious face, triggering another assurance that no one here was a narc.

“I’ll tell you this, though,” he said finally. “We’re not going to have any huge jump in our business.”

And why is that?

“Because I don’t think we have many law-abiding citizens who have been sitting around waiting until it was legal to say the word bong.”

N.J. ranked worst in nation for trying to keep kids from smoking

For the fifth consecutive year, New Jersey will spend no money to deter kids from tobacco use or help smokers quit the habit, according to a public health advocacy organization which ranked the state last in the nation for its lack of effort.

Cigarette smoking among middle schoolers and high schools has been on the decline in New Jersey and nationally for the last decade, according to recent surveys.

But by allocating no state funding to discourage tobacco use, New Jersey does nothing to prevent an estimated 11,800 deaths every year that can be directly attributed to smoking, according to the Tobacco Free Kids Campaign.

Meanwhile, New Jersey will take in $944.5 million in taxes and revenue from the 1998 settlement with the tobacco companies, Matthew L. Myers, President of the Campaign for Tobacco-Free Kids.

Young adults under 21 may continue buying tobacco and electronic cigarette products in New Jersey

“New Jersey is putting children’s health at risk and costing taxpayers money by refusing to fund tobacco prevention programs that save lives and health care dollars,” Myers said.

“Because of the tremendous progress our country has made in reducing smoking, it is within our reach to win the fight against tobacco and make the next generation tobacco-free,” Myers said. New Jersey should be doing everything it can to protect kids from tobacco, including raising the tobacco age to 21.”

Gov. Chris Christie vetoed legislation in January that would have raised the smoking age to 21. He did sign a smoking ban in state parks and beaches his year.

State Health Department spokeswoman Donna Leusner said smoking prevention and cessation programs exist in the state, but they are funded by the federal government.

The state uses $2.2 million in federal assistance to run NJ Quitline, 1-866-657-8677, a toll-free hotline and counseling service that offers nicotine replacement therapy such as gum and patches, she said.

The state also operates the Mom’s Quit Connection, linking pregnant women and new mothers who want to quit smoking with trained counselors, and an enforcement program that cracks down on vendors who sell cigarettes to minors 19 and younger.

The trends show smoking is on the decline, especially in New Jersey, Leusner said. “New Jersey’s youth smoking rate has been declining for a decade and is below the national average at 8.2 percent,” according to 2014 data, she said.

New Jersey’s adult smoking rate is well below the national average–15.1 percent vs. 18.1 percent, she added.

On Tuesday, a University of Michigan survey of about 45,000 middle-school and high-school students that found smoking rates have reach historic lows.

From 2015 to 2016, the percentage of youth who smoked in the past 30 days fell from 11.4 percent to 10.5 percent among 12th grader, from 6.3 percent to 4.9 percent among 10th graders, and from 3.6 percent to 2.6 percent among 8th graders, according to the University of Michigan’s Monitoring the Future survey.

New Jersey is tied for last with Connecticut for allocating the least amount of state funds to curb tobacco use, the campaign said.

High school vapers often become heavy smokers

Also worrisome: Teen vaping rates are skyrocketing, according to a new report by the U.S. Surgeon General’s office

E-cigarette use grew an astounding 900 percent among high school students from 2011 to 2015. That’s according to a report by the U.S. Surgeon General’s office, released December 8. It highlights the harmful effects of e-cigarettes, especially to young people.

E-cigarettes first went on sale in the United States in 2007. Back then, companies advertised them as an aid to help adults give up smoking tobacco. But nonsmokers soon took up e-cigs too . Among them have been teens and even preteens. The Surgeon General’s report says the newly recognized drastic leap in e-cig use could lead many teens to try smoking.

And that would put a new generation of Americans at risk of nicotine addiction, says Thomas Wills. He works at the University of Hawaii at Manoa. He’s also an expert on teen smoking rates.

The Surgeon General’s report and other information about the health effects of e-cigarettes can be found at anew website: Know the Risks: E-cigarettes & Young People.

Two additional new studies back up what the Surgeon General’s office is saying. Both also shine some light on why teens choose to vape — and why some young vapers transition to smoking cigarettes.

Studies had shown that teens who vape are more likely to try cigarette smoking. And that’s disturbing because in the United States alone, the number of teen vapers nearly quadrupled between 2013 and 2015 — to more than 3 million. However, it has not been clear whether these kids who move on to tobacco “are just experimenting with smoking or whether they go on to become regular users,” says Adam Leventhal. He’s an addiction scientist at the University of Southern California, in Los Angeles.

The distinction is important, he says. Teens who become regular smokers during high school are more likely to develop a lifelong addiction to nicotine. According to the Surgeon General’s Report, nine out of 10 adult smokers tried their first cigarettes during adolescence.

To dig into why some teens make this transition, Leventhal and his colleagues recruited more than 3,000 Los Angeles-area 10th graders into a study. The students filled out surveys in the fall and spring. Those questions asked the teens about whether they had vaped or smoked. The researchers then looked at whether the answers had differed between early and late in the school year.

And indeed they did. Vaping seemed to up the likelihood that a teen would start smoking, these data showed.

The researchers broke students into groups, based on their answers in the fall to whether and how often they vaped. One group reported never vaping. A second group said they had tried vaping, but not within the past month. A third group reported vaping on one or two days in the past month. The last group said they had vaped even more than that in the last 30 days.

And the likelihood that a student smoked in the spring doubled in each successive group. For instance, by the spring, students who had previously tried vaping were about two times as likely to use cigarettes as were teens who had never vaped. Each jump to a group that vaped more frequently roughly doubled the likelihood that a student would report frequent, heavy cigarette smoking in the spring. (People who smoked cigarettes on three or more days in the past month were deemed frequent smokers. Lighting up two or more cigarettes on any day was considered heavy use.)

Leventhal’s group published its findings online November 8 in the Journal of the American Medical Association.

The share of teens in this study who reported vaping was slightly lower than the national average. One in three students in the study said they had ever tried vaping. That’s about 4 percentage points lower than the national average for 10th graders. Similarly, about 9 percent of the California kids surveyed said they had vaped in the past month. That’s 5 percentage points lower than the U.S. average 10th graders, according to a February 2016 report. It was conducted by researchers at the University of Michigan in Ann Arbor.

One reason for the lower vaping rate in California could be that kids there also are somewhat less likely to smoke than elsewhere in the country, notes Wills.

It still isn’t clear why some teens make the transition from vaping to smoking, he says. Young people who vape might learn to like the feeling of lighting up, holding a cigarette-like device or inhaling. These are behaviors that are common to both electronic and tobacco cigarettes. That might make it easier for teens to transition to tobacco cigarettes. It’s also possible that kids who use e-cigarettes are getting hooked on nicotine, says Wills. This is the chemical that makes tobacco smoking so addictive. It’s also found in most e-cig liquids.

More research is needed, Wills says, to probe the role of nicotine in teens’ transition from vaping to smoking.

The influence of ads

“Use of e-cigarettes has been rising exponentially among youth,” says Hongying Dai. “Little is known about the factors contributing to this rise,” she adds. Dai is an epidemiologist — a scientist who studies disease risk. She works at the University of Missouri-Kansas City. This researcher wondered whether the number of e-cig advertisements that kids see might affect how likely they were to vape. So she analyzed data from a national survey for clues that might confirm this.

More than 22,000 U.S. middle- and high-school students had filled out the survey about their smoking and vaping habits.

Compared to kids who rarely saw e-cig ads, those who saw them at least “sometimes” were much more likely to vape. Students who frequently ran into ads on the internet were about three times as likely to vape as were teens who reported never seeing such online ads. Kids who vaped also reported high exposure to e-cigarette ads in stores, newspapers and magazines, on TV and at the movies.

Family also seemed to play some role. Kids were more likely to vape if someone in their household used e-cigarettes, the researchers showed.

E-cigarette ads that target teens often portray vaping as glamorous or attractive, notes the Surgeon General’s report. Wills says the tobacco industry used these same tactics to encourage cigarette smoking by young people a generation ago.

Still, some questions remain. For instance, Dai asks, how accurately did the teens report encountering e-cigarette ads? And do all kids notice e-cig ads equally? Or are kids who vape just more likely to pay attention to vape ads?

Dai says she expected to see a link between ads and vaping. Tobacco advertising has been linked to increases in youth smoking rates, she notes. It therefore makes sense that exposure to e-cig advertising could affect teen vaping, she says.

Findings from the second study appear in the August Journal of Adolescent Health.