Hot on the trail of a scourge

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The Elite is only one of many vape shops Irfan Rahman, left, visits to gather vaping products for his research.
(Photos in this article by Will Astor)

Irfan Rahman might be area smoke shops’ best customer. 

In the last few years, Rahman has haunted local smoke shops, amassing what might the largest collection of vaping devices and supplies in the state. It could conceivably be a contender for the country’s largest collection.

In a recent visit to Elite, a Henrietta vape shop and cigar store, Rahman barked rapid-fire orders directing store co-owner Gibran Mehta to add scores of oils to a mounting pile of vaping products as Mehta described the various flavorings and nicotine content of oils, taking occasional hits off an e-cigarette as he worked.

Despite his loyal patronage, Irfan laments, a couple of the smoke shops he frequents temporarily banned him. 

“It was when they noticed this,” says Rahman, holding out a tag dangling from a lanyard he wears around his neck. The tag identifies him as a URMC research scientist. Putting two and two together, he explains, some shop owners began to suspect that Rahman, a non-smoker and no fan of vaping, might be using his trove of vaping supplies to make a case against vaping.

Shop owners who banned him have now relented, but their fears are far from unfounded.

Vaping involves inhalation of nicotine or the cannabis-derived substances THC and CBD in a cloud of vapor rather than in smoke produced by “combustibles” like cigarettes, cigars or pipes. In vaping, a handheld, battery-operated device heats an oil emulsion containing nicotine, THC or CBD. 

Irfan Rahman’s lab is studying vaping’s possible ill effects.

At URMC, Rahman heads a laboratory that is delving into vaping’s possible ill effects. He also is part of a joint URMC-Roswell Park team working under a 2018 $19 million National Institutes of Health grant to study the effects of flavored tobacco. He is working with New York’s Department of Health too. 

Projects Rahman is currently leading include an investigation into the toxicology of flavored e-cigarettes and toxicity of nicotine delivered by e-cigarettes. 

His research is far from conclusive, Rahman says, but he is convinced that what he has determined so far does not bode well for the vaping industry. 

Rising concern

Vaping has been around for more than a decade. Initially, it was largely seen as a harmless hipster affectation. More recently, vaping has been a cause of possible concern as legions of teenagers attracted to flavored vaping oils and vaping devices began to take it up. One company, San Francisco-based Juul Labs Inc., a producer and marketer of oil pods and vaping devices, has led the pack among teens to the point that Juuling has become a synonym for vaping. 

In June, concerns over vaping went into hyper-drive as a tide of otherwise healthy young people began presenting to emergency departments around the country with acute lung injuries, 

As of Oct. 29, the Centers for Disease Control had tallied 1,888 cases  of vaping-related lung injuries in 49 states. The count includes 37 deaths in 24 states.

The national total includes 156 across New York, with more than two dozen in the Rochester area. For reasons not clear, Alaska so far seems to have escaped what appears to be a human-created plague.

The precise causes of the lung injuries have yet to come into focus. One thing that is clear is that it is mostly hitting the young. 

Because of the popularity of its product among teenagers and young adults, Juul has been an early target of critics. The company’s website warns that nicotine is addictive and states the firm’s mission as to “improve the lives of the world’s 1 billion adult smokers by eliminating cigarettes.” 

Still, in September, the federal drug administration sent Juul a warning letter putting the e-cigarette seller on notice that it has “adulterated its products … by selling or distributing them as modified risk tobacco products without an FDA order in effect that permits such sale or distribution.”

Juul claims on its website that “we adhere to strict guidelines to ensure that our marketing and commercial communications are directed toward existing adult smokers.” 

Nevertheless, critics have lambasted the e-cigarette firm, claiming that its now-suspended line of non-tobacco flavored vaping oils indeed targeted vulnerable youths. 

survey conducted earlier this year by anti-tobacco nonprofit Truth Initiative found that more than half of vapers starting using vaping products when they were younger than 18, that 15- to 17-year-olds were 16 times more likely to use Juul than 25- to 34-year-olds and that escalating sales to teens in 2018 helped triple Juul’s share of the vaping market from 24 percent to 75 percent.

“The assortment of fruity and sweet flavors, which are proven to attract young people, was the second most popular reason for use, at 29 percent,” Truth Initiative noted. 

New York, acting on some researchers’ conjecture that flavoring additives might the chief culprit behind the rash of vaping-related lung injuries as well as on the findings on flavored vaping pods’ attractiveness to teens, instituted a ban on flavored e-cigarettes in September. 

But siding with the vaping industry trade group, the Vapor Technology Association, a state appeals court blocked the ban in early October, days before it was to take effect, 

Relying partly on research coming out of Rahman’s lab, state Commissioner of Health Howard Zucker believes the state’s highest court will ultimately uphold the flavoring ban.

In the meantime, a bill signed into law by Gov. Andrew Cuomo in July raising the legal age to buy tobacco and e-cigarette products from 18 to 21 is set to take effect next month.  

In early October, local authorities’ heavily publicized bust of a Wisconsin ring illegally producing and selling THC-laced vaping cartridges added to speculation that Vitamin E acetate, an oil commonly used as a base for nicotine- and THC-laced vaping cartridges, might be the culprit behind vaping injuries.

Authorities said the ring, consisting of a Wisconsin woman and her two sons, were legally buying THC oil in California and using it to illegally produce vaping oils with names like Linwood Lemonade Clear and Razzle Dazzle Clear.

Working out of an unprepossessing suburban condo in the tiny Wisconsin town of Bristol, the unlikely mother-and-sons trio had been running one of the largest illegal vaping rings in the country, authorities said. Some 3,100 THC-laced vaping cartridges, along with a number of mason jars filled with THC oil, were seized in the early October raid.

Analysis of vaping-related lung damage cases have showed THC cartridges containing vitamin E oil to be a common factor in more than half of vaping cases, leading some to tag it as a lead suspect, the Washington Post reported in early September. 

But shortly after the bust, a team of researchers at an Arizona Mayo Clinic facility shot the idea down.  

A quest for answers

Rahman agrees with the Mayo clinic team. He believes vitamin E is harmful but is not the smoking gun that will solve the riddle posed by the sudden rash of vaping-related ills.  

Irfan Rahman

What chemicals might be at fault? Rahman shakes his head ruefully, punching keys on his office computer to call up a list of hundreds of ingredients commonly found in vaping oils. Identifying which one or which combinations of substances might trigger lung damage is a herculean task. How close it might be to completion is hard to gauge, he says.

Rahman’s quests for answers include tests on the scores of vaping products he buys to determine factors like each one’s nicotine or THC content and its effect on lung tissue, which he gauges by exposing a line of human lung cells and lab rats to each one. 

A researcher who for several decades has investigated the effects of inhaled toxicants on lung tissue, Rahman has been ahead of the curve in vaping research.

“I bought my first smokeless cigarette in 2005 in Germany,” he recalls. 

A native of Bhopal, India, Rahman was in his late teens when a pipeline at a Bhopal-based Union Carbide Corp. affiliate leaked, releasing a cloud of toxic gas that Indian government authorities estimate immediately killed nearly 4,000 area residents and ultimately caused as many as 8,000 deaths. Estimates put total injuries at more than 500,000 including some 3,900 who suffered long-term disabling effects.

Those affected included one his cousins, Rahman says. Lung damage caused those who inhaled the toxic gas released in the leak to spew black vomit, he recalls, still shuddering at the decades-old memory.

The incident moved him to study lung ailments, Rahman says. His academic credits include work at the University of Edinburgh in Scotland where he co-authored a book on management of chronic obstructive pulmonary disease with a mentor, William MacNee M.D. , whose work helped first define COPD. 

Because of the heavy incidence of smoking among Scots, Rahman says, the country became a central hub of research into COPD, asthma and other lung conditions. In 2003, he was recruited by URMC, where his current appointments include professorships in the departments of environmental medicine, public health sciences, medicine and dentistry.

Perhaps still haunted by his memories of the Bhopal tragedy, Rahman’s relentless pursuit of answers to questions posed by the recent rash of vaping-related ills seems driven. He speaks with restless energy as he tries to convey the urgency and dimensions of the problem. 

Still short of definitive answers, Rahman is confident in averring that vaping, whether of legally produced products or not, is harmful. He posits that black market products are some 10 times more harmful than smoked tobacco and legal products as much as 10 less harmful. But even legal products are far short of the essentially harmless means for nicotine addicts to wean themselves off of cigarettes that Juul’s founders claim them to be.

Vitamin E oil might not be a smoking gun, Rahman says. But the undetermined long-term effects of any vaporized oil are potentially severe. Lungs have no way of clearing oils deposited by vaping. As they accumulate and cause inflammation, the body sends macrophages to clear up the problem.

Macrophages, also called white blood cells, are the body’s first-line defense against invaders. The name macrophage is Greek for big eaters, a designation that describes macrophages’ function, which is essentially destroying harmful bacteria and other foreign substances by devouring them. When they eat vaping-oil deposits in the lungs, macrophages themselves become a problem, clogging the lungs with an oily deposit and causing a type of potentially fatal pneumonia.

In the longer term, Rahman says, other particles left as a vaping residue may eventually cause even more severe problems. Research has not yet determined what effect these particles might have, but he estimates that in 10 years or so, we will find out. It will not be good news, he predicts.

Rahman and Mehta, the Henrietta vape shop owner and vaper, seem to have struck up an easy familiarity borne of frequent contact that looks something like friendship.

As Mehta pulls scores of vaping products off his shelves, he and Rahman banter in Hindi, Rahman’s native tongue and one of several languages spoken by Mehta, who is of Pakistani heritage. 

The Elite is only one of many vape shops he visits in buying sprees he mounts twice a week on average, but the shared patter with Mehta in his native tongue is something of a treat, Rahman says.

After Mehta totals the considerable expense Rahman has racked up, the pair begin a dialogue in English.

“I see you quoted on TV,” Mehta says. “Why don’t you ever say anything positive about vaping? Why is it always how bad it is?” 

A former smoker, Mehta forsook his cigarette habit for vaping seven or eight years ago. Since switching to vaping, Mehta says, “I know I feel a lot better.” He writes off the current tsunami of anti-vaping sentiment as “politics, that’s all it is.” 

Rahman’s answer is not long-winded. “Because it is bad,” he tells Mehta.

Will Astor is Rochester Beacon senior writer.

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