Like many college freshmen, Sebastian Yanes was delighted at the start of his freshman year of college in fall 2019. But then he smoked an e-cigarette and quickly ended up lying in a bed at Miami’s Nicklaus Children’s Hospital during the second week of the semester.
“It was very shocking,” said his mother, Wendy Yanes. No one outside his circle of friends knew of his vaping, not even his family.
The 18-year-old was in a chemically induced catatonic state. By the end of his first day at Nicklaus, Yanes’ heart began to fail.
“He was so lifeless. We didn’t know if he was going to make it through the night,” remembers Yanes’ aunt, Debrorah Ayash.
Doctors called a code blue and successfully restarted his heart. He was moved to the intensive care unit, where he remained for a week with a heart rate in the low 30’s.
Staring at his reflection in the hospital’s bathroom mirror, Yanes turned to his father and muttered, “Am I dead?” Out of confusion and frustration, he punched the bathroom mirror. He no longer saw a person he recognized in himself.
Doctors then treated Sebastian, who had regularly vaped before the incident, with an anti-psychosis drug that revived him from this trance.
These days, Wendy said her son occasionally goes through what she calls an “altered mental state,” recurring episodes of delusion in which he cannot distinguish reality from fantasy. These episodes last around six days at a time.
“He’ll have perfect days where you can’t even tell that anything is wrong with him. So then you get this false sense of hope that, ‘Okay, we’re done,’ and then it happens again.”
The doctors explained to the family that this is a normal reaction to the chemicals that are still in his system. It could last six months or longer, depending on how fast the body metabolizes the chemicals.
Cases like Yanes’ have appeared across the country recently. Now, as the Trump administration has proposed a compromise vaping ban that has garnered intense criticism for its weakness, such instances take on increasing importance.
In just a few months this past fall, over 2,000 examples of e-cigarette or vaping product use associated lung injury (EVALI) were reported to the Centers for Disease Control. There were 42 confirmed deaths. In the state of Florida, there have been 89 reported cases of EVALI and one known death, according to the state’s Department of Health.
Recently, the CDC identified vitamin E acetate as a chemical of concern among these cases, suggesting the vitamin may be used as an additive and thickening agent in THC products. While vitamin E is harmless when added to foods or applied to the skin, research indicates it can disrupt normal lung function if inhaled.
“Your lungs are designed differently and many of these chemicals cause injury and damage to the lining,” said Dr. Barry Hummel, founder of Quit Doc Foundation and chair of Tobacco-Free Partnership of Broward County. “The point that I always make talking to students is that even the simplest chemical: water – is safe to ingest – but you shouldn’t inhale it. Because if you do, we call that drowning.”
While vitamin E is a new lead in this investigation, the Food and Drug Administration and CDC have not identified one product or specific substance that is the cause of these illnesses; however, the presence of tetrahydrocannabinol (THC) has been found in a majority of the samples tested. The only commonality linking patients is the reported use of vaping devices.
Because it has recently surged in popularity, the medical community is uncertain of the long-term effects of these products on patients. Vaping devices pose a new, little-studied set of health risks and concerns.
The U.S Department of Health and Human Services has, for the first time in history, reported more teenagers using e-cigarettes than traditional cigarettes. An investigation found 54 percent of the confirmed outbreak patients were 24 years old or younger.
Wendy Yanes said that her son “thought it was a safer alternative to like smoking a cigarette, which he never wanted to do.”
Dr. Hummel blames the initial marketing of such products as the reason behind the “healthier alternative” misconception. Ten years ago, many of the products imported to the United States were advertised as being simply water vapor, a cleaner way to deliver nicotine.
“Even the fact that we use the term vaping goes back to the times when they were advertised as harmless water vapor, so that’s where that nomenclature comes from,” said Hummel.
E-cigarette merchandise comes in a variety of sizes and styles. Certain vaping devices resemble USB flash drives, a popular and discreet option among younger consumers. Non-tobacco flavors like candy, fruit, mint and many more creative tastes also play an important role in its youth appeal.
STIG disposable vape pod by VGOD was Yanes’ brand of choice, as it was one of the very same low-profile options.
Dr. Hummel noted the inconspicuousness of these products as a major selling point in the e-cigarette market’s attempt to attract kids.
“There’s a whole subset that’s designed to be hidden in plain sight. So if your parents walked into the room and saw them sitting on the desk, they would not identify them as a drug-delivering device. They look like flash drives or pens. It’s hard to know what they are.”
According to STIG pod’s official website, the STIG is a salt-based nicotine device that provides better and faster nicotine blood absorption over a longer period of time than a pack of regular smokes. Three STIG devices are sold in a single pack, which the company claims is equivalent to approximately 60 cigarettes, for around $20.
An issue many raise is how easily accessible these products are to young consumers.
The FDA did not regulate e-cigarettes as tobacco products until late 2016. A year later the agency pushed back decisions to require e-cigarette manufacturers to report their products’ ingredients until 2022.
The “New Tobacco Rule” aims to restrict access to youth by raising the age minimum, limiting sales through ID verification and abolishing sales via vending machines. However, these are not the most bulletproof methods to deter new customers.
According to recent studies, around 10.8 million Americans began vaping as of last year, including more than 25% of high school students.
Dr. Hummel criticizes the “deceitful, predatory business practices” of the tobacco industry for targeting and misleading a new generation of users. “It is a very, very tough addiction and if you can get somebody to start you’ve got a lifelong customer. The group that is the easiest to manipulate are young teenagers, middle school and high school students. By the time they realize they’ve made a bad decision, it’s too late. We’ve created a whole new generation of nicotine addicts.”
As for Yanes, doctors continue to run tests and administer treatment. So far the results indicate there is no permanent neurological or psychiatric damage. He’s in a state of limbo – uncertain of what his future may hold. Having to put this semester on hold, he hopes to resume college in the coming spring.
In the end, although Yanes made a personal choice to maintain this behavior, Wendy said she is not upset at her son for his actions nor does she blame him. She blames the accessibility and hype created around these nicotine delivery systems. The new standards, which if approved would ban only fruity, minty and tobacco flavors, but allow “open tank”, are also a consideration. They are far scaled back from an earlier plan.
“I just hope we can educate people [because] another [student] maybe won’t be so lucky and might have permanent damage,” Wendy said. “It’s just devastating.”