05:23pm Sunday 17 November 2019

E-liquids often contain alcohol as an unlisted ingredient. What are the health and safety implications?

By Brian McNeill

E-liquids — the flavored nicotine solution used in e-cigarettes — frequently contain the unlisted ingredient ethanol, or alcohol, according to research conducted in the lab of Virginia Commonwealth University professor Michelle Peace, Ph.D.

Out of 56 commercially available vape juice samples Peace’s lab tested, all but three contained ethanol, and 11 contained more than 10% ethanol. That study, published in 2017 in the journal Drug Testing and Analysis, warned that the implications of vaping ethanol as an e-liquid component are not known.

Now, Peace, an associate professor in the Department of Forensic Science in the College of Humanities and Sciences, is investigating those implications under two grants awarded by the National Institute of Justice in the U.S. Department of Justice totaling roughly $1.8 million.

“We were surprised to find such highly concentrated amounts of ethanol in e-liquids. A little bit of ethanol would not be surprising because the solvent for a lot of flavoring chemicals is ethanol,” Peace said. “For instance, if you’re going to be using natural vanilla extract, you’re going to wind up with small amounts of ethanol in the e-liquid. But to find ethanol at high concentrations, definitely surprising. So we started asking: what are the implications of this?”

Peace is exploring such questions as: Do people vaping ethanol feel an effect? Can vaping ethanol lead to impairment? What is the effect on an e-cigarette user’s blood alcohol content? Could vaping ethanol lead to false-positive results for police field sobriety or breath alcohol tests? Could vaping ethanol lead to people becoming unwittingly drunk?

There are few published studies about the effects of inhaling ethanol, but Peace expects her lab will not find that vaping ethanol can lead to high levels of impairment. Yet, she noted, some users have reported in online vaping forums that they felt an intoxicating effect.

“Do people feel some kind of immediate effect or not? For the most part, we thought probably not,” Peace said. “But one of the concerns is that as you inhale ethanol, you’re bypassing the gut, which adds this layer of protection when you swallow alcohol. So, if you’re inhaling ethanol and you’re inhaling a lot of ethanol, then there is enough in the [online vaping] forums that we thought, are people experiencing a momentary impairment or something like that?”

For both grants, Peace’s lab is partnering with the Center for the Study of Tobacco Products in the Department of Psychology, the Department of Pharmacology and Toxicology in the School of Medicine, the Department of Pharmaceutics in the School of Pharmacy, and the Virginia Department of Forensic Science.

As part of the first grant, “Through the Looking Glass: Abuse of the Evolving Electronic Cigarette and the Impact of Vaping Ethanol in the Evaluation of Impairment,” Peace’s lab is investigating vaping ethanol and field sobriety tests.

“Ethanol is in e-liquids and e-liquids are sticky,” Peace said. “It can hang on to the gums and inside the mouth. So, will residual ethanol remain in the mouth for a preliminary breath test or an evidentiary breath test?”

If vaping e-liquids containing ethanol can trigger a positive result in a sobriety test, it could have major consequences for public safety and criminal justice.

For example, Peace said, an attorney representing a client charged with DUI could suggest that the client had simply been vaping, not drinking and driving.

“Some of our concern is that vaping ethanol could be used as some kind of tactic to confuse the court system as to why [a defendant] was positive for ethanol,” she said. “For legitimate cases of driving under the influence, we certainly don’t want there to be a defense that casts so much doubt [of a Breathalyzer result] that a legitimate case gets thrown out.”

The second grant, “Through the Looking Glass Part II: Abuse of the Evolving Electronic Cigarette and the Impact of Vaping Ethanol in the Evaluation of Impairment,” continues the research of the first grant, but also involves collecting oral fluid, blood and urine from users vaping different concentrations of ethanol.

By collecting bodily fluids, the researchers will be able to measure the absorption, distribution, metabolism and elimination of ethanol once a user vapes it.

It’s important to understand if vaping ethanol can be detected in bodily fluids, Peace said, because it could lead to false-positive violations of probation conditions or alcohol treatment facility rules. As a result, she said, people could violate the terms of their probation, which could have serious ramifications such as more jail time or loss of child custody, or get kicked out of a treatment program.

“Our concern is that, for people who are vaping ethanol who are on probation or who have to report to drug courts, or they are in a clinic for substance use and abuse, they [get tested] to show that they are not consuming ethanol,” Peace said. “If somebody is legitimately not drinking alcohol, but they happen to vape and they happen to unknowingly be vaping high ethanol concentration, then they could have the metabolites for ethanol in their urine and then it’d be a violation of the requirements of their program.”

Peace’s research into e-cigarettes extends beyond vaping ethanol. Last year, her lab published a study describing how they tested nine commercially available CBD e-liquids and discovered that several contained unlisted ingredients such as a synthetic cannabinoid linked to deadly overdoses and a chemical found in cough syrup.

Her research into CBD and vaping was featured recently in The New York Times and in a CNN documentary, “Weed 5: The CBD Craze,” with Sanjay Gupta, M.D.

 

Virginia Commonwealth University

 


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