First:  There are NO clear answers about the cause and effect of the newly appearing health effects of Vaping – HOWEVER THERE IS REASON FOR VERY – VERY – SERIOUS CONCERN.

State Health Departments, Federal Agencies (FDA; DEA) and the United States Centers for Disease Control  (CDC) are heavily researching this problem.

Thus far, as of September 6, 2019 – there have been 450 cases of people sickened with severe lung disease believed to be linked to vaping – and 3 Deaths. About 98% were HOSPITALIZED; and 50% required Admission to an INTENSIVE CARE UNIT (ICU) – with 30% requiring being placed on a VENTILATOR !

This “surge” of this public health catastrophe is a NEW phenomenon and NOT mere recognition of a previously existing syndrome. Surely the State of Florida, along with the other multitude of States which have permitted medical marijuana, would not have released “vaping” as an acceptable form of administering medical marijuana had they known of what was about to explode – and explode it has.

Public Health Officials are examining ALL the possible etiologies, which include the type of oil used in vaping, Vitamin E, the ingredients and contaminates of the vape oil itself, concentrations of substances within the vaping product, the use of various “cutting” agents, byproducts of the heating process of vaping, etc. The CDC has thus far identified t least six (6) groups of potentially toxic compounds.  It is indeed a monumental scientific task to narrow down the offending agent(s) and establish a cause-effect relationship.

It’s certainly not hard to understand, however, how taking a substance (oil) and boiling it to 363 degrees Fahrenheit, which is well above the 212 degrees Fahrenheit boiling point for water, and nearly 4 X higher than normal human body temperature – then having it vaporize into your lungs – only to return to its original state when cooling down (oil) – which then coats the inside of your lungs – might be harmful…..To be sure, your lung tissue (I can tell you this as a Cardiothoracic Surgeon) are NOT MEANT NOR CONSTRUCTED to break down or remove foreign substances!  The lungs are designed to deal with Gases – ONLY (it’s NOT like the GI system).

As of today, there are NO CLEAR ANSWERS – there may not be just one culprit linked to these devastating pulmonary catastrophes – thus, GREAT CAUTION MUST BE EXERCISED.


Many have asked – should I stop Vaping – and use the “Smokable” form of marijuana ?   To be clear, “smoke” of ANY kind is HARMFUL to lung health.  Whether from burning wood, tobacco, marijuana, or whatever – toxins AND carcinogens are released from combustion materials.

In fact, in the State of Florida – the Florida Department of Health has issued a NEW Informed Consent document which specifically requires the user (patient) to acknowledge that there ARE health risks associated with the State approved “smokable marijuana.”

The Reproductive and Cancer Hazard Assessment Branch Office of Environmental Health Hazard Assessment California Environmental Protection Agency (Cal EPA) notes that marijuana smoke contains THOUSANDS of organic and inorganic chemicals and state that studies reporting results for direct marijuana smoking have observed STATISTICALLY SIGNIFICANT associations with cancers of the lung, head and neck, bladder, brain, and testis. The Cal EPA further notes that studies investigating the genotoxicity, immunotoxicity, and effects on endocrine function and cell signaling pathways provide additional evidence for the carcinogenicity of marijuana smoke.

The British Lung Foundation’s (BLF’s) June media release claims cannabis is 20 X more carcinogenic than tobacco despite also saying “studies on the subject have yielded conflicting evidence: some suggest there is a link between smoking cannabis and lung cancer while others don’t.”

The United States National Institute of Health (NIH), National Institute on Drug Abuse declares that marijuana smoke contains carcinogenic combustion products, including about 50 percent MORE benzoprene and 75 percent MORE benzanthracene (and more phenols, vinyl chlorides, nitrosamines, reactive oxygen species) than cigarette smoke. The NIH further notes that because of how marijuana is typically smoked (deeper inhale), marijuana smoking leads to 4 X the deposition of tar compared to cigarette smoking.


We realize that in a medical marijuana state regulated program, which permits the use of marijuana for the adjunctive treatment of various medical conditions, that patients receive numerous benefits such as relief of severe debilitating pain, severe anxiety, etc. etc.

However, as with the consideration of administering ANY medication or substance: we MUST WEIGH the Benefits v. Risks.  This “balance” should be performed by qualified physicians – and – should be mindful of patients’ needs (it should NOT be performed by Dispensary Sales agents whose SOLE purpose is to SELL PRODUCT for a Commission or Profit !).

Accordingly, we suggest the following:

  1. If you are not already Vaping  (Marijuana or any other substance) – do NOT Start Vaping.
  2. If you are not already Smoking (Marijuana or any other substance) – do NOT Start Smoking.
  3. If you are already Vaping – and you experience ANY Form of coughing, breathing difficulties, sore throat, change in voice, or chest pain – you should IMMEDIATELY STOP VAPING – DO NOT “switch” to smokable marijuana.
  4. If you would like to consider safer medical marijuana options: consider oral, sublingual and topical forms.
  5. Do NOT buy any “street” products containing marijuana, or purchase any fillers or cutting agents to be used with marijuana.
  6. Do NOT vape or smoke any substances that are “flavored.”

Again – this is an immensely challenging and multi-factorial health catastrophe which we are facing – and there is SERIOUS cause to be Prudent, Thoughtful, Mindful of the recent Hospitalizations and Deaths which have been reported.

It is a solemn time to consider: “Risks v. Benefits.”

We remain available to help and assist you on your path to better health.  I have a 27 page compilation of news articles concerning vaping.  If you would like a copy, simply email and we will forward it to you.

In Good Health,

Thomas A. Gionis, MD, JD, MPH