Ten years ago in May 2013, around the time when vaping changed gears in the USA from a fringe to a mainstream activity, the body representing US chemical companies which make and extract flavours for foods and beverages, the Flavoring and Extracts Manufacturing Association (FEMA) published and publicised its position on flavours in vaping products. Here was an industry that stood to earn billions by having a massive new door of opportunities open if flavours in vapes were ever to be given a green light by regulators.

But rather than embrace flavours in vapes, FEMA did not mince words. It stated that anyone representing or suggesting that inhaling vapourised flavours was safe was engaging in false and misleading conduct. Unambiguously, FEMA said it “does not support the use of flavors in vaping products” despite these chemicals often having been assessed as “generally recognised as safe (GRAS)” for ingestion in foods.

In March 2020, FEMA revised and reiterated its statement, which remains in place today

It is difficult to overstate the significance of FEMA’s long-standing position. This is an industry whose sole revenue lies in developing and refining flavours that make food and drinks more palatable and appealing, differentiating identical products by adding flavouring associations that evoke whole new vistas of gustatory experience. Opening the door to vapes could have been like opening the doors to whole new holy grail.

How are flavouring chemicals used in different product groups?

With so much at stake if a flavouring chemical compound was found to be toxic when consumed in food or drink, FEMA has for years put 10,000 watt arc lights on the importance and credibility of its scientific assessments. A food producer hoping to tinker with experimental flavouring chemistry and simply put it out there for sale would collide with massive regulatory walls in all but chaotic, impoverished nations with perfunctory food standards.

 As it should, the US Food and Drug Administration has taken a similar position with vaping chemicals.  By mid 2021, the US FDA had issued Marketing Denial Orders for some 55,000 flavoured vaping products.

Everyone eats. And with the possible exception of small groups like tribespeople deep in Andaman Island jungles, everyone eats at least some (and usually lots) of commercially processed foods.  So food flavourers have a massive sandpit in which to play.

But it is not difficult to imagine boardroom or greenfields thought experiments at flavouring company retreats where imaginations were let off the leash and ways of expanding the use of flavourants encouraged.

There are five routes where commerce has found its way into our bodies with chemicals: swallowing by mouth, inhaling into lungs, injectable medicines , topical medicines absorbed through the skin and rectal insertion. With the rectum lacking taste buds, flavoured suppositories would be stillborn in any brainstorm. Equally, there’d be no point in flavouring injectables or topicals  for any market advantage. Swallowing across taste buds, of course, has long been the flavouring industry’s bread and butter. So what about inhaling?

Here we have the air freshening industry where combusted incense is the outlier unhealthy bad boy when it comes to respiratory impacts. Air fresheners including the increasingly popular use of essential oils add to indoor air pollution. Insect repellent sprays are also often inadvertently inhaled, but are generally regarded as safe when used as directed.

But two other very common product groups are inhaled: some medicines and tobacco and inhalable nicotine products. 

Inhalable flavoured medicines?

Far and away the most commonly inhaled therapeutic medicine are the puffers used by people with asthma.  In Australia in 2020-21, in a population 25.77 million,  2.7 million people had asthma – one in 10.65 people – with one in three using asthma medication daily.

Everyone diagnosed with asthma is advised to always carry an inhaler which come in two broad types: relievers and preventers. The main ingredient in relievers is the bronchodilator, salbutamol (also known as albuterol). The most common adverse reactions to using this drug are taste alteration (bad, unpleasant and unusual taste).

So with one in 10.7 Australians living with asthma, and one in three of these using salbutamol daily, and unpleasant taste being the most commonly reported adverse side effect it would be understandable if these inhalers came with flavourings, perhaps causing adherence to recommended use to increase, particularly among children with their aversions to taking medicines.

So why is it that there is not a conga line of pharmaceutical company applicants banging on the doors of the world’s therapeutic goods regulation agencies begging to be allowed to add flavourings to asthma puffers? The answer here reflects FEMA’s position I described above: there is no acceptably safe way of inhaling flavour chemicals into your lungs every day. Or as in the case of vaping, many, many times a day. So salbutamol pharmaceutical companies don’t bother applying and neither do companies selling vaping products. The latter think they are too important to suffer the indignity of regulation rejection, so they just don’t apply.

How many times a year do vapers baste their lungs?

If you have ever been near someone vaping, you may have formed the impression that they pull vapour into their lungs an awful lot. Your impressions are not wrong. This has been studied using different methods. Here are three examples.

This early (2016) study using a device for recording cigarette puffing topography found vapers taking an average of 32 puffs across 10 minute observation periods. Two studies have used ad libitum observations (where subjects are asked to vape in the way they felt like doing). In one (2016), researchers observed vapers using their normal vaping equipment ad libitum for 90 minutes. They reported the median number of puffs taken over 90 mins was 71 (i.e. 0.78 puffs per minute or 47.3 per hour). Another (from 2023) found those using pod vapes took an average of 71.9 puffs across 90 minutes, almost identical to the 2016 study number.

But of course vapers do not vape across only one continuous 90 minute period each day. No studies appear to have calculated average 24 hour vape puff counts. But if we (conservatively?) assume 8 hours of sleep and four waking hours of no vaping, then a person vaping for 12 hours a day at this 47.3 puffs per hour rate, would pull 568 puffs across a 12 hour day deep into their lungs, 207,462 times in a year and 2.075 million times across 10 years.

By comparison, the average number of cigarettes smoked per day by Australian daily smokers is 10.7. Unobtrusive observations of smokers smoking in outdoor leisure settings (beer gardens, parks) show the average smoker inhales 8.7 times per cigarette. This suggests the average smoker inhales 93 times a day, about 34,000 times a year and 340,000 times across a decade.

Daily vapers thus inhale on average at just over 6 times the rate that daily smokers inhale. This is an almost frantic rate.

Most studies which have reported on puff topography have focussed on comparing nicotine intake between smokers and vapers, with interest on the way in which people titrate their use of nicotine delivery devices to obtain blood nicotine levels that satisfy their craving. Most studies conclude that cigarettes deliver the most nicotine and from this, researchers conclude that the much higher puff frequency rates with vapes are explained in this way.

While vaping promoters have sought to whitewash nicotine as being almost vitamin-like in its virtues and all-but-benign risk profile, nicotine is obviously a critical component in assessing the net risks of both smoking and  vaping with a recent report in Nature on the mass population exposure to nicotine via vaping concluding:

“This continuing population experiment, combined with a growing number of cell and animal studies, could begin to dissipate the fog surrounding nicotine’s impact on health. “I’ve been more and more surprised at the changes I’m seeing when I expose cells to nicotine,” says Crotty Alexander. “We’ve underplayed the role that nicotine has in the health effects of tobacco products.”

Put simply, there has never been any precedent for the mass exposure of hundreds of millions of people – dominated by 15-30 year olds – to the galactic frequency of point-blank lung bastings of the chemical cocktail that is vapourised nicotine, thousands of unregulated flavouring chemicals, propylene glycol and metal particles sloughed from heated metal coils in vapes.   But thank goodness we have the 3 person Australian Tobacco Harm Reduction Association around to assure us that there is just nothing at all to worry about here.

With the average age of diagnosis of asbestos-caused mesothelioma in Australia being 77 and that for lung cancer being 71, latency periods for chronic diseases like cancer, respiratory and cardiovascular diseases take decades to reveal their bitter harvests. Taunts from vaping promoters that “there has never been a documented death from vaping” have all the scientific weight of  an asbestos industry spokesperson in the 1940s saying “there have been no asbestos deaths” (Asbestos was mined in Australia from the 1930s before Australia finally started regulating asbestos products in the late 1970s). The wave of nicotine addiction we are seeing in young people today will reveal any consequences in the decades to come, not in a few years time.

The Australian government’s 2023 decision to outlaw all vapes unless dispensed via prescription at a pharmacy will involve the outlawing all but a very limited  range of flavours. There is growing momentum for this to happen in other nations like New Zealand, the UK and Canada experiencing the same growth in youth vaping.

Study after study has confirmed a recent bullet-paced entry into the infamous “no shit Sherlock!” archive, that flavours are a major reason that children are attracted to vaping. Who could have ever guessed!

Vaping advocates shoot back that adults like flavours too, and that their widespread availability must never be impaired. Out of the other side of their mouths we then hear their pious concerns that children simply should not vape. You see, the health consequences of vaping apparently only occur in people under 18 years old, and magically stop when they turn 18 and 1 day.  Their ghoulish indifference for the collateral roadkill preparation they are helping foment is beyond contempt.