E-Cigarettes and Ethanol: A Forensic Perspective on Vaping

I had gone across the street to get a cup of coffee in a convenience store, and the store had e-liquids and pods on the consumer side of the cash register. This is an important point. Tobacco products are on the cashier’s side of the cash register. You have to ask for the product. Vaping products are on the consumer side, which is dangerous and results in theft, particularly from children.

I was rifling through out of curiosity. We are used to seeing bubblegum-flavored vape products and so on, but somewhere in the middle of the box was something called whiskey-flavored. I thought, is that just going to be caramel or vanilla, or has that been flavored with whiskey?

I purchased it, took it back to the lab, and analyzed it. It contained ethanol. I told my students, “The most important thing you will do today is analyze every single product we have here for ethanol.”

That is when we found that some of the products in our lab at the time contained as much as 20% ethanol. We were stunned by that. It was not surprising that there would be trace ethanol because most of the flavoring chemicals are in a solvent. But 20%?

Since then, that work has been published, and we have found that some e-liquids contain as much as 30% ethanol. As forensic toxicologists, we got very concerned about the administration of the breath test.

When drinking ethanol, it goes to the gut, which serves as some protection. If you inhale ethanol, it bypasses the gut and goes straight to the brain. Perhaps this could cause momentary nausea, dizziness, or impairment. Or does it create any issues with breath testing or the field sobriety test? We went back to the NIJ and said, “We need to do a study where we have people vape ethanol.” They funded a project where we had participants come in and vape either a 0% or a 20% ethanol vape.

When law enforcement administers the breath test, there is a protocol that says that they need to have a period of time where they have eyes on the subject. They have to watch that person for 15 to 20 minutes to make sure that they have not belched and that they do not have anything in their mouth because they want to be able to measure the ethanol that is coming from their deep lung tissue.

However, other agencies that administer the breath test often do not honor that 15—to 20-minute wait period or a deprivation period. We were concerned that if somebody has been vaping and you are not going to observe that 15—to 20-minute wait period, you are going to have a positive on the breath test. That turned out to be true. We have tried to educate people on this to make sure they employ a depravation period.

This was not anything that we did not expect, but it is so important to get the research into the scientific literature because we know some attorneys tell clients, “I can help get you out of a DUI if you admit that you vape.” If somebody was truly impaired at the time they were driving, then they need to be accountable for that.

What did it look like for the individuals who had that higher percentage of ethanol vape? What behaviors did they exhibit?

The participants took a series of quizzes in which we asked how they felt, if they felt sick, and if they felt talkative. The data showed no trends, but a handful of subjects said, “Yes, I feel impaired. I would not drive.” We had some subjects get very dizzy, and some felt very sick.

While the study demonstrated that there was no definable trend, from the perspective of that one driver who feels impaired, they could get behind the wheel of a car and then potentially kill somebody. One person is significant, whether a trend exists or not.

Communities and consumers need to be thoughtful about this, and regulatory agencies should require that all products have ingredients listed on them, including ethanol. In all of our studies, in the thousands of products we have tested, we have only found one or two that had ethanol labeled.

Regarding your talk here at Pittcon, your abstract mentioned the identification of a variety of chemicals in e-liquids with known health and safety implications. How significant is the presence of these chemicals, such as ethanol, in terms of public health?

Let us discuss all of the other ingredients in vapes, aside from the drug or the pharmacologically active substance. Propylene glycol and vegetable glycerin, the major humectants in vapes, are hygroscopic, meaning they attract water. Your deep lung tissue has a layer of water in it, and that layer of water facilitates oxygen and carbon dioxide exchange.

If you inhale those two chemicals, they will dry out that deep lung tissue, creating irritation and inflammation. That person may exhibit characteristics ranging from a hacky cough to popcorn lung.

There are some significant issues with those two chemicals. When you think about all of the other chemical ingredients in the vapes, the concern is that their hazard classifications indicate that most are irritants, toxins, or carcinogens to lung tissue. So, the propylene glycol and the vegetable glycerin create irritation in deep lung tissue, and then we add another irritant to that.

I do not think we are capturing data on health surveys thoroughly enough. Somebody shows up to a health check with a rattly cough, and often they are just told they have a cold or the flu, when in some instances, the person vapes, and vaping could be the cause.

We have worked on a couple of cases where somebody has been reported as having these flu-like symptoms. There was a soldier with cyclical symptoms over about a year and a half. He would stop vaping because he did not feel well, and in doing so, he began to get better. He resumed vaping, and he’d feel sick again. He reported a rattly cough to the medic, and they told him to drink plenty of fluids and rest. In the end, the case came to us because both of his lungs collapsed, and he was in a coma. There was nothing unusual about the products, but he was injuring his lungs. In the end, he survived, but this is deeply concerning. He was not able to make an informed decision about what he was inhaling.

We have spoken to medical professionals and told them to start asking if people are vaping. We have to get better from a health perspective: physicians and nurses need to ask questions.

What steps do you believe should be taken to address this particular issue, the gaps in product labeling of e-liquids?

The FDA has a process where they evaluate products and put their stamp of approval on them, providing they meet certain requirements. I think a couple of things need to happen. First, we need to have better education and surveillance of products in the marketplace. The FDA currently approves seven or eight products out of 9,000 in the marketplace. We have to identify all those products, talk to manufacturers, and get them taken off the shelves.

The FDA has to move faster because there may be a reason why companies are not pushing their products through the regulatory process. Perhaps it is burdensome, takes a long time, or is expensive. We have to get more regulated products into the marketplace—products with labeling and transparency of ingredients – and a limited list of approved chemical ingredients —and carry out better compliance evaluations.

What are the technologies that you typically use in the forensic lab to investigate the composition of these e-liquids?

We have a pretty standard slate of instruments that are used in general forensic chemistry laboratories. One of the missions of my research lab is to support crime lab work and forensic science. We share all of our methods with crime labs so that they can adopt different methods as analytical needs evolve or shift.

We have an array of analysis equipment: time-of-flight mass spectrometry, gas chromatography, mass spectrometry, liquid chromatography with tandem mass spec, and GCs with FIDs for volatiles analysis.

Are there any technological advancements you see as being particularly impactful in this particular area of study?

One of the things that we have come to conclude in my research lab, and this happens generally in crime labs, is that a single technique is not going to get you all of the answers that you need. We use all of those instruments together. We use one instrument to get one answer, and then we confirm that using another. There is not necessarily one that has been most important. They all have equal importance in the lab, and we use them as a suite.

What are the next steps for you and your research in this area?

We have a second human subjects study ongoing right now. We are concerned about drug courts. Some school systems are conducting drug tests to ensure kids are eligible to play sports. Substance-use treatment and prevention clinics are collecting biologicals. So, in this study, the goal is to see whether we can tell how vaping ethanol acutely affects the biomarkers of ethanol. However it is consumed, the biomarkers of ethanol are going to be in your biological tissues. 

Say somebody has not been drinking alcohol. They show up to give a urine, blood, or oral fluid sample, and it comes back positive for the biomarkers of ethanol. Is it reasonable that they had those biomarkers in those tissues from vaping ethanol? That is what we are looking at now. This is one reason why people need to be able to make informed decisions. If someone is unknowingly vaping ethanol, they could violate a policy or conditions of employment or probation.

We are collecting breath, oral fluid, blood, and urine samples to evaluate six ethanol biomarkers. Some of the biomarkers are standard in forensic toxicology, but a different slate of biomarkers is used in clinical toxicology. We are going to look at those biomarkers in relation to each other to see if we can tweeze out anything regarding the impact of vaping ethanol.

Are there any specific areas within this study of e-cigarettes as a field that you are particularly excited to see evolve in the coming years?

My research team has been very progressive. We were some of the first ones to talk about how e-cigarettes can be used to vape other substances. One of the presentations this week is about ethyl acetate, a really common solvent used as an affirmative defense, which meant that we could not rule out vaping as the reason why somebody was positive for ethanol.

We are concerned about the advice given in drug user forums. We continue to be concerned about children getting access to vapes containing solvents. We are also concerned about the unregulated products in the marketplace. So, we will continue down the path we are on.

The biggest question for me is how I get this information into communities. If I cannot change the system from the top, I will work from the bottom and hopefully influence policy, resulting in some restrictions and education. We are currently looking into funding to develop educational programs that will make our research and data easy for communities to understand.

As we mark the 75^th anniversary of Pittcon, could you share your first memory or experience of attending this conference and how it impacted your view of the scientific community?

Pittcon has been a great forum for the NIJ. It is great exposure for allowing other scientists to see how advancements can be used to help criminal justice and forensic science purposes. There has been so much evolution. While it is going to be years before forensic science might adopt some technologies or advancements, research scientists like myself are always looking for new ways to help science support the court systems.

One of the reasons you come to PittCon is the diversity of industries. One of my first experiences at Pittcon was being heckled by the tobacco industry in the middle of my oral presentation – which is entertaining in retrospective. Some in the industry were very upset by what we were presenting.

When we first found ethanol, we went to a meeting to talk about our research, and a lot of Big Tobacco representatives were there in this forum. Somebody asked the question, “Is there ethanol in any of these products?” Across the board, the representatives from Big Tobacco said there was not. Meanwhile, I was about to get on stage and present, “Look at all the ethanol we found in products.” I am okay with the confrontation.

What have you been most looking forward to about Pittcon 2024 in San Diego?

One of the reasons why we appreciate coming to Pittcon is that we get to see the vendors that help support our research projects. Most of them will come to the forensic science conferences, but it is good to see them in a different space.

Sometimes, they will roll out cooler, newer things at a conference like this because there are so many other industries here that embrace cutting-edge ideas. It is fun to see them in this element, and we highly value those relationships. Sometimes, it sparks different conversations for us.

With some of the instruments and equipment that we have seen here, we will talk to the companies and ask them to demo them and discuss them more. The vendors that we work with have been very open to hearing our problems and suggestions, and they provide our feedback to the company. These relationships are very valuable, and science will not progress without them.

One of the other reasons why we love coming to Pittcon is that you see the future.

About Professor Michelle Peace

Dr. Peace is an internationally recognized forensic toxicologist and a Full Professor in the FEPAC-accredited Department of Forensic Science at Virginia Commonwealth University and is one of the founding faculty for the Department. She served as Associate Chair and Chair for nearly a decade. She has been funded by the National Institute of Justice to study the efficacy of electronic cigarettes, particularly as they pertain to substance use and abuse. Her research has highlighted emerging issues of electronic cigarettes as a tool for vaping drugs other than nicotine. Her current projects are a human subjects study to assess the impact of vaping on drug testing roadside impairment evaluations for suspected DUI and to evaluate emerging synthetic cannabinoid analogs in unregulated cannabis marketplaces. She is also funded by the Virginia Foundation for Healthy Youth to analyze vaping products confiscated and collected on school properties across Virginia. 
Dr. Peace is a Past President of the Society of Forensic Toxicologists and is a member of The International Association of Forensic Toxicologists and is a Fellow in the American Academy of Forensic Sciences. She is a member of the National Safety Council’s Alcohol, Drugs, and Impairment Division. She was recognized by VCU’s College of Humanities in Sciences for Distinguished Mentoring and nationally for Excellence in Teaching and Mentoring by the Society of Forensic Toxicologists. 

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