A top official with the Centers for Disease Control and Prevention warned federal lawmakers Tuesday that a new generation of e-cigarettes now on the market is "even more addictive," than early versions of vapes, and the number of vaping-related lung diseases is continuing to rise.
"We are seeing more and more cases each day," the CDC's Dr. Anne Schuchat told lawmakers at a hearing of the House Committee on Oversight and Reform that is looking into the recent national outbreak.
Ruby Johnson, the mother of a college-aged student hospitalized last month with severe respiratory problems linked to vaping, also testified at the hearing. Teens have been used as guinea pigs, she told the members of Congress.
"These products flooded the market without anyone knowing how they would cause damage, and now we're trying to clean up a mess that involves a cocktail of mystery toxins and proprietary flavors," Johnson said. "If this was romaine lettuce, the shelves would be empty."
Tuesday's was the first of two days of public hearings on vaping's risks, and comes as the state of Massachusetts has announced it will ban the sale of all vaping products for the next four months. Meanwhile, the Trump administration is considering a federal ban on flavored e-cigarettes.
So far, at least 530 people in 38 states have been sickened with vaping-related lung disease. Most have been hospitalized, and many have needed medical assistance to breathe. Many of the patients are young adults who were otherwise healthy.
"I believe that probably hundreds more [reports of cases] have come in since the numbers we released last week," Schuchat told members of the House committee.
Johnson said her daughter's experience was terrifying. "I'll never forget watching her cry that she literally couldn't breathe without excruciating pain," Johnson said.
Though her daughter's health has since improved, she said, the risk to teenagers — and others — who vape continues.
The cause of the outbreak is still unknown. So far, no single substance or product is linked to all the illnesses. While the investigation is ongoing, the CDC continues to warn people against the use of e-cigarettes.
"We know that people are dying in this outbreak — and we really want people to protect themselves," Schuchat testifed.
So, far, many of the patients who have gotten sick have acknowledged using THC — the psychoactive component in cannabis.
"There may be people out there who would like for this to be a THC-only problem — so they can go back to vaping nicotine e-cigarettes, said Rep. Raja Krishnamoorthi, a Democrat from Illinois, during the hearing.
But Krishnamoorthi pointed out that some of the patients who've gotten seriously ill have said that they've only vaped nicotine products. "Do we still need to be concerned about all e-cigarettes at this point? " he asked Schuchat.
"At this point, caution regarding all products is recommended," Schuchat responded.
She said this outbreak reinforces the need to address the vaping epidemic among teens and young adults in the U.S.
At a time when the prevalence of vaping has been on the rise among high school students, Schuchat says the latest generation of e-cigarettes has a higher level of available nicotine than versions sold previously.
"We know that the products out there have changed a lot, Schuchat said. "The newest generation of e-cigarettes seems to have a number of factors that make it even more addictive." When asked to elaborate, Schuchat pointed to a specific concern.
"Juul and related products use nicotine salts, which can lead to much more available nicotine. We believe the product can cross the blood-brain barrier and lead to, potentially, more effect on the developing brain in adolescence," Schuchat explained.
She said the CDC is extremely concerned about flavors in e-cigarettes, and "the role they play in hooking young people to a life of nicotine."
"We really want to avoid another generation being addicted to nicotine," Schuchat says. She pointed to a range of possible harms — from attention and memory problems to the role nicotine can play in increasing the risk of addiction to other substances.
As for adults who are trying to stop smoking cigarettes by switching to e-cigarettes, Rep. Carol Miller , a Republican from West Virginia, said during the hearing that she thinks it's important to consider this use of vaping as a "harm reduction" approach.
"We can both prevent children from using e-cigarettes, while also ensuring that they remain available for those adults who are choosing to quit smoking," Miller said.
The committee heard from a former smoker who said she successfully quit cigarettes by switching to vaping.
However, the chief medical officer of the American Lung Association, Albert Rizzo, who also testified at the hearing, said that "switching is not quitting" if you're still using nicotine.
"The FDA has not found any e-cigarette to be safe and effective in helping smokers quit," Rizzo said. And, public health officials have urged people who smoke cigarettes to use cessation products approved by the FDA. E-cigarettes are not approved for smoking-cessation.
The hearings are to continue Wednesday, with lawmakers scheduled to hear from the FDA, the agency that regulates e-cigarettes.