Subcommittee on oversight and investigations hearing will now come to order. Today the committee is holding a hearing entitled sounding the alarm, the Health Threats of ecigarette. The purpose oftodays hearing to examine the Public Health impact and regulatory authorities related to ecigarette manufacturing , sales and use. The chair recognizes herself for purposes of an opening statement. Our country is facing a serious public epidemic. One that is causing severe harm. This hearing will examine the cause of that epidemic, the uncontrolled and rising use of ecigarette and lifethreatening illnesses ripped the country and the use of ecigarette products young people sort, we must act to protect the American People from the myths and misunderstandings about these products. First, the data is now clear. Over the past several years seen an unacceptably high proportion of young people facing nicotine addiction. This year alone, more than 27 percent of High Schoolers report using ecigarette or vaping as it is also known. From 2011 to 2015 there was a 900 percent increase, 900 percent increase in youth vaping and from 2017 today the rate of High School Use double. The vaping epidemic and impact are personal to me. My home state of colorado has the unfortunate distinction of leaving the country in the vaping. A major factor exhibiting to the continued dramatic rise of ecigarette use among teenagers is the inundation of ulater products. Data from the centers for Disease Control and prevention indicates that 60 percent of students using ecigarette in the last month cited using popular fruit, menthol or make flavors young people turning to ecigarette also may have a false assumption he fox are safe or relatively harmless but contrary to many manufacturers claims, ecigarette pose risks to young people and can lead to addiction, harm brain development, affect respiratory health and can lead to heart disease. Additionally, these use increases the risk of use turning to conventional cigarettes. As much as we do know o, the more troubling concern maybe how much we dont know about these products. For example in some cases we dont even know what chemicals and toxins are being inhaled when vaping and in a very real sense the industry has launched a massive Public Health experiment on our country of which its outcomes and consequences remain unknown recent of serious vapingb of the demises how much we are in the dark aboutthese products. These illnesses numbering 530 so far and increasing daily have led to hospitalization, potential Longterm Health Complications and deaths s. While cdc and fda are here and i want to thank both witnesses and they will provide more information about the status of the investigation and what products may be the culprit, no specific causes of the illnesses yet been determined but these agencies engage in collaboration with partners, i have confidence that the root cause of this outbreak eventually will be identified. But even if the cause is isolated to a product told on the streets or the use of thc, we must keep in mind that brandon ecigarettes sold in storesare not harmless. This brings me to my next concern. Given the potential risks associated with these products, it would be eo reasonable to assume the ecigarette have been closely reviewed and approved by the fda but they havent. Ecigarette products are only on the market today because fda is temporarily giving them a pass bby exercising its Enforcement Discretion. Let me clear, no ecigarette currently on the market in the United States today has been fully reviewed by fda for its impact on Public Health. Fda needs to do its job, examine these products, tell the public what the risks are and how or even if they can legally be sold. In other words, fda must go forward with conducting its repeatedly delayed premarket reviews are all ecigarette products and determine whether the sale of the product is appropriate for the protection of Public Health. After years of the delays around the regulation of ecigarette, the administration recently announced that the fda would prioritize enforcement and clear the shelves of nontobacco flavored ecigarette products. I am encouraged by this but the fda needs to provide Additional Details adand a timeline for action. We have to ensure this policy will be implementedand enforced in a reasonable way. In the meantime, manufacturers, nothing is stopping manufacturers from submitting their applications to fda today. The burden is on the Cigarette Companies to he determine and demonstrate that these products meet the fdas Health Standards and regardless of the administrations recent announcement, legislative action is not off the table. I and others have introduced bills to tackle this Public Health priority including chairman alone whos been a steadfast leader on these issues. Based on the frontline of the youth epidemic have also been taking action on ecigarette, were going to hear some of their plans today. The industry has been swift to rail against efforts to restrict products , claiming they have helped adult smokers in quitting traditional cigarettes but that evidence is far from conclusive and fda has not approved ecigarette or cessation purposes. Any benefits to adult smokers has to be weighed against the generation of young people for which vaping represents an onramp to you. I want to thank the witnesses for their service and i look forward to hearing how we can Work Together very serious Public Health issue and i will yield to mister dockery from kentucky. Chair holding this hearing and i want to say i know a lot of our members are going to be have to be going back and forth for whatever reason , this committee scheduled two important subcommittee hearings at the same time so we had drug pricing upstairs and i think everybody thinks its an important issue and this is an important issue as well and a lot of members care membership in that subcommittee so i apologize were going tobe in and out. Im deeply concerned about the outbreak of lung illnesses associated with vaping. As well as the market, we need to understand the causes of this vaping illness and ensure ecigarette are not marketed to kids. It is important we understand the Health Implications of vaping and ecigarette used more broadly whether an adult is vaping thc derived from marijuana, nicotine or another arsubstance. So far the Available Evidence of the 553 reported cases of lung illness and eight deaths do not point to a conclusive cause. But the debt samples overwhelmingly suggest involvement of illicit ecigarette devices, the psychoactive ingredient in marijuana called thc and another blackmarket product. For example according to the centers for Disease Control patients have experienced lung illnesses have reported a history ofusing ecigarette products containing marijuana or thc. However, have reported using products that contain thc, marijuana with c nicotine while others have reportedusing products with nicotine. The operative illnesses the United States has a youth ecigarette epidemic. The most recent data from the Tobacco Survey shows 27 and a half percent of the youth reported using ecigarette compared with 20. 8 and 2018. The rate was only 11. 3 percent years ago. Thesetrends are unacceptable. A marketing of ecigarette products must be stopped and use access to products must be blocked more effectively. This epidemic is already driving legislation and giregulatory responses. Last september the fda issued more than 1300 warning letters to brickandmortar retailers who illegally sold products to minors and warning letters to ecigarette manufacturers about their plans to address you access. 18 states have increased the legal age to purchase Tobacco Products to 21. Michigan, new york and the district of columbiahave issued relations demand labor ecigarette. September 11, 2019 the Top Administration announced that the fda will finalize compliance policy to prioritize enforcement against the marketing of unauthorized nontobacco labor ecigarette including menthol cigarettes. With these responses, while these responses areaimed at reducing the attraction of ecigarettes to youth , they will almost certainly create blackmarket and in that vein we will need a response to that and address the growing trade in it was canadas marijuana vaping products. A New York Times article reported a recent bus of thc Oil Operation in wisconsin revealed an advance and mature illicit market from marijuana the cartridges and contaminated marijuana carts. I am told these illicit operations are using a tactic in other illegal drug operations, cutting their product with other substances including some that could be dangerous. Public Health Advocates said a particular cutting agent vitamin d acetate is an oil that could cause breathing problems and lung inflation if not meaningfully during the vaping process. Eaby using smaller amounts of the expensive thc or marijuana, and diluting it with oils thatcost much less , they can increase their profit by selling the product. Median grade thc costs 4000 a kilogram. But ideas may cost pennies on the dollar. These operations rely on thin factory by empty vape cartridges from chinese factories and fill them with thc liquid that they purchase from theUnited States market. The cartridges and packaging are available to purchase on the internet. While federal and state authorities are working on an Effective Response against team ecigarette use we must make sure our teenagers are educated. For example in Massachusetts Governor bakers administration launched a campaign to combat vaping and ecigarette use. In the Massachusetts Department of Public Health once the campaign to highlight the dangers of vape pens in 2018. These actions are commendable and i look forward to the results of these campaigns. With regard to adults trying to quit smoking somesuggest there less harmful than traditional cigarettes. According to the cdc ecigarette have a potential benefit on combustible cigarette for adult smokers but cautions ecigarette are not safe for use, young adults, pregnant women or adults not currently using Tobacco Products. Additional resources will look at the effectiveness. I want to thank eyewitnesses for being here on both panels and i look forward to this important discussion. Ideal back. Chair recognizes the chairman of the full committee misterpollard for five minutes. I want to thank chairwoman get for having this very important hearing today. Were examining a growing Public Health crisis involving ecigarette and the proliferation of these products among kids and teenagers and im deeply concerned about the recent outbreak of lung illnesses that have killed eight people and sickened more than 530 in the us. Im also frustrated by the fact that the usage has reached epidemic proportions in recent years among kids. If you talk to any parent of High School Students you know our missions ecigarette problems real and getting worse and its past time for public agencies to address vaping and ecigarette usage in a meaningful way. I look forward to hearing about what the fda and cdc and tell us about how theyre addressing the tragic mysteryb and the recent actions to combat youth ecigarette use but make no mistake, i firmly believe many aspects of the youth vaping epidemic could have been addressed if the fda had moved forward with reviewing all ecigarette on the market when they had the chance two years ago. Instead in july 2017 the fda announced it would delay implementation of key provisions of the agencies final rule which ensured the agency will review all ecigarette products on the market. That same day i issued a statement expressing the concerns that the delays would mean products would continue to lack needed publichealth oversight for several years and risk continued exposure to a new generation and here we are over two years later and unfortunatelymy concerns have come to fruition. That decision youth ecigarette usage has skyrocketed one in four high t School Students have used ecigarette in the past 30 days. These products have been targeted to kids without our knowledge of the Health Consequences and as a result we can lose an entire generation to a lifetime of nicotine addiction. At the same time hundreds of people throughout the country have their love unknown lung illnesses following the usage of Vape Products and in many instances these products were manipulated beyond the products intended use but it still remains unclear what these products contain and how they were manipulated. Lack of certainty on the root cause of these illness speaks to a larger problem. We do not know the full spectrum of consequences associated with the use of ecigarette and years ago the family smoking prevention control was signed into law after coming out of this to me. Tit gave the fda the tools it needed to regulate all Tobacco Products but unfortunately that has not happened. Its critical that fda and cdc explain what actions theyre taking and what more we can be doing to protect consumers and i also look forward to hearing states that have forced their own responses in the wake of action at the federal level the wide availability of flavored products designed for kids consumption are putting the interests of industry the health of our kids. Im pleased the administrations announcement that it plans to pull all flavored products from the market until they undergo full fda review but i believe that man should occur sh immediately. Above all else we must get the bottom of what is causing these illnesses and ensure that Vape Products are kept out of the hands of our kids and at the same time its become clear we must end new comprehensive legislation to address this growing youth epidemic. We must eliminate flavors, prohibit online sales and easy for kids to buy ecigarette and ensure these products are not being marketed to anyone under age. My legislation in reversing you tobacco epidemic act is also raising the age to 21 provide Tobacco Products. Its my intention to move this legislation forward and i hope it will receive the strong bipartisan support deserves. Its long past time to address the Public Health risk associated with ecigarette and we have to use every tool at our disposal to solve this crisis and although its true as i mentioned we want to move legislation i think its very important for the oversight and investigations subcommittee to find out whats happening and what the agencies aredoing. Whats causing this epidemic so i really appreciate the fact that youre having this hearing. I think we need to have this hearing as much as i want to move forward with legislation, we need to have this hearing toget to the bottom of this so thanks again. Ideal back. The chair recognizes the Ranking Member of the full committee Mister Rollins for five minutes. Thanks for holding this hearing. Electronic cigarettes for ecigarette, the current outbreak of illnesses associated with ecigarette and the youth vaping are a Health Concern and particularly in my state of oregon. In recent weeks and as yet unidentified young one the list is killed seven people, ansickened more than 500 across 38 states. As we will hear from doctor Anne Schuchat today the causes unknown but it appears to be vaping related. Many individuals seem to have used blackmarket products that contain thc. Earlier this month Public Health officials in oregon announced a person who died in july of severe respiratory illness and use any ecigarette containing Marijuana Oil purchase from a licensed dispensary meeting that product sold in the store should have gone through a Testing Process regulated by the state of oregon. It was the first death in the us tied to a vaping product by a maryland teshop. What is unknown including which dispensary sold the product and whether it was contaminated or whether something was added into the device after the purchase. In july and 18yearold young man went to a hospital complaining of reading problems. In 40 hours it was the intended unit, diagnosed with respiratory distress and conditions associated with lung injury. It was connected to a breathing tube and placed in a medically induced,. The patients mother found and ecigarette cartridge from a Company Based in california that sells thc products but the cartridge later was found to be a counterfeit of that companys product. In North Carolina five individuals bought the Marijuana Oil that made them sick on the street from unlicensed dealers. All five hospitalized, three in intensive care and it took a battery of tests to figure all five had acute lipid pneumonia and lung inflammation caused by breathing oil. Luckily the individuals in new york survived but not all have been so lucky including the individual from organ