But none of that mattered to Paul Lubell when he decided to try vaping. He wasn’t thinking about pleasure; he was trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain.

Unfortunately, it wasn’t long before he became part of the national statistics tracking an outbreak of a vaping-related lung illness that has more than 50 Americans and sickened 2,400. Lubell ended up in the hospital, seriously ill from vaping an oily liquid containing extracts of THC, the psychoactive ingredient in marijuana.

Lubell, who lives in the Cleveland suburb of Beachwood, is older than most of those who have contracted what is now being called “e-cigarette or vaping associated lung injury,” or EVALI.

Three-quarters of patients with the condition have beenÌý; Lubell is 59.

But like patients in the majority of those cases, he used THC. And the latestÌýÌýsuggests that it’s some added ingredient in THC vapes — likely vitamin E acetate — that is causing the lung disease. The CDC is warning people to stop vaping altogether, given the risk of lung illness, which puts people who vape to manage pain in a tough position.

‘My Pain Would Be Gone’

Lubell suffers from pain in his back, neck and knees. He is not sure when his problems started, but he wonders if they are related to his days on a Navy helicopter rescue team.

“It was fun. I was indestructible and good at what I did. Everybody wanted me,” he recalled, while looking at photos of his much younger self posing on top of one of the helicopters.

Lubell sometimes jumped out of the helicopter and smacked into the water during training and rescue missions. That could have been the genesis of some of his back pain, he said. Lubell has had two back surgeries, and he also suffers from serious neck pain. Every day is a struggle, he said.

Looking for relief, he has tried many medications, including opioids such as hydrocodone, but that drug is no longer an option. Lubell is a patient atÌý, and in the wake of the national opioid addiction epidemic, the VA has revised its pain-treatment protocols.

“The VA is not a friend of opioids at all,” Lubell said. “Unless you’re coming out of the hospital for surgery or something like that, they do not give vets opioids.”

“It leaves someone who is in chronic pain in a very tough situation, having to decide how to deal with it,” he added.

Lubell started using an electronic cigarette device paired with prefilled THC cartridges. Medical marijuana is legal in Ohio, as it is inÌý, plus the District of Columbia.

“When I say it took away pain — it was almost instantaneous,” he said. “Within the span of 10 minutes, my pain would be gone. … It made me capable of doing my daily activities.”

Lubell described his old vaping cartridges as tiny sticks that screwed on top of the vaping pen. When he inhaled at one end of the pen, it pulled the THC extract and other liquids in the cartridge over a heating element. Vaping was different from when he had smoked marijuana, Lubell said.

“It doesn’t have a stench to it. You could do it out on the streets. It doesn’t have that — what’s the word I’m looking for? — stigma,” he said.

Hospitalized With Cough And Fever

Lubell purchased the THC cartridges from a friend at what he described as a below-market price. A few months later, in July, Lubell started running a very high fever and went to the Cleveland VA Medical Center.

“He had this cough that was persistent. He just looked very, very sick,” recalled Dr. Amy Hise, who was on the team of physicians that treated Lubell.

“He was put on very strong broad-spectrum antibiotics, and yet he continued to have fevers. He continued to feel unwell. He had very flu-like symptoms,” Hise said.

After a few days, Lubell seemed to improve and was released, according to Hise. But then, he grew ill again.

Hise said she was surprised when he came back to the emergency department in late August.

By then, however, she had seen a new alert from the CDC about the vaping illness. Lubell had also seen reports in the media about health problems related to vaping.

“He was forthright that he had been vaping, and indeed what had happened is when he was in the hospital before, he’d stopped vaping,” Hise said. “He stopped for a period of time until he started to feel better. And then he started it up again, and that’s when his lung disease came back.”

The doctors at the VA switched tactics, taking Lubell off antibiotics and starting him on steroids, based on information provided by the CDC. Lubell was soon released and on the road to recovery.

No More Vaping

Even though vaping eased his pain, those two bouts of respiratory sickness were too much. Lubell said he won’t vape again, and his doctor endorsedÌýthat decision.

“I think there’s just too much that’s not known about what’s in these products to safely use them,” Hise said.

But Lubell is not alone in having turned to marijuana for pain management.Ìý, a pain management specialist at University Hospitals, said many patients have told her they are trying marijuana to see if it will help.

“That is probably something that I get from patients every day,” Lawrence said. “And it’s not just people who are young, in their 20s. [There are] people in their 80s who are telling me they are looking to try anything to help with their pain.”

Even though some patients say marijuana helps their pain, there is not enough research to prove it’s broadly and reliably effective, Lawrence said.

“Personally, I don’t recommend it for my patients. But maybe after we have more studies, it can be something in the future” she said.

Lubell, who has an Ohio medical marijuana card, is still planning to use marijuana — but he won’t vape it. He turned over his equipment and leftover THC cartridges to health officials for analysis.

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Los arrebatos violentos provienen de los mismos pacientes y de sus familias. Y durante años, se han considerado como un “efecto secundario” del trabajo en salud.

Cuando una persona llega al departamento de emergencias de la Clínica Cleveland, ya sea como paciente, familiar o amigo, una señal grande dirige a los visitantes hacia un detector de metales.

Un oficial inspecciona todas las bolsas y carteras, y luego indica que la persona camine a través del detector de metales. En algunos casos, se usa una vara de metal, incluso en pacientes que llegan en camilla. Los funcionarios de la clínica dicen que confiscan miles de armas al año: cuchillos, gas pimienta y pistolas. Los detectores de metales se instalaron en respuesta a lo que llama una epidemia.

“Hay un problema muy fundamental en la atención médica de los Estados Unidos del que muy pocas personas hablan”, dijo, “y es la violencia contra los trabajadores de salud. Literalmente a diario, cada día, estamos expuestos a arrebatos violentos, en particular en las salas de emergencia”.

Muchos trabajadores de salud dicen que el abuso físico y verbal proviene principalmente de pacientes, algunos porque están desorientados debido a una enfermedad o medicamentos. A veces, el abusador es un miembro de la familia, furioso y frustrado porque un ser querido está muy enfermo.

La Clínica Cleveland ha introducido otras medidas de seguridad, como botones de pánico inalámbricos insertados en las tarjetas de identificación, y más cámaras de seguridad y agentes de civil en las salas de emergencia.

Pero estos incidentes no se limitan a zonas de urgencias.

Allysha Shin es enfermera registrada en la unidad de cuidados intensivos de neurociencia en el Hospital Keck de la Universidad del Sur de California en Los Ángeles. Uno de los incidentes más violentos que ha experimentado sucedió cuando estaba cuidando a una paciente que tenía una hemorragia cerebral.

La mujer ya había atacado a otro empleado, por lo que había estado atada a la cama, dijo Shin. Pero se logró soltar, y la pateó y golpeó en el pecho, antes de lanzarle un puñetazo a la cara.

“Hubo un momento en el que perdí el balance, pero pude esquivar el golpe. Si no lo hubiera esquivado, podría haberme noqueado”, dijo Shin. “Y muy bien podría haberme matado”.

El momento dejó a Shin conmocionada y ansiosa, incluso cuando volvió a trabajar días después. Todavía le vuelven imágenes de la agresión.

Shin contó que antes solía ​​tener miedo de hablar sobre este tipo de ataques, por lo que ella define como una cultura de aceptar la violencia en la mayoría de los hospitales. “Se espera que vayas a recibir una paliza de vez en cuando”, dijo.

Según la Administración de Seguridad y Salud Ocupacional (OSHA), los incidentes de violencia grave en el lugar de trabajo son en la atención médica que en la industria privada. Y una encuesta realizada por el en agosto encontró que casi la mitad de los médicos de emergencia respondieron que habían sido agredidos físicamente. Más del 60% dijo que el asalto había ocurrido en el último año.

Los grupos que representan a médicos y enfermeras dicen que, si bien las mejoras de seguridad que algunos hospitales han implementado voluntariamente son un buen primer paso, se debe hacer más.

Aún hay un código de silencio en la atención médica, dijo Michelle Mahon, representante del sindicato National Nurses United. “¿Qué pasa si lo reportan?”, se preguntó. “En algunos casos, desafortunadamente, se los trata como si fueran ellos o ellas los que no saben cómo hacer su trabajo. Se los culpa de que haya sucedido”.

“Hay mucho enfoque en las técnicas para desacelerar y controlar el momento violento”, agregó Mahon. “Esas son herramientas útiles, pero a menudo se usan para culpar a los trabajadores”.

En California, el sindicato de enfermeras presionó por una ley que otorgue a OSHA más autoridad para monitorear la seguridad del hospital. El grupo ahora está respaldando un esfuerzo nacional para hacer lo mismo. “El estándar que estamos recomendando a nivel federal responsabiliza al empleador”, dijo Mahon. “Se exige el reporte de incidentes y transparencia”.

La , presentada el otoño pasado en el Congreso, requeriría que los hospitales implementen planes para prevenir la violencia. Y cualquier hospital podría enfrentar multas por no informar incidentes a OSHA, dijo Mahon.

El objetivo de la legislación, y del sindicato, es responsabilizar a los administradores por los actos de violencia en sus hospitales.

Esta historia es parte de una asociación que incluye a , y Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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The violent outbursts come from patients and patients’ families. And for years, it has been considered part of the job.

When you visit the Cleveland Clinic emergency department — whether as a patient, family member or friend — a large sign directs you toward a metal detector.

An officer inspects all bags and then instructs you to walk through the metal detector. In some cases, a metal wand is used — even on patients who come in on stretchers. Cleveland Clinic officials say they confiscate thousands of weapons like knives, pepper spray and guns each year. The metal detectors were installed in response to whatÌý calls an epidemic.

“There is a very fundamental problem in U.S. health care that very few people speak about,” he said, “and that’s the violence against health care workers. Daily — literally, daily — we are exposed to violent outbursts, in particular in emergency rooms.”

Many health care workers say the physical and verbal abuse come primarily from patients, some of whom are disoriented because of illness or from medication. Sometimes nurses and doctors are abused by family members who are on edge because their loved one is so ill.

Cleveland Clinic has introduced other safety measures — such as wireless panic buttons incorporated into ID badges and more safety cameras and plainclothes officers in ERs.

But these incidents aren’t limited to emergency rooms.

Allysha Shin works as a registered nurse in neuroscience intensive care at the University of Southern California’s Keck Hospital in Los Angeles. One of the most violent incidents she has experienced happened when she was caring for a patient who was bleeding inside her brain.

The woman had already lashed out at other staff, so she had been tied to the bed, Shin said. She broke free of the restraints and then kicked and punched Shin in the chest — before throwing a punch at her face.

“There was this one point where she swung, and she had just glanced off the side of my chin. If I hadn’t dodged that punch, she could have knocked me out,” Shin said. “And she very well could have killed me.”

The encounter left Shin shaken and anxious when she returned to work days later. She still has flashbacks.

She used to be afraid to speak about these types of attacks, she said, because of what she calls a culture of accepting violence in most hospitals. “It is expected that you are going to get beat up from time to time,” Shin said.

According to the Occupational Safety and Health Administration, incidents of serious workplace violence areÌýÌýmore common in health care than in private industry. And a poll conducted by theÌý in August found nearly half of emergency physician respondents reported having been physically assaulted. More than 60% of them said the assault occurred within the previous year.

Groups representing doctors and nurses say that, while the voluntary safety improvements that some hospitals have enacted are a good first step, more needs to be done.

There is still a code of silence in health care, said Michelle Mahon, a representative of the labor group National Nurses United. “What happens if they do report it?” she said. “In some cases, unfortunately, they are treated as if they are the ones who don’t know how to do their job. Or that it’s their fault that this happened.”

“There’s a lot of focus on de-escalation techniques,” Mahon added. “Those are helpful tools, but oftentimes they are used to blame workers.”

In California, the nurses’ labor union pushed for a law giving OSHA more authority to monitor hospital safety. The group is now backing a national effort to do the same thing. “The standard that we are recommending federally holds the employer responsible,” Mahon said.Ìý“It mandates reporting of incidents and transparency.”

TheÌý, introduced last fall in Congress, would require hospitals to implement plans to prevent violence. And any hospital could face fines for not reporting incidents to OSHA, Mahon said.

The goal of the legislation — and of the union — is to hold administrators more accountable for acts of violence in their hospitals.

This story is part of a partnership that includes , and Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).