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November 12, 2019

On November 8, the Centers for Disease Control and Prevention (CDC) issued a Morbidity and Mortality Weekly Report (MMWR) that noted vitamin E acetate may be the chemical agent that is causing recent vaping-related lung injuries.

The report was “[b]ased on data collected as of October 15, 2019.” CDC used data from 10 state health departments (California, Connecticut, Hawaii, Illinois, Maryland, Michigan, Minnesota, Texas, Utah, and Wisconsin) that included detailed health records on 29 patients. Vitamin E acetate was found in all 29 patient samples. Further, 23 patients “self-reported” using vaping devices containing tetrahydrocannabinol (THC). THC was also detected in “three patients who said they did not use THC products.” Nicotine metabolites were found in 16 of 26 patient samples.

Although the report finally offers some insight into the specific chemical agent that could be causing recent vaping-related lung illnesses, it is rather late, as state health departments linked vitamin E acetate in September, 2019. Moreover, it is alarming public health agencies continue to rely on self-reporting, especially given in the latest MMWR, THC was found in patients who claimed no use of THC-vaping cartridges.

On September 5, the New York State Department of Health (NYDOH) reported lab results “showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” Since September, NYDOH investigated the health effects of vitamin E acetate “when inhaled because its oil-like properties could be associated with the observed symptoms.”

The Utah Department of Public Health (UDPH) announced on September 16 the state’s Public Health Laboratory tested 39 vaping products, including 19 THC-containing cartridges and 20 nicotine-containing products. Vitamin E acetate was detected in 90 percent of the THC-cartridges, whereas 100 percent of nicotine-containing liquids “contained nicotine and none have shown unexpected compounds.”

Although the specific effects of vaping vitamin E acetate are still unknown, the substance is a lipid, or oil, which is “highly toxic and [has] been associated with lung injury for years.” 

The role of THC-containing devices in recent vaping-related lung illnesses has been widely reported by other health departments. Connecticut, Minnesota, Oregon, and Texas have all found that patients with vaping-related lung injuries self-reported use of THC vaping products. In late August, the Wisconsin Department of Health Services reported 89 percent of patients who had been interviewed “reported using e-cigarettes or other vaping devices to inhale THC products.” 

Further, an October 15 CDC report found 78 percent of patients with lung illnesses associated with e-cigarettes reported vaping THC-containing devices, and only 10 percent self-reported “exclusive use of nicotine-containing products.”

Teen use of THC vaping devices is rising. According to the Oregon Health Authority, “[y]outh vaping of marijuana increased 295 percent – from 11 percent among [Oregon]11th graders using marijuana – between 2017 and 2019.” A 2018 The BMJ study analyzing the results of the 2017 North Carolina Youth Tobacco Survey estimated “[a]pproximately 1 in 10 high school students reported ever vaping cannabis in the overall sample.”

Use by adults and youth of THC cartridges is deeply problematic because many consumers use illicit and illegal devices purchased on unregulated black markets. Once again, these products are not regulated and contain many unknown chemicals. A September NBC News study tested “15 black market cannabis vape carts,” finding 13 of the cartridges “came back positive for containing Vitamin E acetate.”

A September 6 report in The New England Journal of Medicine examined vaping-related hospitalizations in Illinois and Wisconsin; in these cases, 21 of 41 patients reported “using a THC product … marketed under the ‘Dank Vape’ label.” UDPH noted that 38 percent of self-reporting patients in Utah used Dank Vapes prior to their lung illnesses. Dank Vapes is an illegal, unlicensed brand that simply acts as a packaging company, and does not manufacture legitimate THC vaping products regulated by state governments.

In order to address recent vaping-related lung injuries, many states are issuing bans on the sales of flavored e-cigarettes and vaping devices. Although addressing vaping-related illnesses is laudable, policies such as flavor bans don’t impact the true culprit: illegal devices containing THC.

Despite recent fear mongering, e-cigarettes and vaping devices are tobacco harm reduction tools that have helped an estimated three million American adults quit smoking since 2007. Further, they are twice as effective as nicotine replacement therapy in helping smokers quit. The American Cancer Society notes e-cigarettes are “significantly less harmful” than combustible cigarettes. Even better, their use can reduce state health care costs. An analysis by State Budget Solutions estimates Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who currently consume these products.”

Lawmakers should refrain from knee jerk reactions to address recent vaping-related lung illnesses. As more information continues to link recent adverse health issues to illegal products, it is imperative lawmakers do not limit access to tobacco harm reduction tools.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.

Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC: Welcome
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