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October 25, 2019

On October 17, the Tennessee Department of Health (TDH) reported “a patient with serious respiratory disease associated with use of electronic cigarettes or other vaping devices” passed away. On August 22, TDH issued an alert, “asking health care providers … to report any cases of suspected respiratory illness[es]” believed to be caused by vaping. On September 9, TDH identified six possible cases of vaping-related lung illnesses. As of October 17, TDH has identified “53 lung injury cases associated with e-cigarette use or vaping.”

Of the 53 patients, 66 percent are male, and the “median age of patients is 24 years old and ages range from 16 to 56 years.” TDH does not provide any information on what type of vaping devices were used by these patients prior to their illnesses. However, TDH does note, “national data suggests the products containing [tetrahydrocannabinol] THC … are linked to most of the cases and play a major role in the outbreak.”

TDH’s lack of transparency surrounding vaping-related lung illnesses is alarming. Further, the death reported in Tennessee was a Minnesota native who admitted to vaping devices containing THC and cannabidiol (CBD) oils.


Although many states and the Centers for Disease Control and Prevention (CDC) have linked hospitalizations to illegal, unregulated THC vaping devices, several state health departments (including TDH) are fueling the fearmongering campaign regarding the use of e-cigarettes. Unfortunately, many state health departments (including TDH) are undermining the potential of electronic cigarettes as a tobacco harm reduction tool.


The circumstances of the Tennessee patient’s death is similar to many other reported deaths. However, unlike TDH, other health departments have provided much more detailed information on the types of devices and products used. For example, the Minnesota Department of Health (MDH) reported the state’s first vaping-related death on September 6, 2019, noting the patient’s “lung injury was associated with vaping illicit THC products.” On October 16, 2019, MDH reported two more deaths from vaping-related lung illnesses. According to MDH, one patient admitted to vaping “illegal THC” and the second also admitted “vaping unknown products in addition to nicotine.”  

Other state health departments have also provided details on products used by patients with lung illnesses supposedly due to vaping. The Utah Department of Health (UDH) noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.” In a now defunct webpage, the California Department of Health found 81 percent of their state’s patients “vaped [a] product containing THC.” On October 11, the Iowa Department of Public Health reported that of 38 cases of possible vaping-related lung injury, 33 patients, or 86 percent, reported vaping THC-containing devices.

Similarly, CDC has linked a majority of vaping-related illnesses to the use of products containing THC. In an October 15 update, CDC found 78 percent of self-reporting patients with vaping-related lung illnesses reported using vaping products containing THC.

Lung illnesses associated with THC are troublesome because the vast majority of the products being used are illegal, unregulated, black-market products. For example, 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.” UDH 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.

Tennessee law enforcement is well aware of the problem of black-market THC vaping products. In November 2017, the Robertson County sheriff’s department seized “seven pounds of high grade marijuana and 31 vials of high potency THC vape liquid … a street value of about $30,000.” In April, 2019, Nashville law enforcement collected “over 26 THC vape pens that contained 85 to 90-percent THC oil.” The 19 year-old in possession of the THC vaping devices “admitted he would buy the pens for $18 and sell them for $40.”

Despite recent headlines, e-cigarettes are substantially safer than traditional, combustible cigarettes. The Royal College of Physicians, the same public health group the United States relied on for its 1964 Surgeon’s General report on smoking and health, noted that use of e-cigarettes and vaping devices is “unlikely to exceed 5% of the risk of harm from smoking tobacco.” Further, the American Cancer Society declared that “e-cigarette use is likely to be significantly less harmful for adults than smoking regular cigarettes.” This is attributed to the fact that “e-cigarettes do not contain or burn tobacco.”

As state health departments address vaping-related hospitalizations, it is imperative that they provide total transparency. The CDC and other state health departments are increasingly linking recent hospitalizations to the use of illegal, unregulated THC-containing devices. E-cigarettes are an effective tobacco harm reduction tool and they should not be confused or conflated with products that are causing hospitalizations.

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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