Officials in five states (California, Illinois, Indiana, Minnesota, and Oregon) have confirmed recent deaths to lung disease in individuals that had reported recent e-cigarette use. Although questions remain about these deaths, officials in two states have explicitly linked these deaths to vaping products containing tetrahydrocannabinol (THC).

​

The Oregon Health Authority reported an individual who died in July “had recently used an e-cigarette or vaping device containing cannabis.” The Minnesota Department of Health reported an individual died from a “lung injury [that] was associated with vaping illicit THC products.”

​

These are similar to findings from the Wisconsin Department of Health Services (WDHS), which first reported vaping-related hospitalizations on July 25, noting the “names and types of products used remain unknown.” On August 29, WDHS reported 89 percent of patients interviewed had “reported using e-cigarettes or other vaping devices to inhale THC products, such as waxes and oils.” WDHS urged residents to stop using products that “may include chemicals or additives that are unknown, unregulated, and unsafe.”

​

A September 6 report in The New England Journal of Medicine examined hospitalizations in Illinois and Wisconsin. Of the 53 case patients the authors examined, 84 percent “reported having used [THC] products in e-cigarette devices.” Although patients reported “a wide variety of products and devices,” 21 of the 41 patients interviewed stated using a “THC product … marketed under the ‘Dank Vape’ label.” This is alarming because empty packaging for that and other known brands, is available for purchase by many online retailers, as well as empty devices, or “cartridges.” Instructions on how to infuse THC in vaping devices is easy to find on YouTube.

​

To date, no specific product has been confirmed as a cause of death. Further complicating matters, many of these deaths occurred in states where medicinal and recreational marijuana use is illegal. Illinois allows medicinal marijuana. Recreational marijuana will be legal January 1, 2020. Indiana allows cannabidiol oil to be used for medical purposes, but it is still a misdemeanor to possess THC. In Wisconsin, marijuana is illegal.

​

Although California and Oregon allow recreational marijuana, both states have large black markets for marijuana products. It has been estimated that “[a]s much as 80% of the marijuana sold in California comes from the black market.” In 2018, black market marijuana sales in California were “valued at an estimated $3.7 billion … more than four times the size of the legal market.” In April 2019, Oregon police seized an estimated $15 million in black market marijuana products.

​

Moreover, the U.S. Food and Drug Administration (FDA) has issued an alert, urging consumers “to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”

​

Although these hospitalizations are concerning, it is imperative that policymakers refrain from assuming they are caused by legal and regulated electronic cigarettes and vaping devices. In fact, since August 8, 2016, per the FDA, no new e-cigarette product can be legally available for sale without an approved pre-market tobacco application.

​

Since 2007, these tobacco harm reduction products have helped an estimated three million American adult

smokers quit tobacco cigarettes. A 2019 study found e-cigarettes to be twice as effective as traditional nicotine replacement therapy, in helping smokers quit. Moreover, their use can help reduce smoking-related health care costs. One study estimated e-cigarette use would have provided $48 billion in Medicaid savings if all Medicaid recipients who smoke cigarettes had switched to e-cigarettes and vaping devices in 2012.

​

Despite recent headlines, e-cigarettes are significantly less harmful than combustible cigarettes. Many public health groups emphasize their reduced harm, including Public Health England, the Royal College of Physicians, and the National Academies of Sciences, Engineering and Medicine. As recently as June 2019, the American Cancer Society (ACS) stated “e-cigarette use is likely to be significantly less harmful for adults than smoking regulator cigarettes.” ACS notes that “[t]his is mostly because e-cigarettes do not contain or burn tobacco.”

​

Although vaping-related hospitalizations are worrisome, public health agencies are linking them to black market THC products. It is of upmost importance that lawmakers refrain from enacting legislation and policies that could further restrict adult access to proven tobacco harm reduction products, which are not causing the recent spate of deaths and 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.