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October 21, 2019

On October 15, the Centers for Disease Control and Prevention (CDC) reported “1,479 lung injury cases associated with e-cigarettes or vaping.” CDC was provided data on 1,358 patients and found 70 percent are male. The median age of the 1,358 patients “is 23 years and ages range from 13 to 75 years.”

CDC obtained information on types of substances vaped for 849 patients. Of these, 78 percent reported using vaping products containing tetrahydrocannabinol (THC) and only 10 percent self-reported “exclusive use of nicotine-containing products.” CDC notes that “national and state data suggest that products containing THC, particularly those obtained off the street […] are linked to most of the cases and play a major role in the outbreak.”


The most recent report parallels others by the CDC. On October 10, CDC found that of patients with lung-illness attributed to vaping devices, 76 percent “reported using THC-containing products,” and 13 percent “reported exclusive use of nicotine-containing products.” CDC reports on September 24 and October 3 also had similar findings. 

These reports are significant because many states have responded to recent hospitalizations by banning the sales of flavored e-cigarettes, and, in some cases, all e-cigarettes. Governors in Massachusetts, Michigan, Montana, New York, Oregon, Rhode Island, and Washington state have directed their state health departments to ban sales of flavored electronic cigarettes, and in the case of Massachusetts, a ban on all e-cigarettes went into effect on September 24. Lawsuits in Michigan, Montana, New York, and Oregon have temporarily halted the bans, but are likely to be challenged. Further, lawmakers in Connecticut, Delaware, Maine, and South Carolina are considering legislation to ban flavored e-cigarettes.

The reactionary policy of banning flavored e-cigarette products ignores the true culprit causing recent vaping-related hospitalizations: illegal and unregulated, black-market products containing THC.

Similar to CDC’s findings, many states have linked recent vaping-related hospitalizations to THC-containing products. The Utah Department of Health noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.” 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, Minnesota, Oregon, Texas, and Wisconsin have all linked recent vaping-related lung illnesses to the use of THC vaping products.

Although some of these states have medical and recreational marijuana programs, Iowa, Texas, and Wisconsin do not. Minnesota and Utah allow for medical marijuana. Only California and Oregon allow for recreational marijuana for individuals 21 years of age and older. However, both states still have thriving black markets for THC products. For example, “[a]s much as 80% of the marijuana sold in California comes from the black market.” In April 2019, Oregon police seized an estimated $15 million in black market marijuana products.

Overwhelmingly, a notorious black-market THC product (that is completely illegal) is being linked to recent vaping-related hospitalizations. 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.” Additionally, 38 percent of self-reporting patients in Utah used Dank Vapes prior to their lung illnesses. Dank Vapes is an illegal, unlicensed product. Essentially, Dank Vapes is a shady packaging company and has been implicated for putting a Wisconsin man into a coma.

Despite these findings, many states are moving to restrict access to tobacco harm reduction products that are regulated and have yet to be definitively linked to any adverse health effects. Since their introduction to the U.S. market in 2007, e-cigarettes have helped an estimated three million American adults quit smoking combustible cigarettes.

Further, e-cigarettes and vaping devices are much less harmful than combustible cigarettes. Numerous public health groups including Public Health England, the Royal College of Physicians, and the National Academies of Sciences, Engineering and Medicine have all noted e-cigarettes’ reduced harm potential. Further, in June 2019, the American Cancer Society declared e-cigarettes to be “significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”

Lawmakers need to understand that health departments and the CDC have linked the vast majority of recent vaping-related lung illnesses to THC devices. Moreover, most of these products are illegal and unregulated. Restricting sales of regulated nicotine-containing e-cigarettes will not reduce recent vaping-related hospitalizations and will likely lead to more black-market activity.

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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