As of November 20, 2019, the Centers for Disease Control and Prevention (CDC) has identified 2,290 cases of vaping-related lung injuries in 49 states and Washington DC. There have been a total of 45 deaths confirmed in 25 states and DC. Of the deceased, the median age “was 53 years and ranged from 17 to 75 years.”

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CDC was able to obtain information on 1,184, or 51.7 percent, of patients with vaping-related lung illnesses. Of these, “83% reporting using [tetrahydrocannabinol] THC-containing products,” with “35% reporting exclusive use of THC-containing products.” Only 13 percent of patients reported exclusive use of nicotine-containing e-cigarettes and vaping devices.

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This report comes after CDC examined 29 patients with vaping-related lung injuries, finding that vitamin E acetate was present in all 29 samples. Further, in that report, CDC noted three patients reported not using THC-containing products, yet THC was found in their patient samples.

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Since August, state and national health organizations have grappled with an onset of vaping-related lung illnesses. It is important to note neither CDC or state health departments have been able to identify a single chemical, let alone product, that could be causing adverse health effects. Further, many other state health departments have determined a majority of their patients are reporting use of THC-containing e-cigarettes, which are often illegal, black market products, containing unknown substances.

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In its weekly update report on November 19, the California Department of Public Health found 82 percent of patients with vaping-related lung injuries reported vaping THC. In a November 1 report, the Connecticut State Department of Public Health noted 76 percent of the state’s patients reported using THC-containing vaping devices. On November 13, Delaware Health and Social Services reported over 70 percent of patients with a vaping-related lung injury reported using THC. On November 14, the Illinois Department of Public Health concluded over “80 percent of the cases in Illinois report recent use of THC-containing products.” In late August, the Wisconsin Department of Health Services noted 89 percent of patients “reported using e-cigarettes or other vaping devices to inhale THC products, such as waxes and oils.” Further, Minnesota’s and Oregon’s health departments have linked deaths in their states to the use of THC products.

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Some state health departments have sought to better understand what is causing recent vaping-related lung illnesses. For example, in September, the New York State Department of Health announced results from laboratory testing on vaping products. The “results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” The Utah Public Health Laboratory tested 39 vaping devices: 51 percent contained e-liquid nicotine and 49 percent contained THC. Moreover, 100 percent of nicotine-containing liquids “contained nicotine and none have shown unexpected compounds.” On the other hand, 90 percent “of the THC cartridges contained Vitamin E acetate.”

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Although vitamin E acetate’s role in the current outbreak is unknown, it “has been identified as a ‘very strong culprit’ in lung injuries related to vaping THC.” Vitamin E acetate is a lipid, or oil, and is “highly toxic and [has] been associated with lung injury for years.”

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Moreover, many patients are reporting vaping illegal, black market products. For example, 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 admitted to using a “THC product … marketed under the ‘Dank Vape’ label.”

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Dank Vapes is not a legitimate brand of THC cartridges. Rather, it is a packaging company, that sells empty boxes and packaging online. In essence, anyone can purchase empty cartridges and then fill these devices with their own concoction of chemicals and resell these seemingly authentic packages. Instructions on how to infuse THC into vaping devices is widely available on YouTube.

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Under federal law, marijuana is a Schedule I drug, with absolutely no medical value. Due to this classification, the federal government has no oversight in any regulations on marijuana products. This is problematic because patients with vaping-related lung injuries in Connecticut reportedly purchased their THC-containing products at a dispensary. Further, the patient in Oregon’s first vaping-related death, “had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary.”

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Due to the recent media buzz surrounding such lung injuries, many states have sought to restrict access to e-cigarette products. These draconian measures include flavor bans and even banning all sales of nicotine-containing e-cigarettes. In September, Massachusetts Gov. Charlie Baker enacted a temporary four-month statewide ban on all vaping products containing nicotine, tobacco, and THC. Rhode Island and Washington State have imposed temporary bans on flavored e-cigarette products. Similar flavor bans in Michigan, Montana, New York, and Oregon have been temporarily halted by judicial proceedings.

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Despite recent fearmongering, electronic cigarettes and vaping devices are overwhelmingly less harmful than combustible cigarettes. Since their introduction to the U.S. market in 2007, e-cigarettes have helped an estimated three million American adults quit smoking. Further, their use is twice as effective as traditional nicotine replacement therapy in helping smokers quit combustible cigarettes.

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In regards to their safety, Public Health England estimates e-cigarettes are 95 percent safer than combustible cigarettes. The Royal College of Physicians noted that risks associated with e-cigarettes “were unlikely to exceed 5% of the harm from smoking tobacco.” Further, the American Cancer Society noted in June 2019, “e-cigarette use to be significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”

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As national and state health departments continue to link recent vaping-related lung injuries to the use of illicit vaping devices containing THC, it is imperative lawmakers do not restrict adult access to tobacco harm reduction products. E-cigarettes are an effective tool in helping smokers quit tobacco cigarettes and their use should be promoted, not threatened.

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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.