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December 20, 2019

As of December 17, the Centers for Disease Control and Prevention (CDC) have identified 2,506 cases of vaping-related lung illnesses. To date, 54 deaths have been recorded in 27 states. The median age of attributable deaths is 52 years old. Of those diagnosed with a vaping-related lung injury, the median age is 24 years old “and age range from 13 to 77 years.” Only 16 percent of patients are under 18 years old.

Since September, CDC has linked a majority of these illnesses to the use of vaping products containing tetrahydrocannabinol (THC)—the psychoactive substance in marijuana. On September 24, CDC had identified 805 reported cases of vaping-related lung illnesses and hospitalizations in 24 states. Data on substances vaped was made available for 514 patients, of those self-reports, 77 percent reported using THC-containing products.


As of December 3, CDC had data on 1,782 patients diagnosed with a vaping-related lung illness. Of those, “80% reported using THC-containing products.” Only 13 percent claimed exclusive nicotine use. However, a previous report examining the lungs of 29 patients with a vaping-related lung injury found THC in the lungs of three patients claiming nicotine-only use. Further, the CDC noted that as of December 3, 56 percent of patients that had used THC-containing devices reported using a brand known as “Dank Vapes.”

Since August, The Heartland Institute has been investigating both CDC and state health department profiles of lung injuries supposedly linked to electronic cigarettes and vaping devices. Interestingly enough, state health departments (not CDC) first linked vaping devices containing THC to recent illnesses.

A September 10 Research & Commentary found that of the six states (California, Illinois, Indiana, Kansas, Minnesota, and Oregon) reporting vaping-related deaths, two states (Oregon and Minnesota) explicitly linked the deaths to THC-containing vaping products. This analysis came after the Wisconsin Department of Health reported on August 29 that 89 percent of their state’s patients who were interviewed reported use of THC vaping devices. A September 24 Research & Commentary reported three more states—Connecticut, New York, and Utah—also linked vaping-related lung illnesses to the use of products containing THC.

Alarmingly, CDC only recently reported on specific “brands” of THC vaping products, despite earlier reports from state and regional health departments. For example, a September report only examined patients in Illinois and Wisconsin, finding 84 percent of patients had reported using THC-vaping devices. Further, 21 of 41 patients interviewed admitted using a THC-vaping device “marketed under the ‘Dank Vape’ label.”

It wasn’t until December 3 that CDC finally named specific brands of THC-devices in its report. On August 20, The Heartland Institute warned policymakers of the possible problems associated with Dank Vapes. On this date, well before CDC indicated Dank Vapes were associated with the outbreak of lung illnesses, Heartland reported there was a “thriving” black market for THC vaping products. We found (now-defunct) listings on Amazon and eBay, where one could easily purchase empty packages under the Dank Vape label, which has overwhelmingly been noted on the black market as being a “legitimate” THC product. We also found empty cartridges available for sale online, and YouTube tutorials on how to extract wax from marijuana to use in a vaping device, including one tutorial employing the use of a hair straightener.

Unfortunately, the wax that is extracted is too thick to be used in a vaping device and needs to be “cut” with another chemical. Vitamin E acetate was first reported in September, by health departments in New York and Utah, as a possible agent causing vaping-related lung injuries. The Heartland Institute notes that 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.” 

Further, in October, the Heartland Institute reported that a September report from the Utah Department of Health found 94 percent of patients with a vaping-related lung illness reported using THC vaping products. Moreover, 38 percent of patients reported using a Dank Vapes THC device.

It’s disturbing that CDC waited until December to report this particular brand, especially as the 2019 Monitoring the Future survey found that marijuana vaping among youth “ranked among the largest single-year increases ever observed by Monitoring the Future in the past 45 years among all outcomes ever measured.” In fact, 21 percent of 12th graders, 19 percent of 10th graders, and 7 percent of 8th graders reported ever use of vaping THC products in the past 12 months. Especially troubling, 12th graders using THC-vaping products “increased 7.7 percentage points in 2019.”

Despite the increasing evidence linking illegal and illicit THC-vaping devices to recent illnesses, states and localities are moving forward with policies that aim to restrict and ban the sales of legal, regulated nicotine-containing e-cigarettes and vaping devices.

Beginning in September, governors in several states (Massachusetts, Michigan, Montana, New York, Oregon, Rhode Island, and Washington) ordered their respective health departments to issue emergency rules banning sales of flavored vaping devices. Massachusetts was the first state to implement such a ban, with all e-cigarettes and vaping devices being temporarily outlawed, effective September 24, 2019. Lawsuits in Michigan, New York, and Oregon have prevented their respective bans from going into effect.

Recently, Massachusetts lifted its temporary ban, however, legislation has been signed by Gov. Charlie Baker banning sales of flavored tobacco products and restricting nicotine content. Menthol cigarettes are included in the ban, which will go into effect June 1, 2020.

State legislatures are also pursing flavor bans. Legislation banning the sale of flavored e-cigarettes has been introduced in Illinois, Ohio, and Pennsylvania in recent months. Similar bills have also been pre-filed for the 20202 session in Kentucky, New Hampshire, and Virginia.

It is imperative state lawmakers refrain from enacting draconian bans on tobacco harm reduction tools. It is increasingly becoming more evident recent vaping-related lung illnesses are caused by illicit, black market products containing THC—not ordinary nicotine-based vaping devices. Flavor bans on legal, regulated e-cigarettes will do practically nothing to stem the tide of lung illnesses. Further, e-cigarettes and vaping devices are an effective tobacco harm reduction tool, and have helped an estimated three million American adult smokers quit combustible cigarettes. The use of these harm reduction tools should be encouraged, not restricted.

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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