A mysterious lung illness that appears to be related to the use of e-cigarettes and vaping devices has taken six lives. Under orders from President Trump, the FDA is preparing to “clear the market” of flavored e-cigarettes. DOPE spoke with doctors and testing facilities to get the real scoop and answer the most pressing questions on the epidemic.
What’s going on?
Six people across the country have now died of a mysterious lung illness that appears to be related to the use of e-cigarettes and vaping devices. Over 400 cases of the disease have been reported in 33 states including legal-use markets like Oregon, California and Washington as well as regions where recreational cannabis remains illegal like Kansas and Indiana. Symptoms of the disease include dizziness, shortness of breath, fatigue, chest pain and coughing.
What’s causing the disease?
No one knows for sure. It’s been reported that about 80 percent of patients with the disease said they vaped THC oil, mostly from cartridges purchased from dealers on the illicit market. However, nicotine-based vape products like the popular JUUL e-cigarette have also been facing scrutiny. This week, acting FDA commissioner Norman Sharpless and President Trump held a meeting with Secretary of Health and Human Services Alex Azar announcing that the FDA would be banning the sale of flavored e-cigarettes.
I just announced with @POTUS and @FDACommissioner that we will be finalizing policies that will clear flavored e-cigarettes from the market. New provisional data show that youth use continues to rise rapidly, and we will not stand idly by.
— Secretary Alex Azar (@SecAzar) September 11, 2019
Late last week, FDA officials and New York’s Health Department identified a compound called vitamin E acetate in a majority of samples connected to the lung disease. While vitamin E acetate is common in skincare and dietary products, most doctors believe it’s harmful to inhale. But medical experts say there’s still no way to tell for sure if vitamin E acetate is the cause of the six deaths. The FDA has said that vitamin E acetate is one of several chemical substances under investigation.
Dr. Wassim Labaki, a clinical lecturer at the University of Michigan Health System’s Division of Pulmonary and Critical Care, told DOPE that it’s too early to pinpoint vitamin E acetate as the cause of the lung disease, but it may be a good starting point for further investigation.
“This does not necessarily mean that vitamin E acetate is the cause of the reported vaping-related illnesses, but it may provide important clues regarding the factors and mechanisms,” noted Dr. Labaki in an email.
Dr. Panagis Galiatsatos, a lung doctor and director of the Tobacco Treatment Clinic at Johns Hopkins Medical Center in Baltimore who regularly treats patients who vape, says the problem is the way substances in vape products were tested.
“The majority of the products that are put in e-cigarettes – like vitamin E – were never tested for safety around inhalation.”
— Dr. Panagis Galiatsatos, lung doctor and director of the Tobacco Treatment Clinic at Johns Hopkins Medical Center
“A lot of them [e-cigarette manufacturers] can go and make an argument, ‘We are on the FDA’s generally recognized as safe (GRAS) list’” Dr. Galiatsatos tells DOPE in a phone interview. “ … but a lot of those substances, if not all of those substances on the GRAS list were evaluated and studied by eating it, topical, or IV [consumption]. The majority of the products that are put in e-cigarettes – like vitamin E – were never tested for safety around inhalation.”
But most people got sick from street cartridges. Dispensary cartridges are safe, right?
We don’t know for sure. In Oregon, a man who purchased a THC vape cartridge at a legal dispensary died of severe lung illness. It is unknown whether he modified the cartridge or received a batch that was contaminated. State health officials are not releasing details about the brand or product that the man purchased. However, this appears to be the only acknowledged case of a dispensary-purchased THC cart making someone sick – most others seem to involve cartridges purchased on the illicit market.
Why are manufacturers using vitamin E acetate if it’s harmful?
Because it’s an extremely cheap thickening agent that dilutes the amount of THC oil required in a cartridge and improves its taste. Some manufacturers have also pushed back against the idea that vitamin E acetate is dangerous. Drew Jones, owner of a company that produces terpenes and thickening agents called Mr. Extractor, posted an open letter linking to several studies that have shown vitamin E acetate may actually treat lung inflammation.
However, as Leafly reported last week, Mr. Extractor and other prominent companies that sell these oil thickening agents have pulled their products from the market in recent weeks. The FDA has also suggested that inhaling vitamin E acetate should be avoided.
According to Jones’ letter, if Vitamin E acetate is indeed the culprit behind lung disease, “this is an industry wide problem with serious ramifications.” He goes on to estimate that approximately 60 to 70 percent of all cartridges on the market contain the substance, which doctors agree should not be inhaled.
“Vitamin E as an acetate form becomes an oil. There is no good reason to inhale an oil,” says Dr. Galiatsatos. “Our lungs are not designed to take those kinds of products in.”
So, should I quit vaping?
If you have been purchasing and using illicit market cartridges, unequivocally yes. It’s impossible to know what’s in these cartridges and most of them have been linked to cases of the lung disease.
As far as vaping legal nicotine and THC products, the answer is murkier. In a statement, Kansas Health Officer Dr. Lee Norman bluntly advised: “If you or a loved one is vaping, please stop.”
“It’s like having a car without knowing if it has an engine or brakes,” says Dr. Galiatsatos “ … until science can back it up and promise that patients’ safety has been assessed, I can’t in good faith tell people, ‘just continue doing this.’”
However, the FDA and CDC both point out that the lung illness has not been conclusively linked to any type of vape cartridge, e-cigarette or oil. If you do continue using either THC or nicotine vape products, only purchase them from trustworthy sources like a dispensary or licensed tobacco shop. Monitor your health and be aware of symptoms like chest pain, shortness of breath or coughing.
What’s going to happen next?
Details of the announced FDA ban are scant so far, but a plan is expected to be outlined within weeks. Several cities and states are taking action locally: San Francisco banned e-cigarettes earlier this summer, and Michigan followed suit last week. The state of New York has issued subpoenas to three leading manufacturers of thickening agents. Other states are reviewing their testing procedures in light of the new revelations regarding vitamin E acetate.
Multiple cannabis testing labs tell DOPE that they are adding vitamin E acetate to their testing procedures. According to Karrissa Miller, lab manager at one of the five testing facilities approved by the Maryland Medical Cannabis Commission, some clients are releasing statements reassuring patients that they don’t use any vitamin E.
“Pinnacle CT Labs is adding Vitamin E Acetate to our current testing protocols,” Miller tells us in an emailed statement. “Many of our clients have already released public statements regarding commitments to patient safety and substances, such as vitamin E acetate, that are not being used in production.”
Steve Donofrio, chief marketing officer at Think20 Labs, another testing company with locations in California and Maryland, says in an email that the problem was with the current regulation of cannabis and that legit cartridge manufacturers shouldn’t get the blame.
“We aren’t interested in partnering with law firms or investigative media outlets looking to destroy companies. We want to help fix the true problem. The lack of regulation is really to blame here; not the brands.” Donofrio also confirmed that Think20 would be adding a vitamin E panel to their testing and predicted that it would soon become an industry-wide standard.
Until more federal guidance and research is available regarding cartridges, e-cigarettes and their ingredients, vape with caution.