State and national health organizations have grappled with an onset of vaping-related lung illnesses since August. It is important to note neither the federal Centers for Disease Control and Prevention (CDC) nor state health departments have been able to identify a single chemical—let alone a legal, regulated product—that could be causing the adverse health effects.
Many state health departments, however, have determined most of their patients are reporting use of e-cigarettes containing the marijuana derivative tetrahydrocannabinol (THC), often in illegal, black-market products containing unknown substances.
The CDC identified 2,290 cases of vaping-related lung injuries in 49 states and Washington, D.C. as of November 20, 2019, stated information posted on the CDC’s web page titled “Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products.” There was a total of 45 deaths confirmed in 25 states and the District of Columbia. Of the deceased, the median age was 53 years, with a range of 17 to 75 years.
The CDC obtained information on 1,184, or 51.7 percent, of the patients with vaping-related lung illnesses. Of these, CDC found “83% reporting using THC-containing products” and “35% reporting exclusive use of THC-containing products,” stated the CDC’s Morbidity and Mortality Weekly Report published on November 15. Only 13 percent of patients reported exclusive use of nicotine-containing e-cigarettes and vaping devices.
Examining 29 patients with vaping-related lung injuries, CDC found vitamin E acetate was present in all 29 samples. The CDC also noted three patients reported not using THC-containing products, yet THC was found in their patient samples.
Role of Vitamin E Acetate
Some state health departments have investigated what is causing the recent vaping-related lung illnesses. In September, the New York State Department of Health announced results from laboratory testing on vaping products, which “showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed,” stated a NYSDH press release on September 5.
After testing 39 vaping devices used by patients with lung injuries associated with vaping, the Utah Public Health Laboratory found 51 percent contained e-liquid nicotine and 49 percent contained THC. One-hundred percent of the nicotine-containing liquids in the sample “contained nicotine and none have shown unexpected compounds,” whereas 90 percent “of the THC cartridges contained Vitamin E acetate.”
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,” The New York Times reported on Nov. 8.
Black Market Practices
Many patients are reporting vaping illegal, black-market products. A September 6 article in The New England Journal of Medicine documented a study of hospitalizations in Illinois and Wisconsin which found of the 53 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.”
Dank Vapes is not a legitimate brand of THC cartridges; it is a packaging company that sells empty boxes and packaging online. This enables people to purchase empty cartridges, fill these devices with their own concoctions of chemicals, and sell these in seemingly authentic packages. Instructions on how to infuse THC into vaping devices are widely available on YouTube.
Under federal law, marijuana is a Schedule I drug, considered to have no medical value. Under this classification, the federal government has no oversight of, or any regulations on, marijuana products.
The lack of federal regulation of marijuana products is significant because patients with vaping-related lung injuries in Connecticut reportedly purchased their THC-containing products at a legal medical marijuana dispensary. Though medical marijuana is prescribed by physicians, the content of what is dispensed is not tested, unlike drugs approved by the Food and Drug Administration.
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,” the Oregon Health Authority stated in a press release on September 3.
In response to the media buzz surrounding such lung injuries, many states have begun to restrict access to e-cigarette products. These measures have ranged from flavor bans to bans on all sales of e-cigarettes.
Helping Smokers Quit
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. Their use is twice as effective as traditional nicotine replacement therapy in helping smokers quit combustible cigarettes.
Public Health England estimates e-cigarettes are 95 percent safer than combustible cigarettes. The Royal College of Physicians stated risks associated with e-cigarettes “were unlikely to exceed 5% of the harm from smoking tobacco.” The American Cancer Society in June 2019 found “e-cigarette use to be significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”
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.
Lindsey Stroud ([email protected]) is a state government relations manager at The Heartland Institute.
Lindsey Stroud, “Research & Commentary: Centers for Disease Control and Prevention Find over 80 Percent of Vaping-Related Illnesses Attributable to THC,” The Heartland Institute, Nov. 26, 2019: https://heartland.org/publications-resources/publications/research–commentary-centers-for-disease-control-and-prevention-find-over-80-percent-of-vaping-related-illnesses-attributable-to-thc