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.
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.
The following documents provide more information on e-cigarettes and tobacco harm reduction.
Tobacco Harm Reduction 101: A Guidebook for Policymakers
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101 details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.
Podcast Series: Voices of Vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.
Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.
Policy Tip Sheet: Vaping Hospitalizations Likely Linked to Black Markets
In this Policy Tip Sheet, State Government Relations Manager Lindsey Stroud examines recent headlines, finding vaping-related hospitalizations are likely linked to illegal black market vaping products. Stroud examines reports from January 2019 which found youth were being hospitalized due to marijuana vaping products. Further, in 2018, the U.S. Army warned of the dangers of vaping synthetic marijuana after more than 90 military personnel were hospitalized and two died after vaping such devices. Further, none of the reports on the recent hospitalizations have been able to identify a single product that would have caused adverse health effects.
Research & Commentary: Latest CDC Reports Link Vitamin E to Vaping Lung Illnesses
The Centers for Disease Control and Prevention found vitamin E acetate in all 29 samples from patients with vaping-related lung injuries in 10 states. State Government Relations Manager Lindsey Stroud notes these are similar to findings by state health departments in New York and Utah and implores lawmakers to refrain from knee jerk reactions to address recent vaping-related lung illnesses.
Research & Commentary: Centers for Disease Control and Prevention Report THC-Containing Devices Cause Most Vaping Illnesses
The Centers for Disease Control and Prevention found 78 percent of patients with vaping-related lung illnesses reported using devices containing tetrahydrocannabinol (THC). State Government Relations Manager Lindsey Stroud examines that report, along with reports from health departments in California, Minnesota, Oregon, Texas, Utah, and Wisconsin, which all found similar use of THC-vaping devices.
Popcorn Lung, Formaldehyde, and Now Seizures, Oh My!
In this opinion piece in Townhall, Lindsey Stroud, state government relations manager at The Heartland Institute, responds to exaggerated and false claims of e-cigarettes. Despite fearmongering news stories, myths surrounding e-cigarettes containing formaldehyde and creating popcorn lung are unfounded, and the risk of seizures is minute. Stroud urges lawmakers to refrain from enacting egregious legislation in response to these claims.
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. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.
The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations department, at [email protected] or 312/377-4000.