What we know about the mysterious vaping illness.
Amid growing concerns about the – for lack of a better term – ‘vaping illness’ sweeping the United States, lawmakers are hoping to enforce bans on flavored vaping products or vaping altogether. The FDA has stated that they aim to remove all current flavored e-cigarettes from the market after some regulatory review. In the meantime, states have begunacting already. Governor Charlie Baker has issued a 4-month ban on the sale of vaping products in the state of Massachusetts. Rhode Island Governor Gina Raimondo and Washington state Governor Jay Inslee also issued an order banning the sale of flavored e-cigarette products.
The panic seems to be rising more in part because research in identifying a chemical culprit is a longer process than one would expect. The CDC has suggested a few theories as to what could be going on, but until one is definitively found, the climate is conducive to the spread of tons of misinformation. Let’s separate fact from fiction and clarify what is really known about the vaping illness so far.
The CDC, or Centers for Disease Control and Prevention released areport on September 27th detailing the statistics of the illness.
- As of September 24th, 805 cases of the illness had been reported.
- This number is up from 530 a week prior.
- 12 deaths have been confirmed in 10 states.
- California, Texas, Wisconsin, and Illinois have the highest number of incidences.
- Using data from the first 771 patients the CDC has estimated that about 69% of patients are male.
- About 62% (two-thirds) of patients are 18-34 years old, with 22% of those between 18-21.
- 16% of patients are under 18 years.
What does the vaping illness look like? In the summer of 2019, young, otherwise healthy people began reporting severe breathing illnesses, and health officials in a few states noticed the trend. Patients’ lungs appeared to be reacting to a corrosive substance and not an infection, as a doctor might expect. The illness presents more like a chemical irritation, allergic or immune reaction. The common factor in all the cases? They had recently vaped.
The symptoms shared by patients are gastrointestinal distress (nausea, vomiting, diarrhea, abdominal pain), fever, and trouble breathing. Some doctors have said that the breathing troubles tend to follow the gastrointestinal issues in a large number of cases.
What we know
The FDA, CDC and state health officials are currently racing to identify the cause of the illnesses and how to treat or prevent them. However, some key facts have been established. The CDC investigated substances from e-cigarettes and vaping products that 514 patients had used in the month before they got sick.
- 77% reported using THC-containing products.
- 36% reported exclusive use of THC-containing products.
- 57% reported using nicotine-containing products.
- 16% reported exclusive use of nicotine-containing products.
What this indicates is that an enormous majority of patients were vaping THC, which is why THC vape cartridges may be emerging as a subject of interest.
A study published in the New England Journal of Medicine in early September found that a majority of patients from Wisconsin and Illinois had used the brand ‘Dank Vapes’ or ‘Chronic Carts’. Both brands seem to have dubious origins, and Reuters reports that they haven’t quite disappeared in the wake of the illness – one can still purchase them off sites on the internet. The report also says that journalists have not been able to determine whether ‘Dank Vapes’ is an actual company or a brand used by multiple operators, and have been unable to reach any representatives at the companies.
Vitamin E Acetate
Both ‘Dank Vapes’ and ‘Chronic Carts’ appeared to be using Vitamin E acetate to dilute their THC oil. Vitamin E acetate was already of interest to investigators. This is because very high amounts of Vitamin E were found in some of the patient-submitted THC cartridges.
Vitamin E acetate is a thickening agent in some THC oils (THC being the psychoactive compound in cannabis) but that isn’t specifically what it’s meant for. Vitamin E acetate is more often applied topically to the skin or used in dietary supplements. The FDA has warned that there is limited data about the effects of Vitamin E acetate on the lungs, and hence should not be inhaled.
To that effect, the New York state health department actually subpoenaed 3 companies that market Vitamin E acetate to vape oil companies. What surprised FDA officials was the sheer amounts of thickener found in the samples they analyzed. In some samples, as much as 50% of the total liquid in the cartridge was a thickening agent.
New York State Health Commissioner Howard Zucker toldNPR that Vitamin E has not been approved by New York’s medical marijuana program as an additive for vape goods. He says the cartridges tested appeared to be black market products purchased off the streets.
However, an FDA senior advisor has cautioned that Vitamin E hasn’t conclusively been found to cause the illness – for one, it was not found in cartridges of patients that were vaping nicotine.
"The number of samples we have received continues to increase and we now have over 100 samples for testing," Felberbaum said to NPR. "The FDA is analyzing samples submitted by the states for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids along with cutting agents/diluents and other additives, pesticides, opioids, poisons, and toxins. No one substance, including Vitamin E acetate, has been identified in all of the samples."
Black market goods.
Research conducted on the vaping habits of high school seniors found that 37% of them reported vaping in 2018, up from 28% the year before. The cause for concern here is that high schoolers shouldn’t be able to get their hands on these goods in the first place – it’s illegal to sell e-cigarettes to anyone under (depending on the state) 18-21 years of age.
If they aren’t getting it through legitimate, state-regulated sources, they could be sourcing them off the streets. When it comes to THC cartridges, in particular, the amount of bootleg companies out there is staggering. Peter Hackett, president of Air Vapor, a company that makes and sells vape hardware toldRolling Stone that “many bootleg cartridge manufacturers will buy packaging en masse on websites like Alibaba and use their own oil — and it has become common practice to add various adulterants as thickening agents, to make the oil in the cartridge look thicker and more legit.”
An investigation by theWall Street Journal also found knockoffs of TKO products, a manufacturer of legal THC vape products in California. These bootlegs, some sourced from China, are readily available online and virtually indistinguishable from the original. Moreover, their investigation suggests that even in states where cannabis is fully legal, the black market for cannabis products has been ‘more resilient than expected’.
In states like Wisconsin, where a large percentage of patients with the vaping illness said that they vaped THC, THC isn’t even legal. The probability of patients having gotten their hands on something adulterated, unregulated and dodgy seems very high. It’s not hard to get these items either: Amazon, Facebook, and Instagram have become breeding grounds for illicit vape sales.
What should you do?
Both CDC and FDA officials repeatedly emphasize that the cause of the illness has not been identified yet, which is incredibly challenging for everyone involved, including vapers. The CDC has laid out suggestions for those concerned:
- While this investigation is ongoing, CDC recommends that you consider refraining from using e-cigarette, or vaping, products, particularly those containing THC.
- If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
- If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak, see a healthcare provider.
- Regardless of the ongoing investigation:
- Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer.
- Youth and young adults should not use e-cigarette, or vaping, products.
- Women who are pregnant should not use e-cigarette, or vaping, products.
- Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
As panic about the vaping illness spreads and we await answers, one can assume that more states will follow in the footsteps of Massachusetts and pre-emptively ban vape products. However, the main reason that black markets thrive is that products are unavailable or too expensive. Restrictions run the risk of pushing even more people into the black market, with adulterated and downright dangerous chemicals. As the FDA and CDC continue to conduct their investigations, we can only wait – and update this space when we know more!
Veppo Vape Team
Gina King is the brand manager for Veppo, a family run brand offering select, tested, high quality vape pen vaporizers, e-liquid and e-cigars. Over the past 12 years, Veppo has provided more than 250,000 customers a friendly alternative to cigarettes.
Gina is a mother, writer, traveler and speaker and has been featured on HuffPost, Forbes, Elite Daily and more.