I don’t know if you’ve been reading the national headlines about vape related illnesses and deaths, but I’ve been keeping a close eye on stories that continue rolling out about severe health problems associated with vaping. Needless to say the stories have me alarmed as somebody who both uses and sells vape products. Right at the top I want to make it clear that I am neither a medical professional nor should anything in this post be construed as medical or health advice. I’m just looking to present and analyze the facts as confirmed media sources have reported them thus far. While there have been only seven confirmed deaths related to vaping, severe medical complications have arisen in several other cases including severe respiratory distress and even some victims lapsing into comas.
The health ramifications are dire indeed, so we’re going straight to the horse’s mouth on this one. The Centers for Disease Control and Prevention (CDC) gave a telebriefing to media sources shortly after the epidemic started making national headlines to apprise citizens of the potential dangers associated with vaping and the likely cause of the current illness, as best as current information suggests. The briefing is expansive and contains reports from across multiple governmental agencies, public health officials, and state and federal medical agencies to examine the issue from as many angles as possible. That said, the content of the briefing can get a little dense, so I’ve read through and selected passages that best illustrate their findings in a condensed fashion.
Dr. Dana Meaney Delman, who is the Incident Manager for the response to this outbreak, wants to make it abundantly clear to the American people that there is no single underlying cause that applies to all of the cases. The illness is being designated as a non-infectious lipoid pneumonia. Dr. Delman states that “No specific e-cigarette device or substance has been linked to all cases, and e-cigarette[s] include a variety of chemical[s] and additives; consumers may not know what these products contain. Particularly, products obtained from social sources or off the street, it is difficult to know what is contained in these e-cigarette products.” However Dr. Meaney also mentions that there is a culprit they’re investigating due to its involvement in several of the cases–a cutting agent known as Vitamin E acetate. Vitamin E acetate is likely being used as a black market cutting agent in cartridges because it’s so darn cheap, only $3 per ounce. Compare that to the price of cannabis concentrate per ounce and it’s not hard to see how an illicit dealer might decide to step on their product to maximize their profits to the detriment of those using their illegal vapes. According to Dr. Delman, “Based on the clinical and laboratory evidence to date, we believe that a chemical exposure is likely associated with these illnesses. However, and I really want to stress this, more information is needed to determine which specific products or substances are involved. We are aware that some laboratories have identified Vitamin E acetate in product samples, and we have connected those laboratories with the FDA Forensic laboratories to compare results. At this time, no one device, product, or substance has been linked to all cases. Continued investigation is needed to better understand if a true relationship exists between any specific product or substance and the illnesses observed in patients.” So while we have a likely culprit in some of the cases, the CDC is still working on identifying the underlying cause behind all of the reported cases.
But what exactly can inhaling vitamin E acetate do to a body? Lipoid pneumonia is being used as an umbrella term to cover a slew of symptoms in these vaping related cases. Dr. Jennifer Layden, chief medical officer and state epidemiologist with the Illinois Department of Public Health, asserts that “What we have found so far is that the majority of people who have become ill are generally healthy, are young – a median age of 19 years and the majority have been men. Patients have had symptoms for days to weeks before admissions, with the median being 6 days. At time presentations, the majority have respiratory symptoms, constitutional symptoms such as fever and fatigue sometimes weight loss, and GI symptoms. All patients have abnormalities seen on lung imaging, apparent in both lungs. Infections have not been identified as the source of the underlying lung illnesses. Among our 53 patients, nearly all patients were hospitalized, 98% and of note and interest, 72% of the patients were seen as outpatient prior to their final admission for symptoms. Among the patients that were hospitalized, over half of the patients required intensive care management and 32% of the patients required mechanical ventilation to help their breathing. Among the patients in this case series, all reported using e-cigarette product use in the last 90 days. The majority reported using a THC-based product. A majority also reported using a nicotine-based product.” These numbers Dr. Layden refers to are current as of September 11th, 2019, though more data is coming in all the time. I will endeavor to use more recent figures wherever possible. But it’s frightening to think that something as innocuous as vapor can land healthy young folks on a ventilator or in the most extreme cases the morgue. So far as current figures suggest–CDC update 9/17/19–seven people have died already from illness linked to vaping: two in California, and one each in Illinois, Indiana, Kansas, Minnesota, and Oregon. I don’t wish to sound callous, but seven deaths does not seem very high (especially given our desensitization to violence and death in the media each and every day in America), but you have to take several factors into account. This whole phenomenon is brand new and seems isolated to America thus far, and this means that there is likely significant under reporting to the CDC, which suggests the death toll could indeed be higher than we know. Also The CDC has only recently compiled an epidemiology for the disease and has begun disseminating rubrics for diagnosis to state and other federal agencies, in order to collect a more whole data set. And who’s to say that the deaths won’t continue? The popularity of vaping is still quite high despite public concern.
So what can we as consumers do in the meantime to minimize our risks of contracting lipoid pneumonia? The official CDC recommendation is as follows: “Most importantly, while this investigation is ongoing, people should consider not using e-cigarette products. People who do use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, or others) and promptly seek medical attention for any health concerns. Regardless of the ongoing investigation, people who use e-cigarette products should not buy these products off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or by adults who do not currently use tobacco products.” You’ll notice who didn’t make that list: adults who are current smokers and tobacco users. Presumably this is because even with the seven person death toll, cigarettes kill more people daily–1300 deaths a day, 480,000 a year in the United States–and vaping is still seen as a potentially risk reducing technology…though a troublesome one. That’s just a guess on my part though.
That said, for those of us who choose to continue vaping, I’ve got a couple of recommendations. First, do your research. Check product labeling for ingredients. You should avoid products containing cutting agents of any kind, including propylene glycol, MTC, vegetable glycerin, and vitamin E acetate. Second, contact the manufacturer of any vapes you might currently have whose contents you are unsure of to be certain they don’t contain cutting agents. Third, talk to your budtenders. Many of us vape and are equal parts concerned and knowledgeable about the issue. Fourth, never use any cartridge on a vape device that wasn’t made by the same manufacturer. Vapes are manufactured to work only with the product that company produces, not third party or black market vapes. Fifth, make sure you buy your vape products from a licensed retailer, not online, out the back of someone’s trunk, or from any other black market or overseas sources. In Colorado, all products in dispensaries are lab tested and are required by law to list all ingredients used in its manufacture, so you know what you’re getting is as pure as can be. And just in case any of you are concerned about vapes you have purchased here at Elements Boulder, myself, our purchasing manager, and general manager have researched the contents of all our cartridges. None of our vapes–Spherex, Pax, AiroPro, V3 Oils, and Natty Rems–contain cutting agents of any sort, so all you’re getting is pure cannabis oil and cannabis terpenes.
But what’s being done about the sources of these contaminated vapes? Well, recently the FDA began a criminal probe into the matter. “FDA officials disclosed Thursday that investigators from FDA’s Office of Criminal Investigations have been pursuing a parallel investigation since the illnesses were first reported earlier this summer. ‘The focus is on the supply chain,’ said Mitch Zeller, director of FDA’s Center for Tobacco Products. The office is not pursuing prosecution of people for personal use of any controlled substances, he said.” So with some luck the people behind the manufacture of adulterated vapes will see justice soon. Sadly, we still don’t know what the long term holds for those unfortunate individuals suffering from pulmonary illness due to vapes, because this is such a new phenomenon. Only time will tell. For now, the best course of action is to stay abreast of current information and watch for more statements issued by the CDC. And if you have any concerns or questions about your vapes, come ask us at Elements.