Investigators Identify a Possible Culprit in Vaping-Related Respiratory Illnesses

The findings reinforce the suspicion that patients' symptoms are caused largely by additives or contaminants in black-market THC products.


Federal and state investigators have identified a common element in many of the cases where people have suffered respiratory illnesses after vaping. The Washington Post reports that tests by the Food and Drug Administration (FDA) found vitamin E acetate, an oil-based nutritional supplement, in 10 of 18 THC fluids used by patients, while a New York state laboratory found "very high levels of vitamin E acetate in nearly all" the cannabis extracts it tested. That substance was not found in any of the nicotine e-fluid tested by the FDA or the lab.

These findings reinforce the suspicion that the respiratory illnesses reported to the U.S. Centers for Disease Control and Prevention (CDC)—215 at last count—are caused largely by additives or contaminants in black-market THC products. Illegal nicotine products may also have played a role in some of these cases, although so far the CDC and the FDA have not identified a common element in patients who vaped nicotine. Notwithstanding attempts to blame these illnesses on the use of legal nicotine products, there is no evidence that standard e-cigarettes are causing the patients' symptoms. That insinuation was always implausible, given that e-cigarettes have been in wide use for years and these conditions were reported only recently.

While vitamin E acetate is safe to consume orally as a nutritional supplement, it is potentially dangerous when inhaled. As the Post explains, citing Bryn Mawr chemist Michelle Francl, "When that vapor cools down in the lungs, it returns to its original state at that temperature and pressure, she said, which means 'it has now coated the inside of your lungs with that oil.'" That observation is consistent with reports from Utah of lipoid pneumonia, a rare condition caused by fat particles in the lungs, in patients who had vaped cannabis extracts.

"Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products that were tested," the New York State Department of Health said in a press release issued yesterday. "As a result, vitamin E acetate is now a key focus of the Department's investigation of potential causes of vaping-associated pulmonary illnesses. Vitamin E acetate is a commonly available nutritional supplement that is not known to cause harm when ingested as a vitamin supplement or applied to the skin. However, the Department continues to investigate its health effects when inhaled because its oil-like properties could be associated with the observed symptoms."

Assuming that vitamin E acetate is the culprit in many of these cases, it is clearly not a complete explanation, since it was not detected in all of the fluids vaped by patients. The FDA and the CDC are still trying to figure out which other agents may be causing the respiratory illnesses.

In states that have reported what patients were vaping, Boston University public health professor Michael Siegel notes, the vast majority of cases have involved THC oil: all 21 cases in California, all eight cases in New Mexico, and 24 of 27 cases in Wisconsin. But despite the evidence implicating black-market THC products, public health officials are continuing to issue general warnings about "vaping" and "e-cigarettes," implying that all such products are equally dangerous. Today, for instance, the CDC reiterated its recommendation that "people should consider not using e-cigarette products," although it did add that "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."

Siegel thinks the CDC's vague warnings are doing the public a disservice. "In their zeal to demonize e-cigarettes," he writes, "the CDC and other health agencies have put the lives of our nation's youth at risk."

The risk is twofold. First, without specific information about the potential hazards of black-market THC oil, people may continue to use those products. Second, people who have switched from combustible cigarettes to e-cigarettes may switch back, even though smoking is indisputably much more dangerous, while smokers who had been considering a switch to e-cigarettes may decide to continue smoking. Both of those choices increase the risk of respiratory illnesses, along with the litany of other diseases caused by smoking. You might think that government officials who claim to be promoting public health would recognize those hazards.

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  1. It should be noted, too, that the products that caused the respiratory illnesses (containing vitamin E and otherwise), appear to have been bough at pop-up retailers and manufactured illegally–even in places where marijuana is legal.

    This is perfectly consistent with libertarian arguments about why legalization is better than black markets. In the days of prohibition, where legal whiskey from established brands had excellent quality control, black market bathtub gin could make you blind.

    I’ve read stories that say that the pop-up, black market retailers that sold the vaping products that made people sick were charging half of what the vaping products down the street were charging for legal, established brands with better quality control.

    If that’s accurate, then banning vaping certainly isn’t the solution to this problem. The solution is to reduce the cost of legal compliance and taxes so that black market brands no longer have such a big cost advantage.

    1. Obvious implication–If they ban vaping products, the problem will grow larger if the only vaping products available are all from the black market.

    2. It should also, also be noted that cannabinoids aren’t soluble in water and perform the exact same function in the lungs in smaller doses while nicotine, being more soluble, doesn’t require oils or surfactants to dissolve and doesn’t coat the lungs in such a manner.

      I don’t think they should ban THC vaping and I don’t think THC vaping is worse for you than standing over a hot grill for an 8-hour shift, but acting like nicotine is dangerous and THC is not is not sensible.

      1. in smaller doses

        To clarify, cannabinoids aren’t more potent they just weren’t as abundant as the vitamin E in these products was.

      2. That’s true. While some THC oil uses a CO2 extraction process, the equipment is quite expensive relative to the more common butane extraction systems. That may very well be the culprit.

        1. THC is itself an oil. There is some butane left in some extracts (which isn’t great for you), but it isn’t going to condense in your lungs like vitamin E or (possibly) THC (though, since it’s the way most people consume it, I think THC is pretty rapidly absorbed by the lungs).

          1. THC is a crystalline solid.

  2. My first reaction is — scape goat at last!

    Study after study on eggs, coffee, chocolate, milk, you name it, have been in conflict with each other over some of what seem to be the simplest health questions. Decades upon decades, study upon study, and still no agreement.

    Suddenly the vaping crisis has been solved in just a few weeks or months?

    My hunch is that given how many people vape, the “crisis” is no such thing, and this “solution” is no such thing either.

    Cops like to do this too. Some young blonde is murdered in the Caribbean, or some local politician is mugged? Quick, round up the usual suspects, coerce the least likely into making up stores about the most likely, ram it through trial with a judge who knows where his bread is buttered, cheap out on the public defender, and bingo! case closed.

  3. Sounds like a solid defense of the Daniel Pantaleo policy.

    It’s pretty clear that Juul had absolutely nothing to with any of these deaths but might as well strangle it to death anyway. Make sure eggs, coffee, chocolate, milk, you name it, really get the message.

    1. Whoops, this was meant in reply to Á àß äẞç ãþÇđ âÞ¢Đæ ǎB€Ðëf ảhf

  4. Assuming that vitamin E acetate is the culprit in many of these cases, it is clearly not a complete explanation, since it was not detected in all of the fluids vaped by patients. The FDA and the CDC are still trying to figure out which other agents may be causing the respiratory illnesses.

    A complete explanation isn’t necessarily needed or even feasible. What might’ve been a correlation was actually explained by confounding factors and noise. Once you’ve explained the overwhelming majority of the cases, the rest can be chalked up to man made global warming.

  5. 215 at last count—are caused largely by additives or contaminants in black-market THC products.

    All THC-based products are life-giving medicine. I refuse to believe this.

    1. 200 out of millions of people who are vaping now doesn’t seem like a really big problem. Especially given how huge the black market in THC vape cartridges is now.

  6. So, sort of the vaping equivalent of drinking moonshine that used an old car radiator as a condenser, it appears.

    1. Or possibly like cutting your cocaine to increase profits or lower prices. I suspect a lot of the black market vapes start with a good extract and add things to dilute it.

      1. A little from column A and a little from column B. I’m certainly not up on market prices for THC oil, but there are a plethora of oils with which to cut it that would be cheaper than Vitamin E enriched ones.

        1. It wasn’t vitamin E enriched oils that were used it was a form of vitamin E that is itself an oil.

        2. I would think it was a matter of the temperature at which the oily materiel vaporizes. Perhaps vitamin E does so close to the same as THC oil. Also I think it is tasteless. So they probably just figured it was harmless.
          Some of this may have been going on for a while just underreported as nobody saw the correlation.

  7. Ouch. Any MMP (medical marijuana patient) should pay attention to this issue. I would want to know with certainty that a state licensed dispensary does not have adulterated products. One workaround for MMPs who vape oil; switch to flower.

  8. Who’s a thunk back in 1968 that a half-century later jackbooted minions of the political State would be lynching VITAMINS as the Assassin of Youth?

  9. You should only dab pure THC crystals.

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