Study Finds That the Vast Majority of Respiratory Diseases in Vapers Are Linked to Illegal THC Products

Among patients in Illinois and Wisconsin, 83 percent admitted vaping cannabis extracts bought on the black market.


According to a new report on patients in Illinois and Wisconsin who experienced severe respiratory illnesses after vaping, 83 percent admitted using black-market cannabis products. While 17 percent said they had used nicotine only, some of them may have been reluctant to admit using illegal drugs, and it's not clear that any of them were using standard e-cigarettes.

These findings cast further doubt on the wisdom of general warnings about "vaping" and "e-cigarettes," which imply that legal nicotine products are implicated in these cases. Such warnings may encourage former smokers who are now vaping to start smoking again, a decision that exposes them to much greater health risks.

The new study, reported Friday in The New England Journal of Medicine, focused on 53 patients who had vaped within 90 days of their symptoms, typically within the previous week. Their median age was 19, and nearly a third were younger than 18. Among the 41 patients who were "extensively interviewed," 80 percent reported using THC products, 7 percent mentioned CBD products, and 17 percent said they had vaped nicotine only. The authors note that "information on product use is based on reports by the patients, and patients may be reluctant to report illicit drug use."

The description of the vapes used by the patients indicates that most were black-market products represented as containing cannabis extracts. "Patients reported using 14 distinct brands of THC products and 13 brands of nicotine products in a wide range of flavors," the researchers say. "The most common THC product that was reported was marketed under the 'Dank Vape' label (reported by 24 of 41 interviewed patients [59%]). Patients reported use of a number of different e-cigarette devices to aerosolize these products."

It's not clear whether any of the products in the THC-only cases were closed-system devices such as Juul, as opposed to refillable vaporizers. Nor is it clear whether the cartridges or e-liquids used in the devices were legally produced, illegal knockoffs, DIY solutions, or mystery fluids concocted by third-party suppliers.

At last count, the U.S. Centers for Disease Control and Prevention had identified "over 450 possible cases," including five fatalities, in which pulmonary diseases may have been caused by vaping. Data from California and New Mexico, like the Illinois and Wisconsin cases analyzed in the NEJM study, point to THC products as the main issue.

E-cigarettes have been in wide use for years, while these cases have cropped up only recently. It therefore seems likely that the agents responsible for the symptoms are relatively new.

The theory currently favored by public health officials investigating lung diseases among vapers, The New York Times notes, is that "some dangerous chemical or combination of chemicals has been introduced into the pipeline of vaping products." Investigators "believe that when people vape this noxious cocktail, it sets off a dangerous, even lethal, reaction inside the lungs." They "have said repeatedly that they do not yet know which substance or device may be causing this reaction, and that is the subject of their urgent investigation."

One possible culprit, identified in most samples of cannabis extracts tested by the Food and Drug Administration (FDA) and health officials in New York, is vitamin E acetate, an oil-based nutritional supplement that may be dangerous when inhaled. "Legally sold nicotine based e-cigs are not harmless," former FDA chief Scott Gottlieb said on Twitter last week. "But most of these severe cases, so far, appear to be symptoms that can occur when either oils or lipid-containing substances enter lungs. This points to illegal products that are being cut with dangerous chemicals as a culprit." He added that "legitimate e-liquids are generally based on chemicals that are water soluble, not oils that can cause acute lung injury."

NEXT: The Joyful Contrarianism of Gordon Tullock

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. I’ve seen a study that shows that the vast majority of the perpetrators of mass shootings were illegally killing people with guns, too, which is why we need to ban guns.

    Same logic as the anti-vape nutters.

    1. Bur you’re a gun control advocate just slightly more permissive than your critics but still in favor of restricting access to weapons.

  2. Top quality China vape juice.

    1. The Chinese triads have also supplied counterfeit AKs with North Korean markings to Mexican drug cartels.

  3. I put kerosene in my gas tank, but it’s the fault of the vehicle that it caught fire and burned me.

    1. The Opium Wars in reverse…

      1. IIRC there are safe and effective speed-like weight loss drugs that are available in Europe which are not available here because addicts might illegally get ahold of them.

  4. Excellent reporting of the findings by the Wisconsin and Illinois health departments.

    The case report seems to contradict what the CDC has put forth thus far as to the causative agent proposed as vitamin E. They did not find lipid laden macrophages on BAL. They found neutrophilic infiltrates more consistent with an acute hypersensitivity pneumonitis.

    The clinical and radiologic findings are coming into focus. Treatment is corticosteroids and life support as needed. Good work from the public health community in reporting what is known to this point.

    1. The case report seems to contradict what the CDC has put forth thus far as to the causative agent proposed as vitamin E.

      You’re full of shit. First, they didn’t say the causative agent was vitamin E. Second, even if they did, it doesn’t contradict that assessment.

      The CDC said it found unusually high levels of vitamin E in a majority of cannabinoid based samples and this report finds that the majority of cases were associated with use of cannabinoid products. There is no assertion of causative agent nor contradiction except in your selectively backwards reading.

      1. Aha. So the hypothesis has been floated that this is a lipoid pneumonia because of the oily content of Vitamin E. The findings reported in the NEJM point more to a hypersensitivity pneumonitis. You are correct that no causative agent has been ruled out.

        What it does mean is this is not likely a matter of “ oil in the lungs” something has triggered a systemic immune reaction and acute alveolitis.

        Backwards testing is not irrelevant. Testing of samples from the vape products which is backward in a sense revealed high levels of Vitamin E in some samples which is not proof but a correlation worthy of further investigation. I do not know and further evidence results in more knowledge.

        1. You’re thinking too deep. The correct response is to run around flapping your arms and howling like your hair is on fire, intermittently demanding a total ban on random objects.

          Reading is for dummies.

        2. So the hypothesis has been floated that this is a lipoid pneumonia because of the oily content of Vitamin E. The findings reported in the NEJM point more to a hypersensitivity pneumonitis.

          No they don’t. If they do, they make no mention of it. Moreover, you mistakenly act like the two conditions can’t be related despite the implicit/imperative underlying correlation.

          1. Sigh.

            Seems to contradict…

            Does not mean can’t be related. Nobody knows which agent or agents are responsible for this disease. If anything the report broadens the differential diagnosis. It does not look like a pure lipoid pneumonia as has been proposed. Something is causing a more systemic reaction.

            I could explain again the clinical, radiologic, and pathologic findings reported if you wish.

  5. But “The Truth” will probably run tendentious ads claiming it was the tobacco. I’m actually allergic to tobacco, and those nutcases piss me off!

    1. Which is ironic given Juul is owned by tobacco and is trying to bring crushing regulation down on itself and the vaping industry.

      It’s no coincidence North Carolina is the first state to launch vaping lawsuits.

  6. The article becomes less frightening when you notice that the number of volunteer guinea pigs testing communist exports is about one busload for the nation. So 80% sounds alarming, till you realize that this is 80% of 53 victims of altruistic sumptuary legislation, which adds up to a dozen more than annual fatalities caused by peanuts. Since these regulatory victims are all answering interviews, the death rate from avoidance of free radicals and polonium is looking a lot like zero.

    1. Don’t confuse the study’s sample size for the number of people being effected nation-wide.

      1. Correct it is a case series report from two states.

        At this point the clinical, pathological and radiology findings are better defined. There is a reporting system to CDC.

        Diagnosis and effective treatment can happen more rapidly. The medicals know better what this is.

    2. More likely to be caused by over pesti/fungicided weed sources than overseas sources. Since the shit gets processed and no one sees the initial product, people can get away with using nastier stuff.

  7. But muh weeeedd!!

  8. Dang. True.

    Today warned a certain millennial I know. Don’t buy the DANK vapes.

    He said “I’ve known that for weeks”

  9. So these black market pots have dangerous amount or aspect of THC (that cause respiratory diseases) that’s not found in legal, regulated pot?

    1. No, it has nothing to do with the THC.

    2. No, more like the additives being used instead of water causing issues, similar to the way back in the day they used all kinds of crap to cut cocaine.

  10. ergo pot is bad for you

    1. Ergot pot is really bad for you. I believe there was whole season of Justified around a cache of moldy pot.

      Reality today. The politicians who legalized pot saw to it that the taxes on legal pot are high enough to assure a demand for the black market pot. They get to collect taxes on legal pot AND maintain a war on illegal pot. A win-win for big government.

  11. “Study Finds That the Vast Majority of Respiratory Diseases in Vapers Are Linked to Illegal THC Products”

    Let me guess, legalizing currently illegal THC products will solve that problem, just like legalizing every other illegal substance will solve every problem those substances cause.

    1. No, it will just solve the problems caused by prohibiting a desired product, the problems of a black market with unknown players contributing to the supply pool. Solving further problems can then proceed once the producers don’t have to hide their sources, process and identities. Innovation can also occur once the gun is removed from their collective heads.

      This is wood alcohol in the prohibition era redux. It is the same problem as fentanyl in the opioid pool. It is a guaranteed outcome of the drug war.

      The coverage by malinformed, mal intended media chicken-littles is harmful to tobacco addicts. I hear some of the most outlandish tales of “my brother’s cousin” had “a piece of nickel the size of a walnut removed from his lung from vaping” at my parts counter. Sad that (now five?) people have died from poison cartridges or juice, but how many died from smoking-related diseases and house fires over the same period? Do we banish a new technology that killed 5 on favor of a highly lethal vice? Seems like a fscking stupid idea.

    2. Even if that did solve the problem, it introduces a glaring hole in libertarian thinking:

      The unregulated market supplied a dangerous substance and only the government can adequately curate the market for safe substances with legal regulation.

      Interesting argument, yes?

      1. Your argument would be stronger If this had happened in a free market, and not an illegal black market.

        1. An illegal black market, unfettered by government regulation, is the most free, most libertarian market possible.

          1. How is being subject to investigation and arrest “free and libertarian” ???

          2. If it were unfettered by government regulation, it wouldn’t be “black market”.

            The most free, most libertarian market possible is one in which the consumer has the choice.

            If government is to be involved, it is to enforce the contract between the buyer and seller. The buyer provides X for a good or service that provides Y. If the seller provides a good or service that does not provide Y, the government provides a third party recourse.

            In this way, for instance, it would not behoove a grocery store to sell tainted milk. If your local grocer sells tainted milk, it would soon be out of business.

            However, as it stands, if your local grocer sells you tainted milk, it simply says “sorry, our milk is USDA certified and inspected, if you have a problem, contact the FDA.” You contact the FDA and the FDA says “sorry, we don’t inspect milk, contact the USDA”. The USDA says “sorry, we inspect milk using guidelines regulated by the FDA, if you have a problem contact the FDA” IOW, the consumer might “feel” protected, but he/she has no real recourse when harmed.

      2. Interesting argument, yes?

        Considering the government doesn’t yet know what’s causing the problem, how to prevent it, or that it even can, no, not really interesting.

    3. You ban anything people feel
      (a) that they have a right to use,
      (b) that they benefit from it, and
      (c) that they use with no harm to others,
      such as alcohol, marihuana, guns, erotica, abortion,
      then you create bootleggers and back alley venders.

      Respect for the law goes down hill among the targeted users.
      Black markets are more likely to pander to abusers of whatever was banned.
      The products bootlegged are likely to be subpar in quality, smuggled from overseas, stolen from legitimate sources, made in basement workshops or labs.
      Billions of taxpayer dollars and government manhours are wasted in enforcement of futile bans that might have been applied to beneficial programs or policies.
      The only people who can’t buy the prohibited thing are the prohibitionists who didn’t want it and wouldn’t look for it.

    4. Libertarian arguments do not predict best outcome.

      Libertarian philosophy focuses on individual liberty.

      This issue should have nothing to do with government.

      Medicals are learning and informing people about risk as known to this point.

  12. ultravnc viewer Remote Desktop Access Computer, likes this post

  13. well…. no shit.
    an additive that’s not necessary for thc delivery causing all this. imagine that…

  14. Don’t confuse the study’s sample size for the number of people being effected nation-wide.

  15. like this post, thanks for information….

    best regards :
    konica minolta driver

Please to post comments

Comments are closed.