Vaping

More Evidence That Black-Market THC Products Are Responsible for Vaping-Related Lung Injuries

The CDC found vitamin E acetate in all 29 samples of lung fluid it analyzed.

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A new study by researchers at the U.S. Centers for Disease Control and Prevention (CDC) reinforces the suspicion that vitamin E acetate, an additive used to thicken and dilute cannabis extracts, is playing an important role in the recent outbreak of respiratory disease among vapers. The CDC analyzed lung fluid samples from 29 hospitalized patients in 10 states and detected the additive in all of them.

Vitamin E acetate is a nutritional supplement that is safe to swallow or use topically but may be dangerous when inhaled, leading to lipoid pneumonia, a rare condition caused by fatty particles in the lungs. While this study does not conclusively show that is happening, the CDC is now calling the thickening agent a "very strong culprit." Prior testing by the Food and Drug Administration and New York's state lab found vitamin E acetate in most samples of THC e-liquids used by patients.

"Among 23 patients for whom self-reported THC use information was available, 20 reported using THC-containing products," the CDC study says. "THC or its metabolites were detected in 23 of 28 patient BAL [bronchoscopy and bronchoalveolar lavage] samples, including in those of three patients who said they did not use THC products."

That last point underlines the concern that self-reports may not be accurate in determining which substances patients have consumed, since they may be reluctant to admit illegal drug use or may not know the actual contents of products they bought on the black market. In cases where the information is available, the CDC says, 86 percent of patients have reported vaping THC, but the actual number is almost certainly higher.

The study says nicotine metabolites were found in 16 BAL samples, but it's not clear how many of those patients had also vaped THC. In an interview with USA Today, a CDC official "said THC wouldn't necessarily remain in the lungs and urine tests might have been needed to confirm its presence." Nor is it clear where the patients obtained nicotine cartridges or e-fluids. But if those products did contain vitamin E acetate, that indicates a black-market source, since the additive is not used in legal e-cigarettes that deliver nicotine. Overall, according to a CDC study published last week, just 11 percent of patients said they had vaped only nicotine in cases where the information was available.

"These findings reinforce CDC's recommendation that persons should not use e-cigarette, or vaping, products containing THC, especially those obtained from informal sources such as friends or family, or those from the illicit market, where product ingredients are unknown or can be highly variable," the new study says. "Until the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette, or vaping, products."

Another CDC study published today underscores the potential hazards of black-market THC vapes. Comparing information on patients with responses to a general survey of vapers in Illinois, the researchers report that patients "had higher odds of reporting exclusive and frequent use of THC-containing products and obtaining these products from informal sources, such as a dealer, off the street, or from a friend, and of using Dank Vapes, a class of largely counterfeit THC-containing products."

As of November 5, the CDC had counted 2,051 cases of vaping-related lung injuries, including 39 deaths. The "convenience sample" of patients used in the CDC's study of lung fluid samples is not necessarily representative.

If vitamin E acetate is causing some of these lung injuries, it is probably not the only culprit. A study reported last month in The England Journal of Medicine, based on lung tissue samples from 17 patients, found no evidence of lipoid pneumonia. The researchers said the samples were consistent with exposure to toxic chemicals.

The CDC says "other diluents and additives of concern (e.g., plant oils, MCT oil, petroleum distillates, and diluent terpenes) were notably not detected" in the lung fluid samples it analyzed. But while "it appears that vitamin E acetate is associated with" vaping-related lung disease, "it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants."

In any case, these findings show once again how misleading it is to imply that legal, nicotine-delivering e-cigarettes are responsible for vaping-related lung injuries. "At this point," Boston University public health professor Michael Siegel says, "it is time for state policy makers and politicians to immediately discontinue their conflation of this outbreak with the problem of youth e-cigarette use. It is time for all policy makers, health agencies, and health professionals to immediately stop stating or implying that legal, nicotine-containing e-liquids have anything to do with the outbreak."

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  1. Looks like the FDA’s dastardly 36DD chess plan is working! Getting everybody else off their rumps and into investigation mode. Pretty soon … grab ’em by the press!

    1. The MMWR is not the press. CDC has been publishing this since there was a CDC. It is intended for a professional readership and has been for many years.

  2. The CDC has done a great job getting out information as they have it.

    This is a small number of cases to begin with 2000 something possible out of a much larger number of vapers.

    Then you have 29 cases where BAL specimens were sent to CDC for pathologic review. Results are as reported vast majority reported or were found positive for THC vapes bought on the so called black market. Near all were found positive for VitE acetate. The pathologists did not find lipoid pneumonia. This and other series indicate an acute inflammatory pneumonitis.

    It is not a controlled study it is a case series.

  3. I’m confused. Is the black market good or bad?

    1. Bad for your health.

      Good for liberty.

      1. The liberty to sell poison to the unsuspecting is the liberty to have your liberty taken away.

        1. Poisoning was common when Alcohol was Black Market.

          Prohibition is socialism for criminals. We learned that from Alcohol Prohibition.

    2. Bad. It’s indicative of an oppressive government attempting to prevent availability of a desired product. If THC vape products were legal do you think you’d see so many folks getting harmed from these products? It would certainly be easier to track down the source.

      1. So proactive regulation by government is the answer?

        Or is regulation after the bodies pile up better?

        It’s one or the other.

        1. Republicans know that every rights-violating law attracts resisters. For this reason they order cops to murder them without hesitation. After the bodies caused by police killings have been piled and catalogued, survivors will be quicker to obey after the example. The reason we know that water is a deadly poison is because water-drinking contests during alcohol prohibition caused deaths, to the absolute delight of the Methodist White Terror and Anti-Saloon League. To them it was Tha Lawerd smiting sarcastic scofflaws.

          1. Did you have any point to make?

    3. If you hate a functioning economy it is bad. Calvin Coolidge understood that violent prohibitionism would ruin the economy his Laffer-curve approach nurtured. With schadenfreude he signed a law making beer a 5-yr chain-gang felony with a gold fine worth $602,000 current dollars. This he did 2 days before Dry Hope Hoover was made President. Market crashes were already occurring in Nov-Dec 1928 and ramped up in March 1929. The Crash began early September, and the rest is Great Depression.

  4. With all due respect, wasn’t vitamin E acetate noted as a probable agent several weeks ago?

    1. It was noted all along. There is not enough evidence at this point.

      Look if ya wanna smoke weed just stick with the plant for now. How difficult is that.

  5. It is time for all policy makers, health agencies, and health professionals to immediately stop stating or implying that legal, nicotine-containing e-liquids have anything to do with the outbreak.

    Don’t hold your breath.

    1. This has been apparent from the first reports when the stories never mention a commercial product. When have the media ever shied away from demonizing a corporation? Their anti-corporate stance is contributing to deaths.

  6. Didn’t the biopsies of the lung tissue collected show what appeared to be damage from chemical burns, something that vitamin E acetate wouldn’t do?

    1. As it says in the article, it’s likely there are several agents at work.

      1. Sorry, I didn’t clarify. The vitamin E acetate is no longer suspected of causing the damage they saw. In fact, no one is 100% sure vitamin E is capable of making people sick. It’s thought it could be possible. However, once the lung burns were discovered vitamin E acetate was disregarded as the harmful component, but still probably shouldn’t be vaped.

        1. Found it. Recent case series by pathologists submitted by the Cleveland Clinic.

          https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqz182/5588493

          There are several things going on here in an area of medicine not strictly defined.

          First the CDC has some preliminary data indicating presence of VitE acetate in nearly all patients they were able to study. That proves nothing in itself yet it gives a path for further investigation.

          Second is pattern of disease on the pathologic and clinical level. The initial thought was that we are looking at lipoid pneumonia. That does not seem to be the case. It is an inflammatory pattern with lymphocyte predominance and often severe damage to alveoli.

          This broad pattern of lung injury can result from many different agents. If you look at the radiology findings there are 5-6 different presentations there in this small series. The report demonstrates a nonspecific set of findings.

          None of that rules out anything as to agent or agents responsible. It does strongly indicate that this is not eosinophilic or lipoid pneumonia.

  7. After weeks and weeks, at a cost of millions, the government came up with a conclusion that Reddit gave us months ago. Whatever would we do without our intellectual betters to tell us what we already knew.

    Pay your taxes, consume, obey. Civilization depends upon it.

  8. According to the pseudoscientist Sullum debated, this is a good thing–like adding methanol to whiskey and beer to blind and kill drinkers during prohibition. “You don’t want harm reduction” say the prohibitionists. Small wonder they favor poison and police breaking into homes to murder men, women, children and dogs so Jesus can lift them all into Heaven. The same monster told Jacob that trade and production are the felony crimes discussed by Ragnar.

  9. You never let a serious crisis go to waste. And what I mean by that it’s an opportunity to do things you think you could not do before.

    Rahm Emanuel

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