Study Finds Nearly All Minnesota Patients With Vaping-Related Lung Injuries Used Illegal THC Products Containing Suspect Additive

Although the CDC is now emphasizing the potential hazards of vitamin E acetate, it continues to warn the public about e-cigarettes that don't contain it.


A new study of vaping-related lung injuries in Minnesota by the U.S. Centers for Disease Control and Prevention (CDC) reinforces the case against vitamin E acetate, a diluting and thickening agent found in black-market THC products. The study, published yesterday in the CDC's Morbidity and Mortality Weekly Report, also provides evidence that use of the additive is a relatively new phenomenon, which might explain why cases like these were not reported until recently.

In light of the accumulating evidence implicating illegal cannabis products in the lung disease outbreak, which as of November 20 included 2,290 cases and 47 deaths, the CDC has modified its advice about vaping. But it continues to imply, without evidence, that legal nicotine products, which have been used by millions of Americans for years without causing acute respiratory reactions like these, might have something to do with the lung injuries.

In the new study, researchers interviewed 58 Minnesota patients, 91 percent of whom reported obtaining THC products from "informal sources such as friends, family members, or in-person or online dealers." Just two patients said they had vaped only nicotine. It is not clear whether those reports were accurate, since patients may be reluctant to admit illegal drug use and may not actually know the contents of black-market products. Previous research has found THC in the lung fluid of patients who did not report vaping it. Without urine or blood testing, it is impossible to verify reports of exclusive nicotine use.

The researchers analyzed 67 product samples provided by patients, 46 of which contained THC. The most common THC brand by far was "Dank Vapes," a label widely used by bootleggers. Of the 12 patients who provided THC products, all but one submitted samples containing vitamin E acetate, which was not found in any of the nicotine products tested. Lung fluid samples from five patients all contained the additive, which is consistent with an earlier CDC study of 29 patients. Comparing 10 THC products seized by law enforcement agencies in 2018 to 20 THC products seized in September 2019, the researchers found vitamin E acetate in all of the latter but none of the former.

"The findings support a potential role for vitamin E acetate in lung injury," the study says, noting that the additive "has been detected in a high proportion of THC-containing products" used by patients, including samples tested in Minnesota, in New York, and in Utah as well as samples from 25 states analyzed by the Food and Drug Administration. The researchers also note that the CDC's analysis of lung fluid from 29 patients in 10 states "found vitamin E acetate in all specimens." And while "vitamin E acetate was not detected in the limited number of tested products seized [by Minnesota authorities] in 2018, it was detected in products seized in 2019, suggesting that vitamin E acetate might have been introduced recently as a diluent or filler."

The researchers caution that "further research is needed to establish a causal link" between respiratory disease and inhalation of vitamin E acetate. Nevertheless, they say, "These Minnesota findings highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources. Because local supply chains and policy environments vary, CDC continues to recommend not using e-cigarette, or vaping, products that contain THC or any e-cigarette, or vaping, products obtained from informal sources."

The latest version of the CDC's official advice about vaping likewise emphasizes the potential hazards of vitamin E acetate and black-market THC products. But the CDC is still describing the problem as "e-cigarette, or vaping, product use associated lung injury (EVALI)," a phrase that is not only absurdly cumbersome but highly misleading, since most people, when they read "e-cigarette," think of legal nicotine vaping products.

The CDC also continues to say that "the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products." Meanwhile, it contradicts itself by warning smokers who have switched to vaping that they should not return to their former habits, which are indisputably much more dangerous.

It's instructive to compare the CDC's general warnings about vaping to its much more specific advice concerning the recent outbreak of illnesses caused by E. coli contamination of romaine lettuce harvested in or near Salinas, California. "CDC's current advice applies to all brands, use-by dates, and types of romaine lettuce grown in the Salinas growing region," it says. The CDC is not suggesting that people stop eating, or that they avoid all fresh produce, or even that they stop eating romaine lettuce in general. The evidence points specifically to romaine lettuce from the Salinas area, so the CDC's advisory appropriately focuses on those products.

Although the conspicuous role of black-market THC products in vaping-related lung injuries has been apparent for months, the CDC has been slow to acknowledge it. The agency's nomenclature and its advice about vaping betray an irrational bias against e-cigarettes that has nothing to do with "EVALI." Its muddled message has done real harm to public health by failing to give cannabis consumers adequate warnings and by scaring smokers away from products that provide a much less hazardous source of nicotine.

A Morning Consult poll conducted in September found that 58 percent of respondents, based on what they had "seen, read, or heard on the news lately," believed people had "died from lung disease" caused by "ecigs, such as Juul," compared to 34 percent who said the cases involved "marijuana or THC e-cigs." Meanwhile, the share of Americans who recognize that e-cigarettes are less dangerous than the conventional, combustible kind continues to decline, a trend that is bound to be accelerated by "EVALI" scaremongering.

According to survey data reported this month in The Journal of the American Medical Association, just 26 percent of respondents perceived "electronic nicotine delivery systems" (ENDS) as less harmful than cigarettes in 2018, down from 39 percent in 2012. Between 2017 and 2018, the researchers noted, "an increase in perceiving ENDS as much more harmful than cigarettes was observed among cigarette smokers, which may influence their decision to try or switch to ENDS use."

The lead author of the JAMA study, Georgia State University public health researcher Amy Nyman, amplified that point in a press release. "Smokers who perceive too much risk from e-cigarettes may decide against using them to quit smoking and may instead continue with their combustible smoking habit," Nyman said. "The increase in perceived harm of electronic cigarettes may reflect growing concerns about the surge in e-cigarette use among young people, and the subsequent media coverage of the teen vaping epidemic."

Notably, the 2018 survey preceded the outbreak of vaping-related lung injuries. "If this survey were to be done again," one of Nyman's co-authors told Vox, "it would probably be shocking in terms of even more negative perceptions."

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  1. This entire situation once again reinforces the notion that prohibition kills…it always has and always will. Whether it was alcohol prohibition that led to “Bathtub Gin” that was killing people, marijuana prohibition which led to K2, Spice, and obviously this situation, heroin prohibition that led to AIDS (and other diseases) and proliferation of fentanyl, et al, prohibition kills. Our government is complicit in the deaths of it’s citizens and it needs to end. Any politician who supports prohibition supports the murder of their citizens.

    1. Prohibition not only kills, it also caused the Crash and Depressions of 1929, 1987 and 2008 and had a large role in the Panics of 1893 and 1907. Even the Panic of 1837 owed much to China’s prohibition of homegrown poppies, leading British India to supply the deficit and profit thereby. Once this monopoly was threatened by China’s equivalent of the Jones 5&10 law of 1929, Brits unloaded U.S. securities to fund naval aggression. The Kleptocracy cares not whose lives it crushes. Forcing it to realize that prohibition impairs securities markets, money, is the path to repeal. Prohibition and the Crash is classic Cause and Effect.

    2. Addiction is a symptom of PTSD. Says Nobel Prize Winner in Medicine Eric Kandel.

  2. Your facts cannot compete with the power of the Moral Panic.

    1. +1000000000000000000 – So well put out in the open for what it really is. Reason writers should take note..

      Article’s title — “Facts cannot compete with the power of the Moral Panic”

  3. I swear this exact article has been written at least 5 times a week for the past month….

    1. It’s just not garnering the outrage it used to. Perhaps you’d better stick to the college prog victim-making articles if you’re here only for the blood boiling.

      As a man who smokes and vapes nicotine, I enjoy reading about sudden deaths to any group but my own. Makes me feel smarter. And thanks to reason, I’m assured that my habits are perfectly safe for the short term.

      In the event that the deaths are found to be from nicotine-only delivery systems, I will simply ignore those articles.

      1. Well – If it’s findings were 47 out of 28,000,000; You just might be justified in “ignoring” those articles. Even for the most severe cases of OCD; a probability of 0.000168% is hardly something to get ape-crazy about.

        1. probability of 0.0168%

          Or about 1.68 per million.

          1. Well I screwed up that one didn’t I?

  4. If you are planning education in New Zealand, the first step would be to draft SOP for student visa. You are not familiar with the task of drafting SOP but it is a mandatory document that needs to be submitted to the foreign universities at the time of admission.

  5. I am making 10,000 Dollar at home own laptop .Just do work online 4 to 6 hour proparly . so i make my family happy and u can do  ……..  Read More

    1. Now that’s something worth going any and all kinds of crazy about!

  6. The CDC needs to get out of policing drugs for America. They totally botched the Guidelines for Opioid Prescribing for Primary Care Physicians which were based on faulty, biased data and even when its been proven by their own statistics that the opioid crisis was NOT started or sustained by doctors writing prescriptions but by Black Market Fentanyl and Heroin they continue to promote a false narrative. They lose more credibility by continuing to promote that vaping deaths and damage are from commercial sources. I believe they are doing this and blaming physicians and pharmaceutical companies for the opioid crisis to try to help the government win their court cases against Big Pharma and commercial vaping manufacturers. They are certainly not non-biased. Scientific research must be conducted by unbiased sources or it will be manipulated to support an agenda. IMO

    1. This:

      Read the whole thing. It is not that technical.

      If that is too much trouble:

      “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 (9). 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. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.”

      CDC is doing its job. It is reporting findings as they become available to the medical and scientific community. Perhaps the press, government and the rest of the public is running around like frightened lemmings.

      Just be careful what you vape.

    2. The CDC needs to get out of denying medicine to people that need it.

      Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood.

      Post USA Civil War alcoholism was called “the soldiers disease”

      Addiction is a symptom of PTSD. Says Nobel Prize Winner in Medicine Eric Kandel.

      People in chronic pain chronically take pain relievers.

      1. The CDC cannot deny anything. It has no enforcement power. All it can do is report and issue advice. That advice can be used by clinicians along with other published reports and guidelines issued by professional organizations. Nobody has to follow them.

        Where enforcement comes in is at the state level. State medical boards issue licenses, not the federal government. If the state issues guidelines that are too restrictive, which many have, then docs should be active in getting those changed.

  7. “Never let the facts get in the way of disseminating an effective piece of hysterical rhetoric” ~~ The Prohibitionist’s Motto

  8. Although the CDC is now emphasizing the potential hazards of vitamin E acetate, it continues to warn the public about e-cigarettes that don’t contain it.

    Maybe that has something to do with the high percentage of e-cigarette users who use both E acetate products, and non-E acetate products? Plus which, some of the injured users did not use the E acetate products—a fact Sullum acknowledges only to dismiss it as user misreporting. He thinks misreporting accounts for it because that sounds plausible to him.

    What kind of reasoning says, members of an injured group used both these similar products, one of which contains a unique ingredient, therefore the unique ingredient caused the injuries? Bad reasoning says that.

    Then there is this:

    But it continues to imply, without evidence, that legal nicotine products, which have been used by millions of Americans for years without causing acute respiratory reactions like these, might have something to do with the lung injuries.

    Well, sure, unless the current epidemic turns out to be a cumulative effect of those years of exposure to the nicotine products, and whatever other ingredients they contain. In that case, then Sullum is just assuming his conclusion. And because he doesn’t know the answer any more than the CDC yet knows it, Sullum is indeed assuming his conclusion, without evidence.

    Does Reason get some kind of financial backing from the Vaping industry?

  9. Yet we allow doctors to prescribe Seroquel to patients for hand tremors or other “off label” reasons, and when they have bad reactions to it – no one cares and blames the patient. Look at prescription medicines too.

  10. It’s hard to come by well-informed people in this particular topic, but you sound like you know what you’re talking about! Thanks

  11. Sullum indicates that “illegal” is the operative term here, and not even the moral majority Liberty Federation sockpuppets have taken issue with that poinpointing of the problem.

  12. While it’s touched upon in the article, it’s worth more clearly noting that DANK is packaging that is used by multitudes of different bootleggers. A quick online search will provide you with lots of links to purchase empty packages/cartridges. There’s really no way of knowing what is in the cartridges when they are purchased.

    Instead of scare tactics and attempts to ban vaping, efforts should be made to legalize the drugs. This would provide a safer, known product to those who desire it.

  13. Somewhat related topic. In Scotland an experimental facility is opening which will provide heroin to be injected under medical supervision to a limited number of addicts. The goal is harm reduction.

    I have really been surprised by the level of opposition to safe injection facilities here even when privately funded. This pilot project goes further.

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