Vaping has been around for at least a decade, so why is it that people are suddenly getting sick? Is it the accumulation of years of vaping and unresearched consequences to blame, or is there a new chemical culprit?
What is happening to e-cig users?
According to the Washington Post, there have been at least 1,604 lung injuries in every state but Alaska and 34 deaths connected to e-cigarettes as of October 22, 2019. E-cigarettes are battery-powered devices that heat liquids that include substances such as THC and nicotine into vapor that users inhale as an alternative to smoking traditional cigarettes. These devices contain a number of liquid additives, including nicotine and THC, but until recent years have been highly unregulated by the Food and Drug Administration.
Patients who have fallen ill as a result of e-cigarette use “typically experienced coughing, chest pain or shortness of breath before their health deteriorated to the point that they needed to be hospitalized,” according to the Center for Disease Control and Prevention. Other symptoms cited have included fatigue, fever, weight loss, diarrhea, vomiting and nausea. Many of these cases resulted in acute respiratory distress syndrome, a life-threatening condition where fluid fills the lungs and prevents oxygen flow.
What do we know so far?
The CDC found that most people who fell ill as a result of vaping reported using THC prefilled cartridges they bought from an illicit rather than licensed vendor. The Post reported that while some patients said they only used nicotine products, their urine tests indicated the presence of THC, so the number of THC vape users may be higher than reported. If THC cartridges seem to be the common denominator, what about them is causing these illnesses? Vitamin E.
But I use Vitamin E!
Vitamin E is traditionally used in skincare products because it acts as a soothing and moisturizing anti-inflammatory agent. When used in a topical or oral capacity, it’s harmless. In fact, it can be beneficial for skincare treatment. However, the safety instructions for Vitamin E acetate supplier Lotioncrafter directly advise users to “keep away from heat and sources of ignition,” and “not [to] ingest/breathe gas/fumes/vapors/spray.” Rolling Stone reports that when inhaled, it can lead to lipoid pneumonia, a condition characterized by chest pain, coughing and difficulty breathing due to fat particles being inhaled into the lungs. These symptoms were all found in patients that reported using “black market THC cartridges,” Dr. Melodi Pirzada of NYU Winthrop Hospital in Long Island told Rolling Stone.
Web MD has found that in New York, Department of Health officials are focusing on Vitamin E acetate, and have found traces of the additive in almost all of the samples they have tested in relation to the outbreak. The FDA has since launched a criminal investigation with the Drug Enforcement Administration to determine the cause of these illnesses.
“The one thing in common is that every single one has obtained ([the vape] from a pop-up shop, or a stranger, or a friend of a friend…no one had obtained it from a licensed dispensary,” said Milton Teske, a public health officer for Kings County, California, and an emergency room doctor at Adventist Health.
How is Vitamin E Getting in these Cartridges?
In state-regulated markets, THC cartridges have to go through mandatory lab tests for potency and purity standards; however, according to an article in Leafly, legal, state-regulated sales only make up 21% of the cannabis industry. This puts the other 79% on the black market where, according to Leafly, “anything goes.” Typically, black market vape cartridges are mixed, or cut,with diluents in order to make manufacturers’ supply of THC oil last longer. The cartridges used to be mixed with propylene glycol, vegetable glycerin or MCT oil. However, these cutting agents create a runny and watery consistency, which consumers now recognize as a less potent cart. “Thin oil is a red flag,” according to David Downs for Leafly, “Thick oil has become a proxy for purity.”
Vitamin E is growing as a popular thickening agent for the underground venders , as it has a consistency that is on par with the consistency of a “potent” and seemingly undiluted cartridge. Rolling Stone reports that in the past, manufacturers would use Vitamin E oil in 20% or less of the mixture. However, due in part to increased demand, black market manufacturers are using 50% or more of Vitamin E oil to cut the cartridges. Honey Cut, a Vitamin E thickening agent that has since erased its online presence after being subpoenaed by the FDA, advertised its ability to dilute vape pen oil up to 75%.
“If you’re going to take some solution that thickens up solutions, what the heck do you think it’s going to do to your lungs?,” says Peter Hackett, owner of Air Vapor Systems of Concord, CA.
Why it is Complicated
In states where there is no legal cannabis market, it is difficult to know where the cartridges are coming from, even if it seems like a regulated source. In his article for Leafly, Downs describes downtown Los Angeles as the “epicenter of the US street cart market.”
“Warehouses in LA will sell you empty carts and pre-printed packaging to stick them in, fresh from China,” Hackett tells Downs. “A pack of 100 empty glass tank carts and counterfeit packaging ripping off Cookies, a highly regarded legal cannabis brand, runs $18 on DHgate.com.”
According to Downs, any illegal cart manufacturer can claim “lab tested” on the label. In the current market, it’s extremely hard to trace where your cartridges are coming from and almost impossible to know what is in them.
What does all this mean?
While the FDA has said it is too early to determine if Vitamin E acetate is the cause of these illnesses, you can never be too careful.
Thomas Whitten, lead consultant at WeedRaR told Rolling Stone that the current cannabis landscape is a “shitshow.”
“Put it this way: I would not touch a pen (right now) even if it was from a licensed facility.”