Among other things, the nationwide outbreak of vaporizer-related lung injuries has been an exercise in epistemology. Scientifically speaking, we don’t “know” what’s causing mostly young men’s lungs to seize up after vaping mostly underground-market THC products; we don’t “know” what’s sickened 1,888 people and killed 37 as of October 29, because we don’t have enough data.
But what data is available seems to strongly suggest that additives, particularly the thickening agent vitamin E acetate, mixed with THC oil in illegal market vape cartridges plays a significant role—a hypothesis supported by recent data out of Utah and California.
In research published on October 23, scientists and public health experts with the Utah Department of Public Health reviewed 83 cases in which patients experienced lung injuries after using vape products, including both nicotine e-cigarettes as well as cartridges with cannabis oil.
Researchers were able to secure interviews with 53 of these patients—and, perhaps most importantly, they obtained product samples from eight.
And of these patients, 92% of patients reported using THC products—all of which were illegal (given recreational cannabis is banned in Utah)—obtained either from friends, in-person dealers or online. The most common “brand” of illegal cartridges was Dank Vapes, better understood as readily available packaging ideal for an underground cartridge merchant. And of the 19 cartridges available for analysis, “evidence of vitamin E acetate”—a “cutting” agent discovered in other states that, when introduced to the lungs, can lead to “lipoid pneumonia,” an inflammatory response to fat in the lungs—was found in 17, or 89%.
So while researchers stressed that “[t]he cause or causes of this outbreak is currently unknown… the predominant use among patients of e-cigarette, or vaping, products with pre-filled THC-containing cartridges suggests that the substances in these products or the way in which they are heated and aerosolized play an important role in the outbreak.” It could be the vitamin E acetate, it could be something else—researchers at the Mayo Clinic found vapers suffered lung injuries resembling chemical burns—but vitamin E acetate sure does seem to appear wherever lung problems appear.
“I think that these results are really striking and really important,” said Dr. Michael Siegel, a physician and professor at Boston University’s School of Public Health who has researched tobacco and its health implications. “If you put these together with what was found in New York, where every single patient had at least one cartridge with vitamin E acetate, this is too much to be coincidence at this point.”
And applying the counterfactual, vape-related lung injuries are not appearing where vitamin E acetate is not appearing—or at least appearing less frequently, if at all.
In California, a sprawling and multitudinous nation-state with 40 million people and the nation’s oldest cannabis marketplace, the state Department of Public Health (CDPH) recorded 144 total cases of vaporizer-related lung injuries and three deaths through October 29.
Keep in mind that according to most estimates, there are more cannabis users in California than there are people in Utah—and that vaporizer products, which make up roughly 30% of the marketplace, have been prevalent in California for more than five years. That disparity suggests there’s something peculiar about illegal markets.
At least one California patient reported purchasing products from licensed dispensaries, but it’s still unclear which dispensaries or if those were the offending products that led to the individual’s illness. A CDPH spokesman was also checking to see if any of the cartridges had been analyzed.
But in the meantime, here’s another data point: One producer, Santa Rosa, California-based CannaCraft, has produced and sold six million half-gram vaporizer cartridges—and has “never” had a consumer or a health agency report a problem after using a product, company CEO Dennis Hunter told Observer last week.
“What this suggests is that in states that have legalized marijuana, there seems to be less risk,” BU’s Siegel added. “That may be because people are less likely to have to resort to black market products.”
In other states, the data is less useful but still suggests vitamin E acetate is at least a cause—and illegal vaporizer cartridges as the vector.
In Michigan, officials have identified five cases of vape-associated lung injury. This data may be the least useful—five cases, five different causes—but still suggests that additives in illegal THC vaporizers play a role.
(For what it’s worth: cannabis-using Michigan Redditors flagged “Dank” vape cartridges bought at corner stores as problematic months before the first cases of vape-related lung problems made the news.)
And in Massachusetts, where 204 people have fallen ill and two people have died, Gov. Charlie Baker has banned all vaping products for four months and is looking to extend the ban even further, despite reports that the ban is just pushing users towards the underground market, where products contaminated with pesticides, as well as vitamin E acetate, proliferate, as Boston 25 News reported.
Certain parties have capitalized on the vaporizer crisis to pursue personal hobbyhorses, such as the thus-far false claim that “marijuana” is killing people. If that was true, it would have appeared earlier. “Sudden lung damage from vaping is a new health problem,” the California Department of Public Health noted on its official website dedicated to the crisis, suggesting that something new—a new additive, a new technique—is behind the arrival of this new development.
It’s just a theory, but that would line up perfectly with the arrival of vitamin E acetate, a thick and oily substance that cannabis merchants can add to THC oil in order to “cut” it.
A THC oil product with a thickener added will be less potent—and, as we know now, potentially deadly—but there will be more of it. A potentially harmful product might contain up to 23% vitamin E acetate or more, as one of the Utah cartridges did. It will not have up to 80 or 90% cannabinoids, as tested products that do not fit the harmful profile will have.
“I think, right now, the most urgent thing is states need to test their products for vitamin E acetate oil,” Siegel said. “They should absolutely not be selling products with vitamin E acetate… all states should be specifically testing products for that chemical, and if it’s in there, throwing them out.”
For now, these are all just data points, marks on a canvas. More data points will be needed to draw any sweeping conclusion, such as “it’s vitamin E acetate in illegal vaporizers that’s making people sick, not cannabis itself,” but the marks are slowly drawing a picture that points towards the thickening agent as a chief culprit of the vaporizer crisis.
It’s not a very nuanced point, and yet it’s been lacking from much coverage of the vaporizer crisis, which—unless viewed with very specific prejudicial blinders—more and more looks like a crisis of a new and dangerous additive found in unregulated products on the illegal market.