A “vaping crisis” has hit the US. As of September 13, there have been 380 confirmed and probable cases of vaping-related lung illnesses in 36 states, and six people have died so far.
In response, President Donald Trump has announced his administration will ban flavoured e-cigarettes and several health bodies, including the American Medical Association and the Centers for Disease Control and Prevention, have urged the general public to avoid using any vaping products in light of the apparent outbreak.
The illness, dubbed or VAPI, is thought to be tied to vaping e-cigarette liquids and cannabis oils, though no specific ingredient or factor has yet been identified as the root cause of the illness.
Many, but not all, of the confirmed cases have involved vape devices containing tetrahydrocannabinol (THC), the compound responsible for the psychoactive effects of cannabis.
So, is vaping marijuana safe? Here’s everything the cannabis industry should know about the vaping illness outbreak.
Is Vaping Bad for Your Lungs?
Officials from the US Centers for Disease Control and Prevention (CDC) are investigating confirmed cases of the vaping lung illness but have yet to identify a sole cause behind the outbreak.
Public health experts have for the outbreak, and now believe that the illness could be being brought on by chemical exposure.
No consistent e-cigarette products or components have been linked to the outbreak so far, and the CDC has clarified that while some of those affected had been using cannabis products, or a mixture of cannabis and nicotine products, they have also seen cases from patients who reported only using nicotine products.
“We are getting clearer about the things we should be looking at to understand the situation,” , acting deputy director for noninfectious diseases at the CDC. “The focus of our investigation is narrowing, and that is great news, but we are still faced with complex questions in this outbreak that will take time to answer.”
Vitamin E acetate, the prime suspect
The prime suspect at the moment is , a diluent thickener used in vape cartridges. According to , vitamin E oils are found mostly in illicit market THC vape cartridges.
is the non-scientific name for a class of oils known as the tocopherols. These oils occur naturally in nuts, seeds, corn and other vegetable oils, and are produced synthetically during the manufacture of petroleum oils. Vitamin E oils are also made and marketed as , as the oils have natural antioxidant properties and is involved in the body’s anti-inflammatory processes.
While the cosmetics industry has researched the as an ingredient in topicals and creams, it has never before considered its effects as an inhaled substance, and so its inhalation toxicity is unknown.
But just one day after the New York State health department declared of investigators, Mitch Zeller of the US Food and Drug Administration , suggesting that multiple chemicals common to vaping liquids were still under active investigation.
Could Chinese tariffs be to blame?
Another theory for what has caused this sudden epidemic puts the blame partly on the Trump administration and its imposition of .
from when the Trump administration announced the new 25 percent tariffs – which may to 30 percent – had cannabis and vape companies worried. China is the largest manufacturer of high-quality vaporizers, vape cartridges, and other e-cigarette parts, and many small cannabis and vape businesses warned that they may not have the resources to survive through this trade war.
“With all the permitting costs and everything that goes into being legal and licensed and getting on shelves in stores, we don’t have that extra money sitting around to get hit with a 25 percent tax out of nowhere,” Julia Jacobson, CEO of Aster Farms, told at the time.
Nick Kovacevich, CEO of KushCo Holdings, the largest US seller of vape products, spoke to about these tariffs and a possible connection to the lung illness outbreak.
The economics are simple, Kovacevich says, when the price of a high quality vape cartridge grows, manufacturers might be tempted by cheaper, lower quality, components. Even if manufacturers stick with the higher quality components, consumers might balk at the price and turn to cheap, yet potentially unsafe, home brews or illicit market products.
“People will go with what is cheaper if the price difference is suddenly a lot bigger,” he says. “We are competing with chop shop factories knocking-off branded counterfeits that say XYZ company on the package but are not really affiliated, and who knows what they are getting.”
There may well be a regulatory backlash
Kevin Sabet, president of the anti-cannabis group Smart Approaches to Marijuana (SAM), took to Twitter last week to demand action be taken against cannabis businesses in light of the outbreak.
“Pot shops kill. Close them down,” he wrote, referencing the case of a man in Oregon who in July after using a cannabis vape device purchased from a local licensed cannabis dispensary.
“What we don’t know for sure is what, exactly, caused the individual’s death – just that the individual shopped at a dispensary before falling ill,” Oregon Health Authority spokesman Jonathan Modie told . However, it’s known that the Oregon man’s symptoms were consistent with others being investigated by the CDC as a part of this outbreak.
There have been wider calls to increase the regulation of e-cigarette and vape products. E-cigarettes have generally been thought of as a safer than traditional cigarettes, and so currently are not subject to the same regulations.
“We must not stand by while e-cigarettes continue to go unregulated. We urge the FDA to speed up the regulation of e-cigarettes and remove all unregulated products from the market,” AMA president Dr Patrice Harris, .
The Trump administration is currently considering in light of the lung illness outbreak. By restricting the flavors available, the administration is hoping to curb the increasing use of vape products by teenagers and young adults.
“We can’t allow people to get sick,” . “And we can’t have our kids be so affected.”
No major sales disruption thus far
Despite the public being warned to cease using vape products, retailers are reporting that there has as a result of the public health scare. This is thought to be in part due to retailers focusing on proactive consumer education.
“We wanted to take a proactive approach,” Jason Erkes, spokesperson for Cresco Labs, told .
Cresco is one of many vendors choosing to use social media to communicate information to their customers about its vape product testing and manufacturing practices.
Since being posted, the social media statement put out by Cresco labs has become “the most-trafficked social media post we’ve ever had as a company,” according to Erkes, and the company has received “overwhelming” support from its customer base.
“We haven’t been receiving a lot of questions from patients or consumers, but people are counting on our products as medicine in many parts around the country, and we feel they deserve to know what’s in these products,” said Erkes.
This could be part of a larger, hidden epidemic
Possibly the most concerning revelation to come out of this outbreak is the suggestion that this vaping illness may not be a new phenomenon at all.
In 2018, published by British Medical Journal Case Reports described the case of a young female vape products user who was admitted to hospital with respiratory failure. Her symptoms, including a cough and difficulty breathing, were similar to those being seen by public health officials in America right now.
After several medical tests, doctors concluded that the woman was suffering from lipoid pneumonia, most likely brought on by her vape product use. is an inflammation of the lungs caused by fat particles accumulating in the lung tissue. Here, doctors suspected that the fat particles originated from the vape products that the woman used.
This case has led to the theory that America is actually experiencing the resurfacing of a long-running epidemic.
Within these discussions over vaping safety, Europe has been . The United Kingdom is the worldwide, with four other European countries also present in the top ten markets by size. And yet, Europe has not seen the same vaping lung illness epidemic that has shaken the United States this summer.
Or has it?
Unfortunately, no one seems to be keeping track. According to , many European countries have voluntary reporting systems, meaning that there isn’t much evidence of this problem for experts to draw from. But Europe does have are than the US.
“We have not seen anything like what we’ve seen in the US recently in Europe, to my knowledge as a scientist, and I’m pretty aware of the field,” said Constantine Vardavas, the European Respiratory Society’s scientific relations director with the EU, to .
The European Commission has the health risks of e-cigarettes and other vape products, while investigation into the cause of the vaping-associated illness outbreak continues in the US.