A Brief History of Vaporizers
Vaporizers didn't exist before 1989. That year a mysterious character named Dr. Lunglife submitted two articles to High Times that were published. They provided diagrams for making your own portable weed vaporizer - the kind with a dome and a hose.
Vaping was alway a weed thing until the tobacco industry got a hold of it. The Volcano vaporizer - the pyramid shaped device that utilizes turkey storage bags to contain the vapor - never was used for tobacco.
But then the tobacco industry, shamed by the high death totals from its products, turned to vaping as an alternative to smoking. There is no evidence that e-cigs are safe, just that perhaps they are "safer" than cigarettes.
Rather than sneak a cig in the bathroom or in some hidden spot around schools, teens snuck hits on e-cigs like Juul. Plenty of adults are hooked on these little black sticks too.
Deaths by Vaping Reported
In the fall of 2019, reports began to surface of people who inhaled cannabis oil in vape pens suffering respiratory problems and requiring hospitalization. Then some started to die. Through the end of the year and into early 2020, there were 68 deaths due to vaping pens or e-cigs and more than 2,800 cases.
On September 27, the Centers for Disease Control and Prevention (CDC) said 82% of the cases were marijuana-related. “The outbreak is currently pointing to a greater concern around THC containing products,” the CDC's principal deputy director Anne Schuchat stated.
Sixteen states have legalized marijuana. Thirty-five states have broad medical marijuana laws. Vape pens are legally manufactured and sold in most of these states. The cannabis oil in the cartridges that's vaporized when connected to a battery and inhaled is generally safe since its required to be tested for toxins, mold and pesticides in legal states.
But, still the vast majority of Americans don't have access to these legal, safe products. In the other 34 states, illicit markets are thriving. No longer content to smoke joints or take bong hits, consumers want the convenience and discreetness of vape pens. Bootleg manufacturers sprung up around the country to cateer to these needs. Their oil cartridges are not tested for diluents or flavorings, which can contribute to lung irritation and possibly death.
David Downs at Leafly on Sept. 6 compared the "outbreak to bathtub gin under alcohol prohibition. It is generally a creature of unlicensed markets where consumers have no legal alternative. It’s akin to recent Spice/K2 poisonings, as well as unregulated CBD market poisonings."
By February and March of 2020, the Centers for Disease Control, the agency that tracked the deaths and cases and researched the causes had a new problem: Covid-19. They stop tracking the vape deaths and cases on February 18. There must have been more cases and deaths that just weren't reported.
The Industry Responds
The California Cannabis Industry Association's executive director Lindsay Robinson sent a letter to the state legislature on Sept. 9. It read, in part:
"While investigations are ongoing and a cause has not yet been identified, it's important to note that no cannabis vaping products purchased at licensed cannabis businesses have been linked to these illnesses. In fact, the California Department of Public Health is currently attributing illnesses in California to untested products purchased from the illicit market."
NORML deputy director Paul Armentano commented on September 5:
"These unfortunate incidents reinforce the need for greater regulation, standardization and oversight of the cannabis market – principles which NORML has consistently called for in the cannabis space. Consumers must also be aware that not all products are created equal; quality control testing is critical and only exists in the legally regulated marketplace."
National Cannabis Industry Association executive director Aaron Smith added:
"These unfortunate illnesses and deaths are yet another terrible, and largely avoidable, consequence of failed prohibition policies. Current federal laws interfere with research, prevent federal regulatory agencies from establishing safety guidelines, discourage states from regulating cannabis, and make it more difficult for state-legal cannabis businesses to displace the illicit market. These policies are directly bolstering the markets for untested and potentially dangerous illicit products... It is now the responsibility of Congress to end prohibition and regulate cannabis without delay."
California vape pen manufacturer Bloom Farms issued the following statement:
"We're closely monitoring the reports of vaping-related illnesses. All Bloom Farms cannabis formulations contain only 100% cannabis oil and cannabis-derived terpenes. We don't add cutting agents (like Vitamin E acetate) or any synthetic agents to our products. In addition, we always test our products to ensure they meet each state’s strict cannabis health and safety standards.
In its policy paper on the current vape crisis, issued on October 2, the Marijuana Policy Project took issue with "banning a popular product," which will likely drive cannabis consumers in legal states to the black market. The paper calls for improved testing standards, complete ingredients lists for all cannabis products and "legalization at the federal level." Read the paper here.
The Vitamin E Acetate Problem
It's being reported the vitamin E acetate is commonly used as a thickener in cannabis oils. While glycols are viewed as harmful diluents, little is known about vitamin E acetate at this point other than it is apparently slipping through tests in legal states. "Just like prohibited pesticides, we need a prohibited diluents list as well as requirements to list ingredients," says Brad Bogus, VP of the testing company Confident Cannabis.
Also known as alpha tocopheryl acetate (ATA), vitamin E oil is used in skin care products, foods like cereals and juices, multi-vitamins and supplements. According to Healthline, the potential risks of taking high doses of ATA (more then 1,000 mg) are dizziness, fatigue, headaches, blurred vision, abdominal pain, diarrhea and nausea.
The symptoms in most of the 2,000-plus reported cases of vape-oil poisoning are coughing, shortness of breath, chest pain, difficulty breathing, nausea, vomiting, diarrhea, fatigue, fever and weight loss.
Clearly, ATA should not be used as a thickener in cannabis oils. "When inhaled," FilterMag reports, "vitamin E acetate becomes grease-like and coats the lungs, which damages them."
BuzzFeed interviewed Sven-Eric Jordt, a toxicologist at Duke University School of Medicine, who said about Vitamin E: "If inhaled at sufficient amounts, it could certainly cause respiratory problems, maybe even lipoid pneumonia. It is an antioxidant, and may burn and disintegrate when heated in an e-cigarette, releasing toxicants.”
According to US Recall News, "Many believe it’s only a matter of time before vitamin E acetate will be linked to all of the vaping illnesses and deaths throughout the U.S."
The CDC Weighs in on Vitamin E
It took several months for the CBD to get a handle on the cause or causes of the vape outbreak. On November 8, the agency reported that vitamin E acetate is the main culprit:
"Analyses of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) of patients with e-cigarette or vaping product use associated lung injury identified, an additive in some THC-containing products.
"Recent CDC laboratory test results of BAL samples from 29 patients submitted to CDC from 10 states identified vitamin E acetate in BAL fluid samples. THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
"This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs."
According to Leafly: "Pure THC extract is a thick amber oil, and traditional THC oil cutting agents thin the oil. In response, customers learned to detect cut oil by flipping over vape cartridges to see how the air bubble moves inside the tank - much like the bubble in a carpenter’s level. A fast-moving bubble means the oil had been thinned with a cutting agent and wouldn’t deliver the high THC potency a consumer desires. Tocopheryl-acetate defeats the bubble test by cutting THC oil without thinning it."
Clearly, vitamin E acetate is dangerous to heat and inhale. "(It) disrupts the function of the lungs’ fluid lining, impeding oxygen transfer, and triggering a progressive and severe immune reaction," Leafly adds. "Some reports indicate a person’s lungs can begin to lose function as quickly as a week after exposure to THC oil heavily cut with vitamin E acetate."
Medicine Man Pulls Tainted Cartridges from Stores in Colorado
On September 26, Medicine Man Technologies, which operates four stores in Colorado, admitted that some of its cartridges contain vitamin E and propylene glycol (PG) and stopped selling them. "The decision to take this particular product off our shelves was significant," the company's president and CEO Sally Vander Veer stated. "Hopefully, the rest of the industry will also conclude that removing these cannabis products with the chemical additives under scrutiny from the market is in the best interest of consumers and all of us as operators."
MedPharm Holdings, which is being acquired by Medicine Man, added in a statement:
"Chemical additives (particularly PG and vegetable glycerine), when heated too high during the vaping process, can degrade into harmful cancer-causing byproducts, such as formaldehyde, acetaldehyde, and acrolein. The additives have also been linked to the presence of lipid-laden macrophages found in the lungs of people who suffer from this new vape-induced lung disease. The presence of these lipid deposits can, in turn, trigger inflammation in the lungs, a condition known as lipoid pneumonia. Many of these suspected additives simply haven't been evaluated for safety when inhaled and could very well be associated with the observed symptoms in the growing number of cases.”
More Disturbing Developments
On September 27, NBC News reported that 13 out of 15 bootleg cartridges they had tested by CannaSafe "contained myclobutanil, a fungicide that can transform into hydrogen cyanide when burned."
NYU Winthrop Hospital pediatric pulmonologist Dr. Melodi Pirzada said it's "very toxic effect on the lungs" and "should not be inhaled."
On October 2, the Mayo Clinic in Scottsdale, AZ reported that it has taken biopsies from 17 people who have been stricken (two had died) and concluded that they've all suffered "direct toxicity or tissue damage from noxious chemical fumes.”
Dr. Brandon Larsen, a surgical pathologist at Mayo, stated: "While we can't discount the potential role of lipids, we have not seen anything to suggest this is a problem caused by lipid accumulation in the lungs. Instead, it seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents."
On June 4, 2020, reseachers at Portland State University reported that pine rosin (colophony) as well as vitamin E acetate had been found in oil cartridges. "The use of pine rosin as an adulterant in cannabis oil has not been previously reported in the scientific literature," they stated. "It has significant inhalation toxicity. To date, there are no reports of testing for this substance in cannabis oil samples from patients with lung injury. Due to the significant toxicity and prevalence based on social media posts, regulators and laboratory personnel should be aware of its use in adulterated cannabis oil."
States Start Enacting Vape Bans
On September 24, Massachusetts Gov. Charlie Baker announced a ban on both marijuana and tobacco vape products through January 25, 2020. Despite a legal challenge, vape cartridges remain banned, but flower vape products are currently available.
Another legal state, Washington, prohibited the use of vitamin E acetate as a thickener in cannabis oil products as of November 20. "The evidence we have linking vitamin E acetate to the outbreak demands immediate action to protect the public’s health,” the state's Secretary of Health John Wiesman commented.
Bans on flavored-oil vape products have been announced in:
• Michigan - six-month ban announced by Gov. Gretchen Whitmer on September 4.
• Montana - ban from October 22 to February 19 announced by Gov. Steve Bullock on October 8.
• New York - announced by Gov. Andrew Cuomo on September 16, currently tied up in the courts.
• Oregon - six-month ban announced by Gov. Kate Brown on October 4, but must be approved by the Oregon Liquor Control Commission first.
• Washington - announced by Gov. Jay Inslee on September 27.
New Mexico Labels THC Vape Products
On October 3, New Mexico's Secretary of Health Kathy Kunkel issued a warning and health advisory "related to vaping high-concentrate Tetra Hydro Cannabinol (THC) and the overall health risks posed by electronic cigarettes (e‐cigarettes), or vaping." The following label will now appear on vape cartridges containing cannabis oil:
“WARNING: Vaping cannabis-derived products containing THC has been associated with cases of severe lung injury, leading to difficulty breathing, hospitalization, and even death.”
The Department of Health prtess release adds: "While the specific cause of the injury has not yet been determined, all patients in the state have reported vaping, particularly vaping THC products, prior to becoming ill. Among New Mexico’s 14 cases in New Mexico, six are persons 21 years or younger, including three teenagers between the ages of 13-to-17 years-old."
Kunkel noted: “We want New Mexico residents to understand this is not a ban,” said Secretary Kunkel, “However, it’s important that everyone know the facts about what they’re putting in their bodies before they continue to do it, and there are health risks no matter what a person is vaping be it THC or nicotine.”
This article was originally posted on September 7, 2019. It's been updated numerous times.