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Federal health regulators indicating that there have now been more than 2,172 confirmed reports involving vaping lung injury, and health officials may be closing in on the culprit, as they focus more attention on the presence of vitamin E acetate in THC products sold under the table.
The U.S. Centers for Disease Control and Prevention (CDC) issued an update on November 14, outlining the latest information about an on-going investigation into what is now being “e-cigarette, or vaping, product use-associated injury”, or “EVALI”.
Officials indicate that the vaping illness has occurred in 49 states, as well as cases in the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, impacting citizens everywhere throughout the United States, except for Alaska.
In addition, the CDC has confirmed 42 vaping deaths due to EVALI complications, which have occurred in 24 states and D.C.
Perhaps the biggest change in the investigation is the announcement that vitamin E acetate has been found in all lung fluid samples collected from 29 patients from 10 states. The CDC indicates it might be used as a thickening agent in THC products made for vaping or use in e-cigarette pods.
“CDC recommends that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers,” the update states. “Until the relationship of vitamin E acetate and lung health is better understood, vitamin E acetate should not be added to e-cigarette, or vaping, products.”
The CDC also called for consumers to avoid adding any substance to e-cigarette or vaping products which were not intended by the manufacturer, even if that product was bought at a retail establishment.
A number of the agency’s findings were published earlier this month in its Morbidity and Mortality Weekly Report (MMWR). That report indicates that, among Illinois residents, 21% of those who vaped admitted using THC-containing products. However, they represented 85% of those who contracted EVALI.
The report also suggests that many cases may be linked to a black market product called Dank Vapes.
“When e-cigarette, or vaping, product use among EVALI patients aged 18–44 years was compared with that of a subset of survey respondents aged 18–44 years who reported use of THC-containing products, a number of significant differences were found,” the report notes. “Specifically, patients with EVALI had higher odds of reporting exclusive use of THC-containing products, as well as reporting frequent use of these products, obtaining them through informal sources, and using a counterfeit THC-containing product marketed as Dank Vapes.”
However, the agency is not yet ready to declare vitamin E acetate or THC as the cause of the vaping lung injuries. There are still a number of cases where THC appears to have not played a role.
The link to vitamin E acetate was first mentioned by New York State Department of Health investigators in early September, after the substance became a key focus of their own investigation.
Vitamin E acetate is a common nutritional supplement. However, it is usually ingested or used as a topical product applied to the skin. However, health officials say its oil-like properties could cause respiratory problems like those being seen when inhaled, and investigators say the samples tested have been shown to contain large amounts of it.
The vaping lung injury problems were first reported by health officials in Illinois and Wisconsin in early August, after several cases of severe lung injury were identified, where e-cigarettes were the only common factor. However, since then, health officials nationwide have either identified similar cases, or realized they had treated similar cases without knowing about the e-cigarette connection.
In recent months, even beyond the lung injuries, there has been increased scrutiny of e-cigarettes, which have become the most popular form of nicotine among teens and young adults. In addition to the risk of e-cigarette respiratory illnesses, there is also now a new generation of teens addicted to JUUL, which contains high levels of nicotine and was aggressively marketed to individuals who were not prior cigarette smokers.
A growing number of JUUL injury lawsuits are now being pursued against the manufacturers, alleging that the products were illegally marketed to kids while failing to disclose that each of the e-cigarette pods contain more nicotine than a pack of tobacco cigarettes.