North American health authorities have recently stated that THC vaping could be the cause of the epidemic of severe lung conditions that have been connected to e-cigarette use in the last few months. This has generated a wave of concern around this increasingly popular way of consuming marijuana, which many users have always regarded as relatively safe. And we wonder: is cannabis the real origin of these illnesses?
According to the Centers for Disease Control and Prevention (CDC), so far 1,299 patients in the US have been affected by severe lung injuries associated with the use of vaporizers or e-cigarettes. 27 deaths have sadly already been confirmed, and doctors fear that there will be more fatalities in the near future.
Even though CDC and FDA (the US Food and Drug Administration) have not yet identified any device, product or substance directly connected to all these cases, an article published in The New England Journal of Medicine suggests that many affected patients reported use of THC, the main psychoactive compound found in cannabis, both as a substitute and in addition to nicotine.
The FDA launched a criminal investigation back in September, and advised against the use of THC-containing vape cartridges, both from retail stores and illegal sellers. The Trump Administration also announced their plan to enforce a ban on all flavored e-cigarettes "to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities."
Michigan, New York and Rhode Island already implemented a ban on flavored vaping products in early October, but judges provisionally blocked it due to pressure from manufacturers, who claim that this measure will force them out of business.
So how does this measure affect the cannabis world?
This research threatens to destroy the existing perception that marijuana vaping is a natural, safe method, a belief that has been gaining force of late as cannabis is legalized in more states. A 2018 Gallup poll found that many Americans view marijuana and e-cigarettes as less harmful than conventional cigarettes; and 40% view marijuana as 'not too harmful'or 'not harmful at all.'
In fact, according to a report by Arcview Market Research, and thanks to the increasing popularity of vape products, US cannabis concentrate sales are estimated to hit $8.4 billion by 2022, only slightly lower than the estimate for marijuana bud sales.
E-cigarettes work by heating a liquid and converting it into a mist. This is often liquid nicotine, but can also be marijuana extracts or compounds suspended in oils or aerosols that can be inhaled. Though a topic for debate, this process is believed to be healthier than the traditional way of smoking, as burning tobacco produces byproducts that are harmful for the lungs and overall health.
What substance could be the culprit?
According to several epidemiologists, it is likely that the processing of THC, rather than the compound itself, is responsible for the recent avalanche of lung complaints. To produce the vape cartridge liquid, THC is suspended in an oil solution that often contains chemical products that alter the mixture's flavour or consistency; this solution is later heated and inhaled.
The regulatory process for vape oils is in a state of chaos at the moment; therefore, it is hard to know what chemical components have been added, or even if the real composition is shown on the product label. FDA has already issued several warning letters to firms that market CBD products (CBD being another marijuana cannabinoid) which do not contain the levels of CBD that they claim to contain.
The FDA is now testing samples from more than 100 products used by patients that developed lung illnesses after vaping, in an attempt to find out exactly what they contain and what could be the cause of their symptoms.
According to some experts, the products responsible for this could be chemicals such as vitamin E acetate, which is used to emulsify THC and CBD in illegal, non-regulated vape oils. A recent study on 12 black market cartridges containing THC, found that 9 of them contained dangerously high levels of this compound. And not only that: all of them contained pesticides like myclobutanil, a chemical used as a fungicide that can decompose into poisonous hydrogen cyanide when inhaled.
Vitamin E acetate has gained popularity in the Californian black market as a diluting agent for cannabis oil, which is then sold all over the country. This acetate is mixed with the oil extracted from cannabis flowers, thus diluting the liquid and thereby increasing production as more cartridges can be filled. Although it is oil-soluble, and sometimes referred to as 'vitamin E oil', this substance is not actually an oil. Its chemical name is tocopherol acetate, and it was used in the past in the manufacture of beauty products and soaps, but was never meant to be inhaled.
How do I know if my vape products are safe?
To date, it is impossible to know if vape oils are safe. We must remember that we still do not even know if vitamin E acetate is the cause of all these lung conditions. It is important to point out that identifying all the compounds in the samples that are being scrutinized is only one piece of the jigsaw puzzle, but might not necessarily give an answer as to what is causing this epidemic.
As research on these lung injuries continues, CDC recommends that "people should not use e-cigarettes" and in particular should avoid obtaining products off the street and adding additional components to their liquids.
Still, even if the agency does not clearly identify the origin of these lung illnesses, there is a belief by both the general public and cannabis users, that federal public health officers will use this sad story in an attempt to kill off marijuana vaping altogether.
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. Jennifer E. Layden, Isaac Ghinai, Ian Pray, Anne Kimball. The New England Journal of Medicine. 2019.