by NORML – September 6, 2019

The US Centers for Disease Control has now identified over 450 cases of respiratory distress that may be associated with the use of disposable vapor cartridges used to consume certain e-liquids.
While initial cases of the phenomenon were associated with consumption of cannabinoid oil products via the use of unregulated vapor cartridges, the CDC reports that some cases have also been linked to the use of nicotine only.

Three people have died as a result of the illness, and a fourth death is under investigation.

In New York State, where 34 cases have been reported, health officials reported the identification of “very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” The inhalation of vitamin E oil has previously been linked with lipoid pneumonia. Medical reports have previously identified an association between vitamin E oil exposure and the vaping of both cannabis and nicotine liquid products, according to a NBC News investigative report. Reporting by Leafly.com suggests that additives may be introduced to unregulated oil products in an effort to thicken their consistency and to mask dilution.

The Health Department bulletin warns: “Anyone using vape products should never use unregulated products purchased ‘off the street.’ … These unregulated products are not tested and may contain harmful substances.” The agency has posted pictures of some of the products linked to the ailments here.
NORML’s Deputy Director Paul Armentano said: “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.”
Nonetheless, a review of the phenomenon published Friday in The New England Journal of Medicine acknowledges, “[N]o conclusions can [yet] be drawn as to which compound or compounds are the causes of injury.” The CDC similarly affirms, “No single product [has been] linked to all cases of lung disease.” The agency adds, “While this investigation is ongoing, people should consider not using e-cigarette products.”

While there exists only limited data assessing the safety of vaporized cannabinoid oil products, scientists have conducted multiple investigations of the use of technologically advanced (non-disposable) vaporization devices on cannabis plant material. In one study performed by investigators at San Francisco General Hospital, researchers reported that use of the Volcano vaporizing device did “not result in [subjects’] exposure to combustion gases.” Authors concluded, “The Volcano [vaporizer] device is an effective and apparently safe vehicle for THC delivery.” In another study, Dutch researchers similarly reported, “Our results show that with the Volcano a safe and effective cannabinoid delivery system seems to be available to patients. The final pulmonal uptake of THC is comparable to the smoking of cannabis, while avoiding the respiratory disadvantages of smoking.”

The latest update from the CDC is online here. The bulletin from the New York State Department of Health is online here. Ongoing reporting from Leafly.com is online here. A Leafly.com primer on the topic, “Vape Pen Lung Disease: Here’s What You Need to Know,” is online here.