ALERT: Major Breakthrough in Investigation of “Mysterious” Lung Disease Outbreak
There has been a major breakthrough in the investigation of the outbreak of more than 300 cases of a “mysterious” lung disease that the CDC and many other health agencies have told the public is due to the vaping of electronic cigarettes. And now, everything is starting to make some sense.
Illicit THC vape carts that were obtained from a number of case patients are being tested in federal and state laboratories have tested positive for vitamin E acetate, an oil that just started to be used late last year as a thickening agent in bootleg THC vape carts. Apparently, for every single case in New York State for which testing is complete, vitamin E acetate was found in at least one of the THC vape carts that were used by the patient. Almost simultaneously, testing of recovered THC vape carts by the FDA revealed vitamin E acetate in 10 of 18 tested samples. Importantly, the FDA reported that it found no contamination in any of the nicotine e-liquids tested.
The Rest of the Story
While there are still a lot of unknowns, the pieces of the puzzle are just beginning to fit together. One the great mysteries about this outbreak is “Why now?” Nicotine e-liquids have been on the market for many years and are being used by millions of vapers but there has never been a problem. Something must have changed to result in the outbreak occurring at this time. But what?
Now there is a possible explanation: it turns out that there was a major change made in the bootleg THC vape cart drug dealing industry late last year. It appears that a new thickening agent started to be used in bootleg THC vape carts. Very possibly, that new agent was vitamin E acetate. Tocopherol acetate (the fancy name for vitamin E acetate) is a thickening agent that is typically used in cosmetics like skin cleansers. But late last year, it apparently began to be used for thickening the THC oil (presumably to hide the fact that it had been highly diluted, which is a clue to some buyers that they are not getting much product). Here is what leafly.com has to say:
“Peter Hackett of Air Vapor Systems and Disinger and Heldreth of True Terpenes both mentioned the recent introduction of a novel diluent thickener called Honey Cut. The product swept through LA’s pen factories late last year. Honey Cut maintains a website, but the identity of the product manufacturer remains unknown, as does the chemical makeup of the substance. Leafly has made many attempts to reach officials at Honey Cut, but they have chosen not to respond.
Honey Cut’s introduction last year proved so popular that competing products by other diluent makers soon began appearing.”
What was the new diluent thickener in Honey Cut?
You guessed it … tocopherol acetate.
An insightful article at WebMD adds this information:
“Investigators are also trying to figure out what may have changed in vape cartridges that could have triggered this rash of respiratory illnesses. According to David Downs, writing in the publication Leafly.com, a marijuana information source, underground sellers began using a new tasteless and odorless thickening agent in late 2018. Buyers often judge THC potency by its thickness.
‘This new additive may or may not play a role in the current health crisis,’ writes Downs, Leafly’s California bureau chief. ‘But it is one of the major new ingredients in illegal vape cart oil in widespread use this summer.'”
If tocopherol acetate is playing a role in the outbreak, it would help to explain why the observed lung illnesses are so severe and why the patients’ lungs basically stop working. Asexplained in the Washington Post:
“Vitamin E acetate is basically grease, said Michelle Francl, a chemistry professor at Bryn Mawr College. Its molecular structure means that “you have to heat it up pretty hot” for it to vaporize. Its boiling point is 363 degrees Fahrenheit, which is well above the 212 degree F boiling point for water, and nearly four times higher than normal human body temperature. Once the oil is heated hot enough to vaporize, it can potentially decompose and “now you’re breathing in who-knows-what,” Francl said. When that vapor cools down in the lungs, it returns to its original state at that temperature and pressure, she said, which means “it has now coated the inside of your lungs with that oil,” she said.
It is not difficult to imagine why the lungs would stop working if they became coated with grease or oil.
It will be interesting to see how long it takes the CDC to issue an unequivocal warning to the public that they should absolutely not vape marijuana using THC vape carts obtained off the street.
This emerging story shows the dangers of bias in public health. The long-standing bias of the CDC against vaping has resulted in the agency failing to warn the public in clear and specific terms about the risks associated with the use of bootleg THC vape carts and instead, issuing warnings against “vaping” and “e-cigarettes” generally and making meaningless statements like “e-cigarette aerosol is not harmless water vapor.”
On my blog, I first issued a warning about the use of black market THC oils on August 25, and then on August 28 I blogged and tweeted an unequivocal warning, since the CDC had failed to do so. It is now 11 days later, and we are still waiting for the CDC, HHS, and other health groups to issue a clear and specific warning against the use of bootleg THC vape carts. We are still waiting for these groups to stop blaming the outbreak on vaping or on e-cigarettes. Although we cannot completely rule out any role of e-cigarettes, it now appears very unlikely that they have anything to do with the outbreak, which appears to be due to e-cannabis, not e-cigarettes.
The truly unfortunate rest of the story is their in its zeal to demonize e-cigarettes, the CDC and other health agencies have put the lives of our nation’s youth at risk. They should have issued a warning 11 days ago. During the past 11 days, how many youth continued to vape THC oils because of the failure of health agencies to accurately convey the known information about the potential causes of the outbreak? The CDC and other health agencies and some anti-tobacco groups have gone to great lengths to protect the illicit cannabis industry. But they have no problem with attacking the e-cigarette companies and telling ex-smokers to return to smoking rather than continuing to vape. Why?
This commentary appears today on my tobacco blog, at: https://tobaccoanalysis.
Michael Siegel, MD, MPH
Department of Community Health Sciences
Boston University School of Public Health
801 Massachusetts Avenue, 4th Floor
Boston, MA 02118