Vaping is the act of inhaling aerosolized liquid nicotine or flavors from a device; despite the name, no vaporizing occurs. The liquid heats up, becomes aerosolized into millions of tiny droplets, and is then inhaled. Device liquids or cartridges can be purchased from authorized stores or from unauthorized, black market sources, such as dealers or online shops. Globally, vaping is increasingly popular: numbers are up from about seven million in 2011 to 41 million in 2018. Future estimated numbers by market research group Euromonitor indicate almost 55 million adults vaping by 2021.
The Case of Vape Lung
As of late October 2019, severe vaping-associated lung illness has affected users in all U.S. states, excluding Alaska. Based on reports from several states, symptoms typically develop over a period of days but sometimes can manifest over several weeks. Roughly 1,300 people had been diagnosed with a vaping-related lung disease since March 2019, and 33 people have died. Of those sickened, 80% are younger than 35, according to the U.S. Centers for Disease Control and Prevention (CDC).
Officials say the lung problems do not appear to be caused by an infection but are likely the result of vaping itself or of inhaling a chemical while vaping. Patient symptoms include shortness of breath, chest pain, nausea and fever, among others. Despite worldwide popularity, no other country aside from the United States is experiencing a similar outbreak of this scale.
One area of expert concern revolves around vape devices, which may be emitting toxic chemicals, particularly if they are held together with lead or cadmium solder as cost-saving measures by the manufacturer. Additionally, substances which may be perfectly safe to eat or rub on skin become something entirely different when heated on a metal or ceramic coil. In the majority of aerosol samples analyzed, researchers found levels of carcinogenic metals in fumes above the minimal risk levels for safe air as set by the Department of Health and Human Services.
One class of vaping product has consistently been implicated in the illnesses: unregulated and unlicensed cartridges which contain THC, the main psychoactive chemical in cannabis.
Recently, the CDC’s Mortality and Morbidity Weekly Report published a study from Utah showing 92% of patients interviewed reported vaping THC — mostly from pre-filled cartridges — before falling ill. Dank Vapes, a popular black-market manufacturer, was the most commonly used brand. Research in Illinois and Wisconsin also shows this pattern. Further, the New York State Department of Health commissioner has stated that the vast majority of cases there have been linked to black market THC cartridges.
As this data has emerged, the vape lung outbreak is less about general vaping risks and more about the harms of vaping certain THC products. It is also a reminder that the way people use THC is shifting, from vaping dried herb to preprocessed manufactured oils containing a variety of ingredients.
It is possible some ingredients introduced into the U.S. supply chain are the cause of sickness, including consistent evidence vitamin E acetate is a contaminate. Vitamin E acetate is a thickening agent used to dilute vape oils; it is safely used in nutritional supplements but is not safe to inhale into the lungs. Of the 225 THC-containing products tested by the FDA, 47% contained the oily substance, while Utah data found the chemical in 89% of the THC-containing cartridges tested there, and New York state found vitamin E acetate in many of the cartridges used by respiratory illness patients.
Previously, vitamin E acetate was used in low concentrations or was lower than 20% of the formula in vape cartridges. As a result of limited availability of cannabis in states such as California coupled with high demand, illicit sellers had used about 50% or higher of diluent thickeners in their formulas to bulk up tiny potency vape cartridges.
How the Vaping Crisis can Help the Cannabis Industry
While the vaping crisis has reached a tragically fatal level, it has not dimmed American support to legalize marijuana, according to a Gallup poll released recently. Roughly 66% of those polled earlier this month continue to support cannabis legalization. Indeed, if the basis of vape lung is due to unregulated manufacturing, then federal legalization is an umbrella approach to curb the health emergency. Black markets historically spring from demand without consistent supply and are often the cause of public issues. Regulation, and well as mandated inspections, would be steps towards normalization of the cannabis industry and minimization of periods with scattered cases being pieced together.