Cause of Vaping Lung Disease Identified

CDC and Media Losing Credibility

While the careless reporting of vaping lung disease shows no sign of abating, the likely cause of this mysterious ailment has been identified as tocopherol acetate, a vitamin E based oil used in some THC cartridges. The Vapor Technology Association (VTA) has demanded that the CDC, news media and public health departments stop conflating this probable source of vaping lung disease and commercially available electronic nicotine delivery systems (ENDs).

Nicotine ejuices are heavily regulated by the FDA and use a totally different formulation which does not contain tocopherol acetate. No commercially available electronic nicotine delivery system has been implicated in vaping lung disease.

Health departments should fully investigate and release all information about these cases. Either there’s a legitimate basis to tell people to stop using e-cigarettes or they are feeding the hysteria around a different product to conflate the issues by failing to distinguish e-cigarettes. The Vapor Technology Association applauds FDA's statement clearly advising consumers to avoid THC-containing vapor products. Even former FDA Commissioner Scott Gottlieb, no friend to the vapor industry, has assigned blame to illegal vapor products containing THC and cannabis. By contrast, CDC's fear mongering statement is misguided and will only cause further harm to overall public health." 

Tony Abboud, Executive Director of the Vapor Technology Association.

The irony is that the sloppy use of the word e-cig is fomenting a new reefer madness-esque scare, only this time legal electronic nicotine delivery systems are the target. And this hysteria is occurring due to a failure to point out that THC carts, specifically black market ones, appear to be responsible. We are living through the the funhouse mirror version of some seriously notorious 1930s propaganda.

Unfortunately, there is nothing amusing about vaping lung disease or the abject failure of the media to provide any clarity or perspective on the subject. The teen vaping epidemic is a serious concern but it does not excuse what amounts to a misinformation campaign against vaping.

While e-cigarette may not be a term of art, it is used by most people to describe an electronic nicotine delivery system. THC vaping devices are more frequently referred to as vape pens. To listen to the evening news, you would think that the NJoy you bought at the gas station and the refillable box mod behind the vape shop counter are responsible for vaping lung disease. The CDC and news media should be concerned about their credibility taking a hit due to their inability to accurately communicate this important information.

FDA and Vaping Lung Disease

The FDA, whose mandate is regulating electronic nicotine cigarettes, has done a much better job of drawing a sharp line between commercially available e-cigs and THC containing vapor products. This is the humane and correct approach. THC cartridge users do not refer to their products as e-cigarettes and could easily remain unaware that the hysterical headlines are actually referring to their device of choice.

In an FDA press release, the details of vaping lung disease are made available to anyone with an interest in getting their facts straight.

As the department responsible for regulating electronic nicotine delivery systems, the FDA's conclusions carry considerable weight.

Many of the samples tested by the states or by the FDA as part of this ongoing investigation have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the marijuana plant) and further, most of those samples with THC tested also contained significant amounts of Vitamin E acetate. Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data are limited about its effects after inhalation.

While the FDA does not have enough data presently to conclude that Vitamin E acetate is the cause of the lung injury in these cases, the agency believes it is prudent to avoid inhaling this substance. Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores. Additionally, no youth should be using any vaping product, regardless of the substance.

FDA Press Release, 9/6/2019

Vaping Lung Disease and Tocopherol-Acetate

This important information is not a bolt from the blue. In a Leafly feature published on August 30th, David Downs reported that tocopherol-acetate was likely the cause. Tocopherol acetate is a compound of acetic acid and vitamin E that most commonly is found in skin care creams and topical ointments.

The Washington Post reported that, “Its oil-like properties could be associated with the kinds of respiratory symptoms that many patients have reported: cough, shortness of breath and chest pain.”

“We knew from earlier testing by New York that they had found vitamin E acetate, but to have FDA talk about it from their overall testing plan, that was the most remarkable thing that we heard,” said one official who listened to the briefing but was not authorized to speak publicly.

Washington Post 9/5/2019

Without delving too deeply into the THC cartridge technology, tocopherol-acetate can be used as a diluting agent, or diluent, in THC oil. Manufacturers of the product may argue that it is safe when used as directed, but there is a financial incentive to include less THC oil in a product. The less reputable the manufacturer, the lower the stakes are for leaning too heavily on tocopherol-acetate as a crutch.

Unlicensed THC cartridges will end up taking the lion’s share of the blame, but in Oregon the fatal case has been tied to a dispensary. According to the New York Times, two of the deaths have been linked to individuals with pre-existing conditions.

There is a shortage of research on the safety of diluents such as tocopherol-acetate, and how they respond to being heated and vaped.

New York Department of Health Blames THC Carts

In a report released by the New York Department of Health, the presence of vitamin E oil, tocopherol-acetate, was confirmed in black market THC carts.

Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing. Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products that were tested.

Anyone using vape products should never use unregulated products purchased "off the street." Cannabis-containing products are not legally available in New York State for recreational use. These unregulated products are not tested and may contain harmful substances. Users of vape products should never modify vape products or add any substances to these products that are not intended by the manufacturer.

New York Department of Health, 9/5/2019

According to PubChem, a database run by the National Center for Biotechnology Information, inhalation of tocopherol acetate can cause severe symptoms such as wheezing, coughing, shortness of breath, or burning in the mouth, throat, or chest.

WaPo Clickbait Falsely Implicates Nicotine Vaping

The Washington Post hopped on the tocopherol-acetate angle, but continue to cast doubt at the nicotine vaping industry with their muddled language.

“The chemical (tocopherol-acetate) is an oil derived from vitamin E. Investigators at the U.S. Food and Drug Administration found the oil in cannabis products in samples collected from patients who fell ill across the United States. FDA officials shared that information with state health officials during a telephone briefing this week, according to several officials who took part in the call. That same chemical was also found in nearly all cannabis samples from patients who fell ill in New York in recent weeks, a state health department spokeswoman said.”

Washington Post, 9/6/2019

While they concede that no commercially available ejuice or device has been blamed, and nothing suspicious has been found in lab tests of nicotine vape juices, they continue to rely on “vaping danger” and “e-cigarette disease” headlines.

Imagine if the seemingly annual romaine lettuce e. coli outbreak was covered the same way. Would headlines warning of “vegetable lung disease” and “produce illness” be considered up to their august journalistic standards?

One thing we can be sure of, there will be no retraction or clarification forthcoming.  They will continue to refer to THC vape pens as e-cigarettes and describe the use of THC cartridges as vaping. Thank goodness the actual scientists and epidemiologists at the CDC are more precise than the headline writers.

Vapor Technology Association Playing Defense

The Vapor Technology Association has blasted the intentionally obtuse coverage of vaping lung disease from the start. The VTA pointed out that the nicotine vaping industry is heavily regulated, and national agencies such as the National Health Service in the UK have supported vaping as being 95 percent safer than smoking, while “None of the products designed for THC, cannabis and any other non-nicotine substances are regulated by the FDA.”

Recent reports increasingly indicate that these adverse events are linked to illicit substances such as THC and cannabis, not e-cigarettes. For example, the New Mexico Department of Health has clearly determined that products containing THC are likely responsible for the cases highlighted in New Mexico. Despite this, virtually every other public health official continues with their generalized and repeated references to “e-cigarettes.” Such inaccurate warnings will result in either (1) people continuing to use the risky products actually causing the harm about which they have not been specifically warned; or (2) many smokers using e-cigarettes becoming ‘scared’ by these reports and moving back to deadly combustible cigarettes. 

Vapor Technology Association, 8/29/2019

Marginalized Groups Punished By Vaping Lung Disease Reporting

As always, it is marginalized groups that pay the price when vaping is vilified with zombie vaping myths and access to cigarette alternatives is curtailed. While the line may be less direct than the strict e-cig bans that punish marginalized groups, the fact remains that the demographic groups most likely to switch to single use vaping in place of smoking, are impacted heavily by misleading headlines.

Where the San Francisco e-cig ban punished marginalized residents directly, funneling vapers without the time, mobility or financial wherewithal back onto cigarettes, misleading headlines are in many ways more damaging. It is nearly impossible to unring the bell of fear.