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- A mysterious and deadly crop of lung injuries is showing up across the U.S. Health experts think vaping may be to blame.
- As of September 24, at least 12 people have died from lung illnesses after vaping, and 805 have been injured. Some have been put into medically-induced comas.
- Authorities at the Food and Drug Administration and Centers for Disease Control and Prevention still aren’t sure what’s causing the dangerous trend, but theories range from issues with vegetable oil in vape juice to the idea that doctors are just now taking note of a problem that’s been percolating for a long time.
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Hundreds of vapers across the U.S. are getting dangerously ill. They’re reporting mysterious symptoms like chest pains, fever, difficulty breathing, nausea, vomiting, diarrhea, and weight loss.
At least 12 people have died from these lung illnesses, and several more have been so near death they were pushed into medically-induced comas. Investigators at the Centers for Disease Control and Prevention suspect that vaping – and in particular, vaping with cannabinoid liquids like THC – may be part of the problem.
As of September 24, the CDC reported 805 cases of vaping-related illnesses in 46 states.
But experts are still stumped as to what, precisely, is causing this unprecedented rash of sicknesses.
“We don’t yet know the exact cause of these illnesses – whether they’re caused by contaminants, ingredients in the liquid or something else, such as the device itself,” Dr. Ann Thomas, a public health physician with the Oregon Health Authority, said on September 3 when she announced that the first person in that state had died from one of these puzzling lung issues.
Because vaping remains largely unregulated by the Food and Drug Administration, it’s tough to know exactly what vapers are inhaling that might be contributing to these health problems. Here are experts’ best guesses to date.
Vegetable oil and vitamin E can help deliver desired drugs to vapers. But they may also cause harm, especially if they’re not heated up right.
In theory, vape users should not be ingesting any liquid oils when they inhale, only the vapor from e-cigarettes that looks like white smoke.
In practice, that’s not always what happens.
Because solvents like propylene glycol and vegetable glycerin (PG-VG) are commonly used to deliver drugs to vapers (everything from cannabinoids to nicotine) there is always the chance that a rogue oil may not get completely transformed into vapor, instead traveling into the lungs as a liquid and causing harm.
This may be what’s happening with vitamin E acetate, which is found naturally in some vegetable oils.
Investigators who were on a briefing call between the FDA and state health agencies recently told the Washington Post that vitamin E acetate has been found in cannabis samples from numerous sick patients who’d vaped in New York.
It could be the case that this vitamin oil, which is meant to harmlessly deliver drugs, is ending up in people’s lungs as a liquid. Then, the body mounts an immune response to the invasive substance, prompting pneumonia.
People are buying vapes off the black market and many contain a fungicide that releases toxic fumes.
In July, an unnamed man used a cannabis vape vial off the street in Wisconsin and was later hospitalized and put on life support.
As Inverse recently reported, there’s a growing market for these cartridges, which use cannabis distillates in a liquid form rather than marijuana flower to get users high. Sellers can open and tamper with these distillate vials, adding other ingredients to make their supply last longer.
Former FDA commissioner Scott Gottlieb believes the underground sale of these products could play a major role in the rise of vape illnesses.
- Thomson Reuters
“I think this is probably going to be associated with illegal products,” Gottlieb told the New York Times. “It’s not like the major manufacturers have suddenly changed their ingredients. It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify THC that is causing these injuries.”
One brand, Dank Vapes, is known to sell these black market cannabis vapes.
- Eduardo Munoz/Reuters
People who sell “Dank Vape” brand devices on the black market market them as premium marijuana consumption devices, but the person who is running the business is a mystery, according to Inverse.
Dank Vapes continues to grow because it offers an accessible marijuana option in states where the drug is still illegal, plus a more inexpensive option in states where legal cannabis is available.
The business is popular enough that others have started copying it with their own “Dank Vapes,” making the name itself even more mysterious and difficult to track.
“These are just people filling cartridges as ‘Dank Vapes.’ It’s not a singular facility. It’s just people in their garages filling them and selling them,” Mark Hoashi, the founder of the Doja app, told Inverse.
Vape juices often contain chemicals like formaldehyde.
- REUTERS/David Becker
The composition of nicotine-containing vape juices varies based on flavor and brand, but according to pulmonologist Dr. Ravi Kalhan, a professor at Northwestern’s Feinberg School of Medicine, certain chemicals that raise health concerns are found in a wide range of these products.
“There’s some disturbing stuff in these things, an endless number of chemicals,” Kalhan told Insider.
Kalhan said some e-cigarettes produce formaldehyde, a chemical that can cause lung disease. The Environmental Protection Agency classifies formaldehyde as a “probable human carcinogen,” which means inhaling the substance could increase a person’s cancer risk.
Most e-cigs also produce acrolein, a chemical often found in weed killer.
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In 2018, The American Chemical Society found that people who inhaled acrolein sustained changes to their DNA. “If the cell does not repair the damage so that normal DNA replication can take place, cancer could result,” a press release on the research said.
The chemical, which releases when gasoline is burned, has been linked to lung and gastrointestinal problems, according to the National Institutes of Health.
Nicotine hurts the lungs, whether it’s vaped or smoked, and could also be at fault.
- Spencer Platt/Getty
“Just be aware that from the lungs’ perspective, vaping doesn’t seem to be better than smoking,” Professor Robert Tarran, who studies vaping at the University of North Carolina Marisco Lung Institute, told Insider.
His recent studies, and others like them in both animals and people who vape, suggest that vaping leads to more lung diseases, just like smoking does. Tarran is starting to think that vaping nicotine may not actually be much better than burning tobacco when it comes to long-term lung health.
“People who vape who’ve never smoked, they’re part of a whole new kind of social experiment,” he said. “Do they really want to be the guinea pigs?”
There’s also an emerging body of evidence that even nicotine-free vaping can still hurt people’s lungs, potentially leading to more cases of pneumonia like the ones doctors have been seeing this summer.
- Reuters/Navesh Chitrakar
It’s still early days for e-cigarette research, but a new study out Wednesday in the Journal of Clinical Investigation suggests that mice lungs are hurt by vaping, regardless of whether their rodent-friendly e-cigarettes include any nicotine or not.
More studies in people are needed to know for sure, but this is some of the first evidence we have that suggests vaping of any kind can hurt lungs.
Mice that used e-cigarettes over a period of four months (a timeframe meant to mimic years of e-cig use in people) ended up producing more fat deposits in their airways, which could make them more susceptible to illnesses and infections like pneumonia, even when there’s no nicotine involved.
“I think there’s an emerging consensus that the immune cells of the lung are a little bit upset by vaping,” Tarran said.
As vape cases crop up, it’s possible doctors have simply started asking more patients about their vaping habits.
“Sometimes, we see people who develop a mysterious respiratory illness and don’t know what caused it. It’s not always something we always ask about, vaping,” Kalhan said.
Recent media coverage of vaping illnesses may have changed that.
Maybe these lung illnesses have been happening ever since vaping began.
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Case studies of vaping injuries go as far back as 2012, when a 42 year old woman was seen multiple times in the ER and prescribed “several courses of antibiotics” before doctors finally told her to stop using e-cigarettes. Only then did her symptoms improve.
Professor Thomas Eissenberg at the Virginia Commonwealth University Center for the Study of Tobacco Products showed Insider six other cases that have been documented in medical journals around the world since then.
“Anything other than air and oxygen is an insult to the lungs,” he said. “The critical thing here is that all of those cases cry out for regulation.”