There is clearly an epidemic that begs for an urgent response
September 7, 2019 8:45 PM   Subscribe

As cases of vaping-related lung illnesses surge, the CDC has advised consumers to "consider not using" e-cigarette products, especially with cannabis, until scientists better understand what may have sickened more than 450 people and killed five people across 33 states, while "public health experts have been urging the government to tell consumers to stop vaping any product until scientists can clarify the cause or causes of the outbreak."

As of September 6, 2019, the CDC reports that "over 450 possible cases of lung illness associated with the use of e-cigarette products have been reported to CDC from the following 33 states and 1 U.S. territory: AR, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MN, MT, NC, NE, NJ, NM, NY, OH, OR, PA, SC, TN, TX, UT, VA, VT, WI, WV, and the U.S. Virgin Islands."

Hospitalized teen Adam Hergenreder, of Gurnee, Illinois warns "it’s going to attack your lungs,” after buying THC-filled devices, called dab sticks, on the street, and the CDC is warning against using cannabis and other e-cigarette products bought on the street, and to stop modifying either nicotine or cannabis e-cigarette devices.

According to Thomas Eissenberg, a Professor of Psychology (Health Program) and Co-Director, Center for the Study of Tobacco Products, Virginia Commonwealth University:
For the past seven years, a steady stream of scientific studies has uncovered potential health risks associated with vaping. These risks include nicotine dependence, airway injury, and cardiovascular disease. Now we must add debilitating lung disease to that list. Lipoid pneumonia is one such disease, probably caused by inhalation of oil-containing vapor: the body’s immune response to oil in the lungs involves inflammation that can be fatal. Oil can enter electronic cigarette liquids either unintentionally as a contaminant or intentionally, such as when vaping substances other than nicotine, like marijuana. Intentional or not, the possibility of oil in electronic cigarette liquids highlights the need for immediate, strong regulation of these products.
The Washington Post reported on September 5, 2019 that "state and federal health officials investigating mysterious lung illnesses linked to vaping have found the same chemical in samples of marijuana products used by people sickened in different parts of the country" and "the chemical is an oil derived from vitamin E." (via Mother Jones). However, the Washington Post further noted the full statement of the FDA, which was also reported by the CDC on September 6, 2019:
"We are leaving no stone unturned in following any potential leads and we’re committed to taking appropriate actions as the facts emerge,” said Acting FDA Commissioner Ned Sharpless, M.D. “Our laboratory is working closely with our federal and state partners to identify the products or substances that may be causing the illnesses and have received more than 120 samples from the states so far. The FDA is analyzing these for a broad range of chemicals but no one substance, including Vitamin E acetate, has been identified in all of the samples tested. Importantly, identifying any compounds present in the samples will be one piece of the puzzle but won’t necessarily answer questions about causality, which makes our ongoing work critical.”
Title quote from David C. Christiani, M.D., M.P.H. (New England Journal of Medicine Editorial, via NYT)
posted by katra (97 comments total) 26 users marked this as a favorite
 
This has been growing in popularity for years, and then suddenly there's this wave of serious illness. Something must have changed. It sounds like they are very suspicious of this Vitamin E derived oil, but is that really a recent innovation?

After many years of frightful abuse, I only use my lungs for air now, and this is making me quite glad about that, but also it's freaking me out because who knows when pulmonary karma is coming for me.
posted by thelonius at 9:01 PM on September 7 [16 favorites]


So I *did* have legitimate cause for annoyance at the men who blew vapor in my face on the bus and laughed like the Joker when I coughed?
posted by The Underpants Monster at 9:04 PM on September 7 [31 favorites]


is that really a recent innovation?

According to the Washington Post:
Officials are trying to come up with a consistent definition of the illness and a standardized system for collecting information from the states. Unlike certain infectious diseases, such as measles, which are required to be reported to federal authorities, states are not required to report possible cases of vaping-related illnesses to the Centers for Disease Control and Prevention, which is leading the investigation.
Emphasis added. Without a federal reporting requirement, maybe there were problems not seen as a pattern until now, but it really doesn't seem clear at this point. Also, according to Thomas Eissenberg (Guardian Opinion)
Importantly, the types of lung injury reported today are not new. The first case of electronic cigarette-associated lipoid pneumonia was reported in the medical literature in 2012. Between 2013 and 2018 there were another six reported cases of pneumonia-like diseases in electronic cigarette users.
posted by katra at 9:17 PM on September 7 [9 favorites]


Good to know about lipoid pneumonia. I was pretty sure those oil-based scent infusers weren’t good for you.
posted by mantecol at 9:56 PM on September 7 [10 favorites]


just another reason why we need a federally regulated cannabis industry. the THC vape pens are the only way i can use the drug these days, it's so easy to figure out the perfect dose for yourself, as opposed to plant matter which is always going to be inconsistent depending on the strain and how long you let it burn for.
posted by JimBennett at 10:04 PM on September 7 [11 favorites]


There are at least three scenarios that could be true. One, vaping is generally far more dangerous than we realized and even casual vaping has its risks. Two, the health problems from vaping are due to the real fanatics that mod their vapes in order to inhale/blow out huge plumes of vapor, and the mods and increased volume is to blame. Or three, vaping is perfectly safe and these warnings are a hit job from big tobacco (which probably isn't all that big these days) and other interested conspirators. I could see any of those scenarios as plausible.
posted by zardoz at 10:52 PM on September 7 [9 favorites]


Or three, vaping is perfectly safe and these warnings are a hit job from big tobacco

This one strikes me as implausible, given the amount of pushing and shoving that Big Tobacco is currently doing to get the sale of nicotine-based vaping liquids legalized in Australia.
posted by flabdablet at 10:55 PM on September 7 [13 favorites]


some additional uninformed guesses about why this could be happening now:

- It's in the actual drugs - vape cartridges, wax, oil, etc. Most people who use enough of the contaminated products will get sick, regardless of their circumstances. This seems unlikely to me given how many different products are producing similar symptoms, but who knows.

- It's in the vapes - the increased popularity of vaping has prompted unscrupulous people to make worse hardware. Anything would be dangerous to vape if you were heating it on or inhaling it through contaminated metal, plastic, or ceramic. Unfortunately, the contaminants might have burnt off of the vape before it could be turned in to the CDC, or people might be worrying about their actual drugs and not the vape pens.

- It's the vape users - there's something about some people that causes them to get very sick while most people are fine, even when the drugs and drug-consuming tools are the same. Maybe it's some kind of allergy or sensitivity.
posted by bagel at 11:16 PM on September 7 [1 favorite]


Let's say this upfront if you're vaping nicotine you don't use oil. It just doesn't happen.
posted by Rubbstone at 11:53 PM on September 7 [12 favorites]


JimBennet - look into dry flower vapourizers like the Pax3 or the like.

Yes, the first couple of bowls from each new batch of dried flower aren't going to be efficient, but blame the regulatory oversight for not requiring accurate reporting of THC/CBD/etc. Once you figure out the potency of a particular lot of product, you can load the correct amount into the oven of the vaporizers.

Extracts (oils, vape cartidges, etc) can be problematic; historically a lot of extracts used diseased (mouldy) feedstock - a lot of fungal toxins are extracted with similar efficiencies as the cannabinoids. Even in the State-level legal markets. A lot of endotoxins and ochratoxins are relatively thermostabile and resistant to pyrolytic degradation.

The chemically induced pneumonia cluster in nicotine vapourizer use is definitely due to a lack of result of regulatory oversight of the "vape juice" market.

At a minimum, it should require similar levels of (very very low and inadequate) proof of non-harm required of "supplements" in Canada where they require registration - including verification of cGMP certification of the processing/ packaging facilities and valid Certificate of Analysis of all raw materials, and any formulation change has to be approved by the regulatory body [which often doesn't know enough to prohibit something, and often prohibits perfectly fine practices/ materials) and issuance of a NPN (natural products number).

Yet another failure of the American regulatory apparatus - ironic since strong regulatory apparatuses and the widespread adaptation originated with American sentiment against bullshit hyper-capitalistic practices originating in America.
posted by porpoise at 11:56 PM on September 7 [13 favorites]


Hi!

I have been consuming THC vape cartridges, both illicit and licit, for the last five years, and spend time around people who do the same. I love the format, the potency, and the ability to totally rip clandestine hits while shopping, at concerts, etc.

Quel horreur, I know.

In the last year, others have passed me "flavored" cartridges (bubblegum, blueberry, strawberry, and the like) that don't seem to contain much in the way of THC - they're not terribly potent, and underneath the fruit flavor there is some strange chemical tang. In addition, the oil in these cheap flavored carts looks wrong. Often it's the wrong color, or has the wrong viscosity, or the wrong surface tension.

I've been offered these cartridges for purchase, and the price is always super low. I don't trust them one bit. I'd rather pay $50 for a cart that works than $20 for one that doesn't actually get me high in a cannabis sort of way.

There should be nothing in a cart beyond THC oil, vegetable or propylene glycol, and maybe terpines if you're getting very fancy with the recipe. There are forums on the dreaded Reddit where users share tips on how to make cannabis vape sauce at home, suitable for cartridge vaping. The results I've sampled have been pretty much identical to the high-end street cartridges I've used.

My informed guess is that somebody is making these to a low price point, perhaps with only a trace of THC, and some adulterant that is not PG/VG. Maybe oil from VItamin E capsules and no cannabis at all? Or Vitamin E used as a cutting agent because it's the right color and $10 worth of it will make you a couple of grand in fake carts?
posted by She Vaped An Entire Sock! at 11:57 PM on September 7 [59 favorites]


Vaping of nicotine has been around for decade at least. Cloud chasers have been around for about half that. Most cloud chasers are vaping liquid with *no* nicotine at all. All those "yes, we know you vape" people would have hit on something by now. This is some sort of adulterant in black-market or shady-cartridge-market that has come to the forefront now. Probably the oils in the THC cartridges (how many of those states have legal THC? dunno). This all reminds me of using kerosene to make cocaine or ether to extract THC or backyard chemistry to extract the good bits from cough syrup. Versus the maybe ok legal and regulated suppliers.

The major iffy bit of nicotine vaping is the flavorings. They're the same flavorings in every bit of candy or food you eat every day. The difficulty lying in the heating and inhalation vs ingestion. The legit vaping industry as it were has been on top of stopping the use of anything that may be bad like popcorn diecytle (sp?) or cinnamon oils (and oils in general).

I can't imagine how Vitamin E acetate would show up in anything ever. My vote goes along the lines of bathtub booze.

Somebodies have a quick and dirty and shady business model that's just reared it's ugly head and is actually hurting people.
posted by zengargoyle at 12:47 AM on September 8 [8 favorites]


Or three, vaping is perfectly safe and these warnings are a hit job from big tobacco (which probably isn't all that big these days)

This is wrong on several counts.

1) big tobacco has in fact been promoting vaping heavily as a way of recovering revenue in developed countries with plummeting smokers

2) Vaping is not perfectly safe, the OP is filled with links clearly demonstrating that. Big tobacco has not created a conspiracy that gives people lipid pneumonia.

3) Big tobacco is still huge. Most of the world doesn't live in the West, and most of it is still smoking heaps of tobacco with virtually no regulatory oversight.

I think it's probably best to keep completely ignorant speculation to a minimum when it comes to public health.
posted by smoke at 1:24 AM on September 8 [50 favorites]


When they say “on the street” they’re talking about from a person illegally selling them? Is there a difference between me buying a cannabis vape pen from a dispensary (legal in Oregon)?
posted by gucci mane at 1:38 AM on September 8 [3 favorites]


I think it's probably best to keep completely ignorant speculation to a minimum when it comes to public health.

You're right, it's "completely ignorant speculation" on my part, but in my defense I did also say other parties--besides big tobacco--could have an interest in seeing the decline of vaping. You cut that out. Anyway, I'm just spitballing, I thought that was clear but I suppose not.
posted by zardoz at 2:13 AM on September 8 [5 favorites]


"on the street". Probably. The thing here is the method of extraction of the THC from the leafy material. Industrial lab-grade-ish would use something like pressurized liquid CO2 (carbon dioxide) which then they would flash evaporate back into a gas to obtain relatively pure product. The street would use something like ether (or some other petroleum distillate) to do the same thing and might end up using basically "engine starter fluid" which is a non-pure version of ether. They might also not do it quite right. This is why THC producing honey-labs in someones garage tend to explode. Then it's what they cut it with to make the final product. The industrial side *probably* uses PG or something, or maybe even ships the distillate directly as a sticky powder sort of thing. The bathroom-gin will end up (if they don't explode themselves) with a residue of extraction via non-medical grade petroleum product they bought at the automotive store and use some non-medical grade untested carrier to dilute it and make it look like normal industrial product.

It all boils down to what is the carrier fluid and adulterants. Nicotine, PG, and VG have had a decade of use. Nicotine has the same rap sheet as Cafiene on the addiction/toxidity level. THC has been in use since forever with the bad effects of 'smoking' (same as cigarettes). These things are relatively well known.

Something has changed in the dramatic and quick uptick of cases that seems at the moment to point to black-market products. This dramatic uptick must have a unique cause that is specific to these cases. If it were a general phenomenon it would have happened long long ago.

Most commercial producers of Nicotine / THC vape products are reasonably prepared for regulation and do their best to avoid being the cause of shuttering the business.

You should be fine. The big name brand professional THC cartridge maker that you're buying from a legal THC shop is taking as much care as they possibly can to not be the bad guy.

This would have happened years and years ago if there was a basic error in the premise. It's a new spike in intensity that implies a previously unseen factor. That's probably garage chemists making street cartridges that they shouldn't be for a market where it's illegal and/or for the below legal age market.

It's an epidemic. The cause of an epidemic cannot be the usual, it must be something new. And probably not some sort of accumulative thing that has only appeared just now given the hints that it's Vitamin E acetate and oils and illicit street cartridges.

n.b. I'm all for the stricter regulation and studies. We're talking about chemicals that have been well studied forever, and it's just the method of production and delivery.
posted by zengargoyle at 3:01 AM on September 8 [16 favorites]


As far as big tobacco trying to promote a few outliers, just from what I’ve seen in Japan (where pot is on par with godless crimes against humanity), Japan Tobacco (70% owned by the government of Japan) is making a hard, hard push on e-cigarettes, to the point that they’re everywhere, available anywhere tobacco is sold, and it’s honestly rarer to see someone smoking actual cigarettes. A while back, when I was working at a bar, doing prep before we opened, I had the fun of dealing with a JT shill trying to get us to allow their proprietary e-cigs in our strictly nonsmoking/nonvaping bar. They had samples of no smoking “except for iquos” placards for tables and everything.

They’re making a ton of money off of this stuff. They wouldn’t be pushing scare stories to ward people away from their new cash cow. Hell, given their history, wouldn’t it be more likely that they’d be involved in covering up a hazard to consumers?
posted by Ghidorah at 3:02 AM on September 8 [7 favorites]


My wife is an ER nurse in one of the areas where this has been more prominent. She’s had to put multiple people on ventilators over the last year because of this issue, though luckily no deaths. The common threads: it’s so far all been young adults (18-24) who vape a considerable amount, and they’ve all been using a vape liquid of THC in an oil-based carrier. Avoid that shit, people; avoid it like the plague!
posted by mystyk at 3:30 AM on September 8 [16 favorites]


I was recently witness to one of these (likely) cases in our peds ICU; it was terrifying how quickly the patient’s body just utterly gave up, though fortunately recovered with ICU care.
posted by obfuscation at 5:22 AM on September 8 [5 favorites]


Let's have some genuine epidemiology before adding more (usually "but it's NATURAAAAL" man) random anecdata opinions on "why my preferred form of vaping couldn't POSSIBLY do this" .

Also, I hate to be that guy, but I told you so.

posted by lalochezia at 5:25 AM on September 8 [21 favorites]


I still want to know how many of these cases were caused by commercially manufactured vape cartridges sold legally in dispensaries. It sounds like a reasonable distinction to be concerned about.
posted by Faint of Butt at 5:42 AM on September 8 [23 favorites]


Why does this bring Jesse Pinkman's chilli flavoured meth to mind?
posted by stonepharisee at 6:03 AM on September 8 [3 favorites]


People have been vaping for a decade, but the potential medical issues have only become really well known in the medical community over the past 1-2 years. 5 years ago, there were potentially not enough cases of lipoid pneumonia or pneumonitis due to vaping to establish a trend, especially in the absence of a centralised registry for such information. Epidemiology needs data. Even now, about 1-3% of the US population is using e-cigarettes, which is a market of let's say 9 million people. The number 450 is almost certainly not comprehensive but that's about 0.005%. How would epidemiologists identify that causative factor in a vaping population of a few thousand or hundred thousand causing a dozen cases scattered across the country/globe?

What if it's just not safe to inhale volatile compounds? There's a lot of no-true-scotsman type reasoning I see above, but I see no reason to assume safety of commercial vape products here. The decade of use is irrelevant, because we do not have enough quality epidemiological data to cover that period.
posted by chiquitita at 6:15 AM on September 8 [11 favorites]


> I still want to know how many of these cases were caused by commercially manufactured vape cartridges sold legally in dispensaries. It sounds like a reasonable distinction to be concerned about.

From the Washington Post link:
“We suspect adulterated or contaminated products, because these [marijuana] products have been out there for some time, and we’ve not seen these cases until this summer,” said Phillip Lamberty, a pulmonologist and critical care specialist at the University of Pittsburgh Medical Center, who cared for three patients in recent weeks. Two of them used products containing THC, he said. He wasn’t sure what product the third was vaping.

One patient purchased his product from an illicit drug dealer. Another patient told Lamberty he had previously smoked marijuana but bought an online product and vaped THC for the first time about a week before falling ill.

In California’s Kings County, all seven patients who had acute respiratory distress syndrome reported buying marijuana vape cartridges from “pop-up shops,” said Nancy Gerking, the county’s assistant director of public health.
Given how large the legal cannabis market is in California, it seems significant that all the cases there involve people who bought from unlicensed pop-ups.
posted by mbrubeck at 6:22 AM on September 8 [8 favorites]


The person who died in Oregon bought the THC product from a legal dispensary.
posted by perhapses at 6:33 AM on September 8 [8 favorites]


That's good to know. The WaPo report was from last week.
posted by mbrubeck at 6:41 AM on September 8 [1 favorite]


They're the same flavorings in every bit of candy or food you eat every day.
A. You hope; B. none of which have been clinically tested for heating and inhaling into the lungs.
posted by aspersioncast at 6:44 AM on September 8 [32 favorites]


There's a lot of no-true-scotsman type reasoning I see above,

Wouldn't that be someone saying that "adulterated or contaminated products' aren't really vape cartridges? I mean, if I said that some Scottish people down at the pub are assholes, but most are nice, that isn't the "no true Scotsman" fallacy.

Of course it remains possible that legally manufactured and sold products are also dangerous, and that blaming black market ones is a form of self-deception or wishful thinking.
posted by thelonius at 6:44 AM on September 8 [3 favorites]


Epidemiology needs data.

hell, we're only just getting a handle on cannabis hyperemesis syndrome.

I have no idea what kind of protocol the FDA has for inhalants, but I assume it's a bit more rigorous than the (extremely not rigorous) "presumed safe and we'll trust you on the rest" list for ingestibles?
posted by schadenfrau at 6:46 AM on September 8 [2 favorites]


I have no idea what kind of protocol the FDA has for inhalants

Looks like the latest guidance document was issued in the early aughts.

On a quick scan there's nothing about heated atomized or "vapor" delivery. It would have been in its infancy then, and wouldn't matter much anyway, since the industry is still barely regulated before point of sale in most states.
posted by aspersioncast at 7:00 AM on September 8 [1 favorite]


thelonius, to belabour the analogy:
Person A: "No Scotsman puts sugar on his porridge."
Person B: "But my uncle Angus is a Scotsman and he puts sugar on his porridge."
Person A: "But no true Scotsman puts sugar on his porridge."

Person A: "No vape cartridge could cause lung disease."
CDC: "But there appears to be an association between all these people who vaped and lung disease."
Person A: "But no true vape cartridge could cause lung disease."

Maybe it is isolated to black market THC products, but that is still vaping!
posted by chiquitita at 7:01 AM on September 8 [3 favorites]


Propylene Glycol - the main ingredient in vape juice - is also what makes smoke machines smoke.

There's obviously quite significant differences in the quantities and methods of consumption. I wonder if these types of symptoms have ever been seen amongst people with high levels of smoke machine exposure.

I also wonder if this type of injury has been seen in other countries where vaping is prevalent but vaping weed isn't.
posted by leo_r at 7:03 AM on September 8 [5 favorites]


I also wonder if this type of injury has been seen in other countries where vaping is prevalent but vaping weed isn't.

None that have been reported, at least in Europe, we’re getting the same news about this type of illness and deaths being reported in the US, not in other countries. Otherwise it would have been mentioned if this had been affecting other countries, I imagine?

There’s also this: British vapers are safe, claim health experts after deaths in US
posted by bitteschoen at 7:20 AM on September 8


Propylene Glycol - the main ingredient in vape juice - is also what makes smoke machines smoke.

Any machine can be a smoke machine if you use it wrong enough.
posted by Faint of Butt at 7:35 AM on September 8 [51 favorites]


Propylene Glycol - the main ingredient in vape juice - is also what makes smoke machines smoke.

Yeah and diacetyl is the main ingredient in artificial butter flavor, smells good, and never killed anybody, but you don't want to deliberate inhale it for long periods of time because bronchiolitis obliterans is not fun.

I'm not sure how many fads we need to go through until we as a species figure out that lungs are delicate machines built for fresh air and nothing else. That's why your entire respiratory system prior to your bronchioles is dedicated to cleaning it as much as humanly possible. Deliberately overwhelming it is not a good long term strategy.
posted by Your Childhood Pet Rock at 7:36 AM on September 8 [26 favorites]


The thing about legalizing and regulating things is that it often doesn't eliminate the black market, because some people can't afford or don't have access to the legal, regulated product. A lot of the affected people are kids or very young adults, who may not be able to afford legal cannabis cartridges, or they may be too young to buy them. (They also may live in states where it's not legal.) Part of the issue with vaping is that it's huge among teenagers, who aren't doing it legally and are disproportionately likely to use unsafe, unregulated cartridges.
posted by ArbitraryAndCapricious at 7:36 AM on September 8 [7 favorites]




I've never understood why people use those cartridges with THC and oil. Shatter (and its relatives like live resin, which does not even necessitate the use of solvents) work very well with pens made for the purpose, and are better for you as well as cheaper than smoking.
posted by not_that_epiphanius at 7:52 AM on September 8 [1 favorite]


The basics of vaping is atomization. If you've ever used a spay perfume, you've been atomizing volatile compounds and inhaling them into your lungs. If it smells, you've been inhaling it. It comes down to volume on the flavoring side. You can't smell and enjoy a cinnamon bun without inhaling those volatile compounds. You can't enjoy a grape jolly rancher without inhaling into your lungs the volatile molecule that is the flavor of grape. It's concentration.

Yep, ingestion vs inhalation.

Vaping in essence is heat driven atomization vs mechanical atomization. The coils boil water to produce bubbles and surface tension creates the droplets. The carrier fluid and additional things should be proven safe at 100C. The vapor as it were is proof that the inhaleant is not left inside the body. Clouds are wasted delivery and by definition not inside you. The carrier should be safe and absorbable by the body by insert various membranes here.

If you can inhale and enjoy a cup of coffee, you are inhaling and enjoying the 'coffee' volatile that is the 'coffee' flavor of e-cigs. It's concentration. If it doesn't break down to some toxic substance at low temperatures there's no difference between smelling someones perfume and tasting or vaping the same molecule.

This it totally the thing where oils in the lungs are bad. And carriers / adulterants that do not atomize at low temperatures are bad. And 'dry-hits' are nasty and hurt. Vaping is basically a very warm atomizer. If it's not, you're doing it wrong. The rest all boils (heh) down to concentrations and absorbtion rates and temperature which can lead to damage and pneumonia.

Basically, this could all be as safe an normal as an ahma inhaler given the the mostly knows facts about nicotine and THC and volatile flavoring compounds.

The issue is carrier fluids and delivery methods. You could put this stuff in a perfume bottle and make it a spritzer and bypass the whole vaping thing. As long as you're not inhaling shit that coats your lungs to the point of failure.
posted by zengargoyle at 7:56 AM on September 8 [3 favorites]



Basically, this could all be as safe an normal as an ahma inhaler given the the mostly knows facts about nicotine and THC and volatile flavoring compounds.


You don't know this. Smelling something ≠ vaping!

If you huffed perfume 20 times a day, and held your breath to maximize lung adsorption and did so repeatedly, you might get a different outcome.

An asthma inhaler has had multiple decades of investigations into repeated use by serious studies.

You are extrapolating from false, naive premises and causing harm. Stop it!
posted by lalochezia at 8:06 AM on September 8 [37 favorites]


An asthma inhaler has had multiple decades of investigations into repeated use by serious studies.

Exactly. They also deliberately use some of the most non-reactive compounds known as propellant specifically because they're going to be inhaled.
posted by Your Childhood Pet Rock at 8:19 AM on September 8


From the NYT: E-cigarettes have been around for years. Why is this happening now?
There are several theories. One is that some dangerous chemical or combination of chemicals has been introduced into the pipeline of vaping products. Public health officials believe that when people vape this noxious cocktail, it sets off a dangerous, even lethal, reaction inside the lungs. These officials have said repeatedly that they do not yet know which substance or device may be causing this reaction, and that is the subject of their urgent investigation.

A second theory is that this syndrome is not, in fact, entirely new and that some people had gotten sick previously, but that the condition had not been recognized and identified as being linked to vaping. As vaping has grown in popularity — both with nicotine and marijuana — more cases may be showing up.

For the time being, though, public health officials seem to believe that the first theory is more likely and they are hunting for a substance, substances or process that might explain the surge in illnesses.
posted by katra at 8:44 AM on September 8 [2 favorites]


there's no difference between smelling someones perfume and tasting or vaping the same molecule

You're downplaying the issue of concentration pretty significantly. Human Odor Detection Thresholds are often measured in hundredths of nM, whereas vape concentrations are literally tens of thousands of times higher. Inhaling e.g. atomized coffee at that concentration would probably kill you.

Plus:
A. Inhaling through the nostrils vs. inhaling directly through the mouth is a substantially different path; B. Misters and Atomizers, including the Salbutamol inhalers you bring up, don't involve heat to perform the atomization, they aeresolize the liquid using propellants or an aspirator nozzle. Ditto for the original e-cigarette, but they're much more expensive to manufacture so most now use heat. Adding energy can cause radical chemical reactions; C. "you are inhaling and enjoying the 'coffee' volatile that is the 'coffee' flavor of e-cigs" assumes that people are actually just using brewed coffee to get these flavors, for which you have provided, and AFAIK we have no evidence. In fact I'd be surprised, since the pleasant odors of coffee pretty rapidly dissipate through a series of reactions with the air - coffee starts to smell "sour" pretty quickly.

I'm sure there are plenty of manufacturers that are actually performing due diligence as far as they know. I'm also sure that, given the state of the industry, plenty are not. I think it's also pretty evident that, as with much of the rest of the cannabis industry, there's a lot of DIY and hobbyist-level production by people who sooorrrrta know what they're talking about.

But there are plenty of studies coming out now, so if anyone's actually interested, there's a bunch of open access analysis of e-liquid toxicity on PLOS these days.
posted by aspersioncast at 8:47 AM on September 8 [15 favorites]


I think at one point Oregon was considering banning vaping because the health risks were so unknown, and I remember driving past a rally of vapers who had a sign that VAPING SAVES LIVES.

I wonder about them sometimes, because clearly it does not.
posted by fifteen schnitzengruben is my limit at 9:13 AM on September 8 [1 favorite]


It's possible that vaping both saves lives and is dangerous. I have a friend who wasn't able to quit smoking until he started vaping. It's clear to me that for people who are already smokers and who haven't been able to quit, vaping is a better choice. It's not totally safe, but neither is smoking, and vaping is better from a harm-reduction standpoint. It's just that Juul and companies like it are clearly targeting people who have never smoked, including very young people, and there's no tradeoff involved in recruiting new users.
posted by ArbitraryAndCapricious at 9:20 AM on September 8 [18 favorites]


A) smell is an intrinsic component to taste. If you smell or taste it, you're inhaling it into your lungs, whatever fraction it may be. I tried to put the concentration bits in there, but it's an unavoidable fact of life that you are inhaling what you taste or smell to some amount. In general.
B) covered in the general 100C water boiling creating droplets. In general you are extracting and boiling and bubbling the water that has been grabbed by the PG/VG hydrophlic propertied of PG and VG which make them a common food additive used to retain moisture. You don't have to go hot on the heat to provide atomization via heat vs mechanical.
C) I pretty much agree on flavorings. Some are well known molecules, some aren't. Some are safe for ingestion but not inhalation. In concentration. No argument there. Still, they're all going to be volatile compounds that can trigger taste buds or nose-receptors... that require the remainder to hit the lungs. We're constantly inhaling and exhaling everything we eat or smell even if it's the awful Axe-body-spray.

Most of the things drug / carrier wise are decently studied if not in the US and FDA or CDC but other countries and history. This is a bad batch of drugs and should be recalled. If only we were regulated.
posted by zengargoyle at 9:31 AM on September 8 [1 favorite]


Oregon appears to be an example of how regulation can work, via USA Today/AP:
Public health officials in Oregon said Wednesday that a person who recently died of a severe respiratory illness had used an electronic cigarette containing marijuana oil from a legal dispensary, the second death linked to vaping nationwide and the first tied to a vaping product bought at a pot shop. Officials have not determined what sickened the middle-aged adult, whether the product was contaminated or whether they may have added something to the liquid in the device after buying it, said Dr. Ann Thomas with the Oregon Health Authority.

[...] Officials cautioned, however, that there have been respiratory illnesses diagnosed where the vaping product did not contain marijuana. [...]

In Oregon, where marijuana is broadly legal for adults 21 and older, dispensaries can’t sell products that have not been tested by state-accredited labs. Mark Pettinger, spokesman for the Oregon Liquor Control Commission, which oversees Oregon’s legal marijuana industry, said the investigation was in its early stages, but if it turns out the THC oil was implicated, his agency can track the product back to its origin and review all the testing results. In general, all marijuana intended for sale at a legal dispensary is tested for pesticides and potency, as well as for solvents, if the product is not dried marijuana flower.
posted by katra at 9:54 AM on September 8 [4 favorites]


atomizing volatile compounds

If you can inhale and enjoy a cup of coffee, you are inhaling and enjoying the 'coffee' volatile that is the 'coffee' flavor of e-cigs.

No, this is all wrong.

A volatile compound is one with a high vapor pressure, meaning that at room temperature and atmospheric pressure, it will exist in an equilibrium between the gas and liquid with a relatively high concentration in the gas phase. Volatile compounds therefore readily enter the air as gasses. When inhaled, they easily redissolve into the liquid of the mucous membranes of the nasal passages, where they can interact with chemical receptors in the olfactory epithelium. The fragrance of coffee comes from a large number of volatile compounds that are dissolved in coffee, which come out of solution as gasses.

The function of an atomizer is to create a mist of liquid droplets from a solution. This allows compounds which may or may not be volatile that are dissolved in the liquid to become airborne, not as gasses, but while still dissolved in the suspended liquid droplets. This is importantly different from the case of "passive" odors in a couple of important ways. First, compounds which do not readily enter the gas phase can be transmitted to the olfactory epithelium, so you are able to smell things you would otherwise never smell. Second, the concentration of odorant molecules (both volatile and non-volatile) can be orders of magnitude greater than they would be if inhaled in the gas phase.

The smell of something is strongly dependent upon both the absolute and relative concentrations of its various odorant molecules. There are specific odorants within coffee, for example, that in isolation and at high concentration smell like feces or vomit, but these odorants smell very different as part of the bouquet of aroma that characterizes coffee. If you were to atomize coffee and inhale it, it very likely would smell quite different, as the concentration of odorants would be very skewed, with a number of non-volatile compounds introduced that are not normally detected at all.

Finally, with vaping, you're inhaling via the mouth, not the nose. The nose is really quite efficient at filtering air before it reaches the lungs; that's one of its primary functions. Solid and liquid particles, including atomized droplets, can be trapped by the mucous membranes of the nose and sinuses, preventing them from reaching the much more delicate lungs. When inhaling using the mouth, this mechanism is bypassed, so the concentration of droplets reaching the lungs is much higher than would be from normal smelling.

Of course, the purpose of vaping is not primarily about smell; it's about delivering a drug to the bloodstream efficiently via the lungs. All of the above is just to emphasize that the identity, concentration, and route of entry of chemicals into the body when vaping is very different than when simply smelling something.
posted by biogeo at 10:05 AM on September 8 [41 favorites]


The basics of vaping is atomization. If you've ever used a spay perfume, you've been atomizing volatile compounds and inhaling them into your lungs. If it smells, you've been inhaling it. It comes down to volume on the flavoring side.

This is not exactly true -- it's well-known, for example, that droplet size modifies how far into the lungs something penetrate, with smaller droplets being capable of being carried far more deeply. This can have issues as well, see for example:

The important attention to be given in the development of pulmonary drug delivery system is the compatibility of polymers used in the design of particulate carriers. The safety of these polymers must be first determined and their compatibility with lung fluid is of great concern. The polymers used to prolong the release rate for chronic use may accumulate in the lung, especially in the lung periphery, which is not served by mucociliary clearance. Chronic inhalation of carrier particles has been shown to induce depletion of surfactant with subsequent recruitment of phagocytic cells. The chances of presence of residual solvent in the final product leads to pulmonary toxicity. Therefore, processing techniques and formulation components must be thoroughly screened in order to avoid the toxic consequences. Carriers used in the design of dry powder inhalation formulations, such as sugars, and cyclodextrins can cause bronchoconstriction in many of the hypersensitive individuals. Chronic use of proteins and other carriers, such as absorption enhancers and enzyme inhibitors, can produce immunogenicity, local irritation, and toxicity. Increased permeability may also allow transport of other toxins and antigens across the epithelial barrier.

This is by no means a solved problem. Witness, for example, the reduced lung function observed in Exubera (inhalable insulin). Afrezza is another inhalable insulin which was withdrawn.
posted by Comrade_robot at 10:38 AM on September 8 [6 favorites]


Vaping might also be "saving lives" by way of being a better alternative to smoking pot or to existing medication. These are only anecdata, we don't have studies, but:

- some people find high CBD marijuana effective enough at anti-inflammatory/anti-nausea/pain-relief stuff to reduce or eliminate their opiate painkiller use. I feel like this group tends to lean heavily on edibles with vapes as a backup, because edibles kick in and wear off way slower - effects in about an hour, for like a day or half a day, rather than pausing to take more hits throughout the day.

- some people find the mood-elevating and sedating effects of marijuana to be effective against acute mental health stuff, to a degree that reduces their use of benzos and/or their risk-taking behaviors. If you're experiencing intense self-harm urges and you know sublingual Ativan will take about fifteen minutes to kick in and a vape hit will take about a minute, that's pretty fucking compelling. Add in that depending on your tolerance, insurance, and psychiatrist it might be easier to get a shitload of vape carts than another bottle of the pills and - even if you know full well that the CDC has asked people to stop vaping, it might still be harm reduction.

and please for the love of God if you are able to pick drugs or drug uses to do safety or efficacy studies on, and somehow you're taking nominees, please do actual goddamn motherfucking research on the maybe-harm-reduce-y weird internet bullshit people are telling each other about, I want that data very badly and have no power to get it, and people I care about put psychoactive stuff into our bodies every day on the word-of-mouth advice of our fellow computer enthusiasts with no medical training, kermit-flail.gif
posted by bagel at 10:49 AM on September 8 [13 favorites]


https://www.rollingstone.com/culture/culture-features/counterfeit-thc-vapes-cdc-vaping-health-alert-875931/

Some folks are filling cartridges with pesticides. Jesus Christ.
posted by pelvicsorcery at 11:02 AM on September 8 [2 favorites]


No real argument biogeo and Comrade_robot. The case at hand seems to point to a large molecule that is liquid/gell/wax at room/body temperature and not easily absorbed. Which condenses in the lungs because - meh the nose/mouth/throat mucal membranes can't catch it all and it ends up in the lungs - and it's not volatile enough to be cleared by respiratory actions and not easily enough absorbed to be harmless enough and leads to rapid pulmonary failure. If our nasal and oral mucus membranes were that efficient at filtering out things we would die of oxygen starvation or at the least would be impervious to mustard gas. A fraction of large and small molecules is caught by membranes on the way down, a larger part makes it all the way down. Absorption happens at every step. That which is not absorbed is expelled and no longer a concern. Except for direct contact, you do not taste or smell anything that is not volatile unless you're upchucking through your nose and making direct contact (and it's yuck). By definition aromatics are thing that have a significant vapor at ambient temperature and pressure or they would have no way to reach the receptors that allow us to perceive them. Some fraction of those floating molecules will reach the lungs depending on their size which will determine how far they reach. Simple small things like oxygen and nitrogen and carbon mon/di-oxide hit the ends. They have low vapor points, go figure. Always a gas.

What you take in you must absorb or expel. Be it solid food or gaseous air. The smelly things have a low vapor point and you can smell them just as easily on the exhale as the inhale because - they're volatile, they stay in every breath you take until they're gone.

And yeah, pneumonia. This seems very quick and abrupt.

I'm totally not qualified to argue fine points of medical studies along other axis. I do wish we had more studies and regulation on these particular axis.
posted by zengargoyle at 11:27 AM on September 8


You can easily buy empty vape cartridges online, complete with branding and packaging. They're even on Amazon. People buy these, make their own homemade THC extract, and then sell them while strongly implying they are retail products from a single manufacturer. There's that and the counterfeit versions of products sold in legal states.

I have a strong suspicion that when this all shakes out, it's going to turn out that a batch of these were the culprit.

In any case the reporting seems very bad if it's leading people to conclude that, say, smoking cigarettes is safer than using a Juul.
posted by vogon_poet at 11:27 AM on September 8 [12 favorites]


Also I don't think anybody is deliberately filling them with pesticide. The extracts are often made by putting otherwise-unsellable cannabis stems and leaves in a solvent; easy to imagine that if these have pesticide on them, you could end up with concentrated pesticide in the extract.
posted by vogon_poet at 11:30 AM on September 8 [3 favorites]


I note a strong whiff of 'if you're stupid enough to vape, you deserve the consequences' in here alas.

The original purpose of vaping is to not smoke burning tobacco, which definitely massively increases your odds of lung and throat cancer. Cannabis smoke has many of the same chemicals, though there's a lot less reliable evidence to prove one way or the other a link to cancer, mostly due to the fact it's been illegal.

Tobacco kills more than 8 million people a year, including 2nd-hand smoke exposure. Nicotine is supposedly as addictive as heroin. Vaping as a replacement for smoking saves lives, no ifs, no buts. Better to not use either, of course - but did you note the bit about how addictive nicotine is?

Strong regulation and product safety is, of course, a good idea.

“Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare Products Regulatory Agency and they operate the yellow card scheme, encouraging vapers to report any bad experiences,” he said.

Deborah Arnott, the chief executive of the health charity Action on Smoking and Health, said that to date no serious side-effects had been reported in the UK. “In Britain, you can check on the Medicines and Healthcare Products Regulatory Agency (MHRA) website whether the product you’re using has been notified and can be legally sold.”

This point was backed by Prof Linda Bauld, a public health expert at Edinburgh University. “It seems highly unlikely that widely available nicotine-containing vaping products, particularly of the type regulated in Europe, are causing these cases,” she said. “All the evidence to date suggests that illicit marijuana vaping products (THC oils) are the cause. In particular, a compound called tocopherol acetate may be the culprit.”

Paul Aveyard, a professor of behavioural medicine at the University of Oxford, said: “These cases are worrying and need investigating but advice from all official bodies in the UK is that it is always preferable to vape than to smoke. These reports should not change that advice.”

posted by Absolutely No You-Know-What at 12:13 PM on September 8 [6 favorites]


con-ta-gi-on I exhale you...
posted by thatwhichfalls at 12:57 PM on September 8


Forget about video enabled cd packaging. This is viral marketing.
posted by thatwhichfalls at 1:01 PM on September 8


Are herbicides still being used against marijuana either by states or governments of countries which are still sources of marijuana in the US?

Because exposure to both Roundup and closely related Paraquat cause pneumonia and severe lung damage.

And pesticide use by legal growers is rampant and essentially unregulated at the federal level.
posted by jamjam at 2:08 PM on September 8 [2 favorites]


What level of intention would constitute "deliberately" for pesticide inclusion? Pesticides totally make it into extract via that route, so testing is required (California), but testing gets expensive, so minimal testing gets done. Less-scrupulous manufacturers use solvents that aren't even rated for human consumption, never mind the whole matter of being safe for ingestion but not inhalation. They'll keep using industrial-grade solvents unfit for human-consumption until proven otherwise - as was seen with diacetyl/popcorn-lung in e-cigs.

I wonder the situation in states where cannabis is still illegal. Regulations are notoriously absent in the black-market, the only saving grace is some grey market products (those sold at "cannabis pop-up markets", primarily for tax-avoidance reasons) are simply diverted from other-wise legal manufacturers that do abide by regulations (however weak they may be).

When "deliberately" makes the leap from mere reckless negligence to malfeasance; I am not qualified to judge.
posted by fragmede at 2:41 PM on September 8


For those who vape in public, please don't indoors. You aren't necessarily bothering anyone, but it's still a problem because some fire suppression systems can be set off by minute amounts of vapor. It is a pain in the ass to evacuate the building when someone had the idea to vape with the vapor turned down enough to be invisible to people but not the sensor. It also costs serious money when the firefighters come out and there's no actual fire.
posted by blnkfrnk at 2:58 PM on September 8 [4 favorites]


Serious question about indoor vaping - would those sensors be compatible with a shower or other steam situation?
posted by Exceptional_Hubris at 3:35 PM on September 8 [1 favorite]


I have no idea. The only other time it's happened have been microwave accidents (e.g. burning popcorn) and someone bringing in a fog machine. We don't have a source of steam in our building. My understanding is that it's something to do with the particulates sensor. All systems are different and it's hard to know what will set it off, as a member of the public, so please be kind and save it for the street just in case.
posted by blnkfrnk at 4:19 PM on September 8 [1 favorite]


Serious question about indoor vaping - would those sensors be compatible with a shower or other steam situation?

No, probably they would not. I have a friend whose kitchen smoke detector goes off when she puts the kettle on for tea and doesn't swoop in the second it goes on the boil -- the concentrated stream of steam from the spout is enough.
posted by halation at 4:56 PM on September 8


fuck I'm going to just use edibles from here out...
posted by nikaspark at 5:22 PM on September 8 [4 favorites]


The black-market THC cartridge contamination theory seems to be the most plausible so far. Vaping in general may be problematic for other reasons, but those would be chronic reasons, not acute reasons like we're seeing now. That Vitamin E Acetate has been called out is very interesting. it's incredibly cheap stuff, wholesale. It's got the right look and feel. (It's the goop in your Vitamin E gelcaps, for example).

Leafly has an article observing that several upstart makers of 'cutting agents' for illicit THC carts have recently gone dark and that those were known to have used Vitamin E Acetate in them.

Clearly regulation is needed in the vape cart scene. That any idiot can get bulk knock-off boxes and empty carts for a few dollars a unit on Alibaba should scare the hell out of everyone. One of the cases was from a cartridge that had been purchased via a "legitimate" dispensary in a state with legal adult-use, meaning that someone scammed that particular dispensary.

Also, as an aside, Vitamin E Acetate's vaporization point is 363F. (This was helpfully mentioned in the Washington Post article, kudos to them.) Many of the better quality devices have temperature setpoints below that. If you use these things, you should investigate your devices' settings and adjust accordingly, if you have no other options.
posted by Xyanthilous P. Harrierstick at 7:01 PM on September 8 [6 favorites]


My son, who is 12, argues with me every week about how the danger of vaping is a hoax and the "TRUTH" orange campaign thing is a hoax and the flatbill cap guys on this one video have proved it. It's fun. Also, fuck YouTube.
posted by Caxton1476 at 6:07 AM on September 9 [7 favorites]


I love the format, the potency, and the ability to totally rip clandestine hits while shopping, at concerts, etc.

You are not remotely clandestine, and the people around you deeply resent getting your exhaled clouds in their face. Outdoor concerts and sporting events have become a nightmare for anyone sensitive to smells because it is like a noxious cloud of bubblegum/mint/earl grey/cannabis/cotton candy/grape.

It has become the hipster version of rolling coal, and it is DISGUSTING. Bad enough to get a big faceful of someone's exhaled vapor when walking down the street, but the people doing it indoors and on public transit are just while being proud of themselves for their stealth are just. the worst.

I am very glad for anyone who successfully uses vaping as harm reduction to wean themselves off cigarettes, or for people using it for pain management with CBD oil. However, the population-level research shows that the majority of people in the US who start vaping actually just keep smoking tobacco AND vaping, increasing their nicotine exposure, while young people who never would have smoked in the first place are STARTING to vape because they think it is safe.

Oh, also, for people who think Juul is somehow better than custom rigs, it is worth keeping in mind that their executives had to sulkily admit under oath that their entire marketing playbook is lifted from Big Tobacco, including the part about targeting kids to get them addicted as early as possible.
posted by a fiendish thingy at 8:24 AM on September 9 [17 favorites]


exposure to both Roundup and closely related Paraquat cause pneumonia and severe lung damage

Aside from both being herbicides, what is it about these two quite distinct chemicals that makes them "closely related" in your view? Their modes of action against plant tissue are quite different, as are their toxicities to humans.

Paraquat will fuck you up very quickly. Glyphosate might do you in with various kinds of cancer some years down the track.
posted by flabdablet at 9:51 AM on September 9 [2 favorites]


You are not remotely clandestine, and the people around you deeply resent getting your exhaled clouds in their face.

Quoted for truth.
posted by flabdablet at 9:54 AM on September 9 [8 favorites]


The "vaping saves lives" thing brings up a weird memory for me.

A few years back I briefly (briefly!) dated a guy who was really deep into the "Rationality community"/Libertarian/tech bro culture. One day, out of the blue, he was *all* hopped up about dumb and oppressive was some recent federal guidance (FDA? CDC? I don't remember) discouraging vaping. He was just spoiling for a fight--I mean a vigorous debate. He obviously had just been reading deeply in some online echo chamber united in their belief in the idiocy of regulation, and was furious and detailed about how the statistics cited were all flawed and how many lives are going to be lost because of kids will start the habit of smoking cigarettes when instead they could be vaping. Outraged!

So he sprung this whole issue on me out of the blue and really wanted to mix it up with me. I had not been reading deeply about vaping and statistics thereabout and so I had no evidence about that subject to argue or counter argue. But I did argue that the public health experts who gave that guidance likely have context, experience, and perspectives on the matter of smoking and vaping that the average SlateStar Codex fanboy did not. Needless to say, this cut no ice with him...

This episode was weird and unsettling, and that general dynamic was a large part of why I didn't want to date him anymore. But as I'm watching these stories unfold about really bad things happening to people as a result of vaping, I keep remembering that conversation. This vaping safety issue as a cause celebre almost, as an ideological vindication of how misguided the "experts" are and how objectionable regulation is. Kinda wonder how many people are going to have to die or to suffer chronic health impairment before the "evidence based community" admits they're wrong... or maybe, just maybe, that some kinds of adverse events are sufficiently bad that it's better to not wait til the evidence manifests. Dumb, dumb, dumb.
posted by Sublimity at 10:33 AM on September 9 [5 favorites]


Thank you to the people who posted actual news about this instead of finding yet more ways to conflate medical users (some of which identified themselves in this thread, and yet people still get the need to be rude and snarky) with problematic recreational users. Cannabis vaping has saved my life (combined with a great therapist and psychiatrist). I don’t have anything else to add.
posted by Drumhellz at 11:55 AM on September 9 [3 favorites]


Caxton, your son may be interested to know that e-cig manufacturers settled at least 2 lawsuits in 2015 and 2016 from people whose batteries exploded, shattering multiple teeth and causing severe craniofacial injuries that required treatment in the ER.

Here's some info from a dental surgeon who says these are not isolated incidents.

If you really want to scare the shit out of him, there are some grisly images -- including a blinded 14-year-old -- in the New England Journal of Medicine article here on e-cigarette explosion injuries.

Does the flatbill cap guy have any wisdom about overheating lithium-ion battery components? Because those photos definitely don't look like a hoax to me.
posted by Unicorn on the cob at 3:21 PM on September 9 [3 favorites]


Basically, if you're considering doing something to be an asshole to others because being an asshole to others sounds like fun, please give non-asshole forms of recreation another shot.
posted by The Underpants Monster at 9:11 PM on September 9 [3 favorites]


Juul Illegally Marketed E-Cigarettes, F.D.A. Says (NYT)
Juul Labs, the dominant e-cigarette company, illegally marketed its vaping products as a less harmful alternative to traditional cigarettes, the Food and Drug Administration said on Monday, casting a deepening shadow over the safety of e-cigarette devices.

The agency issued a warning letter to Juul, saying that the company violated federal regulations because it had not received federal approval to promote and sell its vaping products as a healthier option. [...]

The investigation into Juul’s practices preceded this summer’s spate of lung illnesses, and was prompted by concerns that the company’s marketing and sales practices targeted youths. It included a review of congressional testimony from Juul executives, consumers — students and parents — and antismoking activists.

“Regardless of where products like e-cigarettes fall on the continuum of tobacco product risk, the law is clear that, before marketing tobacco products for reduced risk, companies must demonstrate with scientific evidence that their specific product does in fact pose less risk or is less harmful,” said Dr. Ned Sharpless, the acting F.D.A. commissioner. “Juul has ignored the law and, very concerningly, has made some of these statements in school to our nation’s youth.”

The agency on Monday pointed to specific instances that it said violated restrictions on those health claims. It referred to a statement by Kevin Burns, the company’s chief executive, that had once been posted on the Juul website in which he said that the company’s vaping system was designed to “heat nicotine liquid and deliver smokers the satisfaction that they want without the combustion and harm associated with it.”

The letter also cited congressional testimony about a talk at a school: A Juul representative spoke at a presentation and told students that Juul “was much safer than cigarettes” and that Juul was “totally safe.”
posted by katra at 10:51 PM on September 9 [1 favorite]


Anecdata.

Five years ago, my brother, who was 54 at the time, went to the E.R. with flu-like symptoms, trouble breathing and a high fever.

He was having so much trouble breathing, the E.R. doctor wanted to put him on a ventilator and my brother said yes.

Generally in good physical shape, my brother exercised regularly, weights and running, disciplinary leftovers from his military career. His most recent physical, some four or five months earlier, had shown no underlying problems - his blood pressure was great, his cholesterol and blood sugar levels were fine, his chest x-ray was clear.

His only vice - and health risk - was that he was a smoker. His doc nagged him about quitting and my brother decided to give it a shot. He took up vaping as a way to help him quit.

About 6 hours after going to the E.R., my brother was admitted to the hospital. His condition was fast deteriorating and that evening he grew increasingly weak and began slipping in and out of consciousness. Then he stopped waking up at all. Both lungs were full of fluid, we were told. Within twenty-four hours of his trip to the E.R., his organs began shutting down and because his kidneys just totally quit, he was put on dialysis.

His second morning in the hospital, the docs told us he was throwing blood clots, some of which appeared to be to his brain. His body was not functioning on its own. When I asked if he *could* recover, the E.R. doc just shook his head.

So less than forty-eight hours after my brother went to the E.R. because he thought he had a bad case of flu, my family had to decide whether or not to remove him from life support. Take my word for it, you do not want to be in the room when someone in respiratory failure has their breathing tube removed.

2014 was a moderately bad flu year according to the CDC. My brother was a smoker and had been for 20+ years. Even so, the speed of his complete lung failure and the destruction of his organs made us wonder then -- and we have wondered ever since -- if vaping had anything to do with his death.

Not a single doctor who saw him told us he tested positive for flu. On his death certificate, my brother's primary cause of death is listed as pneumonia, due to or as a consequence of respiratory failure.

So, as I said, anecdata, and I'll never know for sure. But I'd be lying if I said I think vaping is safe or that I am surprised that there have since been studies that show health risks associated with the practice.
posted by faineant at 1:02 AM on September 10 [3 favorites]


Is Juul the new big tobacco? Wave of lawsuits signal familiar problems (Guardian)
An estimated 9 million adults and 3.6 million US teenagers vape, including 20% of high school students, making the potential plaintiff pool enormous. Juul commands three-quarters of the US e-cigarette market, with sales growing 783% between June 2018 and this year to $942.6m, Wells Fargo reported. In less than one year, Juul’s valuation rose from $16bn in the summer of 2018 to $38bn in December 2018. [...]

A wave of teen vaping has not hit the UK, where Juuls have less than one-third of the nicotine potency they have in the US, and where the devices only recently went on sale in stores.
Ban Flavored E-Cigarettes to Protect Our Children (Michael R. Bloomberg and Matt Myers, NYT Opinion)
There’s still much we don’t know about the connection between lung illness and vaping. But we do know that one Juul pod contains about as much nicotine as an entire pack of cigarettes, and that nicotine harms brain development.

Even worse, studies show that kids who use e-cigarettes are more likely to use real cigarettes. E-cigarette companies insist their goal is to help people quit smoking. But 13-year-olds don’t start using cotton-candy-flavored pods for Juul devices to kick a cigarette habit.
posted by katra at 8:48 AM on September 10


Juul commands three-quarters of the US e-cigarette market, with sales growing 783% between June 2018 and this year to $942.6m

Juul also is responsible for almost the entire advertising spend across the industry. I see a few Blu and Vuse ads, but Juul has been on a campaign for a couple of years now.

There’s still much we don’t know about the connection between lung illness and vaping.

And there's a lot we do know. I've been vaping flavorless 50/50 propylene glycol and vegetable glycerin for years now, both of which have decades of science behind them. NIH says that vaporization/nebulization of either ingredient is (by my read) no more harmful than saline.

But we do know that one Juul pod contains about as much nicotine as an entire pack of cigarettes

Uh, yah...that's kind of the thing: it lets you carry a pack of cigarettes in a lighter-sized device. Oh, but let's imply that an entire pod is consumed in a single puff, which I'm not sure what else their use of "but" could mean.

and that nicotine harms brain development.

There is a huge campaign by nicotine scolds ("Nicotine = Brain Poison") in California right now that is simply over the top. tl;dr: vaping is why your kids hate you

Even worse, studies show that kids who use e-cigarettes are more likely to use real cigarettes. E-cigarette companies insist their goal is to help people quit smoking. But 13-year-olds don’t start using cotton-candy-flavored pods for Juul devices to kick a cigarette habit.

I'm tempted to post an AskMe as a challenge to unravel the chain of non-sequiturs in these sentences, but because of all of these bad-faith manipulations I'm giving the side-eye to all anti-vape messaging. Heck, Juul were huge dicks to me when I interviewed there, but I'm not going to let that blind me to the prohibitionist movements among us.

There are ulterior motives going on here -- I don't know what they are -- and I don't think they can be chalked up entirely to anti-smoking activists having to find a new gig now that smoking is almost non-existent. I mean, I believe a big part of it can be chalked up to that, but there's other stuff, too.
posted by rhizome at 9:24 AM on September 10 [4 favorites]


You May Want to Avoid These Ingredients in Cannabis Oil Vape Cartridges (Leafly, 2017)
In a very recent* August 2017 study, a team of researchers summarized the e-cigarette pulmonary toxicity by looking at human studies, animal models and cell culture studies. They described the field of research as rapidly evolving and identified research gaps and challenges, but warned that when heated to high temperatures, propylene glycol can break down into microscopic polymers that can cause damage to lung tissue.

Another 2017 study conducted at the Medical Marijuana Research Institute in Arizona, researchers looked at the byproducts produced when vaporizing cannabis oil. These popular cannabis thinning agents were studied:

Propylene glycol (PG or PPG)
Vegetable glycerin
Polyethylene glycol (PEG) 400
Medium chain triglycerides

These thinning agents were heated to 230°C (450°F), and scientists tested the resulting vapors to detect the presence of harmful compounds like formaldehyde, acetaldehyde, and acrolein. The results showed that polyethylene glycol 400 produced much higher acetaldehyde and formaldehyde byproducts than the other three agents. Heating of the thinning agent propylene glycol also produced significantly greater formaldehyde byproduct. Researchers concluded that individuals who vaporize cannabis oil utilizing these thinning agents may risk harmful exposures to the byproducts.

Furthermore, there has been a lack of adequate safety testing for the vape pen devices. Pre-packaged oil cartridges are not well labeled in some cases, and thinning agents are frequently developed in countries that have no regulatory controls. There are many vape pens on the market, all of which have a different heating source with different activation and temperature.

But is there conclusive evidence that vape pen consumers will develop pulmonary illnesses or cancers? No. Very little is known about either short- or long-term effects of inhalation of thinning agents like propylene glycol and others.
*Update 8/22/17: Since the original publication of this article, a new study from the American Physiological Society on pulmonary toxicity was released.
posted by katra at 10:44 AM on September 10 [5 favorites]


Vaping and Health: What Do We Know about E-Cigarettes? Environ Health Perspect. 2014 Sep; 122(9): A244–A249.
Previous research on propylene glycol, one of the most commonly used constituents of e-liquids, showed it can cause eye and lung irritation.21 In its product safety assessment for propylene glycol, the Dow Chemical Company recommends individuals avoid inhaling the chemical.22

A new study by Goniewicz and colleagues in Nicotine & Tobacco Research reveals that potentially toxic carbonyls can form when e-liquids are heated to high temperatures. In early models of e-cigarettes, the heating element didn’t get warm enough to create these compounds. However, some newer “variable voltage” models allow users to increase the temperature of the heating element to deliver more nicotine—which also generates carbonyls.23

Carbonyls, which consist of a carbon atom double-bonded to an oxygen atom, are found in a variety of organic and organometallic compounds. The carbonyls identified by Goniewicz and colleagues included formaldehyde, acetaldehyde, acetone, and butanol. Propylene glycol–based e-liquids generated higher levels of carbonyls than other fluids, with levels of carcinogenic formaldehyde observed in the range seen in tobacco smoke.23

[...] E-cigarettes may also expose bystanders to emissions, although research in this area is only just beginning. One team of researchers observed increased indoor air levels—albeit less than those associated with tobacco cigarettes—of coarse particulate matter, polycyclic aromatic hydrocarbons, and aluminum following indoor vaping sessions lasting two hours each.31
posted by katra at 10:55 AM on September 10


Hidden Formaldehyde in E-Cigarette Aerosols N Engl J Med 2015; 372:392-394 DOI: 10.1056/NEJMc1413069
E-cigarette liquids are typically solutions of propylene glycol, glycerol, or both, plus nicotine and flavorant chemicals. We have observed that formaldehyde-containing hemiacetals, shown by others to be entities that are detectable by means of nuclear magnetic resonance (NMR) spectroscopy,1 can be formed during the e-cigarette “vaping” process. Formaldehyde is a known degradation product of propylene glycol that reacts with propylene glycol and glycerol during vaporization to produce hemiacetals (Figure 1).

These molecules are known formaldehyde-releasing agents that are used as industrial biocides.5 In many samples of the particulate matter (i.e., the aerosol) in “vaped” e-cigarettes, more than 2% of the total solvent molecules have converted to formaldehyde-releasing agents, reaching concentrations higher than concentrations of nicotine. This happens when propylene glycol and glycerol are heated in the presence of oxygen to temperatures reached by commercially available e-cigarettes operating at high voltage. How formaldehyde-releasing agents behave in the respiratory tract is unknown, but formaldehyde is an International Agency for Research on Cancer group 1 carcinogen.4
posted by katra at 11:10 AM on September 10


Three Companies Subpoenaed in Weed Vape Illness Investigation (Rolling Stone)
Diluents like Honey Cut are primarily used by black market vape cartridge manufacturers, which make up a huge percentage of the THC vape market. And Riley says the best way to stay safe is to purchase pens directly from licensed dispensaries. “It all starts with buying it from a legitimate source. If you’re not going in a dispensary then the product you’re buying is not legitimate…[dispensaries] have a responsibility to protect consumer safety,” he says.

Of course, consumers in states where marijuana is not legal don’t have this option, and even legal dispensaries in California are not currently required to test for vitamin E acetate or other cutting agents. While that’s likely to change as a result of the recent cases of vaping-related lung ailments, many in the industry say that the recent vaping-related hospitalizations further highlights the need for legalization and regulation.

“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,” NORML deputy director Paul Armentano says in a statement sent to Rolling Stone. “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.”

In the meantime, even vaping enthusiasts are now urging caution — not just with bootleg cartridges, but with THC cartridges in general. Whitten refers to the current cannabis industry landscape as a “shitshow.”

“Put it this way: I would not touch a pen [right now] even if it was from a licensed facility,” he says.
posted by katra at 10:19 PM on September 10


Trump administration will move to ban flavored e-cigarettes amid vaping related deaths
The Trump administration officials say they’re considering a ban on all non-tobacco flavored vaping and e-cigarette products following an outbreak of related mysterious illnesses across the US.
posted by bitteschoen at 10:32 AM on September 11


Good ol' Trump and his shotgun surgery.
posted by rhizome at 11:25 AM on September 11


The first case here in in the Seattle area has been confirmed by King County Public Health:
Seattle & King County has identified a confirmed case of severe lung disease associated with E-cigarette use in a King County teenager.

The patient was hospitalized in August for fever, cough and shortness of breath. He was treated in the intensive care unit and released from the hospital five days later and is now recovering. The patient reported using E-cigarette products over the past three years.

We know this teenager reported vaping nicotine with propylene glycol as well as saffron, but our investigation is ongoing and we do not know details about the type of vaping device, where the products were obtained or if other substances were also used.
posted by mbrubeck at 1:36 PM on September 11 [1 favorite]


Saffron? Wtf? This makes me anxious as an ex smoker but that's my nic brain trying to get me to start. I just find it odd that all these cases are just happening in the states. I loathe juul for marketing to kids as most legit vape stores don't and want regulation. People have been vaping for 10+ years so why now and why only in the US. Is it the juul? The juul doesn't let you use any other juice but what they provide. Is it because it kids are vaping any substances in it or the THC? If it's the oil then I wish the media would separate the two. I'm against kids vaping but for ex smokers being 95% less harmful than cigarettes is an awesome harm reduction tool.
posted by kanata at 2:27 PM on September 11 [1 favorite]


I haven't seen anything this side of Trump that says it's anything other than bad THC cartridges, specifically Vitamin E oil as a cutting agent. We're going to have to suffer "vaping deaths" and the resurgence of "e-cigarette" for the foreseeable future, though.

The anti-vaping groups in California (possibly elsewhere?) must just be over the moon these days.
posted by rhizome at 4:09 PM on September 11 [1 favorite]


The juul doesn't let you use any other juice but what they provide.

This is demonstrably untrue. There are plenty of third-party juul-compatible pods on the market, including ones that can be filled with any (ahem. THC.) juice.

Is it because it kids are vaping any substances in it or the THC?

People have been vaping THC e-liquids almost as long as they've been vaping Nicotine e-liquids. This is an acute health problem that is very likely caused by a recent change in the components of the e-liquids. At least three major producers of a suspected bad e-liquid base no longer sell them. That's pretty telling. Illicit drug suppliers don't want to kill their clientele, they just want to make money.
posted by Xyanthilous P. Harrierstick at 4:15 PM on September 11 [2 favorites]


Trump Administration Plans to Ban Flavored E-Cigarettes (NYT)
Hospitals and health officials in nearly three dozen states have reported nearly 500 cases of vaping-related illnesses since the beginning of the summer. Doctors have said that many patients appear to have vaped some THC or cannabis-related products, although others have reported using e-cigarettes as well. No one has singled out a particular company, device or product as the possible culprit.

Deaths have been reported in Illinois, Kansas, California, Indiana, Minnesota and Oregon. The patients’ ages ranged from the 30s to middle-aged or older, and some had underlying lung or other chronic conditions, health officials said. [...]

On Monday, the F.D.A. took action against Juul, sending a warning letter accusing the company of violating federal regulations by promoting its vaping products as a healthier option than cigarettes.

There is little conclusive research on the long-term safety of using Juul or other e-cigarettes.
posted by katra at 6:13 PM on September 11


Good ol' Trump and his shotgun surgery.

Preceded by his sixth sense of finding a crowd — any crowd — that’s going somewhere, then getting in front of it.
posted by cenoxo at 6:15 PM on September 11 [1 favorite]


I didn't know that about illicit juul pods. I only come as an 25 year on and off smoker and vaping is the only way I've managed to get off without severe mental health problems plus I only quit 90 days ago. So I'm not trying to spread misinformation like your sentence kind of implied. I'm just trying to get an idea of why it is happening in America only and why if it is just thc oil then why the media is talking about ecigarette. I also don't know your regulations as opposed to mine. And where America leads other countries follow.
posted by kanata at 6:57 PM on September 11 [1 favorite]


Europe’s missing ‘vaping sickness’ (Politico.eu)
Europe does not appear to be experiencing an outbreak of the “vaping sickness” gripping the U.S.

It’s not clear anyone would know if it was. [...] In European countries like the U.K. and France, which have voluntary reporting systems, there’s not much evidence of this problem, and experts cite tighter e-cigarette regulations in Europe than the U.S.

“We have not seen anything like what we’ve seen in the U.S. recently in Europe, to my knowledge as a scientist, and I’m pretty aware of the field,” said Constantine Vardavas, the European Respiratory Society’s scientific relations director with the EU.

But while several EU and national agencies said they are monitoring the U.S. situation, they weren’t always able to say who’s keeping track on this side of the Atlantic. An EU-wide reporting system is still in the works, and a broad analysis of e-cigarette safety is only due in the fall of 2020.

Some EU experts say there’s no reason to think this side of the Atlantic will be immune. Though the cases are currently limited to the U.S., the Portuguese Society of Pulmonology said in a statement Wednesday that “they are likely to arise in other countries, including Portugal,” given the widespread availability of e-cigarettes. [...]

The U.K. has seen at least one case that has key similarities with the U.S. “vaping sickness,” which is essentially lipoid pneumonia — the accumulation of fat particles in the lungs. Doctors suspected the patient’s vaping liquid was to blame. The case, discussed in the BMJ, does not appeared to have been logged with the U.K. regulator.
posted by katra at 9:01 PM on September 11


Vape death leads Oregon to ask pot shops to review products (AP)
The agency can’t ban vaping devices or any specific ingredients in them until more is known about what is causing the health problems, he said. “The public safety agency has to tell us there’s a public health concern for us to act,” Marks said. “They have not done so yet. ... With the lack of specificity, that’s about the level of action we can take at this point.” [...]

Most of the patients said they vaped products containing THC. But some said they vaped only nicotine, while others said they used both THC and nicotine. After extensive testing, New York investigators have focused on vitamin E acetate, which recently has been used as a thickener, particularly in black market vape cartridges. [...]

Marks, the Oregon regulatory chief, said no companies selling marijuana vape cartridges at state-licensed stores have listed vitamin E acetate as an ingredient, which they would be required to do. Regulators haven’t banned or approved its use because no companies have indicated they are using it, he said.

But Oregon doesn’t test for additives like vitamin E acetate in vaping products sold at retail stores, so the regulators can’t know if it’s being added illicitly by some manufacturers, Marks said. [...] “My worry is that some of these folks may have gone around and put vitamin E in their products that we are unaware of,” Marks said. “If it’s in our products, it’s out there and we don’t have a clear way to know which ones it may or may not be in.”
posted by katra at 10:03 AM on September 12


Trump responds to one vaping crisis by attacking another (Politico)
The administration’s sleight of hand infuriated lobbyists for vaping companies, who are leery of federal regulation, while encouraging marijuana companies, which want more of it.

“It’s like having salmonella in Romaine lettuce and calling to ban peanut butter. It is literally public health malpractice,” said Mike Hogan, a lobbyist for the Smoke-Free Alternatives Trade Association. Critics like Hogan say Trump’s focus on e-cigarettes completely ignores the early state-level data that links cases of lung disease to cartridges containing THC. [...]

Under federal law, the government could raid state-licensed dispensaries and remove all vape products, but even the White House cannot create new oversight of marijuana products beyond what is outlined in the Controlled Substances Act. To change that, Congress would have to reclassify marijuana — a measure far less likely to reach the president’s desk than laws targeting the e-cigarette industry. [...]

The federal prohibition of marijuana means that decisions to change or issue new regulations on marijuana vape cartridges are entirely up to the 33 states that have legalized marijuana for medical or adult use.
posted by katra at 9:21 AM on September 14


It's just like how he responds to calls for gun control by focusing on the mentally ill. He just picks and chooses the nearest whipping-boy.
posted by rhizome at 2:18 PM on September 14 [1 favorite]


Some CBD vapes contain street drug instead of the real thing (AP/ABC News)
Some operators are cashing in on the CBD craze by substituting cheap and illegal synthetic marijuana for natural CBD in vapes and edibles such as gummy bears, an Associated Press investigation has found. The practice has sent dozens of people like Jenkins to emergency rooms over the last two years. Yet people behind spiked products have operated with impunity, in part because the business has boomed so fast that regulators haven't caught up while drug enforcement agents have higher priorities.

AP commissioned laboratory testing of the vape oil Jenkins used plus 29 other vape products sold as CBD around the country, with a focus on brands that authorities or users flagged as suspect. Ten of the 30 contained types of synthetic marijuana — drugs commonly known as K2 or spice that have no known medical benefits — while others had no CBD at all.

Among them was Green Machine, a pod compatible with Juul electronic cigarettes that reporters bought in California, Florida and Maryland. Four of those seven pods contained illegal synthetic marijuana, but which chemical varied by flavor and even location of purchase.

"It's Russian roulette," said James Neal-Kababick, director of Flora Research Laboratories, which tested the products. [...] The results of AP's lab testing echo what authorities have found, according to a survey of law enforcement agencies in all 50 states. At least 128 samples out of more than 350 tested by government labs in nine states, nearly all in the South, had synthetic marijuana in products marketed as CBD. Gummy bears and other edibles accounted for 36 of the hits, while nearly all others were vape products. Mississippi authorities also found fentanyl, the powerful opioid involved in about 30,000 overdose deaths last year. [...]

Experts such as Michelle Peace, a forensic scientist at Virginia Commonwealth University who has found synthetic marijuana in her own testing of CBD vapes, said the federal government should act quickly to protect the public. "As long as it remains unregulated like it currently is," Peace said, "you just give a really wide space for nefarious activity to continue."
posted by katra at 9:53 PM on September 16 [1 favorite]


Not directed at you, katra, but rather the incredulous or licentious press;

Fake/ counterfeit "CBD" has been on the market for at least five years. In the US, product takedowns have been at the behest of Federal Trade Commission rather than DEA or FDA; most of the successful cases were ones that the gov was able to demonstrate that the product did not contain any of the purported CBD phytochemical it advertised as having.

The disinformation out there and rampant snakeoil production has really gotten me down.

I can criticize Canada's cannabis regulations all day and all night, but compared to the disparate systems between States while being Federally illegal; it could be fixed, not just something that needs burning down into the grown and Federally harmonized.

Being overseeing by the "Feds" can overcome some of the corruption from State-level oversight of, say, analytical testing labs.

In the past, Federal-level governance seemed to be better informed than State-level governance. But it seems like it's just mickey mouse play pretend at all legislative levels of government.
posted by porpoise at 10:36 PM on September 16


Yeah, if anything, Canada's system, while not perfect of course, shows the benefits of federal legalization and standardization. That this is all going on while the fentanyl madness rages on is an irony flying over the heads of everybody with the ability to affect (and effect) policy and legislation.
posted by rhizome at 12:53 AM on September 17


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