CDC announces breakthrough in vaping lung injury investigation

Illustration by Alex Castro / The Verge

Samples of lung fluid from 29 lung injury patients in 10 states all contained the same chemical, the Centers for Disease Control and Prevention said today. The discovery is a huge step forward for the ongoing investigation into the severe and mysterious lung injuries that have affected e-cigarette users across the country.

The chemical, called vitamin E acetate is now considered a “chemical of concern” by the CDC, which is investigating the outbreak. As of November 5th, 2019, 39 people have died of the injury, and 2,051 cases are being investigated.

The agency says that vitamin E acetate is an oily substance found in a ton of typical household items, including foods, supplements, and even skin creams.

According to the CDC’s website, “Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning.”

The oil might be great for skincare, but when heated up, it can act almost like a grease, chemistry professor Michelle Francl told The Washington Post in September. As you might imagine, breathing in vaporized grease could seriously affect the lungs, though researchers are still trying to figure out the exact mechanism that’s causing the lung damage.

Investigators believe that the substance has been added to e-cigarette products as a thickener, and is particularly attractive to people manufacturing illicit products because it resembles tetrahydrocannabinol (THC) oil. THC is the substance in marijuana that provides a high.

Vitamin E acetate was previously linked to the injuries in early September, when some state agencies identified the substance in samples of vaping products that had been used by people who later came down with the disease. But finding it in products wasn’t the same as finding it in the patients themselves.

In this case, researchers looked at fluid taken from the lungs of patients suffering from the injury, and found vitamin E acetate in every single sample. THC was found in 82 percent of the lung fluid samples, and nicotine was found in 62 percent of the samples, suggesting that the vast majority of patients were vaping THC products, and that many were using both nicotine and THC products.

The CDC looked for other additives in the samples, including mineral oils and plant oils, but didn’t find anything to cause concern.

Today’s discovery does not mean that the investigation is over, or that vitamin E acetate is the only cause of the injuries. Other chemicals could have also played a role in the ongoing outbreak. The CDC’s work — and an accompanying Food and Drug Administration investigation into the outbreak of injuries — continues. The agency continues to recommend that people not use THC vaping products, particularly ones that were obtained online, or from family or friends.


Investigators believe that the substance has been added to e-cigarette products as a thickener

Vitamin E acetate has been added to THC carts, but there is no evidence it was added to an "e-cigarette" product, unless you’re confused and think that THC carts ARE e-cigarette products.

mysterious lung injuries that have affected e-cigarette users across the country.

First, it’s not "mysterious lung injuries", it’s lipoid pneumonia, caused when vaping lipids, like vitamin E acetate. The CDC was calling it "vaping induced lipoid pneumonia" going back to some time in September, IIRC.

Second, it’s affecting people who vape certain THC products, so there’s actually no evidence that it affects "e-cigarette" users.

"E-cigarettes" are products that contain nicotine.
THC vapes are ones that contain THC.
They are two entirely different products, even if there are black market THC carts one can buy for JUUL.

From an editorial POV, I’d recommend either ONLY using "e-cigarette" in the context of nicotine-based vape products, or ditching "e-cigarette" altogether for "nicotine vape", and use "THC vape" for products that contain that substance.

The other thing to note is the purpose of Vitamin E. It was being used as a cutting agent for THC vapes so it retained the appearance and consistency of pure THC oil.

Proplyne Glycol and Vegetable Glycerine (the common agents in e cigarettes) thinned it out and gave it the appearance of poor quality THC oil. Vitamin E acetate didn’t, and it passed the bubble test which customers did as a test of THC oil quality.

Very interesting story about a Vitamin E producer here.

It surely also a reasonable assumption that some cheap knock offs were also using acetate to thicken the oil.

I presume CDC can’t rule that out yet.

Well, the thing is there’s no need for regular vapes. Vapes come in many different colors and consistencies. No one judges the quality of a vape based on its consistency or color. In fact, dark colors are typically worse since they burn coils faster.

Vitamin E was specifically chosen for THC so that it gave off a look and consistency of pure THC oil. That isn’t really needed for nicotine vapes. Might as well just use vg and pg which are already cheap.

You are making an assumption without evidence.

I stand corrected. They aren’t nicotine vapes, but Amazon sold vitamin E vapes which are health products so you can consume vitamin E through a vape. Yikes, that’s dumb.

There are plenty of evidence that inhaling any heated chemicals (in any form, including conventional cigarettes) is bad for your health. There is no evidence that THC based vapes or e-cigs are the exception.

It’s crazy how many people rush to defend yet another product which so obviously harms the body. Don’t we have enough of them already?

In the long run, everything is bad for your health. Is there actual research that compares the harm from vaping/e-cigrettes vs the harm from smoking?

Is there actual research that compares the harm from vaping/e-cigrettes vs the harm from smoking?

No need. Smoking is the worst thing you can do to your body, besides maybe hard drugs, and I’m saying this as smoker. Just because vaping – or anything, really – is better than smoking doesn’t mean it’s harmless.

The England has done studies. It’s a dramatic reduction in harm vs. analog cigarettes.

This vitamin E situation is for sure an anomaly and primarily affects THC or rogue vapes from the street. It’s like an ecoli outbreak leading to the government to ban lettuce.

The fact that research is in its early stages cannot be taken as evidence that vaping is safe, but vapers seem intent on doing just that. Absence of evidence is not confirmation of safety. If you want to risk your lungs on that, go right ahead. But do it in your own house. You have no right to impose your risk assessment on bystanders.

That’s exactly what this evidence suggests. No. Take your naturalistic folly back to Walden.

There are plenty of evidence that inhaling any heated chemicals (in any form, including conventional cigarettes) is bad for your health. There is no evidence that THC based vapes or e-cigs are the exception.

And there’s plenty of evidence that nicotine vaping is 95% less harmful than cigarettes.

The original comment certainly isn’t advocating for using e-cigarettes or THC vapes, but importantly pointing out the inaccuracies in The Verge post. It’s a shame it takes a commenter to set right an organization such as The Verge, but I imagine that is why readership now is a far cry from a few years back.

Yet there have been cases of fatal lipid pneumonia in people who do not seem to have used anything other than name-brand e-cigarettes. The family of one of these victims was just interviewed on The Daily podcast last week. It’s not so easy to dismiss this as a THC-only problem although that does appear to be the majority of cases.

The fact that we only have a very small handful of people affected when millions of people vape is testiment to how safe these products are. I have no doubt that manufacturing problems happen in any product sold.

Yet there have been cases of fatal lipid pneumonia in people who do not seem to have used anything other than name-brand e-cigarettes

Self-reporting when it comes to drug use isn’t exactly accurate, especially if that drug may be illegal in your state, or couple potentially cause problems with an employer.

It’s also worth pointing out that these patient surveys didn’t all call out "name-brand e-cigarettes", they largely focused on nicotine vs. THC. News reports generally referred to JUUL by brand because it’s the largest brand, and also because it seems that black market THC carts that could be used with a JUUL device were the major culprit.

These critical distinctions have been largely (and probably accidentally) misreported, or poorly phrased, in the news for over two months now.

That doesn’t mean I endorse JUUL at all. I’m wary of any nicotine vape using nicotine salts, because I suspect that they may contain the active ingredients in tobacco that turn nicotine from a drug with weak-reinforcing properties into an addictive one.

I’ve got no evidence of this, since I’ve never seen a MSDS (material safety data sheet) on nicotine salts. In comparison, the chemical makeup of "traditional" freebase nicotine vapes is widely known, and the most well-known providers of flavour concentrates to "juice makers" make their MSDS available online.

The CDC put out a report that the people who self-identified as "only vaping nicotine" had most likely lied as they had found THC in their systems. So, yeah, it really is easy to dismiss this as a THC-only problem.

From a quick review of multiple governmental definitions, "e-cigarette" appears to apply to mechanism regardless of the content it is vaporizing. This would suggest that the legal definition of "e-cigarette" would encompass the vaping device without considering if nicotine, THC, or another substance were delivered. Therefor, THC carts are e-cigarette products and, editorially, The Verge is using the term correctly.

Even IF "e-cigarette" was officially defined by the government as both a THC and nicotine delivery system, it would be a poor definition that SHOULD be clarified. The "but this is what the government says" defense is pretty weak.

My quick review shows the first US government definition as referring to nicotine delivery…

Other governments, like the UK and Canada, also use the term e-cigarettes specifically for nicotine.

The two (nicotine and THC vapes) have only REALLY become conflated since the beginning of this "vaping illness" scare.

1) "This is what the government says" is pretty much the basis of most legal defenses, so not actually that weak
2) The OED definition is "A cigarette-shaped device containing a nicotine-based liquid or other substance that is vaporized and inhaled, used to simulate the experience of smoking.
3) The conflation of nicotine and THC vapes predates the "vaping illness" by years.

"E-cigarette" has, since it first became popular, has referred to a style of device and not the content of the substance being vaporized. By your own definition, if someone chose to vape a nicotine-free flavored liquid, their JUUL would no longer be an e-cigarette.

The way that Verge and other sites reporting on this situation by loading up articles with Juuls and not the actual products that are causing issues is blatant misinformation. They know most people will just see the headline and header image. Any other misleading information in the article is just a cherry on top.

My biggest pet peeve with this entire series of events is that, we’ve known about the vitamin e acetate connection going back to the first reports. I remember seeing someone mention "Its probably being caused by the vitamin e acetate that is being used to thicken the THC carts" way back in August when reports were first coming out about the diseases. And yet, for the next 3 months, every time there was an article about this topic, it was always "We DoN’t knOW wHAt’S cAUsinG tHe DISeasE" and "iT CouLD bE boTH THC and NiCoTINe vAPes" when we knew for a fact that it was Vitamin E Acetate in THC vapes, and that’s it.

why is this comment better written than any verge or major media coverage on the subject

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