A new study of vaping-related lung injuries in Minnesota by the U.S. Centers for Disease Control and Prevention (CDC) reinforces the case against vitamin E acetate, a diluting and thickening agent found in black-market THC products. The study, published yesterday in the CDC’s Morbidity and Mortality Weekly Report, also provides evidence that use of the additive is a relatively new phenomenon, which might explain why cases like these were not reported until recently.
In light of the accumulating evidence implicating illegal cannabis products in the lung disease outbreak, which as of November 20 included 2,290 cases and 47 deaths, the CDC has modified its advice about vaping. But it continues to imply, without evidence, that legal nicotine products, which have been used by millions of Americans for years without causing acute respiratory reactions like these, might have something to do with the lung injuries.
In the new study, researchers interviewed 58 Minnesota patients, 91 percent of whom reported obtaining THC products from “informal sources such as friends, family members, or in-person or online dealers.” Just two patients said they had vaped only nicotine. It is not clear whether those reports were accurate, since patients may be reluctant to admit illegal drug use and may not actually know the contents of black-market products. Previous research has found THC in the lung fluid of patients who did not report vaping it. Without urine or blood testing, it is impossible to verify reports of exclusive nicotine use.
The researchers analyzed 67 product samples provided by patients, 46 of which contained THC. The most common THC brand by far was “Dank Vapes,” a label widely used by bootleggers. Of the 12 patients who provided THC products, all but one submitted samples containing vitamin E acetate, which was not found in any of the nicotine products tested. Lung fluid samples from five patients all contained the additive, which is consistent with an earlier CDC study of 29 patients. Comparing 10 THC products seized by law enforcement agencies in 2018 to 20 THC products seized in September 2019, the researchers found vitamin E acetate in all of the latter but none of the former.
“The findings support a potential role for vitamin E acetate in lung injury,” the study says, noting that the additive “has been detected in a high proportion of THC-containing products” used by patients, including samples tested in Minnesota, in New York, and in Utah as well as samples from 25 states analyzed by the Food and Drug Administration. The researchers also note that the CDC’s analysis of lung fluid from 29 patients in 10 states “found vitamin E acetate in all specimens.” And while “vitamin E acetate was not detected in the limited number of tested products seized [by Minnesota authorities] in 2018, it was detected in products seized in 2019, suggesting that vitamin E acetate might have been introduced recently as a diluent or filler.”
The researchers caution that “further research is needed to establish a causal link” between respiratory disease and inhalation of vitamin E acetate. Nevertheless, they say, “These Minnesota findings highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources. Because local supply chains and policy environments vary, CDC continues to recommend not using e-cigarette, or vaping, products that contain THC or any e-cigarette, or vaping, products obtained from informal sources.”