We now know that the majority of cases of the severe respiratory disease outbreak that has affected more than 300 people and resulted in three deaths across the United States are associated with the use of illicit, bootleg marijuana vape carts that are produced by what is most likely a relatively small cartel of illegal manufacturers. E-liquid samples from patients across multiple states have tested positive for tocopherol acetate and at high levels, with at least one sample reported to be comprised of 50% tocopherol acetate. The CDC itself reported today that a cluster of cases of lipoid pnemonia in North Carolina were all associated with the use of bootleg THC oils.
In spite of this information, the CDC continues to avoid clearly warning the public not to vape
THC oils! Instead, they are continuing to focus on all vaping products and their primary advice is still: "don't vape."
Shockingly, in the CDC's most recent alert, the recommendations to the public do not include a specific warning against vaping marijuana vape carts. The CDC's primary warning is: "While this investigation is ongoing, people should consider not using e-cigarette products." Moreover, nowhere in the paragraph that contains the CDC's recommendations do the words "marijuana" or "THC" even appear! Not even once.
The CDC's failure to warn the public about vaping bootleg marijuana carts is unfortunately filtering down to nearly all reports regarding this outbreak. Even in the prestigious New England Journal of Medicine, today's featured article mimicked CDC in its recommendations. The primary recommendation was that the public should consider not using e-cigarettes. There was not a clear and specific warning to stringently avoid vaping illegal marijuana.
The Rest of the Story
Given what we now know, I find it completely irresponsible for the CDC to continue to obscure the truth and to continue to try to blame this outbreak on legal, nicotine-containing e-cigarettes that have been on the market for years and have not caused any previous problems, rather than to acknowledge that the vast majority of the cases seem to be due to the use of illegal marijuana vape carts.
Why is the CDC going to such great lengths to try to demonize the vaping industry while protecting the illegal marijuana cartel that is producing and widely distributing unregulated THC carts that are apparently contaminated with high levels of a thickening agent that likely coats the lungs with oil and prevents the lungs from working?
We do know that many of the cases are presenting as lipoid pneumonia, that lipid-laden macrophages are being detected in most of these presentations, and that recent changes in illicit vaping marijuana production has apparently resulted in the introduction of a large amount of an oil into THC vape carts that does not vaporize (except at extreme temperatures not achievable with most vape pens) and therefore, youth are inhaling liquid oil into their lungs which is retained. No wonder this is such an extremely dangerous situation and no wonder we are seeing such unexpectedly severe lung failure in these patients. I don't think this can be said to be a complete "mystery" any longer.
In today's New England Journal article, it reports that of all reported cases in Illinois and Wisconsin in which patients were rigorously interviewed, 87% eventually admitted to vaping marijuana, not (just) nicotine e-liquids. It is certainly possible that most or all of the others were just reluctant to admit buying bootleg vape carts from drug dealers.
While the CDC and other health groups are still trying as hard as they can to blame legal, retail e-cigarettes, it is difficult to understand two things: (1) what changed such that we are seeing such an enormous outbreak at this particular time? (2) since there is not one product implicated, how could there possibly be contamination of multiple brands of e-liquids when they are all manufactured at different facilities?
We can potentially explain both of these with marijuana vaping. First, there was apparently a change made by the illicit marijuana vape cart manufacturers late last year and it appears that they started to use tocopherol acetate as a new thickening agent. One would expect that they would put a large amount of the agent into the cart because their chief goal is to make money. Second, the bootleg vape carts are apparently made by a very small number of manufacturers (possibly by one very large production in the Los Angeles area) and then distributed widely throughout the country. This would explain why we are seeing a multi-state outbreak with multiple products and brands. It is thought that the same contaminated THC oil may be used in multiple products, just packaged differently.
I am by no means arguing that we can explain every single case and that no nicotine-containing e-liquid is involved. However, it is clear that this outbreak is primarily related to the illicit, wide distribution of dangerous THC oils by an illegal drug operation.
The rest of the story is that the CDC is doing everything in its power to protect this illegal operation and to deflect blame onto the vaping companies. And the end result is that it is putting the lives of our youth at risk.