New CDC Report Out Today Makes it Even Less Likely that Store-Bought Nicotine E-Cigarettes are Playing Any Role in the Outbreak

A new report published today in the MMWR summarizes the results of the most detailed investigation to date of cases of the outbreak of vaping-associated respiratory illness, focusing on the 83 confirmed cases occurring in the state of Utah. The key findings of the report are as follows:

1. 92% of the patients for whom product use was ascertained admitted to using THC vapes (only 3 out of 53 - 6% - did not).
2. Of the THC products tested, 89% contained vitamin E acetate oil.
3. No abnormalities were found in any of the nicotine e-liquids tested.
4. The report concludes that “unregulated THC-containing cartridges play an important role in this outbreak.”

Another interesting and important finding was that: "Use of three brands of prefilled THC-containing cartridges was reported frequently by patients; these included Dank Vapes (21, 40%), Rove (19, 36%), and Golden Gorilla (11, 21%)."

The Rest of the Story

It is critical to note that as the investigation progresses, the proportion of cases that are being associated with THC vaping cartridges is steadily increasing, while fewer and fewer cases are being linked to the exclusive use of nicotine-containing products.

Over the last three CDC updates, the proportion of cases reporting using nicotine only has decreased from 17% to 13% to 10%. In the states that have released data in the past two weeks, the proportion of case patients who admitted to using THC is in the range of about 92% and higher. And now, in the most comprehensive investigation to date, the proportion of patients who admitted to using THC vaping cartridges is 92%, with only 3 patients not admitting to THC use (and no toxicology testing results were reported on those patients).

Moreover, there were no contaminants found in any of the nicotine e-liquids tested, while it appears that vitamin E acetate oil was detected in THC cartridges used by every THC-using case patient from whom product was obtained. This is consistent with the reported results from testing in New York State and nationally. So far, vitamin E acetate oil has been present in most of the THC vape cartridges recovered and no contaminants have been detected in any of the nicotine e-liquids tested.

The finding that 92% of patients admitted to vaping THC is quite striking, especially since young people (particularly young males) are highly likely to under-report their use of marijuana. In a 2006 study of male emergency room patients ages 18-24, only 25.8% admitted to marijuana use, but drug testing revealed that 48.1% had used marijuana. Given this huge degree of under-reporting, it is not at all unlikely that 3 of 53 patients might not admit to THC use even though they actually did use THC.

In other words, it is entirely possible that the outbreak is a result of contaminated THC vaping cartridges, period. It appears that it is not necessary to invoke nicotine e-liquids, but especially those purchased in brick-and-mortar retail stores, in explaining the outbreak. Nevertheless, there is still some chance that there are some black market nicotine-containing products that are either counterfeit or otherwise adulterated and which could be contaminated with vitamin E acetate oil and therefore involved in the outbreak. For example, one of the e-liquids samples recovered from a Utah patient contained both nicotine and THC, suggesting that a nicotine e-liquid had been adulterated with THC oil.

At any rate, it is being more and more clear every day that the actions of the CDC and many state health departments as well as policy makers in multiple states is putting the lives of the public at risk. The irrational obsession with going after legally sold e-cigarettes at vape shops and other stores while completely ignoring the distribution and use of black market THC vape cartridges is irresponsible and is almost certainly causing more outbreak cases than we would be seeing if health agencies would simply tell the public the truth and address the actual cause of the outbreak, rather than continuing to demonize electronic cigarettes and the businesses which sell them.