Friday, November 08, 2019

CDC Announces "Major Breakthrough" that I Recognized and Reported Two Months Ago; Outbreak is Almost Certainly Not Associated with Legal Nicotine Vapes

Minutes ago, the Centers for Disease Control and Prevention (CDC) announced what they called a "major breakthrough" in its investigation of the vaping-associated respiratory illness outbreak. They tested lung tissue samples from 29 case patients and all 29 (100%) were found to contain vitamin E acetate oil.

This finding does represent a major breakthrough for four reasons:

1. The vitamin E acetate oil was detected in the actual lung tissue of the case patients.

2. The vitamin E acetate oil was detected in every single one of the lung tissue samples from these 29 case patients.

3.  The samples came from 10 different states, confirming that the outbreak seems to have a common cause, rather than geographic variation.

4. Three of the patients whose lung samples revealed vitamin E acetate had reported using only nicotine-containing products, thus confirming that there is significant under-reporting which may explain why about 11% of the patients do not report vaping THC.

This is significant because although not all of the case patients admitted to using THC vapes, the finding of vitamin E acetate in their lungs essentially proves that they were indeed vaping THC oils. This does not mean that they were lying; they may simply not have known what was in the product they were vaping, especially since most of these products are purchased off the black market or obtained from friends or dealers.

The finding is also significant because it provides a marker for vaping products that should not be used and makes it easier for state cannabis regulators to identify those legal THC cartridges that should be immediately pulled from the shelves. Fortunately, many cannabis testing laboratories have developed methodologies for detecting vitamin E acetate.

Every state should immediately require the testing of every legal, THC vaping liquid for vitamin E acetate before it goes on the shelves (or remains on the shelves), unless there is some other definitive mechanism for ensuring that the product does not contain vitamin E acetate oil.

At this point, it is time for state policy makers and politicians to immediately discontinue their conflation of this outbreak with the problem of youth e-cigarette use. It is time for all policy makers, health agencies, and health professionals to immediately stop stating or implying that legal, nicotine-containing e-liquids have anything to do with the outbreak.

At this point, it is also clear that states which have issued emergency regulations to ban e-cigarettes or flavored e-cigarettes are not justified in using their emergency powers for this purpose since it is almost assuredly the case that those store-bought products have nothing to do with the outbreak. While health department officials could argue that flavored e-cigarette bans are designed to address the problem of youth vaping, that problem is not in any sense an "emergency" so the executive branch in those states is abusing its power (and violating the separation of powers clause of the Constitution). Essentially, those states used the outbreak as an excuse to implement vape product bans while bypassing the legislative process. These bans should now all be struck down.

Finally, it is time for every state to issue clear and unequivocal statements that the outbreak is due to the use of THC vape carts and that the public, especially youth, should immediately stop vaping THC products, unless they are obtained legally from a dispensary which can verify that there is no vitamin E acetate oil in the product.

Note that this still does not demonstrate that it is the vitamin E acetate oil itself that is causing the illness, although that remains a possibility. It could also be the case that there is a contaminant contained in the vitamin E acetate oil that is causing chemical respiratory toxicity. It also remains possible that counterfeit and adulterated "nicotine" e-liquids are involved, as illicit manufacturers or dealers may be adding vitamin E acetate oil to otherwise legitimate products or hiding the tainted products in what appears to be legitimate packaging, but is actually counterfeit.

The Rest of the Story

I checked back through my posts and found that on September 5 (more than two months ago), I had reported the same conclusion as was reached today by the CDC in a post entitled:

"ALERT: Major Breakthrough in Investigation of "Mysterious" Lung Disease Outbreak"

In that post, I noted that every single patient who used THC vape cartridges in New York State and provided product samples had at least one cart that contained vitamin E acetate oil.

I wrote: "On my blog, I first issued a warning about the use of black market THC oils on August 25, and then on August 28 I blogged and tweeted an unequivocal warning, since the CDC had failed to do so.. .. It will be interesting to see how long it takes the CDC to issue an unequivocal warning to the public that they should absolutely not vape marijuana using THC vape carts obtained off the street."

"This emerging story shows the dangers of bias in public health. The long-standing bias of the CDC against vaping has resulted in the agency failing to warn the public in clear and specific terms about the risks associated with the use of bootleg THC vape carts and instead, issuing warnings against "vaping" and "e-cigarettes" generally and making meaningless statements like "e-cigarette aerosol is not harmless water vapor."

"The CDC and other health agencies and some anti-tobacco groups have gone to great lengths to protect the illicit cannabis industry. But they have no problem with attacking the e-cigarette companies and telling ex-smokers to return to smoking rather than continuing to vape."

Today's announcement confirms that in fact, the CDC's failure to appropriately warn the public about the role of THC vape carts in this outbreak, and the same failure among many state health departments, has almost certainly led to additional cases of the illness that would not have occurred if they had not used the outbreak as an excuse to demonize e-cigarettes. How many lives could have been saved and how many severe illnesses averted if they had simply told the truth from the beginning? 

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