Monday, November 25, 2019

Oregon State Health Department Claims that Nicotine-Based E-Cigarettes are Causing Respiratory Disease Outbreak

In an op-ed piece published yesterday in the Oregonian, the Oregon state health department claims that a substantial proportion of cases of the vaping-associated respiratory illness outbreak are caused not by THC/CBD vaping, but by nicotine-containing electronic cigarettes. The piece claims that: "we can say the hospitalizations and deaths are not exclusively attributable to cannabis use."

This is very different from claiming that we do not yet know definitively whether some nicotine-containing e-liquids are causing the illness. Instead, the statement claims that we do know that many cases are being caused by electronic cigarettes.

The Rest of the Story

The fact that there are 11% of case patients who did not admit to using THC vape carts does not mean that 11% of cases are being caused by e-cigarettes.

There are several reasons why not every patient diagnosed with EVALI has admitted to THC use. For one, there is tremendous under-reporting of THC use by hospitalized patients, especially youth. Young people may be very reluctant to admit to THC use, both because they don't want their parents to know and because there are severe consequences, such as suspension from school or inability to participate in sports. In addition, many youth do not know what they are vaping. They are not purchasing the e-liquids themselves from stores but getting them from social sources. Moreover, some nicotine-containing products are adulterated with vitamin E acetate oil, so a person could actually be using a nicotine product but unknowingly vaping contaminated THC oil.

It is critical to note that many of the patients who denied the use of THC were later found to have vaped THC oils. In fact, three of the patients who were found to have vitamin E acetate in their lung fluids had insisted that they only used nicotine-containing e-liquids. In the absence of THC urine drug testing, not a single case of EVALI attributable to legal, nicotine-containing e-cigarettes has yet been confirmed.

The fact that 100% of EVALI patients tested had vitamin E acetate oil in their lungs is incredibly strong evidence that THC/CBD oil vapes that contain vitamin E acetate oil as a thickening agent is the cause of this outbreak. 

To continue to tell the public that e-cigarettes are causing this disease and to downplay the role that THC oils are playing is irresponsible.

What I find fascinating is that in the midst of an outbreak that we know definitively is being caused, at least in large part, by the vaping of THC carts containing vitamin E acetate oil, the Oregon state health department would be publicly downplaying and undermining this fact. Why is the state health department emphasizing to the public that nicotine-containing e-cigarettes are implicated when there is not yet any evidence that this is the case?

Frankly, this has the appearance that the health department is taking advantage of this tragic outbreak to carry out some sort of vendetta against e-cigarettes.

It is one thing to mislead the public about the health risks of e-cigarettes outside the context of any specific health recommendation. But I believe it is inexcusable to deceive the public about the role that THC vape carts are playing in an outbreak that is actually killing people and sending thousands to the hospital with respiratory failure requiring mechanical ventilation.

In public health, we don't play with people's lives like this. We don't put the lives and health of the public at risk because we want to further our own agendas, even if that agenda were to be a valid one. Of course, I do not think that demonizing e-cigarette use is a valid agenda. But even if it were, you don't play with the lives of the public (and especially youth) to further your agenda.

The Oregon state health department needs to immediately correct this misleading op-ed piece.

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