Death Toll Rises From Mysterious Illness Linked to Vaping

Vitamin E Acetate now a “key focus” of the investigation; PA and Cresco Labs says its products are safe

UPDATE: To include a statement issued by Cresco Labs, a cannabis company that owns 23 production facilities and 22 dispensaries in 11 states, including Pennsylvania.

After hundreds of illnesses and a total of five deaths linked to vaping, federal health officials and medical experts are warning the public about the dangers of taking part in this recent trend. In a media briefing Friday, the Centers for Disease Control and Prevention (CDC) suggested e-cigarettes be avoided.

“While this investigation is ongoing, people should consider not using e-cigarette products,” said Dr. Dana Meaney-Delman, incident manager of the CDC’s response to the vaping-related lung injuries. “People who do use e-cigarette products should monitor themselves for symptoms, for example, cough, shortness of breath, chest pain, nausea and vomiting – and promptly seek medical attention for any health concerns.”

U.S. health officials say the number of people with a severe lung illness associated with vaping has more than doubled to 450 possible cases across 33 states.

The CDC said some sort of chemical exposure is likely to be associated with the illnesses, but more investigation is needed to determine the exact source. Many of those hospitalized reported recently vaping a THC product, while a smaller group reported using regular e-cigarettes.

 “Although more investigation is needed to determine the vaping agent or agents responsible, there is clearly an epidemic that begs for an urgent response,” David Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published Friday in The New England Journal of Medicine.

According to the CDC, patients typically experienced coughing, chest pain or shortness of breath before their health deteriorated to the point they needed to be hospitalized. Other reported symptoms include nausea, vomiting, diarrhea, fatigue, fever, and weight loss.

Many victims have ended up with acute respiratory distress syndrome, a life-threatening condition in which fluid builds up in the lungs and prevents the oxygen people’s bodies need to function from circulating in the bloodstream.

On Friday, Indiana health officials confirmed a patient died from a severe lung injury. Minnesota health officials linked a death in August to electronic cigarettes, and previous deaths have been reported in Illinois and Oregon. Officials said the Indiana death involved a person older than 18, but released no other information. The Indiana health department said it has confirmed eight cases of severe lung injury linked to vaping and is investigating more than 20 other suspected cases. 

In Minnesota, health officials said the patient was over 65 years old and died in August after a long and complicated hospitalization. Minnesota State Epidemiologist Dr. Ruth Lynfield said the patient had a history of underlying lung disease and was hospitalized with a severe lung injury that progressed to include other conditions. They are investigating if it is linked to THC.

The Los Angeles County Department of Public Health was investigating a possible fifth death, saying Friday that the fatality was “associated with the use of e-cigarettes, also known as vaping.”

No specific device or substance has been linked to all the cases, officials said. The Food and Drug Administration is analyzing samples collected from patients across the country who have fallen ill and is testing them for a broad range of chemicals.

On Thursday, New York state health officials reported that lab tests found Vitamin E acetate in a number of cannabis-containing vaping cartridges submitted by people who fell ill and that it is now a “key focus” of their investigation.

Mitch Zeller, director of the FDA’s Center for Tobacco Products, said in Friday’s briefing that the agency now had 120 samples of e-cigarettes available for testing and that “no one substance or compound, including vitamin E acetate, has been identified in all the samples tested.”

Zeller said the FDA is analyzing samples for a broad range of substances, including nicotine, THC and other cannabinoids, along with cutting agents, diluents, additives, pesticides, opioids, poisons, and toxins.

“We are leaving no stone unturned in following any potential leads, including Vitamin E acetate found in many of the samples containing THC, and we’re committed to taking appropriate actions as the facts emerge,” FDA Commissioner Dr. Ned Sharpless said on Twitter. “We urge consumers to avoid buying vaping products from the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”

Even though a conclusive cause remains unidentified, the mysterious illness is becoming more familiar as officials and clinicians identified clinical similarities in illnesses among people who use e-cigarettes, or vape. Preliminary reports released Friday from clinicians and state health departments in Wisconsin, Illinois, North Carolina, and Utah substantiate and strengthen patterns that individual doctors treating patients have outlined.

According to findings reported by University of Utah Hospital clinicians in the New England Journal of Medicine Friday, clinicians in Utah and North Carolina said they had identified the presence of abnormal immune cells in the lungs of some patients, which could be a “useful marker” for a diagnosis of a rare form of pneumonia known as lipoid pneumonia.

In the joint investigation by Wisconsin and Illinois health departments, the earliest report of symptoms took place in mid-April. Most of the 53 patients were young healthy men, with a median age of 19. All but three patients were hospitalized and more than half required intensive care. One-third needed respirators. All patients used e-cigarettes or related products within 90 days of falling ill; a significant number reported vaping in the week before getting symptoms arose.

About 84 percent of the patients told clinicians they used THC in e-cig devices. They reported using 14 different brands of THC products; the most commonly marketed under the “Dank Vape” label. That label is sold online and industry sources say marketers often fill an empty cartridge with potentially unsafe ingredients and sell to unsuspecting customers.

Patients also reported using 13 brands of nicotine products in a wide range of flavors.

Fifteen patients said they only used THC products; seven said they used nicotine-only products, adding to the mystery of what exactly has caused healthy teenagers and young adults to suffer such severe injuries.

Health officials have said they are focusing on contaminants and counterfeit substances as a probable cause, narrowing the possible culprits to adulterants in vaping products alleged to have THC, although they have not ruled out adulterants in nicotine vaping products.

Officials have said e-cigarette aerosol commonly contains fewer toxic chemicals than conventional cigarette smoke, but it is not harmless and can expose consumers to substances known to damage health, including ultra-fine particles, heavy metals, volatile organic compounds, and other harmful ingredients.

Many of the chemicals in e-cigarette liquids may “undergo thermal degradation” when they are heated, producing new compounds with potentially harmful consequences. “Alone or in combination, these substances could result in a variety of pulmonary illnesses,” the authors of the NEJM paper on the Wisconsin and Illinois investigation wrote. The illnesses could include lipoid pneumonia and could result in severe lung injury and a very serious condition known as acute respiratory distress syndrome.

Cresco Labs, a cannabis company operational in 11 states with 23 production facilities (including one in PA) and 22 dispensaries (including three in PA), posted this statement on their website Friday:

“We are deeply concerned by the recent news reports surrounding certain vape products and their alleged connection to detrimental health outcomes.

At Cresco Labs, we do not use vitamin E acetate as an additive in any vape products, nor do we use cutting agents such as polyethylene glycol (PEG), propylene glycol (PG), vegetable glycerin (VG) or medium chain triglycerides (MCT) which are used by many vape manufacturers.

Our vaping hardware is produced by vendors that maintain the highest quality standards, and we operate with the highest-level manufacturing processes in the most regulated cannabis programs in the country. All products are third-party tested for any outside contaminants to ensure compliance with all applicable state laws.

Please contact [email protected] with any questions, and share this post with those who might be concerned with their vape products.

We will continue to regulate ourselves to a higher standard because it’s the right thing to do. In everything we do, we are not just growing, we are growing for you.”

In late August, as the illnesses were on the rise, the Pennsylvania State Department of Health said their medical marijuana vape products are safe. In an interview with lehighvalleylive.com, department spokesman Nate Wardle said that whatever the patients who are getting sick were using is not the same as the closely regulated THC vaping products sold by prescription through Pennsylvania’s medical marijuana program. 

What Pennsylvania’s dispensaries provide is “a medical product to help the patient,” Wardle said. “It’s not something to potentially harm someone,” he added.

It’s an “approved delivery system,” a department spokeswoman added, not a “recreational” product. There is top-level quality control, with proper testing and labeling of the cartridges, she said. It’s not an “apples to apples comparison” to whatever is making people sick, she said.

Wardle also said that none of the four cases being investigated in western Pennsylvania (at that time) were tied to the state’s medical marijuana program.

According to a report by ABC 27 News, as of Sept. 4, The Pennsylvania Department of Health reported 17 suspected cases of vaping-associated lung injuries in the state.​​

CDC, FDA, and state partners are combining information about e-cigarette exposures, results from FDA testing of product samples, and clinical testing results to identify a cause or causes of these illnesses.

“We are committed to finding out what is making people sick,” said Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention. “All available information is being carefully analyzed, and these initial findings are helping us narrow the focus of our investigation and get us closer to the answers needed to save lives.”

Dispense understands the importance of keeping up to date with news that affects patients in the Pennsylvania Medical Marijuana Program. Stay tuned for updates on this story as we reach out to local officials, medical professionals, dispensaries and patients for their input. Nothing in this article constitutes medical advice. If you are experiencing symptoms of lung illness, contact your doctor or go to the emergency room immediately.