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December 17, 2019

Are legal THC products to blame for vaping-linked illnesses?

Daily Briefing

    As the number of cases of a vaping-linked lung illness continues to grow, state and federal officials have found both legal and illegal tetrahydrocannabinol (THC) products are linked to a number of the cases, but CDC has said the source of the illnesses remains unknown.

    Resource guide: Medical marijuana in the health system

    Cases of vaping-linked illness surpass 2.4K

    CDC data updated Thursday shows the number of reported hospitalized cases of a lung illness officials believe is linked to e-cigarette use and vaping, dubbed EVALI, reached 2,409 as of Dec. 10. There have been 52 confirmed deaths related to the vaping-illness, according to CDC. Cases of the illness have been reported in all 50 states, Washington, D.C., and two U.S. territories, with deaths confirmed in 26 states and the District of Columbia.

    Where CDC's investigation stands

    CDC officials in a report released last month announced a "breakthrough" in its investigation into what might be causing EVALI. CDC officials said they found vitamin E acetate in all samples of lung fluid collected from 29 patients who were hospitalized with the illness after vaping, suggesting the oil is a potential cause of the condition. However, CDC said, "Although it appears that vitamin E acetate is associated with EVALI, many substances and product sources are being investigated, and there might be more than one cause."

    Federal officials so far largely have attributed cases of the vaping-linked illness to THC products purchased on the black market. CDC officials have said most of the cases covered by its investigation have been linked to THC products procured from informal sources, such as friends, family, or in-person or online dealers. However, they noted that they cannot rule out the presence of tainted products from state-licensed marijuana dispensaries.

    CDC officials have determined that Dank Vapes is the brand of vaping products most commonly associated with cases of EVALI, though the agency stressed it still is investigating more than 100 products. According to CDC, 80% of 1,782 patients with complete medical information reported using vaping products with THC, and:

    • 56% of those patients said they used products from Dank Vapes—which CDC classified as a counterfeit brand of products with an "unknown origin";
    • 15% of the patients reported using products from the legally sold brand TKO;
    • 13% reported using products from Smart Cart, which is an illicit brand; and
    • 12% reported using products from the legally sold brand Rove.

    CDC officials also found 13% of patients reported only vaping nicotine, and 12% reported vaping cannabidiol. Based on the data, CDC officials said it is "unlikely" a single brand of products caused the national EVALI outbreak. "The nationwide diversity of THC-containing products reported by EVALI patients highlights that it is not likely a single brand ... is responsible for the EVALI outbreak, and that regional differences in THC-containing products might be related to product sources," CDC said.

    CDC is recommending that people avoid vaping products that contain THC, which is the high-inducing chemical found in marijuana, as well as adding any substances to their vaping products that manufacturers did not intend to be used, including certain products sold in retail stores. However, CDC in its latest update said the "best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products."

    State officials find legal THC products linked to illness

    Massachusetts' Department of Public Health (DPH) on Thursday announced that six patients with probable cases of EVALI reported vaping legal, regulated marijuana products from state-licensed dispensaries. The announcement represents the first time officials have linked legal marijuana-vaping products in Massachusetts to the EVALI outbreak, The Hill reports.

    Massachusetts health officials released a list of THC products identified by patients with probable or confirmed cases of EVALI, including one product labeled as "Dank."

    A spokesperson for the state's Cannabis Control Commission said the commission "will use this new data toward its ongoing investigation into whether marijuana products manufactured by Massachusetts licensees contain substances or contaminants of concern and thoroughly explore the origin of the products identified."

    State officials in Oregon also have announced that all 20 individuals in the state with cases of EVALI, including one patient who died, reported using THC products bought from legal sources.

    Other states with reported cases of EVALI that have been associated with legal vaping products include Colorado, Delaware, Michigan, Maryland, Utah, and Washington (Weixel, The Hill, 12/6; Bean, Becker's Clinical Leadership & Infection Control, 12/9; LaVito, CNBC, 12/6; O'Donnell, USA Today, 12/13; Maddipatla/Sibi Joseph, Reuters, 12/12; CDC website, updated 12/12).

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