An In-depth Look at Vaping

By Melissa Moore

2019 contained many historical events for the cannabis industry, but nothing may be more memorable than the vape crisis. According to the CDC website as of December 3, 2019, a total of 2,291 hospitalized cases of e-cigarette, or vaping associated lung injury (EVALI) have been reported in the United States. Cases have occurred in all 50 states, with forty-eight deaths confirmed in 25 states and the District of Columbia.

The e-cigarette was introduced to the U.S. in 2006, but it wasn’t until August of this year that the first vape-related death was reported in Illinois. As the injury reports piled in, samples have been collected. The CDC has run a study on bronchoalveolar lavage (BAL) fluid samples from 29 affected patients. BAL is a minimally invasive procedure used to collect fluid from the lungs in order to diagnose disease. Researchers at the Mayo Clinic have reviewed lung biopsies from 17 injured patients, and several investigative teams have set out to discover what is being sold and where it’s coming from.

CDC laboratory test results found Vitamin E acetate in 29 BAL fluid samples collected from patients in 10 states. CDC states that THC and nicotine were identified in 82% and 62% of the samples, respectively. Other plant oils, petroleum distillates, MCT oil, and terpenes were tested for, and none of these chemicals were detected.

A report published in the New England Journal of Medicine by doctors at the Mayo Clinic says lung biopsies they reviewed appeared to be caused by chemical pneumonitis. This is contrary to previous reports that hypothesized lipoid pneumonia to be the potential cause of lung injury. Chemical pneumonitis is a form of lung damage caused by chemical toxins or irritants. Prior research shows that the same carcinogens seen in cigarette smoke are present in vape aerosol, but at lower levels. However, people who used e-cigarettes had roughly 19% more lead, 23% more cadmium, 20% more pyrene, and 66% more acrylonitrile in their urine. Researchers purpose this comes from using cheap parts and solder in the construction of the battery and vape cartridge electrical components.

Vaping products often contain added flavors and thinning agents. In 2018, researchers at the University at Rochester analyzed 148 e-liquid samples and placed the samples on human cells. They found varying levels of toxicity produced by the samples, with the greatest toxic effects coming from flavor additives such as vanillin and cinnamaldehyde. “The higher the concentrations of these compounds, in particular, the more toxic the e-liquids were.” Research on thinning agents used in vapor products shows they produce inflammation and oxidative stress in cells. Two popular agents used in vapes are propylene glycol and glycerol which can convert to toxic byproducts at high temperatures. Observations suggest that propylene glycol converts to formaldehyde when batteries are set to 5 volts, but not at 3.8 volts.

NBC News learned about the prevalent use of a prohibited fungicide found in cannabis called myclobutanil which can transform into hydrogen cyanide when burned and causes cellular inflammation. They tested 17 vapes and found 10 black market vapes contained myclobutanil. To this date, no one has concluded the cause of EVALI and it may very well be possible that numerous compounds and mechanisms are at play. are created for use in the lab since cannabis has been difficult to obtain for use in research. Bad actors provide these substances outside the lab and the use has been blamed for at least 11 deaths in Europe. Synthetic cannabinoids bind to some of the same sites in the body but produce much stronger reactions.

Project CBD reported that the same symptoms that can indicate synthetic cannabinoid toxicity surface repeatedly in EVALI. The Associated Press performed a nationwide investigation to understand the availability of products spiked with synthetic cannabinoids and when they commissioned the testing of 30 samples including a sample that sent a teenager into a coma in Utah, 10 of them tested positive for synthetic cannabinoids. According to a survey of law enforcement agencies in all 50 states, 128 samples out of more than 350 vape cartridges tested by government labs, had synthetic cannabinoids in products marketed as CBD.

How to Protect Yourself

The easiest way to protect yourself is simple, avoid the use of vape products. If you continue to vape, the best way to limit your risk is to obtain your product from a licensed distributor (dispensary). Prices may be higher, but you’re paying for increased safety and protection. Licensed dispensaries are required to have their products tested for cannabinoids and contaminants. Convenience stores are not licensed and should not be trusted as such. There is little that stops them from buying vapes illegally and reselling them.

To lower the risk of inhaling toxic substances use lower temperatures, 3.3 to 3.8 volts is sufficient. Purchase high-quality batteries from reputable brands only. Vaping is healthier than smoking, but that comparison likely applies only to regulated products.

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