by Andrea He

 

A cloud of vapor is exhaled from the mouth of the student walking in front of you – smelling not of cigarettes but faintly of mangoes. This scene has become more and more common on university campuses and amongst young adults as vaping becomes more prevalent. Vaping related illnesses are also on the rise, having recently reached a record 1,299 patients with 26 deaths, according to the Center for Disease Control. These numbers seem to be only rising, prompting many researchers to investigate what’s happening.

Vaping, which requires e-cigarettes, is a method of delivering nicotine or tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis, to the user. E-cigarettes are battery-powered devices that heat up liquid containing the active ingredients into a vapor that can then be inhaled. These devices consist of two components: the battery and the cartridge, which contains the ingredients. Although originally intended for nicotine, large companies as well as independent,  unregulated operations have made their own form of e-cigarette with unique cartridges that are meant for THC. Originally formulated as a way to stop cigarette addiction, many young people using e-cigarettes today have no prior exposure to nicotine products. E-cigarettes are unfortunately disproportionately used by young people, with more than half of the patients in the report by the Center for Disease Control under 24 years old.

A Food and Drug Administration (FDA) investigation found that many of the e-cigarette products used were THC-based and contain extraneous ingredients that could be harmful, particularly due to the lack of regulation. THC products in an e-cigarettes are inhaled in a THC oil format, where the oil is vaporized from the high heat provided by the device. Most samples with THC tested by the FDA surprisingly contained very high levels of Vitamin E acetate, a compound commonly found in lotions and creams. Due to the abnormally high levels present and its commonality amongst the samples tested compared to any other substance, the FDA deemed Vitamin E acetate worthy of note. 

While Vitamin E acetate is normally not harmful in a topical application, there is no toxicity data for the inhalation of the substance. It is also classified as a lipid and while it is inhaled as a vapor, it condenses to oil form in the body. Previous studies have shown that non-gaseous substances in the lungs, especially oils, are dangerous and disrupt the lining in the lungs. The FDA ultimately recommended that individuals should avoid inhaling non-gaseous substances while it continues to investigate what exact compound is causing the vaping related illnesses.

Five patients diagnosed with acute respiratory failure due to acute lipoid pneumonia after the usage of THC vaping devices were investigated in a study conducted by Dr. Peter Dicpinigaitis and others. Acute lipoid pneumonia is characterized by chest pain and coughing due to fat particles that have entered the lungs through the nose or mouth. This causes an inflammatory response, which can lead to serious lung damage. Dr. Dicpinigaitis’ results are beginning to support the implication that THC oils could have induced the acute lipoid pneumonia possibly due to the condensation of oil in the lungs. 

X-rays from studies on vaping-related illnesses published in the New England Journal of Medicine show lung inflammation. Patient lung tissue biopsies affected by vaping-related illness in general also show damage that resembles exposures to the toxic substances through inhalation. PAX Labs, the former parent company of Juul Labs and a prominent company in the marijuana vaping market, released a statement on September 11th, 2019 stating that “No PAX products have been involved in any of these cases. While the cause is yet to be determined, none of the brand partners who fill and distribute our pods use Vitamin E acetate in PAX formulations, and all pods are subject to rigorous state regulatory compliance and testing.” Since researchers do not know what exactly is causing the vaping related illnesses and as Vitamin E acetate is only a suspect, more research is required to determine whether PAX products, and other vaping products, are indeed safe.

Although many more studies are needed to determine the exact cause of these illnesses, the CDC has already begun to recommend the discontinued usage of vaping products. Cities such as San Francisco already have begun to ban the sale and distribution of e-cigarettes. If there’s further evidence that arises to support the association of vaping with illness, many more cities may follow San Francisco’s example. 

 

Citations:

Boland, J. M., & Aesif, S. W. (2019). Vaping-Associated Lung Injury. American Journal of Clinical Pathology. doi: 10.1093/ajcp/aqz191

CDC. (2019, November 14). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.

Davidson, K., Brancato, A., Heetderks, P., Mansour, W., Matheis, E., Nario, M., … Fox, D. (2019). Outbreak of Electronic-Cigarette–Associated Acute Lipoid Pneumonia — North Carolina, July–August 2019. MMWR. Morbidity and Mortality Weekly Report, 68(36), 784–786. doi: 10.15585/mmwr.mm6836e1

Dicpinigaitis, P. V., Trachuk, P., Fakier, F., Teka, M., & Suhrland, M. J. (2019). Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia. Lung. doi: 10.1007/s00408-019-00277-6

Fogelman, L. (2019, September 11). PAX Statement on Product Safety. Retrieved from https://www.pax.com/blogs/press/pax-statement-on-product-safety.