Vitamin E acetate, which is sometimes used as a thickening agent in vape products, is emerging as a potential “culprit” of vape-related lung illnesses that have hit every state but one, according to the latest federal and state investigations. And the data examined so far, according to the Centers for Disease Control and Prevention (CDC), “point to a much greater risk associated with the THC-containing products that are acquired from informal sources as opposed to licensed.”
The CDC released these “breakthrough” findings and a number of updates Friday. As of November 5, 2,051 people living in 49 states have fallen ill, and 39 deaths have been reported in 24 states, according to the CDC. The CDC is also reporting that as of October 15, 86% of people with vape-related lung illnesses said they used a THC vape in the three months before they got sick.
Some early investigation findings were released that showed that of 29 patient lung fluid samples tested, Vitamin E acetate was detected in every single one. Of these patients, 21 were male, and the average age was 23, “which is consistent with the sex and age patterns of EVALI patients reported to CDC to date.” (EVALI stands for “e-cigarette, or vaping, product use associated lung injury.) Two of these patients died, a CDC Morbidity and Mortality Weekly Report released Friday noted.
“These findings provide direct evidence of vitamin E acetate at the primary state of injury within the lungs, and the samples reflect patients from states across the country,” CDC Principal Deputy Director Anne Schuchat said during a telebriefing with reporters Friday morning.
While Vitamin E acetate isn’t known to be harmful when swallowed as a supplement, or rubbed onto the skin as a topical, “previous non-CDC research suggests that when vitamin E acetate is inhaled, it may interfere with normal lung function,” Schuchat said.
The early CDC results “relied” on collaboration and input from CDC scientists working closely with epidemiologists, clinicians and public health officials nationwide.
“It’s important to note that these findings do not rule out other possible compounds or ingredients that may be causing these lung injuries. There may be more than one cause of the outbreak. However, they help us better understand the potential compounds or ingredients that may contribute to the cause of EVALI,” Schuchat said.
As the early results still show a majority of vapes contain THC, the findings “reinforce” previous CDC recommendations that people refrain from using THC vape products, “particularly from informal sources like friends or family, online dealers, or the illicit market,” Schuchat said, emphasizing that until the relationship between vitamin E acetate and lung health is better understood, no Vitamin E acetate should be added to any vape products.
And, while Vitamin E acetate was “universally detected” in these 29 lung samples, “additional studies are needed to establish whether a causal link exists between the exposure and EVALI, and it may be that there is more than one cause of the outbreak,” Schuchat said.
Cannabis Wire asked the CDC whether autopsies had been conducted on any of the 39 people who have died.
The “CDC does not currently have any information to release regarding autopsies, however we will be doing an upcoming report looking at the autopsy tissue findings,” Karen Hunter, a senior press officer with the CDC told Cannabis Wire. The CDC does not yet have an estimated publication date of those findings.
During a question and answer period, a Boston Globe reporter asked if cannabis products containing Vitamin E acetate were being sold by state-licensed dispensaries.
Schuchat responded by characterizing the patchwork of state laws, saying that state regulators “set their own regulatory measures in terms of what needs to be done, what ingredients are allowable or what documentation on the quality of production, distribution and handling has been made.”
“It is possible that Vitamin E acetate may be included in dispensary-sold products in one state or another. And it is possible it’s there intentionally, possible it’s there unintentionally. I believe that state regulators are taking a look at their regulations right now in light of the ongoing outbreak,” Schuchat said.
Still, reports could be confirmed that some lung illness cases could be linked to state-licensed shops. “There is some anecdotal information right now about individuals who only report getting products from licensed dispensaries. And exactly what those products are, and whether they were as labeled, or as expected to be produced, is unclear,” Schuchat said. “Might there be some infiltration of the licensed product distribution system in terms of some of the suppliers intentionally or inadvertently having problematic ingredients? I think that’s possible. But the majority of what we’re seeing right now is pointing to the informal sources.”
Jennifer Layden, chief medical officer and state epidemiologist from the Illinois Department of Public Health added, “In Illinois we have not had cases associated with our medical marijuana program.”
Layden shared results of an online public survey of 4,631 Illinois adults that found that 94% used nicotine containing products, compared to 21% THC products. IDPH took the group of survey participants who said that they used THC products but did not have EVALI, and compared them to EVALI patients of the same age group. Key findings emerged.
EVALI patients were roughly two times more likely to report the exclusive use of THC-containing products compared to survey respondents, and a “higher proportion” of EVALI patients than survey participants said they used THC products more than 5 times daily.
“EVALI patient cases were roughly 9 times more likely to obtain the THC containing products from informal sources such as a dealer off the street or from a friend compared to survey respondents,” Layden said.