- Vape juice has been tied to a mysterious crop of hundreds of lung illnesses across the US.
- Multiple people have been hospitalized, and some have gone into medically-induced comas.
- At least eight people across the US have died after vaping.
- Lung and e-cigarette experts say that part of the problem may be that oil from vape juices, including vitamin E, is getting into people’s lungs.
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There’s something dangerous going on in the lungs of hundreds of vapers, and their vape juice might be to blame.
At least 530 cases of serious vaping-related lung issues have been reported to the CDC in recent months across 38 US states, plus the US Virgin Islands.
So far, the lung problems have led to several medically-induced comas and eight deaths. The eighth was reported Thursday afternoon in Missouri, where health officials said a man in his “mid-40s” died after vaping.
“This is an unfortunate case of a young man with no prior lung illness who started vaping because of chronic pain issues,” Dr. Michael Plisco, a pulmonologist at Mercy Hospital in St. Louis (where the patient was being treated), said in a statement. “He started out with shortness of breath and it rapidly progressed and deteriorated, developing into what is called acute respiratory distress syndrome (ARDS). Once the lungs are injured by vaping, we don’t know how quickly it worsens and if it depends on other risk factors.”
“We don’t yet know the exact cause of these illnesses – whether they’re caused by contaminants, ingredients in the liquid or something else, such as the device itself,” Dr. Ann Thomas, a public health physician with the Oregon Health Authority, said earlier this month in a release announcing that state’s first vaping-related death.
No specific vaping brands have been called out, but many of the illnesses have involved cannabinoid liquids like THC.
The FDA is opening a criminal probe into the vaping supply chain
On Thursday, the FDA announced that its Office of Criminal Investigations (OCI) is opening a criminal probe into the supply chain for vaping products, looking for any rogue actors who might’ve introduced harmful substances into vaping products, and especially those that people might buy off the street with THC or other cannabinoids in them.
“Let me be clear, OCI is not pursuing any prosecutions associated with personal use of any controlled substances in these cases,” Mitch Zeller, director of the FDA’s Centre for Tobacco Products, said on a call with reporters. He said even though not all of the vaping illnesses have been in people who used THC, many were.
Experts aren’t sure yet exactly why some people are getting sick and dying after vaping, but they have a hunch that the illnesses may be nothing new. Because the vaping industry is largely unregulated, there are hundreds of different chemicals in vape liquids on the market, making it impossible for people to know whether the ones they’re using are safe.
“We haven’t been able to analyse e-liquid from these people, so we don’t know what’s in them,” Professor Robert Tarran, who studies vaping at the University of North Carolina Marisco Lung Institute, told Insider.
Tarran says despite all the variation in what vapers inhale, there are two common ingredients in e-cigarettes: nicotine (dosed in varying concentrations), and propylene glycol/vegetable glycerin (PG-VG).
“That kind of narrows it down,” he said.
Nicotine isn’t always in cannabis-derived e-liquids, suggesting that the vegetable oils and other liquid solvents (PG-VG) – which are used to deliver drugs in all kinds of vape pens, whether there is nicotine inside them or not – could be playing a major role in the lung illnesses.
Vitamin E oil, used to deliver drugs, could also be making vapers sick
Federal and state health officials are worried about the presence of one of these liquid solvents, vitamin E acetate, in many sick patients’ vapes.
FDA commissioner Ned Sharpless said in tweet on September 6 that “we are leaving no stone unturned in following any potential leads, including vitamin E acetate found in many of the samples containing THC.”
It could be the case that this vitamin oil, which is meant to harmlessly deliver drugs, is ending up in people’s lungs as an invasive liquid. Then, the body mounts an immune response, prompting pneumonia. This idea aligns with what Tarran has found over roughly five years of his own research.
“I think there’s an emerging consensus that the immune cells of the lung are a little bit upset by vaping,” he said.
A small study of 31 healthy adults released by the University of Pennsylvania last month suggested, similarly, that some of the “harmless” oils like propylene glycol and vegetable glycerin (PG-VG) inside vape pens might undergo dangerous transformations as they heat up and aerosolize inside vape pens, potentially turning them into toxic substances.
Cases of vapers suffering from pneumonia stretch as far back as 2012
Professor Thomas Eissenberg at the Virginia Commonwealth University Centre for the Study of Tobacco Products agrees that vegetable oils found in many vape juices could be the major cause for concern. He points to at least seven different case studies published over the past decade, which all suggest that vape oil could be hurting people’s lungs.
One is a 2018 BMJ case report of a 34-year-old British woman who’d been vaping for three years when she developed lipoid pneumonia and respiratory failure, while another from 2012 details how a 42 year old woman was seen multiple times and prescribed“several courses of antibiotics” before doctors finally told her to stop using e-cigarettes. (Only then did her symptoms improve.)
“Vegetable glycerin is derived from vegetable oil, and to the extent that the derivation process is not complete, vegetable oil could be getting into the liquid,” Eissenberg told Insider. “If that’s the case, we may be seeing not the last cluster of lipoid pneumonia, but rather the first.”
If oil gets into people’s lungs, where the body only expects to encounter air and oxygen, it can prompt inflammation, mounting a defensive immune response that leads to pneumonia.
“It makes me wonder whether, if we pulled a hundred electronic cigarette users off the streets and got some of their lung fluid, how many of them would have lipids in their macrophages?” Eissenberg said. “They’re not experiencing symptoms, but they have the underlying cause.”
Tarran also worries the oily lung problems may be larger than the hundreds of confirmed and probable cases that have been reported to the CDC and FDA by medical professionals. But he cautions that there could be other reasons for the pneumonia cases, including “rogue chemicals” or nicotine in vapes.
“I suspect … it’s been happening all along and people are just starting to notice it,” he said. “You just kind of realise, as vaping continues to grow in popularity, how little we know.”
Tarran’s most recent study of vapers, published last month in the American Journal of Respiratory and Critical Care Medicine, suggests that vaping may be nearly as harmful as smoking, when it comes to overall lung health and long-term lung disease risk.
“People who vape, who’ve never smoked, they’re part of a whole new kind of social experiment,” he said. “Do they really want to be the guinea pigs?”
Update: This story was originally published on September 4, 2019. It has been updated with new information about vitamin E found in vapes, a criminal probe at the FDA, and as the death toll mounts.