The outbreak of serious vaping-related lung injuries in the US and Canada is almost certainly due to black-market THC (cannabis) oils sold by street dealers, NOT nicotine e-liquid.

Download one-page ATHRA handout here

The epidemic has caused great alarm amongst vapers, and Australian vendors have reported huge declines in sales eg here and here. The concerns have been fuelled by misleading information from Australian government officials and misleading media reports which have incorrectly suggested that vaping nicotine is the cause of this outbreak.

The pattern of this outbreak is typical of what occurs when a bad batch of illegal drugs hits the streets: the sudden appearance of clusters of acute poisoning, initially in localised areas and especially in young people.

Black-market THC (cannabis) oils

• The vast majority of victims have used  black-market THC (cannabis) oils in a vaporiser. (FDA, CDC, CDC)
• Some black-market suppliers have started adding vitamin E acetate oil (tocopherol acetate) to dilute ('cut') the liquid. Other oils have also been found in THC vape cartridges. The most popular brand is Dank. (Leafly)
• When oils are inhaled, they cause severe, acute lung inflammation, such as lipoid (fatty) pneumonia (Henry, Marchiori; Maddock)
• Other contaminants such as pesticides have also been found in black-market THC cartridges, which may also be harmful (CNBC)
• Almost all victims used pre-filled disposable THC ‘carts’ (cartridges) made and purchased on the black-market (shown above) (CDC)
• The illicit supply chain has been identified for at least some of these products (Leafly) and dealers are being arrested. (CBS)

Illicit market THC 'carts' (cartridges) containing high levels of vitamin E oil confiscated in New York (courtesy New York State Department of Health)

Could nicotine vaping be the cause?

• Millions of people worldwide have been vaping nicotine in propylene glycol (PG) and vegetable glycerine (VG) for over a decade without similar outbreaks.
• Oils are not usually added to nicotine e-liquid. Propylene glycol and vegetable glycerine are alcohols, not oils. (Polosa)
• No contaminated nicotine e-liquids have been found on testing (Wash Post)
• A recent comprehensive review of nicotine vaping found no evidence of any serious lung harm from short to medium term use. (Polosa)

Advice to Australian vapers

Do not be alarmed by misleading media reports.

• The healthiest option is not to smoke or vape
• Non-smokers should not start vaping
• If you are vaping to avoid relapse to smoking, do not go back to smoking
• The full risks of long-term vaping are unknown, but are likely to be much less than the risks of smoking
• The safest option for your long-term health is to quit vaping if you can
• You can always return to vaping if you are worried that you may start smoking again
• Always purchase your e-liquid from a reputable supplier
• Avoid all black-market vaping liquids

Reading

Expert reaction to ongoing deaths and lung injuries being linked to vaping in the US. Science Media Centre UK, 8 September 2019

FDA. Statement on consumer warning to stop using THC vaping products amid ongoing investigation into lung illnesses. 4 October 2019

Vape pen lung injury: Here’s what you need to know. Leafly 4 October 2019

Handout for consumers

Download a one-page ATHRA handout here

Posted by Colin Mendelsohn, colin@athra.org.au

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