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Vitamin E acetate in illicit THC cartridges confirmed as VALI cause, new research

Posted on December 21, 2019

New research has established beyond reasonable doubt that Vaping Associated Lung Injury (VALI)  is due to Vitamin E acetate in illegal THC (cannabis) cartridges, and not due to nicotine vaping.

A new study published in the New England Journal of Medicine examined fluid from the lungs of patients with confirmed and probable VALI and compared it to lung fluid from healthy volunteers. The findings were very compelling.

Vitamin E acetate is found in lung fluid in (all) confirmed VALI subjects

Samples of lung fluid from 51 probable or confirmed cases of VALI from 16 states were tested for Vitamin E acetate. Vitamin E acetate was found in all confirmed cases. The 3 cases without Vitamin E acetate were not confirmed cases and each had another potential explanation for their illness.

In another study by the Centres for Disease Control, Vitamin E acetate was found in the lung fluid of all 29 VALI subjects

Vitamin E acetate not found in healthy volunteers

In this study, 99 healthy volunteers were tested and all were negative for Vitamin E acetate.

No other 'priority toxicants' were found

All subjects and healthy volunteers were tested for a range of other possible toxins and none were found, except for one case of coconut oil and one of limonene. The significance of those findings is uncertain.

THC is associated with all (or nearly all) cases

In this study, 94% of VALI subjects (47 out of 50) either had THC in the lung fluid or reported vaping THC. Those without THC on testing were 'probable' (not confirmed) cases and the authors suggest they may have been misdiagnosed.

Many subjects with VALI have denied using THC, creating doubt about the role of  THC liquids. However in this study, 9 out of 11 subjects who denied THC use were found to have THC in their lung fluid.

Vitamin E acetate can cause lung injury

Vitamin E acetate is known to be toxic to the lungs. It damages the 'surfactant', a thin liquid layer lining the lungs that is important for lung function.

The recent availability of Vitamin E acetate

The addition of Vitamin E acetate to illicit THC this year coincides with the outbreak of VALI .

Testing in Minnesota found no Vitamin E acetate in THC oils in 2018. However testing during the outbreak in 2019 found Vitamin E acetate in all samples.

No Vitamin E acetate in nicotine fluids

Vitamin E acetate was NOT found in 197 nicotine products used by VALI subjects. This is not surprising as Vitamin E acetate is too thick and viscous to use in nicotine liquids.

According to Professor John Britton, Director of the UK Centre for Tobacco & Alcohol Studies:

“These studies provide further evidence that the outbreak of serious lung disease among vapers in the USA this year was caused by vaping THC, and may particularly be due to vaping THC solutions containing vitamin E acetate.  The conclusions provide strong reassurance that people vaping nicotine as an alternative to tobacco smoking are unlikely to be affected, and should continue to vape instead of smoke.”

Now that this matter is resolved beyond reasonable doubt, Australia's Chief Medical Officer and state health departments need to update their warnings.


Blount BC et al. Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. New England Journal of Medicine 2019

UK Science Media Centre. Expert reaction to two papers on e-cigarettes, vitamin E acetate and vaping-associated lung injury. 20 December 2019

Legal vape markets literally 1,000% safer than street. Leafly 19December 2019

Siegel M. Newest CDC Data Confirm that Respiratory Disease Outbreak was Caused by Vitamin E
Acetate Oil in THC Vaping Cartridges. 22 December 2019

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