As of November 5, 2019, 2,051 cases of vaping-related lung injury have been reported to the Centers for Disease Control and Prevention (CDC). Thirty-nine deaths have also been confirmed. While the cause of illness was initially unknown, on November 8, the CDC announced a breakthrough, noting:
This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries.
The chemical in question? Vitamin E acetate.
As more details emerge, many medical marijuana patients are left wondering: Do medical marijuana vaping products contain vitamin E acetate? Are medical cannabis products safe?
As Florida’s leading medical marijuana physicians, CannaMD breaks down everything patients need to know in today’s post.
Vaping Warning: Background
On September 6, 2019, the U.S. Food & Drug Administration (FDA) issued a consumer/health professional MedWatch safety alert titled, “Tetrahydrocannabinol (THC)-containing Vaping Products: Vaping Illnesses.” Also on September 6, the CDC issued an investigation notice regarding a multi-state outbreak of severe pulmonary disease associated with vaping or e-cigarette use. At the time of this first notice, over 450 possible cases of lung illness had been reported, along with 5 confirmed deaths. As of publication, reported cases have increased to 2,051 with a death toll of 39.
The FDA‘s initial warning stated:
[M]any of the samples tested by the states or by the FDA as part of this ongoing investigation have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the marijuana plant) and further, most of those samples with THC tested also contained significant amounts of Vitamin E acetate.
Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data are limited about its effects after inhalation.
In addition to vitamin E acetate, the FDA noted that researchers were also investigating a “broad range of chemicals,” including: nicotine, THC, other cannabinoids, cutting agents/diluents, additives, pesticides, opioids, poisons, and other toxins.
At the time of its first warning, the FDA advised:
While the FDA does not have enough data presently to conclude that Vitamin E acetate is the cause of the lung injury in these cases, the agency believes it is prudent to avoid inhaling this substance.
The FDA continued:
Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products from the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.
Additionally, no youth should be using any vaping product, regardless of the substance.
On September 27, the CDC added the following statement:
While this investigation is ongoing, CDC recommends that you consider refraining from using e-cigarette, or vaping, products, particularly those containing THC.
CDC Vaping Update: Vitamin E Acetate
On November 8, the CDC announced what Anne Schuchat, MD, principal deputy director of the CDC, calls “significant” findings. After laboratory testing of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) from 29 patients from 10 states, scientists found vitamin E acetate in all of the BAL fluid samples.
According to Schuchat:
These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs and the samples reflect patients from states across the country to date.
While Schuchat pointed out that vitamin E acetate may just be one of many toxins causing lung injury, she also noted that the CDC tested for many other substances, including plant oil, mineral oil, petroleum-based oil, and MCT oil with no luck.
As Schuchat summarizes:
No other potential toxins were detected in the testing conducted so far.
However, as the investigation is ongoing, the CDC reiterated its earlier position:
The CDC continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers.
So what does this mean for medical marijuana patients?
Do medical marijuana products contain vitamin E acetate?
Vitamin E acetate is commonly used on the black market to “dilute” or thicken the liquid in non-medical THC vaping products.
As James L. Pirkle, MD, director of the division of laboratory sciences at the CDC, explains:
Vitamin E acetate is enormously sticky. You can think of it to be just like honey and so when it went goes into the lung, it does hang around.
While scientists are still exploring how exactly the compound causes damage when inhaled, Schuchat notes that it’s clear vitamin E acetate does “interfere with lung function.”
But where does that leave medical marijuana patients?
Fortunately, Florida medical marijuana products undergo strict third-party testing procedures, with a majority of dispensaries confirming that their products do not contain vitamin E acetate.
While CannaMD operates solely within the capacity of certifying physicians (and per Senate Bill 8A, has no direct or indirect economic interest in any medical marijuana dispensary or testing laboratory), we are happy to provide peace of mind to our valued patients by sharing the following statements from local dispensaries:
According to a statement published September 9 on AltMed’s Facebook page by Dr. Chris Witowski, Chief Scientific Officer at AltMed Florida:
We do not use other cutting agents such as coconut (MCT) oil, PG, VG, PEG, or the recently publicized Vitamin E acetate in any MÜV Vape Pens as these additives have been shown to be potentially harmful and even deadly.
Instead we use cannabis-derived terpenes in all of our vape pens to reduce the viscosity of cannabis extracts for vaping.
According to a public statement published on September 9:
Curaleaf and UKU vapable products do not contain Vitamin E acetate or any other Vitamin E derivative.
Curaleaf notes that “to date, Curaleaf has not received any reports from patients or customers regarding any adverse effects from vaping products manufactured by Curaleaf or UKU.”
A GrowHealthy representative issued the following statement on September 11:
We want to assure our patients and customers that we do not use Vitamin E acetate in the production of any of our inhalation products.
In addition, all of our products are tested by third-party, independent laboratories and comply with all applicable state laws.
GrowHealthy encourages concerned patients to email them at firstname.lastname@example.org.
A Liberty Health Sciences representative confirmed on September 10:
We do not cut our vaporizer products with anything, including Vitamin E acetate.
Liberty Health Sciences also states that their products are very pure and that “Pax Era is one of the cleanest delivery systems on the market.”
According to a public statement published to Trulieve’s Facebook page on September 9:
We want to assure our patients and customers that we do not use vitamin E acetate in any inhalation product.
Trulieve encourages concerned patients to email them at email@example.com.
A Vidacann representative confirmed on September 10:
None of our products contain Vitamin E acetate.
Our products only contain natural cannabinoids and terpenes.
CannaMD will continue to update this resource section as additional information becomes available. Again, patients are encouraged to consult their state-licensed dispensary directly to confirm chemical profiles of all purchased products.
For more MMTC-specific information, including contact details, please see: Florida Medical Marijuana Dispensaries.
Need Your Medical Marijuana Card?
The FDA specifically warns against buying vaping products “from the street.” In fact, a Forbes article from September 3 suggests that dangers related to non-medical marijuana vaping products could even lead to federal cannabis legalization (which would allow regulatory boards to make sure harmful agents are not included).
According to Forbes:
Just like the days when alcohol was outlawed in the United States, back when thousands of people died every year as a result of tainted liquor produced in the underground, black market criminal organizations are counterfeiting popular cannabis brands.
These knock offs are being sold all over the country — even in states where weed is legal – and it could get worse before it gets better.
To protect your health, only purchase legal, regulated cannabis products.