About That Mysterious Lung Illness Related To Vaping (Updated)

There have been recent reports of a mysterious lung illness, a pneumonia-like syndrome that appears to be linked to vaping.  Fingers are being pointed all over the place right now, since it is still not clear exactly what (let alone which products) are causing it and why, but several theories abound, and there are some very strong, if not probative, clues now.

Here's what we do know so far.  As of September 16, 2019, there have been over 450 possible cases (revised down to 380 confirmed cases) of severe lung illness and/or damage (and even six seven confirmed deaths) in the USA that may be linked to vaping, though the symptoms haven't always followed a consistent pattern.  Not all cases have had all variables teased out, and it all still needs to be fleshed out some more, but vaping of some sort is the only factor that we know is common to them all.  And it's not just young people either (though many of them are), as even people in their thirties, forties, fifties, and now sixties have also succumbed to this syndrome as well.

Many, but by no means all, of the cases involved vape products containing THC (i.e. the primary psychoactive component of cannabis), and virtually all of those had been purchased on the black market (mostly in non-legalization states) based on what we know so far.  And many of those have been found to contain questionable additives, such as Vitamin E oil, that are NOT friendly to the lungs.

Thus far, only one case has been linked to a THC vape product (of undisclosed brand) purchased from an undisclosed licensed dispensary in Oregon, which could be a fluke or perhaps confounded by other products, but it is still possible that even some legitimate products contain such harmful additives, as not all legalization states specifically ban all of such additives.  (Why authorities are being so hush-hush on the details of this case, we really don't know.)

As for the cases that reportedly only involved nicotine, keep in mind that there are also many counterfeit nicotine vape products going around too, so that could perhaps be another culprit in this epidemic.  (That, and perhaps underreporting of illicit THC vaping in non-legalization states.)  That said, as much as JUUL Labs wants to believe and assert it, this does NOT yet automatically exonerate legitimate brand nicotine-containing vape products such as theirs.  And no one should pretend that it does either.

(Separately, there are also three recent reports of seizures and even one report of a stroke thought to be linked to the JUUL brand specifically, presumably due to their very high nicotine content, so they really shouldn't be so smug.  Especially since JUUL is basically circling the drain right now.)

It is important not to create or fan the flames of a moral panic about vaping in general, as that is likely to be counterproductive.  Much more research is necessary until we know more.  So what advice should be given in the meantime?

• First and foremost, do NOT vape, juul, or dab anything that you get from the black market, whether it's THC or otherwise.  They are inherently unregulated by definition, with no quality control, and thus you really don't know what you are getting.
• Especially avoid the pseudo-legitimate sounding (but actually always black market) THC brands "Dank Vapes", "Chronic Carts", and "West Coast Carts".  Avoid them like the plague!  (Ditto for the apparently very bad actor, gray market CBD vape brands "Diamond CBD", "Green Machine", "Magic Puff", and "Yolo!" as well.)
• Do your research and due diligence before buying any vaping product on the legitimate market as well.  Google is your friend, but don't believe everything you hear or read.  This is true whether it is nicotine, THC, CBD, "just flavoring", or anything else for that matter.
• Avoid any oil-based vape products when possible, especially for unfamiliar brands.
• Do NOT modify vaping devices or use any homebrew products with vaping devices.
• And last but not least, if you are not currently addicted to nicotine, do NOT vape (or smoke) anything that contains nicotine.  Keep in mind that all JUUL brand products contain high levels of nicotine, as do many other brands as well.

That seems like sensible advice for now.  As for government officials, the best thing they can do right now is regulate the vaping industry better to quash bad actors and improve quality control, cap nicotine levels, and also legalize cannabis nationwide for everyone over 18 (while keeping the taxes low) in order to quash the black market as well.

And for those who are still concerned:

If you currently vape nicotine, DO NOT go back to combustible cigarettes or any other combustible tobacco products!  If you are concerned about vaping, you can always switch to snus, lozenges, or any of the available nicotine replacement therapy products currently on the market (patches, gums, lozenges, and inhalers).  At the very least, stick to the top-shelf stuff.

If you currently vape "just flavoring", be sure that it really IS "just flavoring" (spoiler alert:  it usually is NOT, and all JUUL brand products contain high levels of nicotine).  But really, what's the point of that?

If you currently vape cannabis derivatives (whether it's THC, CBD, or both), and you don't have access to legal and licensed dispensaries where you live and/or you still don't trust the stuff on the shelves there, but you still don’t want to combust (smoke) weed, there are always dry-herb vaporizers out there (remember those?), as well as edibles, capsules, oils, and tinctures for using cannabis products orally.  Or at least stick to the top-shelf stuff for now.  But DO NOT vape, juul, or dab anything from the black market, the street, pop-up shops, or any homemade concoctions.  EVER.

(For the record, at least in some states like Oregon, with as low as $5 per eighth and $40 per ounce in some places, plain old bud purchased from legal stores is now actually cheaper than vape cartridge concoctions after several years of legalization there.)

Let's be adult about this, shall we?

UPDATE:  As of September 20, 2019, the number of reported cases of what is now called Vaping Associated Pulmonary Injury (VAPI) has crossed the 500 mark, and the number of deaths has increased to eight.  All deaths, and all reported cases except one, have occurred in the USA (the remaining one reported case was in Canada), and no other countries.

As of September 26, 2019, the number of confirmed cases has now crossed the 800 mark, and the number of deaths has now reached 12.  Again, if you must vape, stay away from anything bought on the street or in pop-up shops, or anything otherwise suspicious or sketchy in any way.  Consider alternative methods of use as noted above.  And if you notice any of the telltale signs and symptoms of VAPI, get thee to a doctor, stat!  And be sure to be honest about your vaping with them, so you will be properly treated with corticosteroids rather than antibiotics.

As of October 10, 2019, there are additional theories as to the cause of the outbreak, most notably acute "toxic chemical injury" to the lungs.  More specifically, it seems that inhalation of cadmium fumes from the solder in cheaply made vape pens and cartridges may be causing a particularly severe form of "metal fume fever" known as cadmium pneumonitis, which presents rather differently from lipoid pneumonia.  Though the oil (such as Vitamin E Acetate) causing lipoid pneumonia theory has not been entirely disproven either, as some cases do seem consistent with lipoid pneumonia, and there could in fact be more than one cause as well.  Caveat emptor.