The Vaping Lung Illness Mystery Has Been Solved

Looks like the "mystery" vaping lung illness (now called EVALI) has been largely solved.  And the primary culprit is indeed the same one that Twenty-One Debunked and many others had long suspected several months ago:  Vitamin E Acetate, a common additive found almost exclusively in black-market and counterfeit THC (and probably some gray-market CBD) vape cartridges.  Though harmless when ingested orally or applied topically, when inhaled it is apparently a different story:  this "thick and greasy" oil, and perhaps also its byproducts upon heating it to high temperatures, can indeed cause serious lung damage, and quickly.  It certainly does NOT belong in the lungs at all!  And both samples of vape cartridges as well as (more recently) samples of lung fluids taken from EVALI patients now confirm such suspicions, as noted recently by the Centers for Disease Control (CDC).  But we could have told you that a while ago.

The illness was apparently quite rare before June 2019, when the epidemic apparently exploded, peaked in September, and sharply declined thereafter.  In other words, this was not a trend, this was an event.  Something had clearly changed about vaping between 2018 and the first half of 2019.

Prior to 2019, Vitamin E Acetate was not widely used in THC vape products, whether legal or illegal, and according to cannabis industry insiders it first emerged as a cutting agent for products made in late 2018 at the earliest.  It may very well have been used before that, but if it was it was too rare to be of any concern or on anyone's radar.  But then, the black-market and counterfeit THC vape product purveyors discovered that this cheap additive can be used to dilute (or "cut") the expensive THC distillate oil while (unlike with other, thinner cutting agents) still maintaining a thick enough consistency to fool unsuspecting buyers into thinking it is purer than it really is, and thus greatly increasing the profit margins.  Yes, you read that right--for filthy lucre.  And they now have a ton of karma to answer for.

And while there apparently have also been some bad actors in the legitimate cannabis market that used this additive here and there, the fact remains that it has been quite rare overall.  And there is still no evidence that Vitamin E Acetate was ever used in any nicotine-containing vapes, whether legitimate or counterfeit.  (Note that those EVALI patients who reported "only nicotine" vaping and not THC may not have been entirely honest.)  In other words, it is fundamentally a black-market and counterfeiting problem that is best solved with legalization and sensible regulation, not blanket prohibition or overregulation.

There may very well have been other additives to blame as well, along with heavy and hard metals leaching from the heating coils of janky devices.  And perhaps some statistical flukes thrown in for good measure.  But these other minor culprits are basically sideshows compared with Vitamin E Acetate, and again the best solution is legalization and regulation of such products and devices, not prohibition.

Of course, that would make too much sense.  But truth is always the first casualty in any moral panic.

And really, SHAME on anyone (politicians, pundits, regulators, and activists) who cynically and disingenuously used the horrendous and hellish suffering of the over 2500 EVALI victims (and over 50 deaths) as a ploy to push their hateful and regressive prohibitionist agendas, while essentially hiding or denying the real cause of the illness for several months, before finally admitting it well after the epidemic had peaked.  You had a chance to save so many lives and prevent so much suffering, but you chose to sit on it, because reasons.  You now have just as much blood on your hands as the aforementioned bad actors that chose to adulterate their products with questionable additives for filthy lucre.  What you did was unforgivable in our view, but you now have a chance to make amends (albeit belatedly) to keep your karma from getting any worse.  So what are you waiting for?  Legalize and regulate yesterday!

JANUARY 2020 UPDATE:  The latest CDC report confirms yet again that the vast, vast majority of EVALI patients, among those for whom data is available, reported obtaining THC vapes from "informal" sources.  And while the anti-legalization lobby seized upon the finding that 16% of those reporting THC vaping reported obtaining their products from "commerical" sources, keep mind that that figure also includes unlicensed pop-up shops that may appear legitimate but are not, and there is always the possibility of recall bias when more than one product is used or shared.  Again, the real solution is to legalize, regulate, and root out the bad actors, not to categorically ban cannabis or vaping.

Though relatively rare, Vitamin E Acetate  has recently been found in some legal THC vape cartridges on the shelves of licensed dispensaries, including medical dispensaries upon testing, at least in Michigan.  A product recall was rightly issued.  Another state that bothered to test for it, such as Massachusetts had found none of that additive in their legal products, but had temporarily quarantined their products in November so they could be tested before reaching consumers.  This is how the system of quality control is supposed to work, and far better than the black market, which has ZERO quality control.

(For those who are interested, the hypothesized underlying chemistry of how exactly Vitamin E Acetate can cause EVALI can be found here and here.  Once thought to be lipoid pneumonia based on a handful of case reports, it turned out to be more like chemical burns in the vast majority of cases.)