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.)

The Kids Are Still (Mostly) Alright in 2019

The latest 2019 Montoring the Future survey results are in.  And while the mainstream media are hyping this year's significant increase in teen vaping (of both nicotine and cannabis), they seem to be glossing over the good news.  For example, teen alcohol and (combustible) tobacco use have both plummeted to record lows, prescription drug abuse (especially opioids and amphetamines) is way down (in contrast to adults), and nearly all other substances (even heroin, again unlike adults) have held steady this year at relatively low levels compared with previous decades.  The one notable exception is LSD (acid), which showed a modest increase this year, but still remains far lower than it was before 2000.

Even cannabis use in general held steady overall this year, and while "daily" (i.e. 20+ days/month) use did see a modest increase this year for grades 8 and 10, in grade 8 it was no higher than it was in 2011 (prior to recreational legalization in any state) and is still quite low.  And keep in mind that for grades 8 and 10, data only go back to 1991, unlike grade 12 which goes all the way back to 1975. Thus, one can extrapolate based on grade 12 data that "daily" use for grades 8 and 10 are also both most likely far lower than they were in the late 1970s and early 1980s, as we know to be the case for grade 12.  And actual, true daily use (i.e. literally every day) is likely even lower still as well.

Even the vaping data are a bit outdated now, since the MTF survey was taken in the spring of 2019, at least several weeks or months before the new "mystery" vaping illness (now called EVALI) outbreak was suddenly announced during the summer.  Since then, the widespread fear of this scary but fortunately now-waning epidemic has likely reduced the popularity of vaping in general, so next year's data will likely be significantly lower than it was in early 2019.

Additionally, the data from another survey, the NSDUH, show that past-year and past-month cannabis use in general has been stable or declining for years for 12-17 year olds nationwide, even as it has been modestly and steadily rising for both 18-25 and 26+ year olds in recent years, and as it has become increasingly legal and socially acceptable to use cannabis and admit to doing so.  The same survey also finds that rates of cannabis use disorder (i.e. abuse/dependence) have been steadily declining for 12-17 year olds since the pre-legalization era, and have been relatively stable for 18-25 (undulating plateau) and 26+ year olds (flat) overall since 2002.

But don't expect the fearmongering mainstream media to tell you that, of course.