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.

Have A Safe And Happy Holiday Season

(This is a public service announcement)

It is that time of year again when the holidays are upon us, and many of us Americans (and around the world) will be celebrating with alcohol and/or other substances.  We at Twenty-One Debunked would like to remind everyone to be safe and celebrate responsibly.  There is absolutely no excuse for drunk driving at any age, period.  We cannot stress this enough.  It's very simple--if you plan to drive, don't drink, and if you plan to drink, don't drive.  It's really not rocket science, folks.  And there are numerous ways to avoid mixing the two.  Designate a sober driver, take a cab, use public transportation, crash on the couch, or even walk if you have to.  Or stay home and celebrate there.  Or don't drink--nobody's got a gun to your head.  Seriously.  And the same goes for other psychoactive substances as well, and a fortiori when combined with alcohol.

ARRIVE ALIVE, DON'T DRINK AND DRIVE!!!   If you plan to drink, don't forget to think!  The life you save may very well be your own.

The Federal Smoking And Vaping Age Has Been Raised To 21

Well, it's now official.  As part of a must-pass budget bill to avoid yet another government shutdown, Congress attached several provisions unrelated to spending, most notably a rider that hikes the federal age limit for the sale of tobacco and vape products from 18 to 21 nationwide.  And on December 20, 2019, Trump signed it into law, and even had the GALL to brag-tweet about it.  And while Republican Senate Majority Leader Mitch "Awkward Turtle" McConnell, a big supporter of the age limit hike, was no doubt very pleased with himself for his "victory", we need to remember that both duopoly parties overwhelmingly supported it.  Tyranny is apparently as bipartisan as it is whimisical--and very cowardly as well.

For practical purposes, the new age limit actually takes effect after 180 days plus an additional 90 days, meaning an effective delay of nine months from the date of signing.  Thus, by September 2020, Tobacco 21 will have been fully phased in nationwide.

The text of the new federal Tobacco 21 law does two things:  1) amends the Family Smoking Prevention and Tobacco Control Act of 2019 by changing "18" to "21", and 2) while it technically no longer forces states to change their own laws (unlike the original version), nonetheless amends what was once called the Synar Amendment by requiring states to enforce (against vendors) the new federal age limit of 21 for the sale of tobacco and vape products, in order to quailfy for certain substance abuse prevention grant monies.

Though weaker than its original version, it is that second provision that may prove to be the Achilles heel of this law if it were to be challenged in court, on both Tenth Amendment as well as Fourteenth Amendment.  And if such a challenge ever proves successful, it will no doubt also overturn South Dakota v. Dole, and the National Minimum Drinking Age Act along with it.  But until then, it is long past time to be very, very angry at what passes for "leadership" in America's long, dark night of the soul.

Winter is coming, in more ways than one.

UPDATE:  Looks like the FDA isn't wasting any time in raising the tobacco and vape product sale age to 21.  As of December 27, 2019, they officially noted on their website that it is now illegal to sell tobacco or vape products to anyone under 21.  FEH.

The Anti-Legalization Movement Is Grasping At Straws Now

The anti-legalization movement in regards to cannabis has been getting quite desperate lately.  For example, Kevin Sabet of the anti-legalization group Project SAM has lately been disingenuously harping on the mystery vaping illness (now called EVALI) and shifting the spotlight onto legal cannabis vape products from licensed dispensaries while glossing over that inconvenient fact that the vast, vast, majority of the over 2000 EVALI cases so far are linked to black-market and counterfeit THC vape cartridges (as well as sketchy gray-market CBD vape cartridges).  In fact, non-legalization states have had far more EVALI cases than legalization states, though no state seems to be immune to it.  And the primary culprit appears to be Vitamin E Acetate (and possibly other questionable additives), and perhaps even the heavy metals from janky devices, as opposed to the actual cannabis itself, though he slyly glosses over that as well.  The biggest irony, of course, is that banning legal cannabis dispensaries will only drive even more consumers to the black market, thus pouring gasoline on the raging fires of EVALI.

In other words, Kevin Sabet and Project SAM are nothing more than concern trolls, and need to be taken with at least a grain of salt, if not a whole pound.  While there have been a few outlier cases of EVALI ostensibly linked to legal cannabis products from licensed dispensaries in some states, most of these cases remain either unconfirmed and/or the use of black market, counterfeit, or modified vape products has not been entirely ruled out in such cases.  To the extent that any of these are in fact caused by rogue and adulterated products from bad actors in the legitimate cannabis market, the solution is better regulation and oversight, NOT prohbition.

(In the meantime, it is probably best for the time being for current cannabis vapers to switch to dry-herb vaporizers, which have never been linked to EVALI or any other illness, to vape regular weed if you don't want to smoke it, just to be on the safe side.  Or at the very least, do your research and due diligence, and avoid all black-market, counterfeit, janky, suspect, and/or modified products like the plague.  And there are also edibles and tinctures.)

Oh and by the way, the anti-legalization movement is apparently also tainted with some thinly- and not-so-thinly-veiled anti-Semitism as well.  Not everyone of course, but as the Labour Party in the UK has unfortunately learned the hard way, failing to condemn it, turning a blind eye to it, or even creating a mere perception of same, has the same impact as deliberate and overt Jew-hatred and Jew-baiting does, and we know impact > intent.  And of course, the anti-Semitism in the broader cannabis prohibitionist movement goes back to at least Nixon and his notorious red-baiting and Jew-baiting conspiracy theories, while the movement's virulent racism and xenophobia in general goes all the way back to the very genesis of the movement over a century ago.

To be fair, there is no evidence that Kevin Sabet (or Project SAM in general) personally holds any anti-Semitic or racist views, with their only known bigotry being against cannabis and its users.  But in the broader cannabis prohibitionist movement today, others like Roger Morgan et al. DO apparently hold enough anti-Semitic views to be willing to openly repeat (if not concoct) long-since debunked anti-Semitic conspiracy theories (mainly involving George Soros) all the same, and the silence from Sabet and Project SAM (who just so happen to also share a connection with Morgan) is truly deafening indeed.

To the cannabis prohibitionist / anti-legalization movement, we have one question for you:  how does it feel to be on the wrong side of history?  Because we wouldn't know anything about that.

Are Americans Really Inferior To Europeans?

One common objection to lowering the drinking age to 18 in the USA is that "Europeans can handle a lower drinking age, but Americans can't".  People say this all the time without realizing the irony of it all.  They are literally implying that Americans are inferior to Europeans (and Canadians, etc.), while these are usually the same people who love to shout that America is the "greatest country in the world", often in the same breath with a straight face.

Silly, right?  And when asked to elaborate, they will likely say that Americans don't know the meaning of moderation and are lacking in self-discipline, often citing our legendary high obesity rate as "proof".  But by that logic, we should bring back Prohibition for all ages, right?  After all, there is nothing magical about 21.  But we saw what a failure that was.  And by the same token, the 21 drinking age is the greatest alcohol policy failure since Prohibition, and neither one led to moderation, in fact quite the opposite.  Most adults, including 18-20 year olds, will drink regardless.  Turning alcohol into a "forbidden fruit" makes it all the more enticing, and forcing it underground makes it far more dangerous than it has to be.  And infantilizing young adults will only lead them to be...less mature about it.  Who woulda thunk it?

And then of course is the "life is cheap over there" argument, which also does not hold water.  If life is so much cheaper in Europe, Canada, etc, why do they have universal healthcare, stronger social safety nets, generally better educational systems, higher life expectancies, and lower poverty rates than the USA?  That's because life is really NOT cheaper over there after all.  Again, who woulda thunk it?

And then there is the old chestnut that "we don't have the public transport infrastructure to handle young adult drinking like they do".  It is technically true that the USA is a car culture and our public transportation is inferior to most of Europe's, but the same is true for Canada, and they set their drinking age at 18 or 19 depending on the province.  Ditto for Australia and New Zealand, who both set it at 18, and there are still some parts of Europe, particularly areas of the UK, where you need a car to get around for the most part.  Besides, if our public transportation infrastructure cannot handle 18-20 year olds, they would be even less able to handle the much larger 21+ age group as well, and once again, all roads either lead to either Prohibiton for all or legal drinking for all adults, period.  If you give the ageists enough rope...

How about the idea that Americans are too ethnically and racially diverse to handle drinking at 18?  Not only is that, well, racist, but even if that dubious claim were true, it would also be an argument for Prohibition or greater authoritarianism in general.  Same goes for other specious arguments about Americans having less "social capital" and being too hyper-individualistic compared to other countries, as well as arguments about "affluenza" and "spoiled children", and also arguments about "family breakdown" and a "nation of semi-orphans".

Note that the typical "kids today" arguments often contradict one another.  And even if one were to concede that "kids today" are more infantilized compared to both previous generations as well as the rest of the world, which is debatable though it seems to have some merit, the solution is NOT to infantilize young adults even further still!  The road to serfdom is indeed paved with the ostensibly "good intentions" of "protecting" young people (from themselves), which is gradually expanded to include older and older age groups with every passing generation it seems.  And what better time than now for a U-turn?

And lest anyone trot out the "21 saves lives" argument, keep in mind that that has also been debunked as well by numerous studies, and most thoroughly and eloquently so by Miron and Tetelbaum (2009).  Even if it were true, surely the old joke about having a speed limit of 21 and a drinking age of 55 would save even more lives, and yet no sane person would propose such a thing.  Gee, I wonder why?  Funny how "if it saves one life, it's worth it" and "think of the children" seems to only apply when it's convenient for the dominant age group in society.

Let America be America again, and lower the drinking age to 18.  If you're old enough to go to war, you're old enough to go to the bar.  'Nuff said.

QED

Pennsylvania Raises Smoking Age To 21

It's official, Pennsylvania just raised the legal age limit for tobacco products from 18 to 21, effective July 1, 2020, making them the 19th state (and counting) to do so.  And the new law also expands the legal definition of tobacco products to include vaping products as well, since apparently they didn't even have an age limit for vaping products at all (though the federal age limit of 18 applied by default from 2016 onwards).

The part about including nicotine vapes in the definition of tobacco products is totally reasonable.  But raising the age limit to 21 is really not justified at all.  And Pennsylvania had been seeing so much progress in reducing teen smoking and vaping already, mainly due to tax hikes on both.  It would really be a shame to risk derailing such progress now with such an utterly illiberal and ageist law.

Yes, there is an exception in the new law for active military and veterans, who only need to be 18 or older instead of 21 to buy tobacco products.  But that one silver lining does still not make it OK to deny adult rights to otherwise legal adults over 18 who are legally old enough to join the military, regardless of whether they are actually in the military or not.  Thus, the exception does not actually resolve the inherent ageism and hypocrisy of this otherwise bad law.

I like to joke about "the other Tri-State Area", where NY, NJ, and PA all meet.  Port Jervis, NY, Montague, NJ, and Matamoras, PA are all right next to each other, and Matamoras is basically "come for the fireworks, stay for the cigarettes", since fireworks are legal in PA to sell to nonresidents, cigarettes are cheaper in PA, and the age limit in PA for tobacco has been 18 (until July 2020) while it is 21 in NY and NJ.  Looks like the tobacco part of that equation will no longer be true, at least the age limit part, and the price difference is also narrower now for cigarettes, and reversed for vape products, due to the tax hikes.  And gas is also more expensive now in PA than either of the other two states, while NJ gas is almost as pricey as NY now.  Thus the whole microeconomic dynamics of "the other Tri-State Area" are fundamentally different now, except for the fireworks of course.

Finally, Some "Reefer Sanity" In The Vaping Debate

It seems that at least some pundits, politicians, and public health officials are just starting to catch up with reality.  There is rapidly mounting evidence now that the primary culprit in the mystery vaping illness (that has killed over 40 people and sickened at least 2000 in the USA as of November 15, 2019) is the thickener additive Vitamin E Acetate in mostly black-market or counterfeit THC cartridges. This "thick and greasy" oil is harmless when used topically or ingested orally, but when inhaled it is apparently VERY bad for your lungs, much like any other "thick and greasy" oil would logically be.  And finally, several cannabis legalization and even medicalization states are belatedly banning or trying to ban its use in both legal and illegal THC cartridges, since until now almost no state banned or restricted this additive.

Better late than never, but honestly, what the hell took them so long?

THIS is what more states need to be doing.  Legalize cannabis, keep vaping legal in general, but regulate better and root out any bad actors in the legitimate market, while cracking down on any remaining illicit market that continues to hawk questionable wares.  In contrast, broad vaping or flavor bans, as well as cannabis prohibition and/or age limits set higher than 18, will only drive more customers to the black market, essentially pouring gasoline on the fire.  And those who foolishly opted for the later strategy while dithering over the real cause now have the blood of over 2000 Americans on their hands.

Of course, Vitamin E Acetate may not be the only culprit.  Other additives may also be to blame, as can perhaps the toxic cadmium fumes from cheaply-made and janky vaping devices and cartridges often made overseas (which can also be true for counterfeit nicotine vapes too, by the way).  And possibly pesticide contamination as well.  But again, in any case regulation would still work far better than prohibition to really get to the root of the problem.

As for the youth vaping epidemic driven by nicotine vapes, which is often disingenuously conflated with the mystery vaping illness, the best way to quash that is to raise the tax on nicotine-containing vape products, cap and phase-down the nicotine content of vape products down to European and Israeli levels, strictly enforce the existing age limit of 18 on vendors rather than raise it to 21, restrict vape advertising to be similar to the way it currently is for combustible tobacco products, and stop hyping this ridiculous moral panic so damn much for once.

So what are we waiting for? 

It's Not Just JUUL: The (Un-)American Vaping Association (And Trump) Also Throws Young Adults Under The Bus

As Trump announced the other day that his administration is looking at, among other things, raising the federal age limit for vaping products from 18 to 21 (which would require an act of Congress), the president of the American Vaping Association, Gregory Conley announced that he (and by extension, his trade group) openly supported the move as an alternative to prohibition.  Such a stance of regulatory appeasement by throwing 18-20 year old young adults under the bus to protect the vaping industry is cowardly at best, and will ultimately backfire as well.

And it is also all the more nonsensical given how the mysterious vaping lung illness that is sweeping the nation is driven primarily by black-market or counterfeit THC cartridges, not legal and legitimate nicotine vapes, and literally on the same day it was announced that they found further confirmatory evidence that the additive Vitamin E Acetate in the rogue THC cartridges is most likely the main culprit in causing this illness.  It is basically a thick, greasy oil that was NEVER meant to be inhaled, and can cause lipoid pneumonia when one does so.  Though likely other additives or contaminants could be causing it as well, such as cadmium fumes from the jankier vape devices themselves, since not all cases are consistent with lipoid pneumonia, and may be cadmium pneumonitis or metal fume fever instead.  And the Trump trade war with China may have led companies to shift to the use of cheaper and lower-quality devices and cartridges from 2018 onwards, ironically.

Thus, we at Twenty-One Debunked hereby excommunicate the American Vaping Association, just as we already did with the quislings at JUUL Labs.  And we can also add Trump 45 to the list as well now.  May their names and memory be forever blotted out.

The Needham, Massachusetts "Miracle", Debunked

Remember when Needham, Massachusetts made history in 2005 by being the first place in the USA to raise the age limit for tobacco to 21 in modern times?  And how the propoents of Tobacco 21 laws used them as an example of how successful such laws supposedly are at reducing teen smoking?  Well, a new article came out that thoroughly debunks that claim.  Scratch that, it debones, slices, dices, and juliennes it, and lays waste to its remains for good.

From 2006 to 2010 (the original study curiously did not include data before 2006), Needham did indeed see a faster drop in smoking rates among high school students compared to surrounding communities which kept the age limit at 18.  But from 2010 to 2012, the reverse was true: surrounding communities that kept it at 18 began to see faster declines in teen smoking rates than Needham.  This inconvenient fact was acknowledged buried in the original study (that went up to 2012) used to sing the praises of Tobacco 21, so it was not simply an oversight by the authors.  And according to the publicly available data that can be gleaned from schools in the surrounding communities, by 2014 the pattern reversed entirely, with the neighboring towns seeing larger net declines in teen smoking (59 to 77% drop) than Needham (40% drop) since 2006.  Hardly miraculous.  And by 2016, we see that some of these other towns raised the tobacco age limit to 21, but without seeing any further decrease in teen smoking (in fact, they saw a slight increase from 2014 to 2016).  If that's "success", we'd really hate to see what failure looks like.

So what explains the short-term success in the first few years in Needham?  Well, it could simply be have been a real but short-lived (and hollow) effect of the policy, just as Miron and Tetelbaum (2009) saw with the 21 drinking age versus traffic fatalities in the 1980s, with the effect being fairly small, dissipating after the first year or two before rebounding later, and further limited to the early-adopting states only (while in the later-adopting, coerced states, it actually had a perverse effect, or at best no effect).  But Needham also increased their enforcement on vendors dramatically, and also had at least some other tobacco laws that surrounding communities lacked.  And the percentage of smokers under 18 who bought their own cigarettes from stores also declined in Needham but not in the other neighboring towns.

Thus, it is very likely that the early decline in teen smoking would have been just as large if not larger had they simply kept the age limit at 18 but stepped up enforcement all the same, ceteris paribus.

Indeed, one should note that Woodridge, Illinois saw a similarly large drop in teen smoking in an even shorter timeframe (just two years) from 1989 to 1991 while keeping the smoking age at 18.  Leominster, MA also saw a drop almost as large from 1989 to 1991 as well.  And NYC, who raised their age limit from 18 to 21 (with no grandfather clause) in 2014, did NOT see teen smoking rates drop any faster than in the nation as a whole from 2013 to 2015.  Thus, the most parsimonious explanation is that Needham's (short) success story was primarily (if not entirely) due to increased vendor enforcement interacting with secular trends, and not the raising of the age limit itself.  In any case, it turned out to be a promise built on sand all along, if not a total statistical mirage.

Tobacco 21 laws, just like the ageist abomination that is the 21 drinking age, clearly belong on the trash heap of history.  And this is the final nail in the coffin.