More deaths, no clues, and a sense of emergency as e-cig use soars and a black market thrives
As the death toll from a respiratory illness tied to vaping reached eight on Thursday and the number of total cases in the crisis climbed to 530 across 38 states—with 16% of the afflicted under age 18—the mystery began to take on Hollywood qualities, with the U.S. Centers for Disease Control and Prevention activating its emergency operations center while scrambling to find a cause, or even just some clues, in a health crisis that has officials baffled. Unlike with salmonella or E. coli outbreaks, experts have no clue what substance is behind this one.
“I wish we had more answers,” Anne Schuchat, the CDC’s principal deputy director, said in a press briefing. “We’re working closely with state and local health departments, FDA, and the clinical community to learn as much as we can to try to stop this outbreak.”
That would be easier if scientists knew what they were looking for. Officials don’t know if the illnesses are tied to commercial vaping products or black-market alternatives, let alone which substances might be the culprits. Schuchat had much more to say about the investigation’s process, and about what’s not known, than about what is known.
“CDC is working 24/7 with the states to try to find answers,” she said. “I’d like to stress how challenging this situation is, as patients may have been exposed to a variety of products and substances, may not know the contents or sources of these products, and in some instances may be reluctant or too ill to fully disclose all the details of interest.”
While it would be convenient to finger black-market vaping products, and helpful to determine whether the illnesses are tied to one substance or another, the CDC has not been able to zero in on anything beyond vaping in general.
“No consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases, nor has any single product or substance been conclusively linked to lung injury in patients,” Schuchat said.
Of the rising death toll, she said, “we do expect others.”
The Food and Drug Administration is on the case, too. But Mitch Zeller, director of the FDA center for tobacco products, had no more definitive information on the cause than what the CDC offered, calling it an “ongoing investigation that has way more questions than answers.”
The FDA “has now collected more than 150 vaping product samples from a number of states for analysis in our forensic chemistry center,” Zeller said. “FDA is analyzing these samples for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, along with opioids, cutting agents or dilutants and other additives, pesticides, poisons and toxins.”
The FDA has also launched a criminal investigation, not to make life difficult for vapers, but “to identify what is making people sick, as well as a focus on the supply chain,” Zeller said.
Here are some things that are known about the crisis, according to the CDC:
More than half the illnesses involve people under age 25, and 16% are younger than 18, but victims range up to 65 years old. Some 75% of the people afflicted are men. The newly risen case total represents both individuals reporting new symptoms along with sicknesses that may have been identified previously but only now are being counted as part of this outbreak.
Symptoms include coughing, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever and abdominal pain.
Most of the patients report a history of vaping with products that contain THC, the feel-good chemical that’s extracted from marijuana, the CDC says. Some, but not all the patients, report using e-cigs with nicotine.
Schuchat hinted at the possible additional risk posed by home-brewed vaping cartridges, made by users themselves or by opportunistic bad guys. “Anyone who uses an e-cigarette or vaping product should not use or buy these products off the street and should not modify or add any substances to these products,” she said.
Criminals are, indeed, producing vaping cartridges in their homes, and the contents are anyone’s guess.
Last week, detectives in Arizona arrested two men in a Phoenix home for allegedly making vaping cartridges, conveniently packaged with child-friendly graphics and a brand name of Dank. That brand was reportedly used by 24 of 41 of the lung-illness patients interviewed earlier this year, as detailed in a paper published Sept. 6 in the New England Journal of Medicine.
Maricopa County Sheriff’s Department detectives found cash, guns, pot, manufacturing equipment and vape cartridges, along with THC extract, all valued at $380,000, when they raided the home. In a statement, MCSO said the setup was similar to those found to make vape cartridges around the nation.
The Arizona arrests came just a few days prior to the state’s Department of Health Services announcing the first three cases of the vaping-related illness in that state.
A larger series of busts were made in Wisconsin earlier this month, which along with Illinois was ground zero for the vaping illnesses that began cropping up in July. Officials in Wisconsin seized 57 Mason jars filled with THC-laced liquid, 31,200 vape cartridges, each filled with 1 gram of THC, and 98,000 unfilled cartridges, along with cash and guns in a stockpile worth $1.5 million, according to the local sheriff’s department. Also found: professional-looking packaging that officials said makes the Dank brand look legitimate, The New York Times reported.
The mystery illnesses coincide with the soaring popularity of electronic cigarettes. Vaping among adolescents and teens doubled the past two years, the National Institute on Drug Abuse announced this week.
“With 25 percent of 12th graders, 20 percent of 10th graders and 9 percent of 8th graders now vaping nicotine within the past month, the use of these devices has become a public health crisis,” NIDA Director Nora Volkow said in a statement. “These products introduce the highly addictive chemical nicotine to these young people and their developing brains, and I fear we are only beginning to learn the possible health risks and outcomes for youth.”
Earlier this year, I reported on how easy it is for kids to get e-cigarettes and the candy-colored vape cartridges, sometimes called pods, with kid-friendly flavors like mango, mint and creme.
“I can call up anyone I know who is 18 and give him $40 for a Juul and a pack of pods, and if I can, so can any kid who is under 18,” said one 17-year-old in a suburban neighborhood at the northern edge of Phoenix.
Juul, the most popular commercial maker of e-cigs and vaping products, has been targeted by the for targeting kids, and for the high nicotine content of its products. A single pod, or cartridge, can contain as much nicotine as 20 cigarettes, the CDC says. Studies have shown that the flavorings alone can be dangerous, breaking down into dangerous chemicals like formaldehyde.
Michigan and New York have banned the sale of flavored e-cigarettes, and the Trump administration is also considering a similar nationwide ban.
Whether the current nationwide health crisis involves black-market vaping products or those commercially available, it’s becoming increasingly clear that vaping is not the totally safe alternative to smoking that proponents have cracked it up to be.
E-cigs don’t create smoke. They heat a soup of liquid chemicals in a cartridge to create an aerosol, or vapor, whose properties are not yet well studied. The liquid can contain marijuana, nicotine, flavorings and other substances. As I reported last month, studies are finding that this stuff is far from innocuous after it’s combined in a vapor. A brief summary of the research:
E-cig vapor contains lead, nickel, cancer-causing materials and fine particulate matter that seeps deep into the lungs, says the CDC. What happens when chemicals mix in the vaporizing process is not entirely known. But the vapor can inflame the lungs in ways similar to asthma, one study finds, and another study shows the vapor can kill white blood cells, which are key to the body’s the immune system.
Another new study finds that a single session of vaping significantly reduces blood flow to the femoral artery, choking off the supply of oxygen and nutrients to the lower body. It’s not known if the effect will recur with perpetual vaping, but if it does, it would raise the risk of atherosclerosis, which can lead to stroke or heart attack, says the study’s lead researcher, Felix Wehrli, a professor at the University of Pennsylvania’s Perelman School of Medicine.
Importantly, research shows that some of the harmful effects of the vapor seem to be related to what happens when various chemicals — including the flavorings — are vaporized together. More research is needed to figure all that out, including what unhealthy role the vaporized flavorings might play.
Health experts say vaping is particularly bad for young brains, which are vulnerable to nicotine addiction, and which can be harmed irreparably while in the formation stages, as the brain is building the hardware and writing the software that a young person will be stuck with for life (I’ve got much more on that, in relation to youth marijuana use, here).
But it will be years — after longitudinal studies can be done — before the long-term effects of this relatively new habit are known.
Meantime, Schuchat has some advice: Anyone who uses e-cigs to avoid regular cigarettes should not return to their old habits, she said. See your doctor about other options, she suggested. For everyone else, she said this: “Until we know more, if you are concerned about these specific health risks, CDC recommends that you consider not using e-cigarette or vaping products.”