New details are emerging about the spate of e-cigarette-related lung injuries that have killed one Michigander and sickened 44 amid a national outbreak that expanded this week to include 1,604 people and 34 deaths.
The Michigan Department of Health and Human Services reported Friday that 81% of the people who were sickened by vapes in Michigan used products containing THC, also known as tetrahydrocannabinol, the chemical responsible for most of marijuana’s psychological effects.
Investigators from MDHHS, the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration are trying to pinpoint what is causing these illnesses.
Although the cause is not yet known, one hypothesis under investigation is whether contaminants in THC vapes, such as vitamin E acetate, could be dangerous when aerosolized and inhaled, state health officials said.
Vitamin E acetate is an oil derived from vitamin E that is often used in skin ointments or creams, ingested in food or supplements. It also has been used as an additive in some vape products.
Patients who developed vape-related lung injuries in Michigan were asked to provide any e-cigarette materials they had for FDA testing. Preliminary results from five patients in Michigan found:
- Two patients’ products contained only nicotine
- One patient’s products contained only THC
- One patient’s products contained both THC and nicotine
- One patient’s products contained THC and vitamin E acetate. One product, a Dank Vape Birthday Cake THC cartridge, contained 23% vitamin E acetate
In addition, state health officials reported two vaping cartridges submitted by a medical marijuana caregiver to a Michigan Marijuana Regulatory Agency licensed safety compliance facility also contained 40% or more of vitamin E acetate.
So far, no specific brand of device or e-liquid has been identified as a source for the outbreak of lung injuries. Although the THC products, particularly those obtained illegally, appear to play a major role in this outbreak, nicotine products cannot be ruled out, the MDHHS reported.
More: Vape warnings starting to affect sales of tested marijuana products
More: Michigan’s flavored vape ban stops sales this week. Here’s what you need to know.
All of the people who’ve been sickened by this illness have reported breathing problems such as cough, shortness of breath or chest pain. Some had to be hospitalized. Patients also have had nausea, vomiting, or diarrhea; fatigue, fever, or abdominal pain.
All had an abnormal lung X-ray or CT scan, and all reported using e-cigarette/vaping products within the last few days or weeks before getting sick.
Teenagers and young adults made up the majority of people hospitalized for this condition.
Other states are also finding vitamin E acetate in the products they have tested. The New York State Department of Health found high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed as part of its own investigation of lung-injury patients.
And testing at the Utah Public Health Laboratory showed evidence of vitamin E acetate in 89% of THC-containing cartridges provided by six lung injury patients.
“We urge Michiganders not to use e-cigarette or vaping products, particularly those containing THC,” Dr. Joneigh Khaldun, chief medical executive and chief deputy for health for MDHHS said in a news release. “This outbreak is still under investigation, and the exact substance or devices that are causing the outbreak are unknown.”
The CDC and MDHHS recommend that no one use e-cigarettes or vape products, but especially those that contain THC. In addition, they suggest:
- E-cigarette and/or vaping products should never be used by children, young adults or women who are pregnant.
- If you do not currently use tobacco products, do not start using e-cigarette or vaping products.
- Do not buy any type of e-cigarette or vaping products off the street, particularly those containing THC.
- Do not modify or add any substances to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments.
Last month, Michigan became the first state to announce a temporary ban on flavored vapes as concern about the safety of vaping and e-cigarettes grew.
The six-month ban on sales of flavored vape products, which took effect Oct. 2, was administered by the MDHHS upon an order from Gov. Gretchen Whitmer.
Whitmer pointed to research that showed e-cigarettes are the most commonly-used tobacco product in the United States. Nationally, their use rose 900% among middle school and high school students between 2011-15.
Sharp increases in the use of e-cigarette products among high schoolers were reported in Michigan from 2015-16 and 2017-18, with counties reporting an additional 30% to 118% increases, according to the MDHHS.
That, coupled with a national outbreak of vape-related lung injuries, Whitmer said, constituted a public health emergency. She instituted the ban through Michigan’s administrative emergency rules process, which allows state agencies to create regulations or policies that, once authorized, act as laws.
It quickly met with legal challenges.
The Michigan Court of Claims stopped the state’s ban on flavored vapes on Oct. 15, when Judge Cynthia Diane Stephens issued a preliminary injunction.
Her ruling said the harm done to vape businesses, which would have to shut down because of the ban, outweighs the interest of the state in stopping youths from using the products.
Whitmer filed an emergency leave Friday with the Michigan Court of Appeals, asking the state Supreme Court to take the case directly.
“After seeing how the Flint water crisis was mishandled, it’s more important than ever that we listen to our public health officials when they make recommendations to protect our citizens,” Whitmer said in a statement Friday. “Our Chief Medical Officer has found that the explosive increase in youth vaping that we’ve seen over the past few years is a public health emergency. For the sake of our kids and our overall public health, we must act swiftly to get these harmful and addictive products off the market. I’m hopeful that the Supreme Court will immediately take up this case so we can ensure our kids’ safety.”
Contact Kristen Jordan Shamus: 313-222-5997 or email@example.com. Follow her on Twitter @kristenshamus. Free Press staff writer Kathleen Gray contributed to this report.
How to get help
Help is available for people addicted to nicotine from vape products.
Health officials urge anyone who has vaped in the past not to switch to cigarette/cigar smoking as a replacement for nicotine. Instead, seek free help by calling 800-784-8669 or consider an FDA-approved nicotine-replacement product like gum, lozenges, nasal sprays or patches.
Teens who are trying to quit tobacco or stop vaping can call or text the My Life, My Quit program at 855-891-9989 for real-time coaching. This program allows teens to work with a coach who listens and understands their needs, provides support and can help them build a plan to quit.
To learn more about vape-related lung injuries, go to Michigan.gov/vapelung.