US State and federal health officials investigating mysterious lung illnesses related to vaping have found the same chemical in samples of marijuana products used by people sickened in different parts of the USA and who used different brands of products in the last few weeks.
The chemical in question is an oil derived from vitamin E. Investigators at the U.S. Food and Drug Administration detected the oil in cannabis products in samples collected from patients who got sick across the United States. FDA officials revealed this information to the state health officials during a telephone briefing this week, as per several officials who took part in the call.
A state health department spokeswoman said that this particular chemical was also found in approximately all cannabis samples from patients who fell ill in New York in recent weeks. Though this is the first common element found in such samples from across the country, health officials concede it is too early to know whether this is causing the injuries.
Vitamin E is naturally found in certain foods like canola oil, olive oil, and almonds. The oil derivative from the vitamin is called vitamin E acetate which is commonly available as a nutritional supplement and used in topical skin treatments. It is not yet known to cause any harm when ingested as a vitamin supplement or applied to the skin. Experts said that its name sounds harmless, but its molecular structure could make it hazardous when inhaled. Its oil-like properties could be linked with the kinds of respiratory symptoms of cough, shortness of breath and chest pain, that many patients have reported, as per officials.
One official who listened to the briefing but was not authorized to speak publicly, confided, “We knew from earlier testing by New York that they had found vitamin E acetate, but to have FDA talk about it from their overall testing plan, that was the most remarkable thing that we heard”.
The FDA also told state officials on Wednesday that its lab tests detected nothing unusual in nicotine products that had been collected from sick patients, according to another person who participated in the call.
This investigation has been predominantly challenging for health authorities.
“We don’t know what we’re looking for,” commented an official at the Centers for Disease Control and Prevention, which is leading the investigation last week.
Health Officials Warn Vaping-Related Illnesses On The Rise
Officials are attempting to come up with a consistent definition of the illness and a standardized system for gathering information from the states. Unlike certain infectious diseases like measles, which need to be reported to federal authorities, states are not required to account for possible cases of vaping-related illnesses to the Centers for Disease Control and Prevention, which is heading the investigation.
State health departments are now reporting new cases every week. By Aug. 27, there were 215 possible cases reported by 25 different states. Additional reports of lung illnesses are also under investigation, according to CDC officials.
Last Wednesday, Oregon health authorities reported a middle-aged adult who died in late July of severe respiratory illness and had used an e-cigarette containing marijuana oil purchased from a legal dispensary. This is the second death linked to vaping countrywide and the first to be directly linked to a product bought at a store. Illinois officials confirmed the first death last week but did not specify what kind of product was used in that case.
State and federal health authorities have stated that they are focusing on the role of contaminants or counterfeit substances as a possible cause of vaping-related lung illnesses. Many patients have told officials and clinicians that they bought cannabis products off the street. Majority of those who have fallen ill confess that they have vaped products containing marijuana, but others claimed that they used traditional nicotine e-cigarettes. Many reported using both. Authorities stated that they are not ruling out adulterants in nicotine vaping products.
Even though the discovery of a common chemical in lab tests from the FDA and highly regarded Wadsworth Center lab in New York, offers a potential lead, officials cautioned that they have a long way to go before understanding what exactly is making so many people sick.
An FDA spokesman commented that the agency is “looking into potential leads regarding any particular constituent or compound that may be at issue.” The FDA is currently analyzing samples for a broad range of chemicals, with nicotine, THC, other cannabinoids, “cutting agents” that might be used to dilute liquids, other additives, pesticides, opioids, poisons, and toxins. THC is the constituent in marijuana that makes users high.
“The number of samples received continues to increase and we now have over 100 samples for testing,” FDA spokesman Michael Felberbaum commented on Thursday.
He added, “No one substance, including Vitamin E acetate, has been identified in all of the samples tested. Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about causality.”
Also, not all given samples are suitable for testing. The FDA analyzed 12 viable nicotine samples and 18 viable THC products, according to state officials. Vitamin E acetate was identified in 10 of the 18 THC products.
“This was the only thing that seemed to show up in 10 of the 18 cannabis products,” commented one state official who took part in the call.
The federal lab results appear to confirm findings from New York State. Late last week, that lab found “very high levels of vitamin E acetate in nearly all” the cannabis samples tested. More than a dozen samples were tested, a health department spokeswoman disclosed on Thursday. At least one vape product holding vitamin E acetate has been linked to each patient who submitted a product for testing, the department stated.
“Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape samples and was not seen in the nicotine-based products that were tested. As a result, vitamin E acetate is now a key focus” of New York’s investigation, New York State Health Commissioner Howard Zucker stated in a statement on Thursday.
As of this Thursday, New York had recorded 34 reports from doctors of severe pulmonary illness among patients who covered ages from 15 to 46 and were using at least one cannabis-containing vape product before falling sick. All patients confirmed recent use of various vape products, officials said. Many are even suspected to be imitations of recreational cannabis-containing vape products available in other states.
The report of a second death has emphasized the danger of this lung disease.
Ann Thomas, a physician with the Oregon Health Authority said, “It was surprising that the patient suddenly appeared without any other underlying health conditions and became ill enough to die from this syndrome”.
Vaping is the increasingly popular practice of inhaling vapor from an e-cigarette device, which normally involves heating a liquid that can contain nicotine, marijuana or other drugs.
Vitamin E acetate is essentially grease, according to Michelle Francl, a chemistry professor at Bryn Mawr College. Its molecular structure implies that “you have to heat it up pretty hot” for it to vaporize with a boiling point of 363 degrees Fahrenheit, which is much above the 212 degrees F boiling point for water, and approximately four times higher than normal human body temperature.
Francl said, “ Once the oil is heated hot enough to vaporize, it can potentially decompose, and now you’re breathing in who-knows-what”.
When this vapor cools down in the lungs, it returns to its original state at that temperature and pressure, she explained, which means “it has now coated the inside of your lungs with that oil,” she added.
In Utah, clinics have treated numerous patients with acute lung injuries who were diagnosed with a rare condition called lipoid pneumonia, with symptoms like chest pain and difficulty breathing. Doctors said those patients had abnormal immune cells filled with lipids. Unlike the human digestive tract which has the ability to break down and get rid of foreign substances, the lungs aren’t intended to handle anything except gases, experts said.
Laura Crotty Alexander, lung inflammation and e-cigarette researcher at the University of California at San Diego’s School of Medicine, commented that it’s not clear whether the chemical itself or its byproducts could be toxic.
She said, “We haven’t looked at the toxicity of vitamin E in the lungs. The lungs are designed to exchange gas molecules; they’re not designed to be exposed to other chemicals.”
When the lung cells die, that often provokes an inflammatory response, and “other cells need to come in and clean up the cell debris,” Alexander held. But the lungs are very delicate. When extra cells enter, “they get in the way of gas exchange,” she explained. That makes it more difficult for oxygen to get into a person’s bloodstream. The inflammation can cause the liquid to accumulate in the lungs, making it difficult for someone to breathe, she elaborated.