In late August, public health officials reported that an individual in Illinois became the first person to die from a strange lung illness connected to vaping. Hospitals and doctors nationwide have been seeing a growing number of vaping-related respiratory illnesses this summer. There have been 193 cases occurring in 22 states and 22 of these cases are happening in Illinois.

Increase in Lung Illness Caused by E-cigarettes

Health officials are stumped as to the cause, and no common link has been found by state investigators, except for vaping, among the victims showing up in emergency rooms. A number of patients, however, have admitted using tetrahydrocannabinol (THC) in their vaping devices, per reports from state and federal health agencies. THC is the principal psychoactive chemical in marijuana that produces a high in individuals. Officials are speculating whether the lung problems are caused by one of the following: e-cigarettes, a marijuana-type substance, or a street concoction. It is also a possibility that some sort of contaminant or defective device could be involved.

Representatives from the Food and Drug Administration (FDA) joined officials from the Centers for Disease Control and Prevention (CDC) and the state of Illinois to publicly disclose the Illinois patient’s death at a news conference. No information was provided regarding the deceased’s identity other than to report that the decedent was an adult who had recently vaped before succumbing to a serious respiratory illness. Health representatives gave no indication of what substance had been vaped nor which vaping product was used.

The Risk of Vaping

This report comes after a series of recent Juul related injuries. One teenage boy suffered a collapsed lung after repeated use of the Juul e-cigarette. 

With very little information to assist them, investigators find themselves scrambling to uncover any shared links between the respiratory problems that are surfacing. A statement from officials said that a number of young adults and adolescents involved reported chest pain, difficulty breathing, fatigue, and vomiting. Critically ill patients had substantial lung damage that required oxygen treatment, along with a number of days on a ventilator. Some of the patients are likely to have permanent lung damage

An official with the CDC, Ileana Arias, stated that, “More information is needed to know what is causing these illnesses.” Health departments within individual states are handling the bulk of the investigations into these respiratory disorders.

“We’re at a relatively early stage of understanding,” according to Mitchell Zeller, the FDA’s director of the Center for Tobacco Products. A number of agencies are aiming “a lot of resources at this,” he continued, but part of the problem was that state investigations are not always complete, causing problems in forming a clear picture.

One unproven theory is that these medical disorders may be resulting from substances believed to be toxic in the vaping devices, which use heat to vaporize nicotine and other inhalants. The CDC’s deputy director of research translation at the Office on Smoking and Health, Brian King, mentioned that potential irritants include “ultrafine particulates, some heavy metals, such as lead,” and further stated there “are also concerns about some flavorings.” 

He did explain, however, “We haven’t specifically linked any of those ingredients to specific cases.”

The University of Pittsburgh Medical Center’s medical director at the Pittsburgh Poison Center, Dr. Michael Lynch, said doctors there are seeing lung injuries that are comparable to injuries from chemical inhalation. Dr. John Holcomb, a Texas pulmonologist in San Antonio, observes that the FDA has no control or oversight over what ingredients may be used in vaping devices. “The problem is we don’t know what’s being inhaled through these devices, of which there are five or six hundred different kinds. We have to assume that some of them may be dangerous and some may not be dangerous.”

Another suggested answer is that people are emptying out the supplied nicotine in pods that can be purchased commercially for vaping devices, then refilling the pods with THC oil or other chemicals. If the mystery respiratory illnesses are eventually traced to THC vapors produced in vaping devices, doctors and health officials will be forced to look fervently at another angle in the battle against youth vaping: an unregulated black market or bootleg cannabis liquid.

According to Nancy Gerking, the assistant director of public health for Kings County in California where numerous cases have occurred, “We believe that they are getting empty cartridges from somewhere and filling them with their own products. We don’t know what they are cutting it with or anything else.”

The Fight Against Youth Vaping

Public health officials and doctors have already been fighting an uphill battle to get youth to stop vaping e-cigarettes. Perhaps tunnel vision kept most of these new cases out of the view of medical professionals. However, now that cannabis oils and liquids are widely accessible online and in stores, with no requirement for ingredients to be labeled, unsuspecting buyers could be exposing themselves to dangerous chemicals.

With the e-cigarette market having broadened to counterfeiters, it is not clear whether potential problem-causing products are being manufactured by large mass-market companies or the counterfeiters. It is also unclear if potentially damaging inhalant concoctions are standard for vaping devices or are being made and mixed by individual consumers themselves.

The image of e-cigarette companies is already somewhat tarnished because of the increased popularity of vaping among teens. Recent revelations of damaging lung disorders and vaping-related deaths further serve to complicate the image of e-cigarette manufacturers.            

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