Over the past year, nearly 2 300 Americans have been sickened – and 47 have died – from a mysterious and severe lung illness tied to vaping.
Now, a study of lung illnesses in Minnesota supports the notion that a compound known as vitamin E acetate, present in many "black market" vape products, could be to blame.
The study found that while vitamin E acetate was not found in most illicit vape products tested in Minnesota in 2018, a year later – coinciding with the recent illness outbreak – nearly all such samples contained the chemical.
This chemical analysis of these before-and-after samples "support a potential role for vitamin E acetate in the [illness] outbreak," according to a team led by Joanne Taylor, of the Epidemic Intelligence Service at the US Centers for Disease Control and Prevention.
The illnesses that are affecting vapers can be sudden and severe. Symptoms include cough, shortness of breath and chest pains. Some patients have had so much trouble breathing that they wind up on oxygen, and in extreme cases are placed on a mechanical ventilator.
In the new study, Taylor's team focused on patient data from Minnesota. Between August and November of 2019, 96 Minnesotans were diagnosed with vaping-linked lung injury. Ninety-one percent needed to be hospitalised, and three died.
As is the case nationwide, patients were typically young (average age 21) and male (60%).
The research team was able to interview 58 of the patients. Nearly all (91%) said they had used vaping products that contained THC, the marijuana chemical that provides a high.
Positive for vitamin E acetate
What's more, these products were typically obtained outside of the usual retail outlets. The vape products were obtained from friends, family members or "dealers" contacted in person or via the internet, those interviewed said.
Taylor's team went further, analysing 46 samples of these illicit vape products obtained from 12 of the patients. They also analysed illicit vapes that had been confiscated by Minnesota police in both 2018 and 2019.
The result: "Twenty-four products obtained from 11 [lung-injured] patients from 2019 contained vitamin E acetate," the study authors found.
In other words, 11 of the 12 patients had been exposed to inhaled vitamin E acetate prior to getting sick in 2019.
In contrast, among products seized by the police, "none seized in 2018 contained vitamin E acetate," Taylor's group reported. But a year later, "all tested THC-containing products seized in 2019 tested positive for vitamin E acetate," they said.
Because most illnesses tied to vaping didn't arise until 2019, that lends credence to the notion that the recent addition of vitamin E acetate to illicit vapes could be fuelling the illness outbreak, the CDC team explained.
Discouraging use of any vaping product
It's too early to say for sure that the theory is correct, Taylor's group stressed. But, in the meantime, "vitamin E acetate should not be added to e-cigarette, or vaping, products," they said.
Vape users are also strongly advised to avoid illicit e-cigarette products with certain brand names that turned up in samples obtained from patients. On the list to avoid are "Dank Vapes", "Dr Zodiak", "Rove", and "TKO Extract", all of which tested positive for vitamin E acetate, the researchers said.
But the CDC's recommendations go beyond avoiding certain brands.
As Taylor's group noted, "CDC continues to recommend not to use e-cigarette, or vaping products that contain THC and not to use any e-cigarette, or vaping, products obtained from informal sources."
Even more broadly, the agency discourages use of any vaping product at all by teens, young adults and pregnant women.
The new findings were published in the CDC's Morbidity and Mortality Weekly Report.
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