The Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day took place on October 26. The agency announced in a press release that it would, for the first time, collect and dispose of vaping devices and cartridges at all events last weekend. The drug take-back program, now in its 10th year, has primarily focused on collecting opioid medications, but since vaping has been linked to more than 1,000 illnesses in the United States, the DEA’s mission has expanded. 

According to Acting Administrator Uttam Dhillon, “The DEA’s National Prescription Drug Take Back Initiative helps get unused and unwanted prescription medications out of circulation and ensures their safe disposal. This year, we are taking a step further by accepting vaping devices and cartridges as we work with our federal partners to combat this emerging public health threat to the nation’s youth.”

While this may seem like a dig at e-cigarette companies due to the lung injuries and deaths that have stemmed from vaping, companies like Juul are probably not the ultimate “threat” as far as the DEA is concerned. The Centers for Disease Control and Prevention (CDC) has claimed about 78 percent of the patients who developed lung injuries from vaping were using THC products, so before the DEA takes their mission another step further by exploiting the chance to demonize cannabis all over again, one fact is certainly clear: The artificial ingredients in the vape cartridges are linked to what’s causing the national vaping epidemic. Cannabis itself isn’t the problem. 

Research has shown that vaporized cannabis is a better way to medicate when compared to smoking. Since the late ’90s, the classic Storz & Brickel’s Volcano has been known in cannabis culture as the finest flower vaporizer that money can buy. Prior to the vape pen phenomenon, a 2004 study conducted by MAPS (Multidisciplinary Association for Psychedelic Studies) showed that the lingering “harmful toxins in marijuana smoke can be effectively avoided” when using the herbal vaporizer known as the Volcano. The study concluded that “vaporization therefore appears to be an attractive alternative to smoked marijuana for future medical cannabis studies.” 

Since then, other studies indicated the same conclusion, including a 2007 study published in Harm Reduction Journal that determined “respiratory symptoms like cough, phlegm, and tightness in the chest increase with cigarette use and cannabis use, but are less severe among users of a vaporizer.” While the CDC continues to investigate the outbreak of lung injuries associated with e-cigarette use, inhaling cannabis vapor from the plant material itself has been and continues to be safe and efficient. It is not an “emerging public health threat.”

Big Tobacco likes to refer to studies like these to claim that vaping is safer than cigarettes (and can even help people quit), but there’s a key piece of information missing from that narrative: Not all vaping is the same. Vape pens don’t produce the same clean THC vapor produced by the Volcano simply because, whether the vape users are inhaling nicotine or THC oil, there’s a chance they can develop lung injuries similar to pneumonia that are severe enough to result in death. The e-cig company Juul in particular is facing multiple lawsuits for this, including a former Juul vape user who spent eight days in a coma as a result of vaping. The CDC has admitted that the specific cause of vape-related illnesses and deaths remains unknown, but the agency released several warnings earlier this month recommending not to use any kind of vaping product—including e-cigarettes, THC or flavored vape juice pens—due in part to the health risks stemming from a variety of ingredients found in the vape cartridges. 

While the DEA, CDC and Food & Drug Administration (FDA) have yet to point fingers, vape pen cartridges are being mixed with a variety of chemicals, some of which contain bacteria. In April, Harvard School of Public Health researchers disclosed that dozens of popular e-cigarette products are contaminated with bacterial and fungal toxins known to cause lung disease. The study focused on finding two microbial toxins among 75 popular e-cigarette products: 37 of which were single-use cartridges and the remaining 38 were e-liquids from the top 10 U.S. brands. The products were placed in four different categories (tobacco, menthol, fruit and other) and screened for endotoxin and glucan, two toxic substances that damage the lungs and cause asthma, reduced lung function and inflammation. 

Out of the 75 products tested, 17 contained endotoxin (a potent inflammatory molecule found in bacteria), and 61 contained glucan (a toxic substance found in the cell walls of most fungi). Fruit-flavored products were particularly high in endotoxin, indicating that the materials and chemicals used to create the flavors could play a role in contaminating the lungs of e-cig users. However, no one vapes at the same rate, or uses the same exact products, so it’s difficult to pinpoint exactly what amount of vaping (and what concentration of these bacteria-ridden chemicals) results in lung damage.

The study’s senior author and environmental geneticist Professor David Christiani noted that “the pattern of inflammation in the lung varies widely from patient to patient, as does the severity of the different types of inflammation, which suggests maybe more than one offending toxin is responsible.” 

Vape juice has also been found to contain heavy metals, including aluminum, calcium, chromium, copper, iron, lead, magnesium, nickel, silicon, tin and zinc. One study published in Scientific Reports found that merely using a tank-style e-cig can be dangerous. The heat produced by the tank can activate and separate the chemicals used to create the flavors, so “harmful by-products (e.g., formaldehyde and diacetyl)” are being inhaled. Flavors such as cinnamon, strawberry and banana have also been found to cause inflammation in the cells of the arteries, veins and heart. A study by Boston University found that this inflammation can also cause the body to react in a way that mimics the early stages of heart disease, heart attacks or strokes. 

While admittedly the cannabis industry lacks any FDA regulation (in vape pen cartridges and in all other aspects), these findings are coming from regulated e-cig products. So yes, the FDA is doing a poor job of regulating them, but there are guidelines in place nonetheless. 

Aside from regulation, the major difference between cannabis and other vaping products is how the products are being used. In states where cannabis is legal (either recreationally or medicinally), guidelines are in place to ensure the cannabis being sold at dispensaries is safe to consume. The federally legalized hemp industry is also highly scrutinized to ensure CBD products remain below 0.3 percent THC and don’t contain any harmful pesticides or heavy metals. Guidelines do vary from state to state, and some aren’t all that thorough, but there’s a universal focus on safety, particularly because cannabis (whether from marijuana or the hemp plant) is being used as a medication for many Americans. 

E-cig users might be vaping to ward off stress or quit cigarettes, but no e-cig user has ever relied on them for medication. No one is vaping nicotine or flavored vape juice to combat arthritis inflammation, chronic pain, glaucoma, seizures or the wide range of ailments that cannabis use might help alleviate. While many e-cig users state they were manipulated by manufacturers into thinking it was a safer alternative to smoking cigarettes, no one ever said vaping nicotine and chemicals was a good idea or even healthy. In fact, class-action lawsuits against Juul claim the company targeted its products to teens and created a public health crisis.

Studies have shown vaporized cannabis is better than smoking it, but there’s a new gap in that logic due to the popularity of vape pens. When THC and/or CBD are extracted into an oil for vaping, some manufacturers took cues from their competition and added chemicals, preservatives or artificial flavors to the vape cartridge. Typically, this was done to thin the THC or CBD oil or decrease the potency. It’s not a good idea to inhale artificial chemicals in general, and we know this to be true because cannabis vape users are seeing the same adverse reactions to these chemicals as e-cig users. 

Yes, cannabis is used recreationally, but since it’s also a medication, this could be part of the reason why the CDC has found so many THC-related lung injuries. Vaping THC can provide relief, but some users find it only lasts for about 45 minutes to an hour (depending on the severity of the medical condition) and then they might have to vape again. Medical cannabis patients who vape their medication throughout the day could be highly susceptible to lung injury from vape chemicals, especially since they’re already battling existing illnesses. 

Advocates in the cannabis community have addressed this concern. The Americans for Safe Access (ASA) recently recommended “that patients and consumers stop using cannabis-containing cartridges” until there’s more clarity from the CDC on what is causing the resulting illnesses and deaths. 

“Americans for Safe Access started out in 2002 with the mission to not just ensure access to medical cannabis to patients across the county, but to ensure safe access,” said Americans for Safe Access Interim Director Debbie Churgai. “As a patient-focused organization, we take the safety of patients very seriously.” 

While the organization doesn’t support outright bans on cannabis-vaping products, ASA did recommend patients use other means, “such as dry herb (flower) vaporizers, tinctures, edibles, or topicals.”  

Here are some of the alleged culprits found in e-cigs and some cannabis vape products that are currently being linked to the vaping epidemic:

Vitamin E acetate

Vitamin E acetate is the oil naturally derived from foods. It’s used as a nutritional supplement and can be found in topical skin treatments. However, there’s very little research to indicate if inhaling Vitamin E acetate is a good idea or if it could cause respiratory issues. New York State’s Health Department has indicated Vitamin E acetate is a “key focus” of its vaping epidemic investigation, since the ingredient is in flavored vape pens and cannabis vape pens that have been linked to lung illnesses in the state.

Vegetable glycerine (VG)

The lung and respiratory cases in the United States that have been linked to vaping primarily stem from lipoid pneumonia, a form of inflammation caused by the buildup of lipids (fat particles). In a report of a rare disease, the Birmingham Heartlands Hospital’s “Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes” noted that a patient with respiratory failure, coupled with cough, night sweats and fever was diagnosed with lipoid pneumonia, and the only form of lipid found in her lungs was vegetable glycerine, which originated from her e-cigarette. In 2010, a 57-year-old British man became the first person to die of lung disease linked to vaping, and he also had oils saturating his lungs.

Propylene glycol (PG) and Polyethylene glycol (PEG

A pilot study published in Cancer Prevention Research this month found that another oil in e-cigs and cannabis vape pens known as PG can cause lung inflammation. While PG is used as a preservative in many beauty care products such as deodorants, moisturizers, shampoos, suntan lotions and lipsticks, it’s also used as an anti-freeze because it lowers the freezing point of water. Some people are allergic to PG (and VG) and experience hives, acne and other side effects. Multiple studies have also indicated that PG and PEG can break down into carcinogens (including formaldehyde) if vaped at high temperatures.

Medium chain triglycerides (MCT) oil

While MCT oil is healthy to ingest (it’s a fat found in coconut oil that’s good for brain function), it isn’t necessarily healthy to inhale. When it’s heated in a vape pen, it can produce harmful levels of cancer-causing particles, including acetaldehyde and formaldehyde. MCT oil isn’t as widely used in the cannabis industry because it’s a runny oil compared to vegetable glycerine or Vitamin E acetate, and consumers can notice the difference (and automatically assume the product is less pure).

Since hospitalized vape users are found to have alternated between several brands, a combination of any of these chemicals could cause a reaction, especially since none of them are meant to be inhaled. 

“The majority (about 80-84%) of [vape patients] used a combination of marijuana-related and nicotine types of products,” Harvard Professor David Christiani stated. “So, the resultant mixture [of the ingredients in both products] may well be responsible for the rapid lung injury response, as opposed to a single toxin.”

Although the cannabis industry lacks unified regulation, there can be a difference between cannabis vape cartridges purchased at legal dispensaries and what is being referred to as “black market” vape oil. The CDC recommended that people shouldn’t “buy any type of e-cigarette, or vaping, products, particularly those containing THC, off the street.” Independent testing conducted in California has shown that vape cartridges purchased in legal dispensaries didn’t contain any pesticides, heavy metals or Vitamin E acetate. Out of 15 cartridges (or carts, for short) that weren’t purchased from legal dispensaries, 13 contained Vitamin E; out of the 10 unregulated carts tested for pesticides, all 10 tested positive. While this may seem like a small sample, some THC vape cartridges linked to the vape epidemic have contained myclobutanil, a fungicide that turns into hydrogen cyanide when burned. 

“I think the important message is to recognize you have no idea what you’re inhaling. And the alveoli of the lung is a very sensitive tissue,” stated Dr. Robert Redfield, Director of the CDC. “A lot of these bootleg products have material in there that wasn’t meant to be there. For example, we find pesticides in there. You don’t want to be sucking pesticides into your lungs.”

If customers are purchasing THC vape cartridges outside of the regulatory system, there’s a greater likelihood that they could be laced with pesticides or the THC content could be significantly cut with Vitamin E acetate. Some black market suppliers have been known to use 50 percent or more vitamin oil to dilute their vape carts, meaning the customer could be unknowingly vaping mainly Vitamin E acetate instead of THC.

“The recent issues associated with vaping cannabis oil raise serious concerns for consumers and emphasize why it is increasingly important to legalize and regulate cannabis,” explained Steve Hawkins, Executive Director at the Marijuana Policy Project (MPP). “Unregulated markets are producing unregulated products, which are proving to be detrimental to public health. Consumers who choose to responsibly consume cannabis deserve to know that the products they are using are tested and safe. This is only possible through legal and regulated markets.”

Hawkins’s statement also echoes the CDC’s findings: “To date, national and state data suggest that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family members, or illicit dealers), are linked to most of the cases and play a major role in the outbreak.”

Trust and full disclosure are clearly of the utmost importance, and some cannabis dispensaries have already gotten ahead of the issue by discontinuing vape cartridges that contain even trace amounts of PG, MCT oil or Vitamin E acetate. Medicine Man, a Colorado-based medical cannabis dispensary, announced in September that it removed products containing these and other chemical additives. 

States are also taking matters into their own hands. Colorado’s Marijuana Enforcement Division is in the process of finalizing a ban on additives in vape products, including PG, Vitamin E acetate and MCT oil. Washington, Michigan and Massachusetts have placed emergency bans on all things vape, forcing vape-related businesses in those states to close. The Vapor Technology Association, a vaping industry trade organization, filed a lawsuit against the Washington Department of Health in response to these bans, and several vape shops in Utah are taking the Utah Department of Health to court over a similar e-cig ban. 

Even President Trump weighed in on vaping during a September news conference: “Vaping has become a very big business, as I understand it. Like a giant business in a very short period of time. It’s very dangerous. Children have died. People have died.”

Initially, Trump went as far as to suggest the need for a federal ban on vape products, particularly flavored vape juice, but the details of this ban haven’t been released yet. Anyone even vaguely familiar with the DEA’s War on Drugs knows that banning or prohibiting something from the public doesn’t make it go away. If people want it, they’ll turn to the black market, which has already been identified as part of the problem. 

In the meantime, Americans for Safe Access offered these words of caution and advice to vape enthusiasts and lawmakers:

ASA does not support outright bans on cannabis-containing cartridges or devices intended for the consumption of cannabis concentrates, which could cause more people to the unregulated market and exacerbate the spread of VAPI [Vaping-Associated Pulmonary Illness]. Rather, we recommend bans on the inclusion of any additives (e.g., diluents, thickeners, flavoring agents) not derived from cannabis. Additionally, we urge that patients and consumers only purchase cannabis products that have undergone testing at an independent, third-party laboratory that has verified composition and potency and screened for adulterants, contaminants, heavy metals, residual solvents, chemical residues, and other health concerns, such as mold and dangerous bacteria.

The CDC found that 80 percent of the nearly 1,500 people hospitalized due to vaping were under 35 years of age. Vaping can be convenient, and it’s actually the third most popular way to use cannabis, but there are safer ways to consume (such as incorporating it into food) that don’t damage lung tissue. Even if you know the exact ingredients of your THC vape cartridge, if it’s encased in plastic, there’s no guarantee the plastic won’t leech into the oil. Breathing in microplastics can inflame the lungs and even increase the risk of lung cancer. Plus, the disposal of vape pens and carts has become a significant waste management problem since they can’t be recycled at this time. No one is forcing anyone to hand over vape paraphernalia to the DEA, but for now, exercising caution and switching to another delivery method is obviously more beneficial for the lungs (and for the environment). If anything, the vaping illnesses sweeping the nation only strengthen the case for full cannabis legalization and regulation. 

Jen Hobbs is the author of American Hemp. Her forthcoming book Cooking with CBD is available for preorder and scheduled to be released nationwide in June 2020. Her family owns and operates Nature’s Nectar, a CBD extract facility in O’Fallon, Missouri.  

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