What had been a series of isolated vaping illnesses became a serious health concern when the Center for Disease Control (CDC) reported in mid September that number of vape-related cases had exceeded 500, with eight confirmed deaths. The growth of nicotine vaping, especially among teens, had been a concern for some time; the fact that vaping could cause death became alarming. With no definitive research on what was causing these illnesses, Massachusetts Governor Charlie Bake instituted a 4-month ban on vape cartridge sales—tobacco and cannabis alike. 

The ban was challenged by the vaping industry and medical cannabis users, who argued that the ban was causing people to turn to black market sources, or purchase products from other states where testing is less rigorous, exacerbating, rather than reducing the problem. The state’s High Court will hear the case in December. In the meantime, a state judge ruled that the ban on medical cannabis vape cartridges would end if the Cannabis Control Commission (CCC) didn’t support it. The CCC declined to support the ban but agreed to temporarily quarantine medical cannabis oil vape cartridges, as additives in the oil are suspected to be the primary cause of illnessCannabis flower vaporizers for medical use are not banned. 

Research released by the CDC on November 8th indicates that vitamin E acetate, an additive used largely in black market cannabis oil vape cartridges, is the most likely culprit. If true, a ban on the use of vitamin E acetate, with rigorous testing of all vape oil cartridges, and a public education campaign about the risks of black market vape oil cartridges, might significantly reduce the number of new cases.   

There is no evidence that flower vaping had anything to do with this outbreak.    

What are the concerns about vaping?  

There are really two issues here: the growth of teen tobacco vaping and a serious lung illness connected to both tobacco and cannabis vaping.  

Health officials have been concerned for quite a while about the growth in teen use of e-cigarettes—the most common form vaping. Marketing of flavored tobacco vapes has been seen as an insidious way of attracting teens, and while not as damaging as smoking, is still a health hazard.  The Massachusetts legislature just passed a ban on flavored e-cigarettes, and raised taxes on vape cartridges to 75% to discourage future vaping. 

A more serious lung illness appeared this year, with patients showing signs of chest pain, coughing and severe breathing problems. Many of these were linked to recent vaping. In some cases, the patients died.  Currently there are over 2,000 such cases, with 40 deaths.  There are 68 such cases in Massachusetts, and three deaths. 

According to the Boston Globe, “State officials say 31 percent reported vaping only nicotine, 38 percent reported vaping only THC, and 25 percent reported vaping both nicotine and THC. Two of the people who died in Massachusetts vaped only nicotine; one vaped THC and nicotine. 

Current status of ban in Massachusetts 

On September 24th, Governor Charlie Baker instituted a total ban on vaporizers and oil vape cartridges.  This ban includes tobacco, medical & recreational cannabis vapes.  The ban began on the 24th, and unless overturned in court (there’s a challenge to the ban by vape manufacturers & retailers and advocates for medical cannabis), it will remain in effect until January 24, 2020.  

Suffolk County Superior Judge Douglas Wilkins ruled recently that the ban was unconstitutional, and unless the Baker administration holds hearings on vaping, the ban will end on December 24th.  Hearings are scheduled for November 22nd.    

Judge Wilkins also ruled that the Cannabis Control Commission, not the Baker administration, has the authority to ban medical cannabis products. The Commission declined to support the Governor’s ban, but issued its own temporary quarantine of cannabis oil cartridges. Cannabis flower vaporizers were not included in this ban, as there appears to be no connection between cannabis flower vaping and the illness.   

Impact of the ban  

According to the Boston Globe, the vape industry could lose $7-8million in sales during the ban, stores have closed and a number of employees have lost their jobs.    

There’s also anecdotal evidence that vape users are driving to other states to purchase products, or turning to black market sources, which is disturbing, as research suggests vitamin E acetate, an additive found primarily in black market cannabis oil vape cartridges, may be one of the leading causes of the illness.   

Research 

According to a September 5th editorial in the New York Times, there’s much to be learned about the cause of this vaping illness: “Health officials have identified one potential cause of the mysterious vaping-related illness that has sickened more than 450 people and claimed at least three lives: vitamin E acetate, an oil found in some marijuana-based vaping products. But there’s still a lot they don’t know. Are other adulterants also involved? Does a combination of vaping ingredients, or the use of a certain vaping device, increase the likelihood of falling ill? 

Since this Times editorial piece was written, more than 1,500 have fallen ill, and 37 more have died. The CDC release a report last Friday that identifies vitamin E acetate as one of the primary contributors. According to the Boston Globe, “Calling the information a breakthrough in their months-long investigation, authorities at the US Centers for Disease Control and Prevention said vitamin E acetate, an oily substance added to some vape cartridges, is a “very strong culprit” behind the lung illnesses, though they said other ingredients may also be contributors.” Vitamin E acetate has been used primarily in black market cannabis oil vape cartridges. Rolling Stone reported that the CDC had found that “…78% of the 514 cases it has analyzed thus far involved patients using products containing THC, while a separate study reported that 66% of patients had specifically used Dank Vapes, a black-market manufacturer of ambiguous origin that purports to contain 90% THC. 

There is concern that some legal vape cartridges may be using vitamin E acetate as well.  

Because many of those who’ve fallen ill have not vaped cannabis, Vitamin E acetate is probably not the only contributing factor—other oil additives, such as propylene glycol and polyethylene glycol, and flavorings, have been found to be harmful as well.    

Alternatives 

For cannabis consumers there are two simple solutions: edibles, and flower vaping. Neither have been linked to the recent outbreak of lung illness.  Edibles are not banned in Massachusetts, and flower vaporizers for medical use are no longer banned since Judge Wilkins ruled medical cannabis products could only be banned by the CCC (sale of vaporizers for recreational use is still temporarily banned in the Commonwealth). 

Until more thorough research has been conducted into vaping and vaping oil products, we strongly urge cannabis consumers to avoid all cannabis oil vape products. 

Sources 

Boston Globe: “CDC finds one possible cause of vaping illnesses but can’t confirm yet whether legal regulated vapes are safe”  

Boston Globe: “Cannabis board declines to uphold Baker’s medical marijuana vape ban, but products may stay off shelves” 

Boston Globe: “High Court to hear vapes sales ban case in December” 

Boston Globe: “Hearing on vape ban planned by Mass health officials for Nov.22”   

Boston Globe: “Cannabis Control Commission quarantines marijuana oil vapes, effectively extending ban” 

Boston Globe: “What we know about the Massachusetts vape ban and its future”  

TheNextWeb: “THC cartridges linked to multiple deaths: Here’s how to vape loose-leaf instead”

The New York Times: “Banning-cigarettes do cause more harm than good”  

The New York Times: “We still don’t know how safe vaping is”