Pubdate: Sat, 28 Sep 2019
Source: New York Times (NY)
Copyright: 2019 The New York Times Company
Author: Denise Grady


Several marijuana products have been identified as possible culprits in 
the mysterious epidemic of serious lung illnesses that has sickened more 
than 800 people who use vaping devices and e-cigarettes to inhale THC or 
nicotine, or both.

Health officials said on Friday that the products include THC-filled 
vaping cartridges labeled "Dank Vapes," as well as some other illicit 
brands that people bought from friends or family or on the street.

But officials said Dank Vapes appeared to be a label that THC sellers 
can slap on any product and is not a specific formulation or a single 
product. THC is the psychoactive ingredient in marijuana.

"Dank Vapes appears to be the most prominent in a class of largely
counterfeit brands, with common packaging that is easily available
online and that is used by distributors to market THC-containing
cartridges with no obvious centralized production or distribution," said 
a report published on Friday by state health officials from Illinois and 
Wisconsin, and from the federal Centers for Disease
Control and Prevention.

It is unknown who makes the THC products or where they come from, the 
researchers said.

The new information comes from researchers' interviews with 86 people in 
Illinois and Wisconsin, from 15 years to 53 years old, who had become 
ill after vaping. Almost 60 percent had required treatment in intensive 
care units. About 87 percent of those interviewed had vaped THC from 
prefilled cartridges purchased from "informal sources" during the three 
months before they got sick, and 57 had used Dank Vapes.

Other THC brands named are Moon Rocks, Off White and TKO. The
extensive use of prefilled cartridges suggests they "might play an
important role" in the outbreak, the researchers said. Part of the
appeal of vaping THC is that it lacks marijuana's telltale odor,
enabling users to hide what they are doing.

But officials said they did not know if vaping illnesses or deaths in 
other parts of the country were related to the same THC brands
identified in Illinois and Wisconsin.

The new report may not surprise longtime users of THC, who have been 
warning one another online for months that Dank Vapes and other illicit 
brands may contain toxins. But some of the online reviewers admit that 
they have continued vaping those products anyway.

E-cigarettes first came on the market in the United States in 2007, 
ostensibly as a nicotine replacement to help smokers give up
cigarettes. But the huge array of fruity and candy-like flavors and 
sleek devices have attracted increasing numbers of teenagers.

In Illinois and Wisconsin, among the patients who reported vaping
nicotine, Juul was by far the dominant brand. Many who vaped THC also 
reported vaping nicotine products.

The C.D.C. held a briefing on Friday to discuss some of the findings in 
the health investigations of vaping illnesses that have now been 
reported in 46 states, involving 805 cases and 13 deaths. Oregon 
reported a second death on Thursday; state health officials said the 
person was hospitalized with respiratory symptoms after vaping cannabis 

Dr. Anne Schuchat, principal deputy director of the C.D.C., called the 
lung illnesses "serious and life-threatening." She described the 
marketplace for vaping products as dynamic, and said that there was a 
large array of products, ingredients, packaging and supply chains, and 
that consumers had no way of knowing just what is in the liquids they 
are vaping.

The 86 patients from Illinois and Wisconsin who were interviewed
reported using 234 types of e-cigarettes or vaping products, labeled 
with 87 brand names. Of 75 who vaped THC, 49 used it at least once a 
day, and some more than five times a day.

Many of the patients throughout the United States had also reported 
using THC products, the agency said. Some patients have said they vaped 
only nicotine, but the Wisconsin researchers found that some patients 
who made that claim actually had used THC.

According to the C.D.C., of 771 patients nationwide, 91 percent had been 
hospitalized; 69 percent were male; and a little more than 60 percent 
were between the ages of 18 and 34. Of the deaths, the C.D.C. said that 
nearly 60 percent were of men, and the median age was 50 years old.

Both the C.D.C. and the Food and Drug Administration have been
investigating the outbreaks of vaping illnesses, in an effort to not 
only identify the products used but also the substances that were inhaled.

The F.D.A. commissioner, Dr. Ned Sharpless, told a congressional panel 
on Wednesday that the agency had been testing vaping liquid provided by 
people who got sick.

"We've received about 300 samples," he said. "We've tested about 150. I 
would say the answer is about 70 percent are THC products. The rest are 
nicotine products or something else. A significant fraction of the THC 
products, like maybe half of them, are contaminated with vitamin E acetate."

Vitamin E acetate is a skin oil and has "no business" being in a
product that people inhale, Dr. Sharpless said, adding that the
product is added to dilute or "cut" THC before it is sold.

But other ingredients or contaminants may also be contributing to the 
illnesses, health experts have said.

"We do not know what is making people sick," Dr. Schuchat said on

It is not known whether THC itself is the culprit, or whether
solvents, contaminants or the devices themselves are to blame.

Patients have become weak, short of breath and sometimes nauseated. Many 
need supplemental oxygen and treatment in intensive care units. In some 
patients, the lung damage has been so severe that they have been placed 
on ventilators. In a few cases, lung function has been so poor that 
ventilators were not enough, and the patients also had to be connected 
to machines that pump oxygen directly into the bloodstream.

Most of the patients have recovered enough to go home after days or 
weeks in the hospital, but doctors say it is too soon to tell whether 
they will suffer permanent lung damage.

Given the unanswered questions about the exact cause of the illnesses, 
many health experts say people simply should not vape. Those who 
continue to do so should avoid THC and not buy vaping liquids off the 
street, or add ingredients to commercial products, the C.D.C. said.

It emphasized that adults who do not smoke should not start using
e-cigarettes, and that young people and pregnant women should never use 

The spate of illnesses this summer has led several states and
lawmakers to call for more restrictions on e-cigarettes and for law 
enforcement agencies to crack down on illegal vape shops and illicit 
sales of vaping products. Michigan, Rhode Island and New York have 
imposed bans on flavored e-cigarettes, while Massachusetts has imposed a 
four-month ban on all vaping products. Gov. Jay Inslee of Washington 
State said on Friday that he would seek a statewide ban on flavored 
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