Tests show that the contaminant found in cannabis-based vaping products is associated with lung diseases
The US Centers for Disease Control and Prevention and the US FDA work around the clock to investigate cases of serious respiratory illnesses associated with the use of e-cigarette products. Last week, we learned of the death of an adult in Illinois who had been hospitalized with severe respiratory illness following the use of an e-cigarette product. Health and federal officials who have investigated mysterious vaping-related lung illnesses have found the same chemical in samples of cannabis-containing products used by sick people in different parts of the country that have used different brands of cannabis. products in recent weeks.
The chemical is an oil derived from vitamin E. U.S. Food and Drug Administration investigators found that cannabis oil in cannabis products was found in samples taken from patients who became ill across the United States. United. FDA officials shared this information with state health officials during a telephone briefing this week, according to several officials who took part in the call.
This same chemical was also found in almost all the samples of cannabis from patients who have become ill in New York City in recent weeks, a spokeswoman for the state health department said.
Although this is the first common element found in samples from across the country, health officials said it was too early to know if it was causing these types of lung infections.
Vitamin E is also present in certain foods such as almonds, olives, canola oil or jojoba. The oil derived from the vitamin, known as vitamin E acetate, is commonly available as a nutritional supplement and is used in topical skin treatments. It is not known to be harmful when ingested as a vitamin supplement or applied to the skin. Its name sounds harmless, experts have said, but its molecular structure could make it unsafe if inhaled. Its oil-like properties could be associated with the types of respiratory symptoms reported by many patients: cough, shortness of breath and chest pain, officials said.
“We had learned from previous trials in New York that they had found vitamin E acetate, but the fact that the FDA was talking about it as part of their overall testing plan was the most remarkable thing we did. heard, ”said an official who listened to the briefing. was not allowed to speak in public.
The FDA also told national authorities on Wednesday that its lab tests did not reveal any abnormalities in nicotine products collected from sick patients, according to another person who took part in the appeal.
The investigation was particularly difficult for the health authorities. "We don't know what we're looking for," an official at the Centers for Disease Control and Prevention, who heads theinvestigation , said last week.
Officials are trying to come up with a consistent definition of the disease and a standardized system for collecting information from states. Unlike some infectious diseases, such as measles, which must be reported to federal authorities, states are not required to report possible cases of spray-related illnesses to the Centers for Disease Control and Prevention, which conducts the report. investigation.
State health departments report new cases every week. As of August 27, there were 215 possible cases reported from 25 states. Additional reports of lung disease are under investigation, according to CDC officials.
Wednesday, Oregon health authorities have declared the death of a young adult following a severe respiratory disease, had used an electronic cigarette containing cannabis oil purchased from a legal dispensary. It is the second vaping-related death nationwide and the first to be linked to a store-bought product. Illinois officials reported the first death last week. They did not specify what type of product was used in this case.
Health officials have indicated that they are focusing on the role of contaminants or counterfeit substances as a likely cause of vaping-related lung illnesses. Many patients told officials and clinicians that they purchased cannabis products on the street. Many of those who fell ill said they had vaporized products containing marijuana, but others said they used traditional nicotine e-cigarettes. Some say they use both. Authorities have said they do not rule out adulterants in nicotine vaping products.
Although the FDA has discovered a common chemical in laboratory tests and the well-known Wadsworth Center in New York offers a potential trail, officials have warned that they are far from understanding what makes people so sick. .
An FDA spokesperson said the agency is "looking for potential leads regarding any offending component or component." The FDA analyzes samples for a wide range of chemicals including nicotine, THC, other cannabinoids, “cutting agents” that can be used to dilute liquids, other additives, pesticides, opioids , poisons and toxins. THC is the component in marijuana that makes users get high.
“The number of samples received continues to increase and we now have over 100 samples to test,” FDA spokesman Michael Felberbaum said Thursday.
“No substance, including vitamin E acetate, was identified in all of the samples tested,” he added. “It is important to note that identifying the compounds present in the samples will be a piece of the puzzle, but will not necessarily answer questions regarding causation.”
Not all samples are suitable for testing. The FDA analyzed 12 viable nicotine samples and 18 viable THC products, state officials said. Vitamin E acetate was found in 10 of 18 THC products.
"This is the only thing that appeared to appear in 10's 18 cannabis products," said a state official who took part in the appeal.
Federal lab results appear to confirm New York State's findings. At the end of last week, his lab found "very high levels of vitamin E acetate in almost all of the samples" tested. More than a dozen samples have been tested, a spokesperson for the health department said Thursday. At least one product containing vitamin E acetate has been linked to every patient who has had a product tested, the department said.
“Vitamin E acetate is not an approved additive for vaping samples authorized by the New York State Medical Cannabis Program and was not observed in the nicotine products tested. As a result, vitamin E acetate is now a key part of the investigation, ”New York State Health Commissioner Howard Zucker said in a statement Thursday.
As of Thursday, 34 doctors in New York had reported cases of severe lung disease in patients between the ages of 15 and 46 who used at least one cannabis-containing vaporizer before becoming ill. All patients have reported recent use of various anti-vapor products, officials said. Many are believed to be counterfeit cannabis-containing recreational vaping products available in other states.
The second death report highlighted the danger of this lung disease. “It was surprising that the patient suddenly appeared without any other underlying health problem and became sick enough to die of this syndrome,” said Ann Thomas, a physician with the Oregon Health Authority.
Vape refers to the increasingly widespread practice of inhaling vapors from an electronic cigarette device, which often involves heating a liquid that may contain nicotine, marijuana, or other drugs.
Vitamin E acetate is basically fat, said Michelle Francl, professor of chemistry at Bryn Mawr College. Its molecular structure means that you have to “heat it hot enough” for it to vaporize. Its boiling point is 363 degrees Fahrenheit, which is far above the boiling point of 212 degrees F of water and almost four times higher than normal body temperature.
Once the oil is heated enough to vaporize, it can potentially break down and “now you're breathing who-knows-what,” Francl said.
When this vapor cools in the lungs, it returns to its original state at that temperature and pressure, which means “it has now coated the inside of your lungs with this oil,” she said. declared.
In Utah, clinicians have treated several patients with acute lung injury who have been diagnosed with a rare condition called lipoid pneumonia, accompanied by symptoms including chest pain and difficulty breathing. These patients had abnormal immune cells filled with lipids, the doctors said.
Unlike the human digestive tract, which can degrade and get rid of foreign substances, the lungs are not designed to treat anything but gases, experts said.
Laura Crotty Alexander, a researcher on lung inflammation and e-cigarettes at the University of California San Diego School of Medicine, explained that it's not so obvious which chemical its byproducts are. so toxic.
“We didn't look at the toxicity of vitamin E in the lungs,” she said. “The lungs are designed to exchange gas molecules; they are not designed to be exposed to other chemicals. “
When lung cells die, it often causes an inflammatory response and "other cells have to come in and clean up the cell debris," Alexander said. But the lungs are very delicate. When additional cells enter the room, "they interfere with the exchange of gas," she said. This makes it more difficult to get oxygen into a person's blood. The inflammation can cause fluid to build up in the lungs, making it difficult for someone to breathe, she explained.