Vaping nicotine is a harm reduction strategy used by millions of smokers all over the world. Since the injuries only occurred in North America, it was clear the injuries were being caused by something other than standard nicotine eliquid.
Almost 100% of the injured patients reported using illegal THC cartridges. Despite the evidence, the injury was named EVALI (E-cigarette or Vaping product use-Associated Lung Injury) implying the cause was vaping nicotine.
To identify the substance causing the injuries, lung samples from the patients were analyzed. The fat-based substance, vitamin E acetate, was identified as causing the injuries. This substance can not be dissolved in water-based nicotine eliquid; they would separate in the container.
The patients surrendered the products they were vaping to help identify the cause of the injuries. Nicotine eliquids contained no unexpected or harmful chemicals but 9 out of 10 illegal THC carts contained vitamin E acetate which is used as a cutting agent.
EVALI patients use of vaping products vs vapers without injuries
Vaping habits of 66 vapers that suffered with the lung injury were compared to the vaping habits of 519 vapers that didn’t have the lung injuries. The injured vapers clearly showed a significant increase in THC vaping, illegal THC use and purchased the illegal brand that was associated with the lung injuries. This study further confirmed the safety of commercial nicotine eliquid.
The Food and Drug Administration issued warnings that were specific to the injuries. To best ensure the public can make informed decisions about safety, the more specific information about the dangers, the better. The FDA issued warnings that were based in the evidence discovered.
Word spread on the street that illegal THC cartridges were making people sick. Law enforcement busted several illegal THC cartridge makers and distributors. A legal thinning agent, ‘Honey Cut’ was removed from the market. The injuries declined.
Confiscated illegal THC cartridges from 2018 and 2019 found that the vitamin E acetate was only detected in the 2019 cartridges and not the 2018 cartridges. This shows that the causative agent was recently introduced into illegal THC cartridges.
Illegal THC cartridges caused the death of 68 people. Smoking kills half a million Americans and over 45,000 Canadians every year. Vaping nicotine has helped millions of smokers quit and has not killed anyone.
Despite the overwhelming evidence, the public were constantly bombarded with claims that vaping nicotine caused EVALI. Thousands of vapers that had successfully quit smoking with vaping, returned to smoking out of fear.
The media featured health experts and authority figures that blamed vaping nicotine for what was causing EVALI. Utah Department of Health were one of the few health authorities that told the public the truth.
Because illegal drug use has legal consequences, patients living in areas where a drug consumed is illegal, sometimes lie about what they have taken because they are afraid of being charged. Even though, initially, THC cartridges were illegal in Canada, authorities didn’t verify the patients’ self-reporting by testing lung samples, performing toxicology screening nor analyzing the patients’ vaping products used.
Since May, 2018, eliquid with or without nicotine has been regulated by the Canadian federal government. Prior to 2018, (and currently in the USA), the vaping industry self-regulated product manufacturing safety. No serious lung injuries from vaping commercial nicotine eliquid have been reported. Vaping nicotine is less than 5% the risk of smoking and therefore, a significant harm reduction strategy for smokers.
When we say “smoking” we mean smoking cigarettes. When people smoke something else, we specify such as smoking a pipe or smoking a joint. When we say “vaping” we mean vaping nicotine. When people vape something else, we specify such as vaping nicotine-free eliquid or vaping THC carts (cartridges).
North American health authorities such as the CDC recommended people stop all vaping and did not specify the injuries were caused from THC cartridges. Cannabis users were left at risk because “vaping” commonly means vaping nictoine NOT vaping THC carts.
With a disease outbreak, it’s important to notify the public, especially the population at risk. Vape shops across Utah were utilized to get the word out about the cause of EVALI & ensured their customers could make informed decisions about harm reduction for not only smoking but drug use.
30 mice were studied: 10 with aerosolized vitamin E acetate; 10 with aerosolized eliquid (propylene glycol & glycerine); and 10 with air (control). The first group were given the equivalent dose of vitamin E acetate that a person vaping the illegal THC cart would get. Those mice developed the same lung injury. The injury was not present in the eliquid nor the air groups.