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Cases of Vaping-Related Lung Illness Surge, Health Officials Say (nytimes.com)
88 points by neom on Sept 6, 2019 | hide | past | favorite | 97 comments



The main problem I see with vaping Cannabis extract is, there isn’t much that a consumer can do to verify the quality of the product. The cannabis could be contaminated with mold or neem oil from the grow up or it could be leftovers from the extraction method, because it wasn’t purged right.

Neem oil is something that was cleared for fruits and vegetables, something that you wash and eat. But I think it would be poisonous when you inhale it.


Not to mention who knows what pesticides and solvents. There's an Instagram user who has posted lab results from (legit, branded, supposedly reputable) cartridges that he's personally submitted. The results were enough to scare me away from the entire idea.


yes definitely a big issue; testing requirements must be improved, and there should be random samples of product batches taken for testing so companies cannot game the tests


I'm more concerned about the future backlash than the present reporting.

I mean, remember the salmonella tomato scare in 2008? Restaurants around the country stopped putting tomatoes on their food, and grocery stores pulled all tomatoes from the shelves, until the issue was isolated and resolved.

So while I do think it's quite the overreaction to tell everyone to stop using any and all vaping products, particularly people who are continuing to vape juices that have been used for years without issue, it's an understandable overreaction.

In the end, they are going to find the issue, and it won't have anything to do with traditional e-cig alternatives to tobacco. But I suspect there will be legislative backlash that will be vastly disproportionate to the issue. They will punish innocent retailers, make e-cigs outrageously expensive by over-regulation, and discourage a large number of people from a product that really is substantially safer than the tobacco they are leaving behind.


> I mean, remember the salmonella tomato scare in 2008? Restaurants around the country stopped putting tomatoes on their food, and grocery stores pulled all tomatoes from the shelves, until the issue was isolated and resolved.

If this follows a parallel path though, wouldn't this mean that vaping levels will basically be back to normal shortly after the cause is discovered? A temporary cessation of vaping until we can find and eliminate the cause of these health problems doesn't strike me as a huge issue.


No. Because tomatoes is food. Vaping is stigmatized, and has been in the crosshairs of legislative action for a long while now.


As it should be? It is disgusting, offers no benefit, creates a ton of plastic waste and gets children hooked to nicotine.


Vaping high quality CBD cartridges helped me through some serious situational depression and anxiety.

Of course some people told me that vaping was a "trash" thing to do, but thankfully I don't care and recognize that my needs are valid regardless of peoples' judgements!


Why not move to the crystal isolate? You can add those to food or your drinks. Not sure vaping makes sense cbd wise when there are different options.


It offered me the benifit of being the first successful eat to quit smoking two packs a day. I haven't had a cigarette in years, but I vape.


Disgusting? Truly? Everything else I’ll agree with you on, but disgusting isn’t a descriptor I associate with vaping. Certainly not in comparison to cigarettes!


>offers no benefit

Got me off of cigarettes. Seems like a pretty huge benefit to me.


People shouldn't be on them to begin with.


Wow, looks like you just solved it! You should go out and preach your gospel to all smokers, drinkers, and beef eaters. While you're at it please solve climate change and make everyone be nice to one another.


You're committing a logical fallacy with your response. Each of those issues you listed are different from the rest.


Yeah well obviously they are, but I always do love an HN "oh logical fallacy I win!" response.

My point is that your approach helps no one and has failed time and time again in the past. Remember D.A.R.E? How about abstinence health ed. programs? "Just say no" doesn't work. People like their vices. When a healthier alternative comes along it's a good thing.


Maybe in the US, but abstinence works in other countries. There should be investigations into why that is the case.


Agreed. Smoking and vaping are zero benefit activities that harm people and the environment. There should be a complete ban on smoking of all sorts.


Vaping as an alternative to smoking offers considerable benefits.


Agree entirely that it’s disgusting and attracts kids to the habit.

Problem is kids do stupid things and who has the right to decide for me if I get to do something disgusting?

Bigger issue for me is the talk of socialized healthcare where I’d have to pay the healthcare bills for people who smoke. Why should I have to pay for their bad habit?


A temporary cessation? That just means people go back to cigarettes. Moving from cigarettes to vaping isn't easy.


If it were that easy to stop I wouldn't be vaping in the first place.


The replacement good for vaping isn't "nothing", it's cigarettes. I think the negative health effects of smoking are pretty well established.


Or nicotine gum?


It's always funny to hear people talk about solutions to addictions they don't understand.

Gum/patches don't work for me and have a very low success rate in general. Part of my addiction is the act of smoking. I've been vaping for eight years and it's the only thing that has worked.


many are not aware of the oral fixation and/or ritual part of the addiction (which not all nicotine users share); no reason to take a pot-shot at the person you are responding to


It wasn't a pot shot. Gum and patches have abysmal success rates, oral fixation or not. For someone to suggest those as a simple alternative to vaping obviously isn't and never was a smoker. And it is a bit personal; others like to tell me what to do and why it's easy. Vaping is about to be regulated out of existence by people who don't give a shit about the ramifications.


I just got a "breaking news" notification saying the CDC is recommending not vaping at all. This is definitely going to have some effect.


Do they provide context?

You shouldn't vape and you shouldn't smoke, but plenty of people do unhealthy things for reasons that are difficult to explain and/or understand.

So, is this a "finger wagging" recommendation, or is there a tangible reason to avoid vaping?


It's pretty misleading that all the headlines are just calling this "vaping-related" when the actual cause is probably bad THC oil. How many people are going to stop vaping nicotine and go back to cigarettes after hearing about this? The number probably isn't zero, and those people are going to be at a greater risk for a litany of awful illnesses.


>It's pretty misleading that all the headlines are just calling this "vaping-related" when the actual cause is probably bad THC oil.

That's pure speculation on your part.

All of them are vaping related, but not all necessary THC related:

>Many patients report using e-cigarette products with liquids that contain cannabinoid products

The might be under-reporting due to THC legality fear. Or it may not be. Who knows?

>at a greater risk for a litany of awful illnesses.

Long term maybe. But whatever this is it seems to kill pretty fast.


The Washington Post reported earlier today that this may be caused by marijuana vaping products which use Vitamin E to achieve a higher THC concentration: https://news.ycombinator.com/item?id=20898456


A majority of Americans believe that vaping is more dangerous than smoking. This kind of jounalism is literally killing people.

https://reason.com/2019/04/10/the-percentage-of-americans-wh...


> This kind of jounalism

What kind? Accurate? Is it not true that these cases are increasing and deaths have happened in close succession? A lot of these vape cartridges are being made with untested adulterants or solvents that we have no idea about, especially black market cartridges and counterfeits from other countries. Until there's more testing and regulation around what is actually in these things, they are in fact more dangerous than smoking in my opinion. Smoking causes all kinds of issues over the long term, but these vape cartridges are causing serious acute illnesses.

Maybe more dangerous is the wrong word. Vaping, at this point, is way more _risky_ than smoking, given the acute possibilities.


>What kind? Accurate?

no, the type that omits relevant information in order to scare people. nearly every article I've seen talking about the dangers of vaping has failed to mention flaws in the studies that they cite, and there's never a follow-up. numerous articles were written citing a study that burned liquid at incredibly high temperatures. A person would never use a vape that way.

In this case, we know that these people were vaping, but we have no cause. Another article came out today that found high amounts of vitamin e in THC oils these people were vaping[1]. I couldn't find a mention of that in the article.

There are an estimated 10 million people who vape in this country. We have a tiny, tiny fraction who have demonstrable health issues related to it. in those cases it has almost always been a manufacturing issue, not an issue with vaping in general. I'm not trying to say it's perfectly safe, obviously that is unlikely to be the case, but cigarettes are absolutely going to kill you.

[1]: https://beta.washingtonpost.com/health/2019/09/05/contaminan...


> it has almost always been a manufacturing issue

"If you do it right, it's harmless." Problem is, people are doing it wrong. They do a lot of things wrong, and reporting on that is quite valid. People use guns wrong, but that doesn't mean there's anything improper about reporting on people being shot.


To add to your comment, I’ve never flat out condemned vaping but I’ve always been skeptical.

I was a smoker for almost ten years before I quit.

After I quit my doctor ran some basic tests and blood work, etc. He told me that within 4-5 years my lungs would be as if I’d never smoked and that would also improve with regular exercise. That was about 4 years ago and I don’t feel the former construction in my lungs as I did back then. (Though I think I might have been a better singer, but there’s something to be said for warming up...)

Anyway even after ten years of smoking and finally quitting my risk of any disease is extremely low—but only because I quit completely.

The surge in popularity of vaping surely would draw in some less scrupulous device and cartridge manufacturers.

Edit: Thought I should add a point of clarity here that I wouldn’t recommend cigarette smoking instead! Better off just to take a week away from work and hold up in bed if you’ve had a hard time kicking it. It’s those first couple of days that are the very worst.


The NHS claims that smoking is 95% more likely to be more dangerous than vaping. Isn't that important issue to consider?

https://www.google.com/amp/s/www.independent.co.uk/news/heal...


Only if you believe firstly that people only smoke e-cigarettes as a replacement for cigarettes, which is not true, and secondly that quitting smoking is not possible without using e-cigarettes, which is also not true.


I still am convinced that this is people vaping way too much at one time. Cannabinoids are “sticky” oils, i.e. pretty good binding agents. It’s plausible that a carcinogen (in an e cigarette) is binding to them that would otherwise be metabolized and creating a negative side effect.

I do think vaping is probably better than smoking, but it is probably ideal not to be addicted to nicotine. It is much more dangerous to your long term health than either THC or alcohol (assuming you’re not an alcoholic).

Best to lay off vaping weed and nicotine at the same time for now. That seems to be the common thread in these cases.

As someone who only vapes weed, I have to say I’m not too worried.

Edit:

Corrected brain fart of saying “weed and marijuana” instead of “weed and nicotine”.


What do you mean by:

  vaping weed and marijuana at the same time
? Or do you mean weed + nicotine?


Yep, thanks.


It would seem appropriate to caveat the fact in the headline that the vast majority of these cases were vaping with THC related products (although a majority had used a nicotine related product as well, exclusively nicotine related cases are much fewer).


I mean it's not surprising, considering that the only thing you should be breathing in is air, not anything else. (not that I personally follow that rule though :\)

I wonder if it's an ingredient that's used to make it taste better - since the article posted an item of the "fun" flavored vape liquid.

I don't think we should outright ban these devices like the one doctor mentioned in the article. Find out what specifically is causing the problem with lung deterioration and ban that ingredient from the mixture (Probably vitamin E acetate according to the article). Seems fairly simple.


I think Air has lost it's quality too, so breathing it is in need of some cannabis to offset the carcinogenic particles- just don't smoke E acetate or any other substance with it, keep the grow clean of chemicals and you will have healthy lungs IMHO. You do see studies of cannabis smokers having healthier lungs than non-smokers and nicotine smokers.


You need to update your information.

Cannabis smoke, like any smoke generated from combustion of plant matter, contains a number of carcinogenic compounds. Smoking cannabis does not cure cancer. Quite the opposite.

Your position that breathing air is unhealthy without cannabis is quite interesting. I'd love to see some of the studies you're talking about. I have never seen a study concluding that smoke inhalation is a good thing.


I keep seeing this headline, reading the articles and being disappointed that none of them seem to differentiate between cannabis/tobacco oil vaping (e-cigarettes) and dry-herb vaping. Dry her has no other chemicals, and no fillers. It just boils the THC/CBD and other cannabinoids out of the leaf. There is no smoke, and the vapour is pretty much colourless. It's very easy on the lungs and much better (and cheaper, I find) than smoking it.

Those oil based vapes just seem nasty. Smaller vaporizer though, I guess.


https://leafist.com/news/health/are-cannabis-vape-pens-safe for a brief overview of the extraction process —- but as another commenter mentioned, the issue is there’s no verification. If you want to make real use of a blockchain, it’d be to tag all these cartridges with a QR code that is tied to specific farm, and there would be a third party that the county would require to test the contents. Then when I purchase I can view it on some public chain. This already happens for large scale growers at (reputatable) dispensaries who sell flower. Most larger companies (Marly Naturals, Jetty Extracts, to name a couple) in the cannabis space typically have good quality. As far as the nicotine vapes, it’s less regulated so you’re more likely to get some bad “juice” from a place with low/no standards.


There was a similar story on HN a few days ago. I found this thread to be a really interesting take on the possible cause:

https://news.ycombinator.com/item?id=20855683

TLDR: Vaporizer cartridges contain fillers. The fillers are apparently very expensive. The theory is people in the industry are trying to boost profits by using cheaper (never tested on humans) fillers that are potentially damaging to health. Whether or not this is true, I don't know, but it makes for an interesting theory.


It feels like this is going to end up being very similar to the melamine milk situation in China in 2008 https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal


The british NHS claims that vaping is at least 95% more safe than smoking.

https://www.google.com/amp/s/www.independent.co.uk/news/heal...


It blows my mind how HN which can discuss many issues in a nuanced and skeptical way is so reactionary and treats government press releases with so much credulity when a mind altering substance is involved.


Michigan banned flavors is going to cause a surge of this when people start to DIY it.


If it just killed the smoker unlike cigarettes, liberty issue.

At best same treatment as cigarette


“Surged” from zero to five.


This all seems like such terrible journalism. Vaping can refer to: 1. Juul and similar e-cigarette nicotine products 2. Iqos or Pax tobacco or marijuana non-combustion products 3. Legal Cannabis oil branded products 4. Illegal cannabis oil products.

All issues have come from illegal products. No brands are mentioned. Clearly, contamination is the issue. It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common.

About 10 people a day die in swimming pools. But 4 total deaths ever is an epidemic?


>It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common

Is it irresponsible to criticize OxyContin because an alternative like fentanyl is even more dangerous?

Vaping might be safer than smoking, but it isn't necessarily safe. Vaping can and often is used by smokers to handle their nicotine addiction. That doesn't mean we should ignore that vaping can of often is used by people who aren't yet addicted to nicotine, namely teenagers. In those cases it can lead to nicotine addiction and eventual smoking.

I don't want to completely vilify vaping, but the whole idea that we should be fine with it because it is "safer" is completely flawed.


It's irresponsible because it's ignoring a very clear factor in all these cases is that they're all linked to illegal, off the street goods filled with who knows what. It would be more akin to saying oxycontin is bad because people die from contaminated heroin. Not that oxys don't have their own dangers and addiction issues.


I'd like to understand why you think it is completely flawed. That is a strong statement that confuses me.


Because it sets up a false dichotomy that one can either be anti-vaping/pro-smoking or pro-vaping/anti-smoking. It is possible to recognize that vaping is safer than smoking but it is still dangerous and provides enough negative externalities that it should be highly discouraged.


Ok, fair enough. But you'd agree, then, that the degree of discouragement should be proportional to risk, right?

And that's where the 10 people per day dying in swimming pools seems relevant to bring up. Or the fact that 67% of smokers die from smoking, with hundreds of thousands of deaths per year. Or the fact that a majority of Americans believe that vaping is more harmful than smoking. https://reason.com/2019/04/10/the-percentage-of-americans-wh...

That's weird, right?


>But you'd agree, then, that the degree of discouragement should be proportional to risk, right?

Yes partially, but it should also be proportional to the public's knowledge too. That is why some products are recalled after a single accident. It isn't that people are destined to die. The problem is instead when people assume the level of risk is low when it is actually moderate. That can be more dangerous than a riskier option in which everyone knows it is risky. For example, a swimming pool is unquestionably more dangerous than a trampoline. However most parents know a swimming pool is dangerous and won't let their kids swim unsupervised. They might not be aware of the dangers of trampolines. That asymmetry in the knowledge of the risks might end up making the trampoline more likely to result in an accident.

The general public thinks vaping is safer than it is. The general public is already very well aware how dangerous smoking is. I therefore think it is perfectly reasonable to be louder in denouncing vaping, especially considering this recent news seems to show it is even riskier than initially thought.


Check this article out. I see where you are going, but we are talking about an alternative to smoking, which is really bad.

https://www.bmj.com/content/360/bmj.k575


Sure, but that is missing half the equation. Every person who vapes is not a person who previously smoked or would have chosen to smoke if vaping didn't exist. The rate of the growth in vaping is much higher than the rate in decline of smoking. Like I said before, vaping can help people who are already addicts become healthier, but it is also creating new addicts and that is a problem.


I like to vape. I like to drink coffee. I like potato chips. All are addictive. If potato chips and coffee were released in 2019, would they be banned in San Francisco because they are addictive and dangerous for public health?


If OxyContin and fentanyl were both available at grocery stores, and a bad batch of poorly formulated street Oxycontin caused a slew of numerous deaths. And the blame causes more people to switch to fentanyl then Oxycontin that blame could be dangerous


> Is it irresponsible to criticize OxyContin because an alternative like fentanyl is even more dangerous?

Except that "fentanyl has a higher therapeutic index than morphine (400 vs 70)". Meaning that the difference between a therapeutic dose and lethal dose is much bigger with fentanyl (ie: safer!).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312206/

The main issue with fentanyl is that it's potent. Which our supply-driven interdiction system has favoured the movement toward.

But so potent that intermediaries can't mix it up right outside of a proper lab.


The issue which I understand is primary with fentanyl is purchasing black market fentanyl and selling it on the street as heroin or whatever other opiate and cutting it with various things leading to a wild variety of potency of street drugs, even within the same purchase (poorly ground, poorly mixed) which leads drug users to overdose much more frequently.

Fentanyl, absolutely is safer than many other popular pharmaceutical opiates but only when the dosing is done competently and accurately (even someone abusing opiates is safer using fentanyl IFF they are capable of knowing and distributing their desired dose)


Exactly. It would be better to dissolve easily-measurable-at-home quantities into large volumes of fluid, but it's hard to make powdered synthetic H substitutes that way.

Properly micronized and triturated, synthetic H made with fentanyl would be very safe stuff. Unless you could afford enough to OD yourself, which you might now be able to at the prices it could be sold at.


Are you certain this is only happening from illegal products?

Here are pictures of brands new york has flagged: https://www.flickr.com/photos/nysdoh/sets/72157710703391248/

And according to this article: https://beta.washingtonpost.com/health/2019/09/05/contaminan... a man died after using a product purchased from a dispensary:

  a middle-aged adult who died in late July of a severe respiratory illness had used an e-cigarette containing marijuana oil purchased from a legal dispensary. It’s the second death linked to vaping nationwide and the first to be linked to a product bought at a store.


These are not actual brands. Black market vape manufacturers buy generic packaging that is sold to anyone. There's no actual company behind these "brands". They exist only on the black market.


Decent article on buying boxes and how "brands" like Dank Vapes can have a social presence on IG and other platforms but avoid responsibility for "official" or "unofficial" products.

"They act like a cannabis company, but they actually don’t exist. They’re in the packaging industry," ... "These are just people filling cartridges as 'Dank Vapes.' It's not a singular facility. It's just people in their garages filling them and selling them.”

https://www.inverse.com/article/58581-dank-vapes


Thanks for that info


The title of your first link is literally "Pulmonary illnesses associated with black market vaping products"


thanks for that, flickr cuts off a significant portion of the title for me:

  Pulmonary illnesses associated with b...
I also don't live in NY so I don't know those brands; the fancy packaging makes it appear similar to much of the recreational stuff I've seen in other states.

The second point still stands.


I'm not hip to all the various state's stands on THC/CBD containing products, but from your first link:

>Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing. Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products that were tested.


I suspect it is only illegal products because they have only shown pictures of brands but not actually referred to any brands in the text of the article. I find that strange.


“All issues have come from illegal products.” You confidently state Yet claim terrible journalism...


One man died from _legally_ bought cannabis oil.

https://www.usatoday.com/story/news/health/2019/09/05/vaping...


That’s not entirely clear, it’s just stated that he purchased from a dispensary. That doesn’t mean that’s the product that caused his issues, that he never used (cheaper) black market products, etc.

https://www.google.com/amp/s/www.nytimes.com/2019/09/05/heal...


This is as much the CDC's fault, it seems like, digging in to the underlying sources.


This is the FDA's wheelhouse. CDC handles epidemiology.


epidemiology

> the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

disease

> a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

Is this not a disease? One of which the actual cause is still unknown and symptoms hitherto unseen? I guess it could still ultimately be the result of physical injury to the lungs, but it still seems up in the air. You may still be right, but I don't think it's as simple as "CDC handles epidemiology".


They don't regulate the use or sale of controlled substances.


Do they regulate funding of research around either the material or its affect on the human body?


Products like Juul do have harmful byproducts:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342216/


I think you misread this paper:

"Gas-phase benzene was not found above blank levels in any of the JUULTM samples for any of the four flavors. "

They detected benzene with two other tank-style vaporizers and seems benzene production is strongly correlated with wattage.


>All issues have come from illegal products. No brands are mentioned. Clearly, contamination is the issue. It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common.

This doesn't sound like that:

>The Los Angeles County Department of Public Health was investigating a possible fifth death, saying on Friday afternoon that the fatality was “associated with the use of e-cigarettes, also known as vaping.”

I'm assuming e-cigarettes are the legitimate sort.


> Public health officials have underscored one fundamental point: that the surge in illnesses is a new phenomenon and not merely a recognition of a syndrome that may have been developing for years.


I'm pretty sure these cases are all from legal retail cannabis oil products.


> It is irresponsible to blame "vaping" especially considering that the alternative is "smoking"

False dichotomy. Not consuming nicotine is also an alternative.


Not breathing is also an alternative. Perhaps I should have said that vaping is an obvious alternative to smoking


I'm unclear why it's an obvious alternative. Nothing inevitable about the use of nicotine (or THC).


except for the rich and far-reaching history of human substance use (or abuse, depending on your perspective)


Also gums, patches, etc.

I'd guess patches as the best, because the slow release breaks a lot of the fun of the addiction cycle. Apparently though, it's best to use both patches and one other NRT - https://www.cochrane.org/CD013308/TOBACCO_what-best-way-use-...

Vaping is just too much like smoking. It's basically the same habit, it's got the same quick hit, you'll have very similar rituals (leave your desk, go for a vape break, "light up", etc).

There's also the community factor. There's no nicotine patch community, but there's a vaping community. Maybe the vaping community was originally all people trying to quit cigarettes, but now it's also a gateway to people getting into smoking.


The media needs to slow their roll here. This totally has the vibe of the "Cuban sonic weapon attacks" or the "cops contact ODing on fentanyl" thing.


Maybe, but the anticipation of something like this, a concrete reason to bash vaping, has been palpable for a while now.

For a long time all they had was "it looks like smoking and smoking is unhealthy" or "nicotine is bad" or "tobacco companies are evil". Now it's "vaping will destroy your lungs and kill you". So I'd say this reaction is entirely predictable.




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