
CDC Confirms a THC Additive, Vitamin E Acetate, Is Culprit in Most Vaping Deaths - harmmonica
https://www.npr.org/sections/health-shots/2019/12/20/790154919/cdc-confirms-a-thc-contaminant-vitamin-e-acetate-the-culprit-in-most-vaping-deat
======
macinjosh
Vitamin E Acetate is _not_ a THC additive. Sure, someone sketchy in the
blackmarket added it to their product but its not a thing normal people using
THC do intentionally.

The cause behind recent fear mongering over vaping is pure and simple. Some
jurisdictions have become dependent on the revenue from the vice tax on
tobacco and have seen vaping slashing their income more and more each year.
Vaping must be made out to be dangerous so there is an excuse to tax and
regulate it just like tobacco.

~~~
nrp
People dying from toxic cutting agents that managed to get distributed pretty
broadly across the US seems like a pretty good reason on its own to regulate
it like tobacco is. Added “sin tax” revenue is just icing on the cake.

~~~
hurricanetc
There have been fewer than 50 deaths attributed to vaping.

It shouldn’t even make the top 1,000 list of things to bother worrying about.

~~~
nrp
Indeed. In the US we have the FDA and the CDC precisely so that all of us
don’t have to worry about it. Per the linked article, they seem to be doing
their jobs. The CDC has identified the likely vector for harm, and the FDA has
been cracking down on unlicensed manufacturers and sellers.

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dangus
> A health-surveillance system put in place after the terrorist attacks of
> September 2001 has been used to pinpoint the cause of the...

That’s the interesting part of the article.

~~~
capableweb
More:

> It was important to understand the timing of the outbreak as part of this
> investigation. Health officials wanted to know when exactly the problems
> first cropped up, and whether they had missed many cases before those
> initial reports. That's why they turned to the surveillance data, collected
> from more than 3,200 emergency rooms from most states.

>They found a gradual increase in emergency-room visits among people who vaped
or used e-cigarettes, starting in January of 2017.

> The surveillance system doesn't automatically flag health concerns – often
> scientists dive into the data once their suspicion is raised, as it was in
> this case. The outbreak only became apparent in the data once researchers
> defined more closely what they were looking for and focused on one age
> group.

~~~
nerdponx
> The surveillance system doesn't automatically flag health concerns – often
> scientists dive into the data once their suspicion is raised, as it was in
> this case. The outbreak only became apparent in the data once researchers
> defined more closely what they were looking for and focused on one age
> group.

I'd be surprised if there wasn't some kind of outlier detection method that
could automatically flag a sudden increase in unusual cases.

~~~
prepend
The web site has a lot of papers talking about that. They do detect spikes in
defined syndromes.

But for stuff like this that isn’t a defined syndrome and isn’t really
captured well at the hospital it’s not an outlier until scientists do a lot of
analysis.

~~~
AmericanChopper
The ETL for 3200 emergency rooms worth of data must be a nightmare. It would
have to be largely unstructured upon ingestion, and I can’t imagine
normalising it enough for this sort of automated outlier detection would be
possible.

~~~
prepend
The guide [0] shows like 20 defined fields and then free text notes.

It would be cool, but seems kind of impossible to tell a significant outlier
(vape lung) from an insignificant outlier (misspelling).

The way the article describes it, epidemiologists define a new condition (vape
lung) and then look for that.

[0]
[https://www.cdc.gov/nssp/documents/guides/syndrsurvmessaggui...](https://www.cdc.gov/nssp/documents/guides/syndrsurvmessagguide2_messagingguide_phn.pdf)

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martinald
Really, the WHO and other governmental health authorities should be throwing
_billions_ of dollars at making vaping effective and safe. The RoI is
absolutely insane - even if 10k people switch to a well researched alternative
to tobacco and avoid serious health implications (probably costing $1million
per person at a minimum in the US healthcare system), that's $10bn saved. You
multiply that by around a billion worldwide smokers and the public health
benefits are absolutely crazy. Probably on the order of tens of trillions of
dollars, maybe even a quadrillion dollars over the next century.

~~~
forrestthewoods
I have very bad news for you.

Smokers (and the obese) are cheaper in health care costs than non-smokers.
Why? To be blunt, because smokers die early.

Keeping someone alive into their 90s is more expensive than someone who dies
of smoking derived illness in their 70s or younger. This is similarly true for
the obese.

[https://www.nejm.org/doi/full/10.1056/NEJM199710093371506](https://www.nejm.org/doi/full/10.1056/NEJM199710093371506)

~~~
chiefalchemist
Yes and no.

The use less. But they also are able to contribute less.

That said, yes a whole lotta money is spent on the last 0 to 6 months (or so)
of life. From what I understand, this is a USA only problem.

~~~
cm2012
Don't people more or less stop producing economic value at age 60 on average?

~~~
chiefalchemist
Obese people? Dying of diabetes related or heart attack? They going younger
than 60. Furthermore, they're missing work, are less effective, etc.

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DenisM
In case you wondered where "Vitamin E Acetate" comes from:

> Further research focused on vitamin E acetate, which is used in some of
> these preparations to dilute the much more expensive THC oil.

~~~
ianai
Further, it’s synthetic. I don’t think it exists in any food sources
naturally. Probably shouldn’t be in lung tissue:

“vitamin E acetate, is a synthetic form of vitamin E. It is the ester of
acetic acid and α-tocopherol” (Wikipedia)

~~~
TTPrograms
I'm not sure the addition of white vinegar should be of any particular
concern...

[https://en.wikipedia.org/wiki/Acetic_acid](https://en.wikipedia.org/wiki/Acetic_acid)
[https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa....](https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2016.4412)
\- "The substance readily hydrolyses"
[https://en.wikipedia.org/wiki/Lipid_pneumonia](https://en.wikipedia.org/wiki/Lipid_pneumonia)

~~~
heavyset_go
Food safe doesn't mean its aerosol or combustion products are safe to inhale.

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MiroF
Mods- could we edit the title? Vitamin E is not a "THC additive"

~~~
bitxbitxbitcoin
It's a vape juice additive and this problem only arose because of the
prohibition.

~~~
AmericanChopper
It’s an THC product additive, that’s not used in non-THC vape juices. The
title is perfectly accurate, even if it could be a little more verbose. I know
a lot of commenters here have a vested political interest in promoting
marijuana and its derivative products as safe, but you can’t change the facts
because of that.

~~~
MiroF
I believe the CDC also found it in illicit nicotine cartridges

~~~
AmericanChopper
The CDC have not found it in any nicotine cartridges. The CDC have also not
found the substance in the lungs of any vape users who didn’t use THC
products. There are also jurisdictions which have reported finding it in 100%
of seized THC cartridges.

~~~
MiroF
It was found in carts that had THC and nicotine combined. That makes it about
as much as a nicotine additive as a THC additive, if we are using the
incredibly low standards of "found in coexistence with substance sometimes" as
the definition of additive.

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stjohnswarts
The british have a perfectly sane and working way of handling vaping products
and e-cigarettes, the USA could easily copy them in how it's regulated. The
USA is just too damn proud to ever copy something another country is doing,
even if it's vastly superior to what we're doing currently.

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jcampbell1
Given the scale, a Mexican cartel was almost certainly the source of the bad
carts. It just makes sense that someone there ordered a few barrels of vitamin
e acetate from China and the problem appeared suddenly across the US but not
in Canada and much less in states with legal carts.

~~~
susijdjdjxa
If you’re going to go and blame Mexico, you ought to have at least a bit of
evidence.

~~~
stjohnswarts
oh no, he's picking on the Mexican cartel that is the primary source the
majority of drugs in the USA. That's really hurtful to them I'm sure.

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rolltiide
So how fast does this happen?

Taking a hit from a friends vape of unknown origin and substance still cool?
Or is that insta KO

~~~
stjohnswarts
don't do it if people are trying to vape THC or just black market pods. Just
get your own and do it legally or simply tell them nope and pass on the hit.

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jokesnotfunny
I am curious, how it wasn't already known to people working at these vape
manufacturing companies?

~~~
sjnair96
Vitamin E dilutions have only found in blackmarket THC vapes. There's simply
no need for legitimate vendors to dilute product with vit E Acetate.

THC Distillate which is the base for most THC cartridges is made from any and
all cannabis biomass or 'leftovers' from other processes. Since it's a highly
pure (~94%) extraction, in terms of cannabis extracts, there is no worry about
the starting products' quality/looks/smell as is the case with most cannabis
products. All this results in this high-purity substance being much cheaper,
and very high value for the customer.

The legitimate cannabis industry has dabbled with other diluents though (such
as PG/PEG/VG and most commonly terpenes), mostly to help the very viscous THC
distillate work with the cartridge hardware. However, nowadays, cartridge
technology has improved so much that it is possible to use very viscous THC
distillate in most cartridges. These legit vendors have known about various
issues related to health concerns, due to health-savvy cannabis users.
PG/PEG/VG are almost completely phased out for terpenes, which are currently
seen as the better alternative (compared to PG/PEG/VG, not that it's safe).
I've never come across legal cannabis vendors discussing Vitamin E as a
dilutant in my research.

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droithomme
Obviously then ban Vitamin E, just as these imbeciles once banned Tryptophan
and Ephedra.

~~~
wahern
You can buy ephedra in supplements, and ephedrine over the counter as
Primatene or Bronkaid. Primatene is the perfect cold remedy--ephedrine to
clear your nasal passages and guaifenesin to loosen mucus. Bonus that
ephedrine gives you some zip, especially if you're in the minority of people
whose viral-induced sneezing and runny nose is responsive to OTC
antihistamines, which can sometimes make you drowsy (not as much of an issue
for me since cetirizine went generic).

Warning: both ephedrine _and_ guaifenesin increase blood pressure, so take
care if that might be of concern.

~~~
mkagenius
> not as much of an issue for me since cetirizine went generic

Yes, fexofenadine is great (for me at least)

------
catalogia
Vitamin E Acetate may be the cause of the fatalities, but that's not the full
extent of the problem. Lack of testing or fraudulent testing for pesticides
seems to be a serious issue as well:
[https://www.thestranger.com/slog/2019/01/07/37770867/why-
eve...](https://www.thestranger.com/slog/2019/01/07/37770867/why-every-
washington-pot-smoker-should-be-worried-about-californias-weed-recall)

Beyond pesticides, I'm also generally skeptical of some of the solvents used
for extraction. Supercritical CO2 extraction should be perfectly fine, but
apparently not every brand is using that.

~~~
meowface
I stopped all use of cannabis vape pens after reading a study that found lead
often leaches into the oil cartridge over time (I believe from the pen and/or
the metal contact on the cartridge). I imagine there could be other risks, as
well.

Vaping is definitely safer if implemented ideally, but it looks like the
ultra-portable solutions are mostly still pretty sketchy.

~~~
catalogia
Vaporizers that use ground up bud instead of concentrates seem ideal to me;
it's much harder for producers to adulterate the product in that form.

I get the impression this style of vape has started to go out of style though.
Which is a shame because it's much more efficient than smoking, particularly
if you save the toasted weed to make edibles with (extraction using food-grade
coconut oil, butter, etc in your kitchen is very easy, or since it's already
toasted you can even consume it without any processing.)

~~~
calgoo
There are a lot of new models coming out each year. However, the oil vapes
tend to be easier to use when out on the street or in a place where it’s
forbidden to smoke / vape as they leave very little trace and smell. But even
with the dry vapes you have to be careful what you buy as some of the cheaper
ones use plastics that can’t take the heat, causing you to inhale plastic
fumes. For example, most of the snoop dog branded vapes.

~~~
stjohnswarts
I guess I don't understand people using black market oil based anything since
you obviously never know where it came from or it's the same stuff that the
CDC says is destroying people's lungs. Just seems like survival of the fittest
(in this case brain power) after you hear about all the people dropping like
flies.

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perl4ever
I expect the other 90% of the iceberg is food and prescription drugs.

This is like how people gossiped about Boeing management for years before the
737-MAX finally demonstrated the consequences.

Or how people have smothered their doubts about the President because the
market has been going up.

