
CDC says stop vaping as mystery lung condition spreads - tinyduck428
https://techcrunch.com/2019/09/06/cdc-says-stop-vaping-as-mystery-lung-condition-spreads/
======
zelienople
Several things have failed to show up in the comments that might illuminate
this discussion.

(1) The condition is called lipoid pneumonia, which comes from inhaling
organic fats and oils.

(2) The CDC reports and early studies indicate that the condition has appeared
in some people who only vaped with nicotine in glycerol (which is also
sometimes called glycerin or glycerine).

(3) Glycerol (the Christmas molecule--HO HO HO) is a type of alcohol called a
polyol, meaning that it has multiple (in this case, three) hydroxyl groups on
a carbon chain.

(4) Glycerol is not a fat and cannot be responsible, on its own, for lipoid
pneumonia.

(5) However, glycerol is the precursor to fat synthesis in the body:
triglycerides, for example, are fats metabolized from glycerol.

(6) The reaction of glycerol -> triglycerides in the body is catalyzed by
nicotine-containing enzymes mostly present in the liver, but expressed to a
lesser extent in every cell.

(7) The reaction of carboxylic acid (derived from CO2) with glycerol creates
fatty acid esters through the process of acid-catalyzed esterification.

(8) The key unanswered question is where does the fat that is found in the
macrophages (a type of white blood cell whose function is to engulf and digest
foreign substances) that is the sine qua non of lipoid pneumonia come from.

(9) Many vapers are formerly heavy smokers, meaning that they have some degree
of chronic lung disease, that they retain CO2, and are very likely to have
respiratory acidosis.

(10) Elevated CO2 also occurs in many other circumstances, such as opioid use
and sleeping in poorly ventilated conditions.

(11) If the early reports are correct that lipoid pneumonia is occurring in
vapers who have only used nicotine in glycerol with no flavoring or
impurities, then we must ask the question: Is glycerol being converted to
fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-
catalyzed esterification in the presence of high CO2 levels and acidity?

~~~
otakucode
Whatever the cause, it has to be something extremely subtle and very unlikely
to occur. We know that from the simple numbers. Tens of millions of people
vaping on an hourly basis for years amounting to ~500 cases means that
whatever is occurring is a freak occurrence and not some direct consequence
that has a high likelihood of occurring in typical people.

~~~
metamet
And isn't one of the common threads within this whole thing the presence of
Vitamin E acetate within the oil?

Earlier reports were suggesting that contaminated oils may be part of the
cause, which could explain why all these cases are hitting at once. Not sure
on the process of making these oils, but I could see new methods being
introduced causing unforeseen side affects.

~~~
davinic
The initial NY report mentioned also that they were likely counterfeit
products, which I could easily see as being prone to use an unsafe
substitution.

------
johngrefe
I had a startup in Vaping(nicotine) and am still fairly in touch with the
industry. There has been no major innovation in nicotine eliquid that would
cause a sudden cluster of issues. It's stayed pretty constant since 2013 with
the exception of Salt Nicotine, which Pax labs has a gras study published for.

The majority of cases seems to be THC carts where it can be confirmed. One
case was confirmed from a dispensary in Oregon. The "Dank Vapes" carts are
sold on eBay/AliExpress and anyone can fill them with anything. Reading on
here the VitE may have been to increase potency is not something I'm familiar
with since I'm not in the TCH trade, but I do know that synthetic vitamin E is
made from a petroleum product precursor, and a food grade level of
purification may not mean a quality to which it should be vaporised and
inhaled.

CDC's reaction is over the top, especially next to the FDA which is offering
more precise warnings of avoiding THC carts. Be safe if you're using these thc
products, especially since even larger suppliers have trouble tracking supply,
bank accounts and company formation that typically cleans up quite a bit of
the bad actors from an industry. Nicotine vapes have matured significantly
because of this moving to clean labs and central production of the liquid.

~~~
atlasunshrugged
As someone who was in the industry, what do you think about the argument of
vaping being a safer alternative? I see pretty mixed things in the health
community but it's tough because some of the argument seems to be that the
tobacco industry has acted nefariously in the past so we can't trust any
innovation in the space.

Is there any known experience similar to vaping/smoking of today that has
really minimal health consequences but maybe isn't as addictive?

~~~
Reelin
> vaping being a safer alternative

A safer alternative to what? Smoking cigarettes? There's absolutely no
question that it is.

One is a plant product (smoke is bad to inhale) that naturally contains a
number chemicals that you probably don't want to be consuming. On top of this,
there are additional additives (which vary by manufacturer) that also have
significant health effects. Overview
([https://en.wikipedia.org/wiki/List_of_additives_in_cigarette...](https://en.wikipedia.org/wiki/List_of_additives_in_cigarettes))
and more details
([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040350/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040350/)).

The other is almost entirely a mixture of Propylene Glycol and Vegetable
Glycerin.

...except when it isn't, as seems to be happening here. The safety of vaping
is _entirely dependent_ on what's in the liquid you're vaporizing; always keep
that in mind when purchasing it.

Also, do bear in mind that it's probably not fantastic for your health to be
chronically inhaling anything other than highly purified air, no matter how
benign it may seem. Relative to smoking cigarettes (or any other plant
product), it's much safer. Relative to not vaping at all, there are likely to
be at least _some_ health risks, even if they haven't been clearly established
yet.

> Is there any known experience similar to vaping/smoking of today that has
> really minimal health consequences but maybe isn't as addictive?

If you're asking about drugs with similar effects to nicotine that are less
addictive, I'm not aware of any. You could always purchase vaping liquid that
doesn't contain any nicotine though.

~~~
cowsandmilk
> The other is almost entirely a mixture of Propylene Glycol and Vegetable
> Glycerin.

What an extraordinary meaningless statement. The question is the health
effects of vaporizing those and inhaling them (along with other ingredients).
You are happy to provide links about health effects of cigarettes, including
ingredients present in n minute amounts, but will only provide a list of major
ingredients in vaping products and provide no evidence on whether inhaling
them is safe or not.

I believe the current scientific consensus is that more research is needed.
These are fairly new products and studies have only started. There are
definite impacts on the lung physiology and the heating process does cause
chemical reactions between flavorants and the carrying solution creating new
compounds such that even if the flavorants and major ingredients are safe
independently (which they aren't, see next link), there are byproducts that
are produce that may not be[2]. The glycerol in commercial vaping solution
seems to be a source of impurities that are known to be harmful[3].

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/31483291](https://www.ncbi.nlm.nih.gov/pubmed/31483291)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/30335174](https://www.ncbi.nlm.nih.gov/pubmed/30335174)

[3]
[https://www.ncbi.nlm.nih.gov/pubmed/31460462](https://www.ncbi.nlm.nih.gov/pubmed/31460462)

~~~
Reelin
> > The other is almost entirely a mixture of Propylene Glycol and Vegetable
> Glycerin.

> What an extraordinary meaningless statement.

Not at all. The point being made is that we're dealing with a product composed
primarily (99%) of two chemicals that are very clearly established as safe for
human consumption (propylene glycol is commonly _injected_). As such, it seems
unreasonable to assume absent evidence that the chemicals themselves would
pose any significant threat to health.

That leaves other additives (which I noted) and the inhalation itself (which I
also noted). As I stated in my previous comment, chronic inhalation of
_anything_ is likely to be bad for your health.

You really seem to have missed the context of the question I was responding to
- it asked not about absolute safety, but rather safety relative to cigarette
consumption.

Yes, as you note, there is always the potential for chemical reactions when
mixtures are heated. Given the particular chemical composition and
temperatures involved, I'm not personally concerned absent solid evidence.
None of the byproducts listed in the study you linked appear particularly
worrisome to me. Compared to cigarette, weed, or wood smoke, the contents of
vaping such aerosols appears downright healthy. (Only in comparison, of
course!)

Rereading my previous comment, something I failed to mention is the risk of
inhaling things that are too hot. Depending on what temperature the aerosol is
heated to, it could burn you internally (but then we're comparing this to
inhaling burning plant matter, so... meh).

> I believe the current scientific consensus is that more research is needed.

To establish what, their precise negative health effects? Of course. But not
to establish that they are safer than smoking cigarettes - there's absolutely
no question about that.

~~~
Retric
Fog machines also use a glycol solution, and have been shown to be harmful.
Thus vaping glycol may not be safe.
[https://www.cdc.gov/niosh/hhe/reports/pdfs/1990-0355-2449.pd...](https://www.cdc.gov/niosh/hhe/reports/pdfs/1990-0355-2449.pdf)

~~~
Reelin
The report you linked shows quite the opposite, actually. They concluded:

> Based on the results of this study, there is no evidence that theatrical
> "smoke," at the levels found in the theaters studied, is a cause of
> occupational asthma among performers.

That being said, chronic exposure is probably not good for you. From a health
perspective, don't inhale anything other than air!

~~~
Retric
Asthma is only one of many possible heath impacts. It was associated with
others, just not Asthma.

 _When compared to actors from the non- "smoke" productions, actors from two
or more of the four productions utilizing theatrical "smoke" reported
experiencing a significantly greater prevalence of nasal symptoms (sneezing,
runny or stuffy nose), respiratory symptoms (cough, wheeze, breathlessness,
chest tightness), and mucous membrane symptoms (sore throat, hoarseness, dry
throat, itchy/burning eyes, dry eyes) during their performances for the week
prior to the survey._

The final line is: _The quantity and frequency of use of the various fogs
during a performance should be minimized._

PS: A method of action was suggested to be the breakdown of glycol due to high
temperature.

------
testis321
Vaping is great!

Take someone who smokes two packs a day, give him a niccotine vape, and he
gets all the 'high' he needs to fuel his addiciton, with (by some sources)
only 10% of the "bad things" going in his lungs (compared to cigarettes). Less
coughing, easier to reduce the dosage (just buy a liquid with less nicotine -
you still keep your rutine and cigarette breaks, but slowly lower your
addiction level).

...but...

Then youtubers with smoke challenges come, and tutti frutti bubblegum pina
colada reeses pieces flavoured liquids come... and 13yo kids (that would never
have smoked otherwise) start buying vapes. And not just any 'normal' vapes
(that the people from the top of this post use), but the ones with very high
power heating elements, producing HUGE amounts of smoke (for the youtube
likes), and making the "bad stuff" intake into lungs comparable to actually
smoking 2+ packs of cigarettes.

...and now, when even that's not enough, someone's selling some "special" (or
just really shitty, but really cheap) e-liquids, that make you sick.

~~~
atlasunshrugged
I think if it really was purely a device for cessation then this could be
solved by putting it behind the counter and requiring a prescription. I
remember before weed was legal in California there would be a doc office next
to a pot shop and you would get your prescription and then walk in. I imagine
there would be a market for people who wanted to quit to go to a 5 min doc
meeting, they'd verify you're a smoker and write you a prescription and then
you could pick it up with any flavor your heart desired. That said, I'm not a
big fan of creating another inefficiency in the healthcare market but it does
seem like a way to stop the secondary effect of new users entering the market
in a major way by creating a nontrivial hoop to jump through

~~~
tom_mellior
"Inefficiency" is a weird word for including doctors in healthcare.

~~~
atlasunshrugged
I'd say it's an inefficiency in the case I referenced because I don't think
it's 'healthcare' per se. If you go to your primary care physician during a
checkup or because of an issue (even if it's this specifically) then I would
consider that healthcare, but what I saw was basically this tack on service
that was rubber stamping anyone who paid $X for an appointment as cleared to
use medical marijuana and I would consider than an inefficiency since the step
was purely created as an administrative hurdle

------
milofeynman
The thing causing this outbreak seems to have been someone using a vitamin e
oil to increase the potency of their thx carts up to 95% or so. [0]

I also believe they were out of Chicago. Or at least they shipped a lot of
carts to Chicago/Illinois and then they spread out from there. But this is
just from the cases I've read.

Also from today _Doctors have identified previously unrecognized
characteristic of the vaping-related respiratory illness that has been
emerging in clusters across the U.S. in recent months. Within the lungs of
these patients are large immune cells containing numerous oily droplets,
called lipid-laden macrophages._ [1]

[0] [https://www.theverge.com/2019/9/5/20851866/cdc-fda-
investiga...](https://www.theverge.com/2019/9/5/20851866/cdc-fda-
investigation-vaping-lung-illness-vitamin-e)

[1]
[https://www.reddit.com/r/science/comments/d17qm9/doctors_hav...](https://www.reddit.com/r/science/comments/d17qm9/doctors_have_identified_previously_unrecognized/)

~~~
perseidbath
From a thread on Reddit[0], written by a cannibis biologist:

“The reason [vitamin e is] being found in black market carts is because black
market manufacturers are incentivized to dilute out their product as much as
possible to maximize profit. They don't have to provide you with potency
numbers, they just need the cartridge to look plausibly full of distillate.

This means they use any of the aforementioned dilution methods, or even other
less safe methods and wind up with a thing and runny product that is obviously
not high purity distillate.

So what do they do? They thicken it back up to be more believable. This is
where Vitamin E acetate comes in. It can reliably dissolve a large range of
organic compounds but is also similarly viscous to Maple syrup. This means it
can be used to dilute distillate or thicken up heavily cut distillate, but
leave it looking comparable to an actual high quality distillate. Thus they
can turn a 1g cart into 5 1g carts, for the low low price of the health of the
end user.”

[0]
[https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clea...](https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clearing_up_the_ongoing_vape_scare/)

~~~
milofeynman
That person is incorrect. I know a toxicologist who actually had one of the
carts tested due to a patient with these symptoms and the high potency was
accurate. Not something I can source but the data is out there in the
toxicology circles.

~~~
MiroF
I've also heard talk that Vitamin E does something to increase the potency?

------
v64
It's my opinion that the media has been irresponsible about its reporting on
this issue, wildly jumping to conclusions before any actual facts have been
established. Some of the most egregious reporting I've seen conflates vaping
from e-cigarettes with dry plant vaping, which is an entirely different
process.

Furthermore, vaping in this form has existed for over a decade, so if any of
the health problems were related to the process itself and not contaminated
cartridges, these issues would have already arisen. However, the media
continues to report as if it's a fact that vaping is dangerous.

Reports are also coming out that users who originally stated their ailments
came from nicotine cartridges are admitting they were actually using THC
cartridges and lied because they feared the legal repercussions of admitting
they were using illegal substances. I've yet to see a credible report linking
a serious ailment to nicotine vaping.

As a vape user myself, there's no doubt in my mind that inhaling substances
into the lungs may cause serious side effects in some individuals. But until
the facts are released by the CDC and other medical authorities as to what the
primary cause of these ailments are, the media needs to cease this fear
mongering clickbait FUD.

~~~
freeone3000
So: there's an unknown number of contaminated liquid vape cartridges, all of
which so far were THC? And since the substance is illegal it's going to be
impossible to do a recall. This is a major health risk, and I wouldn't vape
liquid THC for the near future.

~~~
v64
My understanding of the issue is that the THC cartridges causing these
problems are all done by unregulated black market producers. THC cartridges
have been available for years in a number of legal states and there have been
no reported issues with those cartridges purchased from licensed dispensaries.
I've lived in legal and illegal states, and I would not buy or use black
market cartridges. To further conflate things, many black market cartridges
steal the branding of legitimate cartridges in order to pass themselves off as
authentic.

Individuals can and should make their own personal decisions regarding their
usage. My issue is with the media's inaccurate reporting causing people to
make these decisions based on incorrect data. For instance, you have people
who nicotine vape who are now concerned about their usage, despite the fact
there's been no conclusive evidence linking these ailments to nicotine
cartridges.

Conspiratorially, I have a feeling there are many corporate players who would
benefit from and encourage this kind of fear mongering, but that is my own
personal baseless speculation.

------
phnofive
Source: [https://www.cdc.gov/media/releases/2019/p0906-vaping-
related...](https://www.cdc.gov/media/releases/2019/p0906-vaping-related-
illness.html)

CDC’s actual recommendation:

“What the public can do

While this investigation is ongoing, people should consider not using
e-cigarette products. People who do use e-cigarette products should monitor
themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea,
vomiting, abdominal pain, fever) and promptly seek medical attention for any
health concerns.”

~~~
_fizz_buzz_
That's the exact quote that is also in the article ...

------
jaequery
They can start by listing what type of or what “brand” of ecigs and cartridges
these patients were vaping. I don’t know why they won’t just do that, the
public deserves to know that information. Like catching a suspect.

And if it is indeed THC related, there’s gotta have some form of traceability
in place so it shouldn’t be that hard to find the source of the issue.
Something about it all just has a weird vibe to it.

~~~
milofeynman
If I have put the pieces together correctly, they were sketchy THC carts that
used a vitamin e oil to achieve super high concentrations of THC (95%) or so.
Normal THC carts don't have that high of a concentration. I'm guessing some
backyard chemist realized they could cram more in using vitamin e oil over the
more standard vape oils used (propylene glycol, etc).

~~~
davewritescode
It's not to achieve high concentrations, it's to disguise the fact that it's
been cut at all.

Distillate that's minimally cut will typically be very very thick. The more
it's cut, the thinner and runnier it will be. Customers figured this out and
started equating runny pens with low quality.

Dealers basically responded by using cuts that aren't obvious. This doesn't
make the concentration any higher but fools the end user.

~~~
qes
Are you sure? Because it's not that easy to dissolve cannabinoids, except in
lipids. I haven't been into making carts myself in a number of years, but back
when I did the major hassle and challenge was actually getting your extract to
dissolve, and people were experimenting with formulations to get better
mixtures with less effort and heat.

------
Merrill
Inhaling anything other than pure air has always seemed like a bad idea. Bob
Newhart just turned 90...

>INTRODUCING TOBACCO TO CIVILISATION ...
[https://monologues.co.uk/Bob_Newhart/Tobacco.htm](https://monologues.co.uk/Bob_Newhart/Tobacco.htm)

You can chew it!... or put it in a pipe!... or you can shred it up... and put
it in a piece of paper. ha! ha! ha!... and roll it up. ha ha ha... Don't tell
me, Walt, don't tell me. ha! ha! ha! you stick it in your ear, right? ha! ha!
ha!...

Oh! between your lips!...

Then what do you do, Walt? ha! ha! ha!...

You set fire to it! ha! ha! ha!...

Then what do you do, Walt?...

Ha! ha! ha! You inhale the smoke, huh! ha! ha! ha!...

You know, Walt... it seems you can stand in front of your own fireplace and
have the same thing going for you!

You see, Walt... we've been a little worried about you, y'know, ever since you
put your cape down over that mud.

Y'see, Walt... I think you're gonna have rather a tough time selling people on
sticking burning leaves in their mouthes...

------
keithwhor
When the CDC tells people to stop eating a specific food because of disease
outbreak, even if rare, people stop eating that food.

When you dive in to the comments here, keep in mind a number of the posts are
from addicts minimizing cognitive dissonance. The internet would’ve looked the
same when cigarettes were first blamed for lung disease as well.

~~~
lonelappde
When there is an e coli outbreak, authorities are very specific about which
batch of produce was affected. They don't say to stop eating all spinach or
all vegetables.

~~~
brokensegue
In 2016, all bagged spinach was recalled nationwide.

>The U.S. Food and Drug Administration (FDA) called for bagged fresh spinach
to be removed from shelves and warned people not to eat any kind of fresh
spinach or fresh spinach-containing products

It happens.

------
blablabla123
I had an e-cigarette for 1 or 2 years which I used almost exclusively. The
benefits were big but charging, changing filter/liquid, buying liquid was a
lot of effort. But at some point I had a burning sensation, actually the
"smoke" felt really hot already when entering my mouth. I'm quite sure these
were technical difficulties because I had a cheap replacement device as I lost
the old one. Anyhow, I also had slight pain in my lungs if I remember
correctly.

It seems like a very immature technology and I doubt that it is in general
dangerous as I know several people that used heavily customized e-cigarettes
with self-made liquids for years. The sensation is almost relaxing when using
this combination. (Of course these people had become experts on this topic.)
But honestly, if one feels pain with anything one should probably stop doing
it. (Same with cigarettes, if one feels respiratory problems one should _at
least_ pause it. A former boss of mine had that sometimes so he only smoked
seldomly and sometimes does pauses of half a year or so. He must be now 60 or
so but he's always far away from being a regular smoker.)

------
ChrisRR
I knew something like this would happen. The market is flooded with cheap
foreign liquids which no-one has any idea what's been put into them. How
they've managed to bypass national trading standards is beyond me.

But it means that now we've got an understudied activity, with people using
liquids filled with who knows what. There was bound to be health risks sooner
or later.

~~~
cynic_
The cases are in the US and related THC containing liquids. So it makes no
sense blaming foreign liquids.

------
Mtinie
Who benefits from a temporary demand reduction or regulatory shift in vaping?

* Health advocates

* Alcoholic beverage producers

* Tobacco producers (though I believe they have gone all-in on vaping as a healthier replacement)

* Black- and grey-market cannabis growers who prefer not to concentrate their product

Who else should be on that list?

I’m not suggesting a false-flag or major conspiracy, simply that some group(s)
will see a disproportionate benefit from wide-spread social panic over, and
rejection of, vaping. If you are interested in trying to forecast economic
conditions in order to increase/decrease investment in an industry, where
would you look?

~~~
notimetorelax
Society, if those products are found unsafe earlier rather than later.

~~~
Mtinie
I agree, but my questions have to do with the economics of the panic,
warranted or not.

To build on your comment: Vaping is not a new concept[0] and if the act of
vaping itself— rather than a problem with the supply chain (product purity,
dosages, etc.)—was the problem why has it taken 13 years in the U.S. to
surface?

I can imagine the contemporary spike in numbers of users and frequency has
effect on the number of cases. For all we know this condition with the same
set of symptoms has been seen before but connections never drawn to a wider-
spread problem.

This may be the “earlier discovery” you reference, compared to the decades it
took for Society to recognize how dangerous cigarettes are.

[0] [http://www.casaa.org/historical-timeline-of-electronic-
cigar...](http://www.casaa.org/historical-timeline-of-electronic-cigarettes/)
(note: industry source)

------
katet
Screw it, let's wade into this one briefly (because I've searched and nobody
has mentioned this as far as I can see):

I currently live in South East Asia, the land of palm-oil-plantations-as-far-
as-you-can-see, and it's that time of year again: slash and burn.

There is _so much_ particulate matter in the air, that you can see the street
lights illuminating it, you can't see islands from the shoreline, and schools
will be closed this week if gets any worse (smack bang in the middle of the
exam period as well).

I sympathise entirely with the view that vaping is not safe, only "safer". I
desperately want to know the underlying cause of the CDC cases so I know what
to look out for when I buy juice.

But any argument that implies that vaping is dangerous for me, and I should
stop - in light of the fact that I am breathing in what is essentially _ash_
on my commute to work - is completely and utterly missing the forest for the
trees.

~~~
ssully
Sai, I think you are in a pretty unique position compared to most people. For
your average person who isn't breathing in ash on a daily basis, I think it's
pretty safe to say that vaping is more dangerous then not vaping, just like I
think it's safe to say vaping is still safer then smoking.

------
ilaksh
I strongly suspect that it is somewhat harmful and dangerous but I am
convinced that most vape products are much less harmful than cigarettes. I
mean they are talking about 5 deaths. Cigarettes kill 500,000 per year.

Some people are literally going to see a headline like this and use it as a
reason to go back to cigarettes. I think they should put declarations like
this in context. They have no reason to believe that it's anywhere near as
dangerous as cigarettes.

~~~
systematical
Cigarettes kill a lot of people per year, but they take decades to do it. Not
many lifelong smokers in their 20s, 30s, or even 40s are dying from
cigarettes.

With that said. Vaping has been around for about ten years and this appears to
be the first thing we've seen like this. Some of the victims are 18 or 19.
I've been vaping on and off for 6 years. I only feel better when I vape vs
smoking. Of course, that is purely based on my feel for cardio, lung capacity,
and how my chest feels. Who knows under the hood at a cellular or other level.
I've never been a big cloud guy, but I know big cloud people who have vaped
twice as much as I have and they are still alive. The whole situation is very
confusing. I'm hoping science prevails here.

If the FDA wants to outlaw vaping, so be it, but please be even-handed and
outlaw plant-based nicotine products as well.

------
cthalupa
This seems to be incredibly well correlated with the increase in use of oil
based thickening agents, particularly for black market cartridges. This year
we've seen a lot of these products gain popularity, along with the rise of
people selling cartridges in packages that look legitimate (Dank Vapes, Mario
Karts, etc.) but are just cartridge packages, with no company selling THC
carts with that name or product line existing. We've also seen a rise of rip-
off packaging of real brands appearing on sites like AliExpress. People
purchase these, fill them with something that resembles THC concentrate, and
then sell them.

I know that correlation isn't causation, but my gut feeling is that we're
going to find out that these additives are the culprit. To my knowledge, we're
not seeing any reports of this occurring for people that are part of a state-
run and well regulated medical marijuana program, where many of these products
have been available for years. For recreational use, even in states that have
legalized it, the stringency of regulations vary for dispensaries, so I don't
know that I would necessarily assume that a cartridge purchased at a
dispensary is necessarily safe from this sort of thing, either.

I'm not a research scientist or medical professional of any sort, though, so
no one should take any of this as anything but a layman's PoV.

~~~
fragmede
The death in Oregon was linked to a "an electronic cigarette containing
marijuana oil from a legal dispensary".

[https://www.usatoday.com/story/news/health/2019/09/05/vaping...](https://www.usatoday.com/story/news/health/2019/09/05/vaping-
death-oregon-man-dies-thc-vape-dispensary/2218501001/)

~~~
cthalupa
Yep! Thus why I mentioned I wouldn't necessarily trust something from a
dispensary as being safe. People have reported seeing some of the Dank
Vapes/Mario Kart/etc. cartridges in dispensaries in California as well,
despite these 100% being 'black market' cartridges of unknown origin.

------
qzx_pierri
Something about all the sudden bans in flavored, (enjoyable) vapes, mixed with
the fear mongering all over the news makes me feel like this is all FUD being
pushed by the tobacco industry. I mean, consider what’s happening. “Why vape
if it’s flavorless and tasteless? At that point, I might as well stick to my
Marlboro Reds, at least they have some established flavor” - I’m just playing
devils advocate.

And about the “Think of the children!” replies - Classic red herring fallacy.
Decent parenting and better local regulation could solve this problem. Or
maybe it wouldn’t. Teenagers under the smoking age buy cigarettes every day,
so vaping is no different.

I realize people are getting sick, but why is everyone acting like it’s
“average” people getting sick like this? It’s those “HUGE CLOUD XD” people who
are taking ridiculous sized rips, and black market THC vape carts. Juuls
aren’t perfect, but their popularity and the losses to the tobacco industry’s
profits make me wonder....

Very similar to the FUD campaign put out against La Croix last year when the
18-24 crowd stopped drinking soda, and started drinking sparkling water
instead.

Source: [https://nypost.com/2018/10/05/la-croix-hit-with-class-
action...](https://nypost.com/2018/10/05/la-croix-hit-with-class-action-
lawsuit-over-ingredient-found-in-cockroach-insecticide/)

~~~
soulofmischief
> It’s those “HUGE CLOUD XD” people who are taking ridiculous sized rips, and
> black market THC vape carts. Juuls aren’t perfect, but their popularity and
> the losses to the tobacco industry’s profits make me wonder....

From what I understand, the issue is almost purely surrounding THC carts
because of the lipids many producers use to increase the THC's solubility.
People who make those big clouds are using high concentrations of vegetable
glycerin which has not yet been shown to contribute to this illness and has
several decades of established prior use. It helps to be less judgemental
about others' lifestyles and stick to the facts.

~~~
qzx_pierri
> It helps to be less judgemental about others' lifestyles and stick to the
> facts.

Sorry if I came off as judgemental. With that being said, we're still unsure
of the long terms effects of vaping. Those hobbyists who set their temps to
ridiculously high levels and push their coil designs to the max are definitely
taking it too far. I don't have a source for this claim, but rock with me on
this one. Inhaling anything other than air isn't good for your lungs, and
huge, HOT vape clouds aren't innocent in this discussion. I could almost argue
that people who engage in that type of behavior are abusing vapes, especially
when you consider what e-cigarettes were originally designed to do.

I could also reference the numerous articles (.gov) that connects 'diacetyl',
a flavorant used in numerous vape juices, to "popcorn lung". However, my
original intent wasn't to attack vaping, but the people who take it way too
far, and give casual e-cig users a bad image.

~~~
soulofmischief
You're still passing undue judgement and exhibiting stereotypical
categorization towards people who use atomizers, without having all the facts.
Most of these people _don 't_ push their temps to the max because it ruins the
flavor and destroys the compound. They actually use very precise temperature
control and a higher temp doesn't mean more clouds. Except for extreme
temperatures, temperature has also not been cited as contributing to this
epidemic.

> Inhaling anything other than air isn't good for your lungs

What is "air"? The air quality where I live is pretty awful and filled with
contaminants. Also, can you point to a case where inhaling marijuana
smoke/vapor has lead to cancer or serious disease? Not all smoke/vapor is
created equal. It matters what its composed of.

~~~
qzx_pierri
I can tell you aren’t willing to understand my argument, so I’ll just slowly
back away.

~~~
soulofmischief
We can respectfully disagree without you attempting to discredit my ability to
understand what you're trying to say.

The fact is, regardless of what either of us believe, that this is an ill-
formed opinion of yours and it needs more work. Instead of being quick to
double down, consider working to refine it by listening to what others have to
say.

------
villgax
Maybe also ask people to stop smoking, like unless they're actually on fire.

~~~
tom_mellior
Yeah, if only they had a page that says "Smoking harms nearly every organ of
the body, causing many diseases and affecting the health of smokers in
general. Quitting smoking has immediate as well as long-term benefits for you
and your loved ones."
[https://www.cdc.gov/tobacco/basic_information/](https://www.cdc.gov/tobacco/basic_information/)

------
andrewksl
I wonder if this reddit comment was on to something:
[https://www.reddit.com/r/CannabisExtracts/comments/b1w76g/tr...](https://www.reddit.com/r/CannabisExtracts/comments/b1w76g/true_terpenes_viscosity_extract_liquifier_lab/eiondb8/?utm_source=share&utm_medium=ios_app)

Some background information:

\- Cannabis, particularly THC, extracts are quite viscous and require thinning
in order to feed into a vaporizer’s heating element. In other words, even for
very pure use, some thinning is necessary.

\- Thinning agents include propylene glycol (PG) and polyethylene glycol
(PEG), also commonly used in nicotine liquids

\- A market for terpenes as a thinning agent has emerged amidst uncertainty
about the long term effects of PG and PEG

I wonder if mineral oils sold as terpenes are behind the lipoid pneumonia as
the commenter mentions. Considering at least some of the carts were tested to
be of advertised potency, I could conceive of a contaminated batch of
“terpenes” making it into a well-meaning producer’s cartridges.

------
johngrefe
Also, we have a first published study. They are a week or two behind.

[https://www.nejm.org/doi/full/10.1056/NEJMoa1911614](https://www.nejm.org/doi/full/10.1056/NEJMoa1911614)

------
alistproducer2
This was bound to happen. For the life of me, I cannot understand how things
have gone this long without even a whiff of regulation. This is what you're
going to get when u let a market be the wild west for a decade.

------
HeraldEmbar
It’s a worthy mention that it’s mostly THC vapes. Rarely nicotine vapes alone.

------
smashthepants
Would this apply to vaping 'dry herb'? Or is it specific to oil?

~~~
moftz
I'm guessing this is strictly related to people using bootleg THC cartridges.
You can buy empty carts on ebay/Alibaba and fill them with whatever you want.
I'm sure there is a proper way to make THC vape juice and it doesn't involve
using vitamin E oil. THC is soluble in vegetable glycerin which is the same
component used in standard nicotine vape juice so I don't understand why
Vitamin E is being used in the mixtures. Only thing that makes sense is that
is being used as a thinning agent or some moron thought THC "oil" was made by
actually using oil.

------
RenRav
I ordered 'vape juice' online for my nephew one time. For the past few months
I've received spam about cheap CBD vaping juices. Most of these articles
mention low quality or debased CBD formulations. I would bet on some
connection between the spam I've been receiving and this recent vaping
illness. Just my initial suspicion after seeing these articles crop up at the
same time as my received spam emails.

------
A4ET8a8uTh0
I will admit that I am a little confused about all this. To the best of my
understanding, LD50 for nicotine is appx. 13 mg and nicotine poisoning can
cause all the issues listed ( including death ). The difference appears to be
ease of passing those tresholds. I get that vapers add all sorts of enhancers,
but why THC seems like an odd strawman to use here.

------
mrzool
“One trend worth noting, however, is that very few of the cases involve only
nicotine products; most of the afflicted users reported using THC exclusively
or as well as nicotine.“

Looks like this is an issue mainly related to home-brew liquids containing
THC.

Edit: care to follow up on your downvotes and maybe post a clarifying comment?
I just reported a passage of the article verbatim.

------
seamyb88
Ten of my friends got food poisoning eating at a Chinese restaurant in town.
Conclusion: prawn crackers are unsafe.

------
snarfy
> One trend worth noting, however, is that very few of the cases involve only
> nicotine products; most of the afflicted users reported using THC
> exclusively or as well as nicotine

If victims used "THC exclusively", why are nicotine vapes being targeted? Were
there any victims that used nicotine vapes exclusively?

~~~
qzx_pierri
> If victims used "THC exclusively", why are nicotine vapes being targeted?
> Were there any victims that used nicotine vapes exclusively?

See my comments above

------
patientplatypus
Does anyone have any idea if this is fatal/permanently debilitating or if it
is temporary? That would seem kind of important.

EDIT: I guess I meant to say, yes, people have died, but of those that
recovered is it a full recovery or a permanent disability?

~~~
bdibs
There have been 5 confirmed deaths so it seems fairly serious.

~~~
sdinsn
5 deaths is fairly serious?

Almost 500k die from smoking cigarettes every year, so vaping seems like a
great alternative.

------
NKCSS
Yeah, who could have thought...

------
mlindner
It amazes me people freak out about GMOs and the material Starbucks cups are
made out of yet will breathe vaporized chemicals of who knows what sorts
directly into their lungs. Mind boggling.

~~~
cobbzilla
Reminds me of the old joke about the guy at the fast-food joint: I’ll have a
double bacon cheeseburger, a large fries, and a _diet coke_.

Like — why are you buying this totally unhealthy meal and then getting a
_diet_ coke? Who are you kidding?

Yet — I’ve been that guy. So it’s not so mind boggling.

~~~
exDM69
Some groups like T1 diabetics can not have the amount of sugar in "normal"
fizzy drinks. That amount of sugar can cause issues from nausea to messed up
glucose levels needing hospitalization. Hamburgers and fries are not a problem
(not healthy but not dangerous).

"Diet Coke" is just a stupid name for sugar free drinks.

~~~
skocznymroczny
Is that actually true? Bread contains very high carbohydrate levels, I'd
imagine a hamburger bun is not much worse than a glass of coke.

~~~
entropy_
Not an expert, but I would imagine the speed at which these carbohydrates get
metabolized is a factor in whether or not it messes them up? Carbs from bread
take a much longer time to raise blood glucose levels and do so for longer
than a spike induced by drinking what is essentially liquid sugar.

------
openureye1s288
Huh? How come they are not coming out saying to stop smoking regular
cigarettes too? How are regular cigarettes still legal?

~~~
sdinsn
> How are regular cigarettes still legal?

Tax revenue & lobbying

------
Gatsky
Yes ok, it’s a bad batch of juice (probably), it won’t effect most vapers
(probably), better regulation will solve the problem (maybe). But I have got
to ask... was all the vaping done thus far and into the future worth even one
person dying needlessly?

It’s cigarettes all over again. Who benefits except the people selling it? Yes
freedom, yes whatabout other pointless harmful things in the world, but vaping
has already caused more harm than we should accept, I think.

~~~
dieFledermaus
> _...was all the vaping done thus far and into the future worth even one
> person dying needlessly?_

This is a reduction to absurdity that I can't quite grasp: People die of all
sorts of maladies every year and a single person dying from vaping is your
apex priority because, " _it could 've been prevented by banning vaping_"?

This almost seems like a variation of the " _won 't someone think of the
children_" argument.

To whit: What of all of the vehicular deaths every year? Or deaths via trains
or planes? Should we just ban _all life_ because it will result in death at an
astounding success rate of 100%?

~~~
newswasboring
I am not on anyone's side here, but didn't you just answer a logical fallacy
with another? Namely whataboutism?

~~~
brianpgordon
_Reductio ad absurdum_ is similar to whataboutism, but it's not the same.
Whataboutism is more like an abrupt detour off into a different issue to try
to confuse the conversation or transform the topic of discussion into a
referendum on the personal morals/motivations of the involved parties. The
appeal to extremes does have to ask the question "what about x" but it's
relevant because it's done to demonstrate the logical consequences of the
other person's line of argument. It's not trying to deflect, it's getting to
the heart of the issue.

------
sneak
Reminder: millions and millions of people worldwide are vaping. This condition
affects fewer than 500 people thus far.

------
magwa101
"Mystery Lung Condition" aka cancer.

------
ronjouch
_Chuckles at picturing Cult of the Dead Cow giving health advice_ :D.

Okay okay, "Centers for Disease Control and Prevention", one more US TLA
unknown by non-US folks.

------
rpmisms
Solution: do not buy crappy weed juice off the street. VG, PG and nicotine do
not have this effect when combined. This is a symptom of overregulation, not
vaping.

------
ganitarashid
If there’s one positive thing in all this it’s that we can stop pretending
that vaping is safe. I hope this will save a lot of lives.

------
Double_a_92
This title totally sounds like one of those headlines in Plague Inc. :D

