
A Vaping Illness That’s ‘Becoming an Epidemic’ - mhb
https://www.nytimes.com/2019/08/31/health/vaping-marijuana-ecigarettes-sickness.html
======
cannaceo
As someone who has experience in this industry I can point to the cause.

Biomass ("trim") was very easy to source leading up to CA recreational
legalization in 2018. For those of you who don't know the majority of cannabis
nationally comes from CA and OR. Legalization brought with it enforcement
against unlicensed NorCal farms that drastically reduced supply. This was
amplified by the massive overproduction of the 2017 market that had many
farmers leave the market due to extremely low prices. This is evidenced by the
shutdown of soil/grow supply warehouses throughout NorCal.

By February 2019 the last of the October 2018 harvest had been processed to
distillate. Many operators started reprocessing waste material. At the same
time, distillate started to make it's way over from Mexico. There is a drought
of product in the black market but wholesale buyers were reluctant to pay
higher prices after becoming accustomed to the low prices of 2018. In the
beginning unscrupulous sellers started diluting their product by 60%. Buyers
eventually caught on to the charade and started paying attention to the
reduced viscosity of the oil as an indicator of cutting agents. Sellers
countered this by adding thickening agents.

Now you have an illicit market with high demand, not enough supply, and
customers that represent established black markets across the country that
don't want to pay a risk premium for oil.

The cutting agents themselves are expensive so people have started making
their own. Now people are getting sick from the cutting agents.

~~~
wcchandler
Do you think that pesticide use could be a contributing factor as well?

I ask because my hemp mentor will never touch concentrates. He argues that
even the tiniest bit of pesticides or inorganic fertilizers will also be more
concentrated and he’s not willing to gamble on it. There’s just too many
unknowns when it comes to that.

~~~
kortex
If they are extracting from trim and other low-value parts of the plant, yeah
that is a possibility. Myclobutanil has a boiling point around 200 C, THC
around 155 C. They have similar hydrophobic nature. So any extraction process
favoring THC will also likely partition myclo. If you are making concentrate
from buds, this isn't an issue, as your ratio of active components to
pesticide is going to be similar. However if you are extracting low-density
plant matter, your ratio of myclo to actives will be higher.

However, the highest number I've seen reported was just shy of 1 ppm
myclobutanil. Not great, but that's still pretty low.

[https://www.thestranger.com/slog/2018/12/20/37272899/no-
one-...](https://www.thestranger.com/slog/2018/12/20/37272899/no-one-will-
take-responsibility-for-this-pesticide-ridden-vape-cartridge)

~~~
cannaceo
I've seen 700ppm total pesticides and typically between 50-300ppm in the CA
medical market of 2015-2017. Myclo up to 150ppm was pretty common in the crude
I was testing. I tested at SClabs, Anresco, Steep Hill, CW Analytical, etc.
depending on client preferences.

~~~
MPSimmons
Is this specific to vaping supplies, or would it also impact CBD oil
tinctures?

------
ng12
This is a casualty of state governments dragging their feet when it comes to
legalization.

You can get very "legit looking" THC cartridges very easily where I live (New
York). They're Chinese-made copies of legit dispensary brands which are then
filled with whatever junk. It doesn't surprise me at all that some of them are
tainted.

~~~
velox_io
I find it interesting that the article is targeting vaping in general rather
than buying tainted products.

(My money is on THC extraction using Butane that is meant for fuel (that's
heavily contaminated) rather than lab-grade/ pure.)

~~~
thomaskcr
Surprised terpenes aren't mentioned in article -- when heated too hot they can
degrade into benzene. Seems like they are targeted for something to extract
not remove (although I know nothing about cannabis - only industrial
contaminants).

Not sure how hot the heating elements are supposed to get but if they get too
hot you're inhaling stuff that basically creates pneumonia symptoms.

~~~
wcchandler
The mighty vape is pretty well respected and ranges from 180C to 200C. Would
that be hot enough to convert some into Benzene?

------
ptest1
I believe these vaping cases are from using elicit, underground THC vaping
products and not the usual e-cigarette / nicotine vaping we usually associate
with the word “vaping.”

There’s some details over on Reddit:

[https://www.reddit.com/r/electronic_cigarette/comments/cxov1...](https://www.reddit.com/r/electronic_cigarette/comments/cxov1b/no_one_needs_to_read_this_but_i_need_a_place_to/)

~~~
root_axis
That thread seems like speculation without much to back it up. Not everyone
showing symptoms smoked THC cartridges and the article makes it clear that
experts have not yet identified a specific cause

~~~
Thorrez
>Not everyone showing symptoms smoked THC cartridges

Are we sure about that? The article doesn't seem to say that to me. It also
says that patients sometimes lie about what they vape.

------
rgejman
I remain cautiously pessimistic because there are two main possibilities: (1)
there is one product (or a series of products manufactured/purified in the
same way) that causes respiratory failure in many or all users, (2) all vaping
products have a low level risk of causing respiratory failure. I don't think
there is enough data to make a conclusion yet, but I am worried this will end
up being a low-level persistent problem with vaping products—bootleg or
not—for the rest of our lives.

Maybe the culprit truly is dirty oil based extraction of THC... but if so,
that will remains a problem for as long as there is no regulation of the
official market as well as an operating black market.

OTOH we may end up with a situation like we have in the world of muscle
builder / hormone supplements where most people are fine but some users get
really sick (e.g. deer hormones sold at regular stores causing severe kidney
injury), but not enough of them get sick to get the CDC/FDA involved. I've
seen those cases in the hospital and the patients are always confused as to
how this could happen because they got the supplement from a vitamin store.

With respect to some of the European posters below who have been using vape
products for years: I would not be surprised if there were health consequences
to those devices that had not been identified in Europe. The US has one of the
best disease identifying-apparatuses in the world (the Centers for Disease
Control) and a tradition of surveillance and reporting that is unparalleled.
If a substance is harmful to health, it's got a better chance of being found
here than anywhere else.

------
adanto6840
Only tangentially relevant, but does anyone have any insight on how applicable
this broader topic might (or not) be to the "essential oil" industry?

Specifically talking about the business of "essential oil diffusers" and the
sales of essential oils. From my understanding, the diffusers are largely akin
to ultrasonic humidifiers containing oil instead of water (though several
forms of diffuser exist including ultrasonic, evaporative, heat, etc) -- which
I would imagine is basically just putting oil into the air for later
inhalation...

The article mentions several times, and somewhat unsurprisingly, that the
inhalation of oil is not good for you or for the health of human lungs. Is
this the case with all types & classes of oils (ie "essential oils"), or are
oils used for vaping specifically bad/worse, or is there just not much data on
the broader topic of inhalation of atomized oils yet?

I've read the relevant Wikipedia articles and read through the studies/sources
that are freely available, but if anyone has any further insight or knowledge
I'd really love to better understand it.

FWIW, my personal _guess_ would be that the inhalation of most any non-gaseous
matter is probably bad for you -- but if there's any science/data out there on
it I'd love to hear about it.

~~~
grenoire
I think concentration and magnitude is key. Frying definitely vaporises oils
into the air but it doesn't seem to be causing lung issues.

~~~
jacobolus
Breathing the smoke and grease from frying is definitely not _good_ for you.
That’s one reason kitchens tend to have serious ventilation.

But people accept a certain amount of risk, since everyone needs to eat and
cooking is a career for many people. Cooking is nowhere near as dangerous as
smoking cigarettes.

~~~
vastoi
Most cooks I know do both unfortunately

~~~
mastazi
Do we have reliable data about the incidence of smoking among cooks and food
preparation workers? How does it compare to the general population? Smoking is
supposed to affect negatively your ability to recognise taste and smell, which
are very important if you work in a kitchen but, at the same time, I too know
several people who are in that line of business and are smokers.

~~~
gambiting
You know why? Because all the chefs I know say the same thing - smoking is the
only way to get any sort of break while in the kitchen, going outside and
standing still doing nothing for 5 minutes is not acceptable, but somehow
going out and smoking for 5 minutes is absolutely ok in most kitchens. I know
some people who picked up smoking _only_ to have an extra break at work.

On the plus side, I also know someone who bought himself an e-cig and somehow
buys "blank"(saline/water filled) cartridges for it, just so he can have a
short break but without any side effects of actually smoking.

------
phillipseamore
Vaping has much more history in Asia and Europe and seems to be without cases
like this. The products from the cigarette industry aren't very prevalent in
those contintents and also not vaping of THC and other such fluids. That plus
the limited geography and timeframe seems to point only to contaimated juice.

~~~
userbinator
Yes, a good investigation would be to analyse what all of these people vaped,
and if they all came from a common source.

~~~
nannal
I'm 90% sure they just gave right up when they figured they'd vaped.

what else do they have in common, that's what I'd like to know, maybe they'd
eaten that day, or consumed water.

~~~
shkkmo
I don't think that is how the CDC works...

------
sandworm101
I'm in the military. Some cadets visited our unit recently and I dropped in to
say hi. One of them, a 13yo, asked about using a Juul while on duty. Our tour
guide didn't know what a Juul was. Then a dozen kids showed him. Maybe 1/4 of
the cadet group were carrying the devices.

~~~
callalex
This has a HUGE sampling bias of only 13-year-olds that end up in a military
recruitment program while still being the age of a child.

~~~
sandworm101
Cadets /= "a military recruitment program". Cadets are more like the boy
scouts, at least what scouts were a few generations ago. It is more like a
summer camp where, if you are the best camper, you get to go on a helicopter
ride on the last day of camp.

~~~
atlasunshrugged
Does cadets = JROTC?

~~~
sandworm101
Maybe in the US. There are other countries on this planet.

------
kerkeslager
The actual number of cases isn't given, only a minimum:

> Dr. Pirzada is one of the many physicians across the country treating
> patients — now totaling more than 215 — with mysterious and life-threatening
> vaping-related illnesses this summer.

215 is a much smaller number than I would have guessed based on that headline,
and it's also an oddly-specific number to just say, "More than" with. This
stinks of sensationalism. Shame on you, New York Times, you're better than
this.

Why does it matter? Vaping only has to be a tiny bit healthier than smoking
and prevent a small percentage of people from smoking, to save "more than 215"
lives. The research into the effects of vaping doesn't seem to be conclusive,
so I don't know yet whether vaping is safer, or by how much. But when research
does come to some concusions, I want public policy with regard to vaping to be
written based on facts viewed in context, not sensationalized fearmongering.

~~~
TylerE
Don't think it's a weird number. i would certainly hope they know _exactly_
how many cases have actually presented - plus there will always be some more
that never see a doctor's office.

~~~
kerkeslager
If they know _exactly_ how many cases have presented, then they could have
said _exactly_ how many cases have presented, instead of saying "more than
215".

And this is the number of cases, it's the number of _patients_. You're not a
patient until you see a doctor, so that doesn't include people who don't see a
doctor.

There are a lot of numbers that are more than 215, but with such a specific
number, it makes me think that the number is something like 217, and they just
said "more than 215" to sensationalize it.

And to be clear, 215 cases in a nation the size of the US is _not_ "becoming
an epidemic".

------
Redoubts
I'd like to remind everyone of the trial of Tim Heidecker, which was a case
similar to this

[https://www.youtube.com/watch?v=WWotb3gci0A](https://www.youtube.com/watch?v=WWotb3gci0A)

~~~
pram
He was fully exonerated though!

~~~
tabs_masterrace
common don't spoil the ending like this

------
kappi
I don't know how founders and investors of vaping startup sleep with blood in
their hands. Outside this epidemic, there is real epidemic among school
students making an entire future generation of adults addicted to nicotine.

~~~
wahern
1) Vaping is far safer than smoking, and I applaud any efforts, profit-seeking
or otherwise, that induce smokers to switch to vaping _now_. And though some
claim that e-cigarettes didn't hasten the decline of cigarette smoking, and
are possibly slowing it, if you look at the data you can't make that
inference. In fact, if you look at the data it's just as possible that vaping
was hastening the long-term decline. The problem is that of those who claim to
both vape and smoke cigarettes, nobody is reporting the ratios--are they
vaping in addition to smoking the same number of cigarettes, mostly vaping but
smoking a few cigarettes each week, etc?

2) The source for the epidemic of vaping comes from the yearly youth drug
survey. And if you look at the survey results, youths are experimenting with
vaping in the same numbers as marijuana. And just like with marijuana, the
activity is mostly only once or twice a week, not daily smokers. Where's the
concern about the "epidemic" of pot smoking among youth? There's ample
evidence that smoking pot is much more harmful for youth, both for their
mental and physical development.

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chiefalchemist
Maybe I'm showing my age but it brings back memories of Legionnaires Disease.

------
ghostpepper
> But vaping has its own problems: To become inhalable, nicotine or THC, the
> high-inducing chemical in marijuana, must be mixed with solvents that
> dissolve and deliver the drugs.

This is not strictly true; there are vaporizers that take regular dried
cannabis buds and deliver THC. No chemicals are involved.

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usrlocaletc
Mass hysteria / moral panic perhaps? Isn't the greater, real threats are
people are inhaling massive quantities of nicotine and propylene glycol, and
not sufficiently cleaning their atomizers?

------
taurath
This is all weed pens and concentrates right?

~~~
Forge36
Local news said "89% report using products which contained THC" I've not seen
it stated online

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mikkelam
I vape dry herb, should i be worried?

------
AltmousGadfly
We already know exactly what's causing this, and it has nothing to do with THC
or vape juice (vegetable glycerin).

These people are vaping grey market THC carts. Grey market being the operative
word, because the process used to make wax relies on using butane and other
heavy solvents to dissolve the plant while keeping the THC intact. These
small, backyard producers are dumb as shit and don't know how to properly
remove the solvents.

