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.
1) vaping things that really should not be vaped, resulting in oil droplets getting in your lungs. e.g. "cannabidiol oil, which is not designed for vaping but has been used that way." Apparently some vaping fluids are much worse than others, thus the recommendation to "stop buying bootleg and street cannabis and e-cigarette products, and to stop modifying devices to vape adulterated substances."
2) people not seeking timely medical attention and lying about the causes, as marijuana possession is still a crime where they live.
From the article:
> The patient’s older brother, a police officer, was suspicious. He rummaged through the youth’s room and found hidden vials of marijuana for vaping.
> Health investigators are now trying to determine ... whether the risk stems from a broader behavior, like heavy e-cigarette use, vaping marijuana or a combination
> Many vaping ingredients are not listed on the products. Vitamin E oil appears to have been a common substance associated with the severe and sudden respiratory problems in some of the New York cases, according to state health officials. It is not known how it was used. Vitamin E is sometimes advertised as a supplement in cannabidiol oil, which is not designed for vaping but has been used that way.
Nicotine is typically in a base of propylene glycol or vegetable glycerine (I think I got those right). I believe both are cheaper than the "adulterants" such as vitamin e oil being used to cut the THC oils, so it is unlikely that people vaping exclusively nicotine products are being affected.
There's been some concern around certain flavorings being much riskier than others (i.e. popcorn lung) though I suspect it'll be some years yet before the effects from those start playing out.
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.
However, the highest number I've seen reported was just shy of 1 ppm myclobutanil. Not great, but that's still pretty low.
People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis.
I run a cannabis copacking company and one of my clients was the first to go pesticide free back in 2016. It was near impossible to source material for them. Prior to 2018 about 95% of material was sprayed with pesticides. Because black market distillate is typically made from mixed batches of oil there was higher contamination rates than that.
I think it's questionable to consume cannabis in general and especially concentrates. The safest method is likely oral consumption. I have seen contaminants in concentrates, such as fire retardant, that pass all screening tests. Neem oil, for example, is an approved pesticide for CA but is really nasty stuff to be smoking.
This. People have been vaping THC e-cig cartridges for years. Same for using other concentrated products like wax. Yet it seems only very recently that this has become some kind of 'epidemic'.
I'm not saying that it's safe, but it seems very sudden that all these cases show up. Or maybe they were happening before, but because it seemed so hard to diagnose, people weren't connecting the cases?
My worst episodes of CHS I've had from smoking synthetic cannabinoids, I'm not aware of neem oil having any relevance in the production of those.
Imho a large factor could simply be an overabundance of product leading to people overconsuming because "Cannabis has no negative effects", so nobody cares about basics like tolerance breaks anymore , instead people just keep upping their THC doses to get past their tolerance threshold.
Speculation should not be presented as fact.
We don't know what is causing these cases but you have presented a reasonable hypothesis.
Common cutting agents in the licensed market are PEG200, PEG300, and MCT oil. None are those are proven safe from what I know.
In the black market the initial cutting agent was PEG600. Then TrueTerpenes came out with Viscosity ( https://trueterpenes.com/products/diluent/viscosity-extract-... ). Initially they said it was all terpenes (simple alcohols found in cannabis responsible for some effects and flavor) to sell it. It later came out that it was "mineral oil" but the reality is no one knows exactly what it is but it's a petroleum-based product of some kind. There was backlash against TrueTerpenes for this but selling mineral oil at $1500/liter (price point for cutting agents) is profitable. Some reports have described the symptoms as consistent with lipid pneumonia.
Next FloraPlex released their thickening agent. Then HoneyCutt. I started hearing stories of people selling 0% THC epoxies to unsuspecting buyers as distillate starting a few months ago.
Now there are people making their own thickening agents.
Is it a theory? Yes. I'm normally scientifically conservative but I'd place a friendly wager on this one.
In my research, one finding that stuck out  was that natural oils (triglycerides, saturated or unsaturated) are more pro-inflammatory than straight-chain mineral oils. MCT oil would absolutely cause acute inflammation and in severe cases, collapse of alveoli.
However, the long chains, longer than C14, have half-lives measured in months to years. The effects of these is harder to know, but excessive exposure causes essentially COPD.
Edit: oh look, here's an article specifically pointing out lipoid pneumonia . I actually disagree with their thesis, that vegetable glycerine is causing the inflammation. I would bet it's more likely to be one of these thickeners, or a carrier agent for a flavor, causing the inflammation. I know people who go through over an ounce per day of VG solution that aren't getting chemical pneumonitis, but inhalation of sub-milliliter amounts of oils has sent friends of mine to the hospital.
Basically, if it's not air, it doesn't belong in your lungs. However, the degree and character of the damage done depends on the chemical composition.
Shorter molecules, molecules with more hydrophilic nature (alcohols, polyols, ketones, acids), biologically active molecules, are more acutely inflammatory, but usually the body can deal with them. Longer molecules, biologically inert ones, are less acutely reactive to the immune system, but can cause disruption of membranes and long term toxicity. Unsaturated fatty acids are especially bad because they can be oxidized directly into inflammatory signal chemicals. 
 pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040
"Mineral oil (a mixture of inert, long-chain, saturated
hydrocarbons obtained from petroleum) and
vegetable-based oils tend to cause minimal to
mild inflammatory reactions (Fig. 3). The intraalveolar oils can coalesce in the alveoli and
become encapsulated by fibrous tissue, resulting in a nodule or mass (paraffinoma) (Fig. 4).
Conversely, animal fats are hydrolyzed by
lung lipases into free fatty acids that trigger
a severe inflammatory reaction that manifests
as focal edema and intraalveolar hemorrhage
 html - https://casereports.bmj.com/content/2018/bcr-2018-224350
"unsaturated fatty acids can be oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators. "
I wonder if you have any words on "MCT" being too broad a term. I made my carts with Bulletproof's Brain Octain, which claims to be 100% caprylic acid (C8).
I'm not naive enough to ask "Is it safe?" But I'm curious if you think an 8-chain MCT would treat your lungs significantly different than a 12-chain MCT?
I could easily imagine someone learning that you can make carts with MCT, and finding something cheap, only to be unknowingly using 100% C12. Cue the lipid pneumonia.
C8 is really fascinating because, I reckon, it's too short to set off the inflammation cascade directly, so it would be up to macrophages to alert the body "hey this doesn't belong". However you still have the usual risk from hydrophobic product in the lung.
Personally, I would use vegetable glycerine and nothing else if you can at all avoid it. PG is a bit more irritating than VG, but any short polyol is going to be diffused away into the mucous much more easily than hydrophobic products.
For marijuana/hemp you can make a water-based tincture using VG as the solvent just using dried plant matter. A magical butter machine can do it, putting it in a bottle and shaking it up every day for a few months, there are likely other methods. It's similar to making a CBD/THC oil but instead using VG as the carrier.
Making your own tincture from decent-quality dried plant matter is the most economical and surefire way to know that it unadulterated and limited in contaminants.
Theatrical fog causes "irritation of mucous membranes such as the eyes and the respiratory tract associated with extended peak exposure to theatrical fog. " Another study "also found long-term exposure to smoke and fog was associated with both short-term and long-term respiratory problems such as chest tightness and wheezing".
Cigarettes are terrible, but vaping ain't vitamins.
Not all theatrical fog is the same as vaping as far as I am aware. If you have any articles specifically dealing with the components used for vaping I would be interested to read them. Vaping does not use oil.
My issue was only that you followed a bunch of informative facts with an untested theory that was not differentiated from the facts that preceded it.
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.
(My money is on THC extraction using Butane that is meant for fuel (that's heavily contaminated) rather than lab-grade/ pure.)
If they were longer chained they'd be less volatile but still disappear quickly. If they were long enough to hang around to mess up lungs then they'd probably not vapourise well in the first place so wouldn't make good solvents. Just a guess though.
But if I'm wrong, if it wasn't volatile at room temperature & pressure, it would remain in the container as the butane was released so probably never meet the THC/weed anyway.
I dunno, but that's my reasoning.
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.
if big tobacco could outright ban vaping, I would wager that they would, juul be damned.
Just because they've hedged their bets doesn't mean they aren't interested in preserving existing markets.
Yea, I don't vape anything but I think it's a pretty fascinating public health issue and I'm very interested in potential developments in our understanding of its health impacts. I read the first couple of paragraphs and realized that the article has little to do with what its headline implies. I suppose I should've known better than to credulously read a headline from a clickbait rag like the NYT.
There’s some details over on Reddit:
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.
Patients are notorious liars
The health effects of vaping still aren't settled science, but that doesn't make these article any less FUD: The fact that headlines like this and others are eliding the critical fact that the cases they describe are limited to bootleg cartridges is pretty much a central case of FUD.
Again, what I'm trying to explain to you is that for some of us, there are more than two possible positions here. Mastazi complaining about FUD in a WaPo article (or the original nyt one posted here) doesn't mean he agrees with a random Reddit commenter who also disagrees with the article.
The problem is that vaping is NOT safer than NOT smoking.
The issue is that vaping is seen as "absolutely safe" rather than "relatively safer". Since vaping is now seen as "cool" (look at the "Game of Thrones" stars being shown vaping--especially the attractive, young women), it is converting non-smoking, non-vaping people into vapers.
That's a problem.
Smoking kills over eight million people every year, 480,000 of them in the US alone.
Even if the current epidemic turns out to be global, vaping is still several orders of magnitude less lethal.
Edit: lots of downvotes but still nobody actually willing to provide evidence for these ridiculous "several orders of magnitude safer" claims.
10 years is not nearly long enough to measure long term health effects, sorry. Being “safer than cigs” isn’t worth anything at all.
I agree with you that the amount of evidence we have is not conclusive and if you browse the various vaping forums online, you can see that most vapers openly admit that as well, the problem arises when the lack of conclusive evidence is used as an argument in favour of prohibition, that is what drives many vapers to respond.
In other words, if something is “possibly harmful but we’re not sure yet”, is that a sufficient reason for making it illegal? Most vapers think that the answer is no.
Spreading false, misleading information doesn't help legitimize your cause.
> the problem arises when the lack of conclusive evidence is used as an argument in favour of prohibition, that is what drives many vapers to respond
I haven't see anyone here doing that, I certainly haven't.
> In other words, if something is “possibly harmful but we’re not sure yet”, is that a sufficient reason for making it illegal? Most vapers think that the answer is no.
I do not thing there is any doubt that vaping is harmful to some degree (that appears to be the scientific consensus). The unresolved questions are "how harmful?" and "is it a net negative for society?". However, even if the answers are "almost as harmful as cigarettes" and "yes, it increases public health risks overall despite reductions in smoking", I still would not support banning e-cigs (though I would support advertising restrictions).
Another related Glycol saves sick infants from infection and no long-term sequelae reported:
Vegetable Glycerin: https://monq.com/science/vegetable-glycerin/
The more research you do on pharmacodynamics and pharmacokinetics the more the 96% less harmful than smoking figure appears likely to be in the correct ballpark for harm-reduction vs smoking. Source: https://pneumonia.biomedcentral.com/articles/10.1186/s41479-...
There appears to be a lot of dispute about those numbers are unrealisticlly high and concerns about conflicts of interest. The wikipedia article provides lots of references on those disputes:
Specifically, the study itself states "A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria"
You could apply the same assessment to strawberries, no? Can't estimate the harm caused by something for which we don't have evidence of harm.
My point is that there are good reasons to view the number presented in that report as very preliminary and unreliable.
Claiming that vaping is orders of magnitude safer than smoking, without proof, is still highly irresponsible. We simply don't know how safe vaping is.
The history of making safety claims about addictive products is quite fraught with delibratly misleading and false statements. Please take care not to exacerbate this.
Why do you say this so categorically?
"...[R]ats were nose-only exposed to filtered air, nebulized vehicle (saline), or three concentrations of PG/VG mixtures, with and without nicotine...Compared with vehicle exposure, the PG/VG aerosols showed only very limited biological effects with no signs of toxicity."
Propylene glycol has been used as a carrier for pulmonary inhalers as well as in food and cosmetics for decades.
> Propylene glycol has been used as a carrier for pulmonary inhalers as well as in food and cosmetics for decades.
Propylene glycol was deemed safe for oral consumption, not inhalation. I have not seen any sources of information indicating its use in pulmonary inhalers, do you have some sources you can link?
See, e.g., https://www.ncbi.nlm.nih.gov/pubmed/12425745
It's also listed as approved as an inactive ingredient by the FDA, including for inhalation:
PROPYLENE GLYCOL | RESPIRATORY (INHALATION) | LIQUID | 57556 | 6DC9Q167V3 | 10%w/w
PROPYLENE GLYCOL | RESPIRATORY (INHALATION) | SOLUTION | 57556 | 6DC9Q167V3 | 25%w/w
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.
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.
I googled for answers, and found out that Awair warned about this: https://blog.getawair.com/awair-investigates-how-your-humidi...
The humidifier was spewing crap out into my air!
I switched to distilled water and the measurements were OK again, but a bit scary to see how bad it was with regular tap water.
What's the problem supposed to be with low humidity? All of the humidity-related problems I know of, including discomfort, come from high humidity.
One of the main reasons why they recirculate some air instead of making it an open circuit is to conserve moisture. Outside air at high altitude is extremely dry. Moisturizers could be used but that would require heavy and therefore expensive water tanks.
Also occasional nosebleeds.
I’ve heard that there are other forms of vaping where e.g. cannabis oil is involved but that type of device works very differently and has nothing to do with “nicotine e-juice” vaping. (Edit: the NYT article is just conflating many separate phenomena under the umbrella term “vaping” which is very unfortunate).
PS Ex smoker and ex vaper here (I went from smoking to vaping to quitting everything, couldn’t have done it without vaping), I‘m fairly technical since I was involved in DIY juice making and device “modding” so hit me if you have questions.
If proof is what you’re looking for, scientific studies about the effects of vaping abound.
Additionally, I believe the flashpoint for glycerol is lower than most vegetable oils so your argument doesn't make sense.
However, different essential oils may have adverse effects as well and it seems like this is definitely understudied. It wasn't until I started looking into essential oils that I realized that almost every type of commercially available essential oil is toxic to cats. I would exercise extreme caution when using diffusers and stick to the few essential oils that have been well studied and considered safe for humans & pets.
And a meta-analysis:
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.
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.
That said, the “oils” are pretty dilute.
Anything that isn't air doesn't belong in your lungs. Period. Some things are less bad than others. However diffusers are unlikely to increase the concentration to harmful levels for healthy individuals. As an asthmatic though, I can definitely feel it when lots of diffusers are running.
Of course many people are rushing to ban it before we fully understand it and like any controversial topic FUD is everywhere. But that doesn't mean careful small steps cant be made today.
Vaping vials of THC in Long Island, NY, as what happened in this article, isn't something sold through legal channels AFAIK though so I'm not sure how much an agency could help with this specific problem (other than to highlight them).
Everyone loves to bash Juul (which is a garbage product I'd never touch) and the big tobacco company which owns it, but there's tons of small mom-and-pop style juice makers, shops, and device manufacturers which run a big part of the Vaping industry. These are the ones who will be impacted the most by the policies so we should keep them in mind when designing policy and not let Juul and their lobbyists write the legislation, in response to Juuls own bad behaviour (as always seems to happen), so we only end up with Juul type big companies.
That seems like a tricky needle to thread, though. How do you formulate a rubric that somehow places nicotine on the "fine to put into consumer products" bucket, while placing everything else that might hurt you in the "dangerous and should be banned" bucket?
Nicotine by itself is not particularly harmful. It can have acute effects if you overdose on it, but it doesn’t cause cancer. The harmful part of cigarettes is all the burnt plant matter you’re inhaling. You don’t see anybody discussing the risks of nicotine patches or gum.
I used vaping to quit smoking (and then eventually quit vaping). I’m sure vaping is better for me than smoking, and I’m sure not vaping is better for me than vaping. I’m all for safety regulations and more research to be done. But regulating or taxing the hell out of it just because it looks like smoking seems incredibly short sighted to me. Id want any regulation to be based on sound safety practices, and a legitimate understanding of the health affects.
I'm more trying to call attention to some tension. The idea that vape juice should be tightly regulated to keep harmful chemicals out implies that we should be defining some sort of toxicological ceiling on what things are allowed. And I'm wondering what that would look like, and how it would work out in practice. If we focus on LD50, I doubt there's much that goes into vape juice with a higher LD50 than nicotine, aside from perhaps something egregious like what's killing all these kids in TFA. If we focus on some long-term health outcome, it's probably similar - nicotine in isolation hasn't been as well-studied as whole tobacco, but it seems unlikely that, upon closer scrutiny, a chemical with such strong acute physiological effects wouldn't turn out to have some fairly serious chronic health effects, too. We narrow in on cancer, sure, but that seems like a standard that's more specifically for establishing that vaping is less harmful than cigarettes than it is for establishing an overall consumer product safety standard.
My inclination would be to say that a better starting place might be just to require vape juice to post ingredients labels, and set up some enforcement there. It's possibly not as strong a regulation as tightly controlling what's allowed to go into vape juice in the first place, but I'm guessing it also has a lower risk of creating a "be careful what you wish for..." situation for people who vape.
... if being a highly addictive drug isn't considered harmful.
Or being a teratogen. Or messing with sleep cycles. Or harming brain development.
In utero nicotine increases the likelihood of hypertension and diabetes.
No medical study considers nicotine harmless. Yes, it won't cause cancer. But that's not synonymous with "not particularly harmful".
Pregnant women should definitely not drink, they probably shouldn’t use nicotine either.
Which is kind of also where I'm going, saying, "by what standard?" There are plenty of ways to play gotcha with any potential regulation, based on the list of findings in this survey. I mean, let's assume, for the sake of argument, that GP was thinking that maybe we shouldn't allow vape juice manufacturers to deliberately add any banned pesticides such as DDT or arsenate. . . well, it turns out that nicotine is a banned pesticide, too.
Like I said in another comment, the research on pure nicotine doesn't seem to be as extensive as one would expect. It's been overshadowed by research on smoking and chewing tobacco. But it is there, and it's not that equivocal. I've heard this meme that nobody's proven nicotine is particularly harmful plenty of times, especially among ex-smokers who still use nicotine lozenges or vape juice or whatever, and I'm not sure where it comes from, but my guess is that it's based on a motivated interpretation of the situation. Like Upton Sinclair said, "It is difficult to get a man to understand something, when his ability to not spend the next longwhile feeling crappy due to withdrawal symptoms depends upon his not understanding it." Or something like that.
Which, again, at least in a vacuum, I'm not particularly worried if people want to vape. Me, I like alcoholic beverages. But I fully acknowledge that alcohol is a toxic chemical that's probably shortening my life. What worries me more is when people decide they're OK with vaping based on what amounts to a sort of conspiracy theory, because it's impossible to give informed consent when you're uninformed.
> Or being a teratogen.
> Or messing with sleep cycles.
> Or harming brain development.
> In utero nicotine increases the likelihood of hypertension and diabetes.
what else do they have in common, that's what I'd like to know, maybe they'd eaten that day, or consumed water.
You can make excuses and dismiss what's happening any way you want, but citing geography undermines your argument.
This is not an impressive response to
>> Vaping has much more history in Asia and Europe and seems to be without cases like this.
> 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.
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".
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.
This is not strictly true; there are vaporizers that take regular dried cannabis buds and deliver THC. No chemicals are involved.
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.