State governments continue to crack down on flavored e-cigarettes and other vape products, largely in response to the deaths and illnesses that began coming to light this past summer. But as lawmakers deliberate over their policy response to vaping, researchers are still trying to understand the cause of the illnesses. PBS NewsHour science correspondent Miles O’Brien reports.
States around the country continue to crack down on flavored e-cigarettes and other vaping products. Much of that is in response to the deaths and illnesses that began coming to light this summer.
But even as lawmakers are trying to determine what to do, researchers are still trying to better understand the cause of these illnesses.
Miles O’Brien has been looking into that very question for our regular series on the Leading Edge of science.
Like at least five million young Americans, 18-year-old Adam Hergenreder started vaping electronic cigarettes two years ago, because everyone else was doing it.
He loved all the flavors.
Mint tasted just like a mint. Mango tasted just like a mango. Cucumber tasted just like a cucumber.
So I didn’t really know that it had nicotine in it.
It is an extremely potent punch of nicotine. He preferred the strong pods made by Juul. Each carries as much of the highly addictive drug as a pack of cigarettes.
E-cigarettes, or vape pens, use a battery to heat a coil, which turns a nicotine infused liquid into an aerosol. Before too long, Adam was inhaling a pod-and-a-half a day.
I was hooked. I mean, I knew I was addicted, but I just couldn’t quit.
Eventually, the nicotine rush from Juul wasn’t enough for him. So he bought some black market vape pens containing cannabis oil. And, soon, he was enjoying head rushes from both nicotine and THC,the psychoactive ingredient in marijuana.
The Juul lasted about 10 seconds. The THC product lasted about an hour. That’s why I switched over to that.
But at the end of August, he got sick, very sick.
I started to experience some tremors. And then that was for about a day. And then the next three days, I started throwing up violently, again, throughout the whole day.
He ended up here at the Advocate Condell Medical Center in Libertyville, Illinois.
Pulmonologist Stephen Amesbury showed me Adam’s initial chest X-ray. All that haziness is inflammation.
When you see a 17- or an 18-year-old with a chest X-ray like that, what is the next step? What do you do as a doctor?
Many months ago, the consideration would primarily be pneumonia or some possible toxins or if they have taken some drugs. Nowadays, in light of all the vaping illnesses, that’s one of the first questions we ask young people when they come in with breathing problems.
Adam had EVALI, or E-cigarette or Vaping Product Use-Associated Lung Injury.
The condition emerged in Illinois and Wisconsin in April. As of December 3, it had sickened nearly 2,300 mostly young people nationwide. Half of them, like Adam, end up in intensive care, many attached to ventilators.
One young person required a lung transplant. And 48 have died. Adam came close.
It’s killed some people. Could it have killed him?
If he hadn’t come in, and just tried to stick it out at home a few more days, absolutely.
All those young people with very sick lungs triggered a series of investigations by state health authorities and the Centers for Disease Control and Prevention.
What we know now is that the vast majority of individuals have a history of using vaping products that contain THC.
Anne Schuchat is the principal deputy director.
So, our laboratory tested 29 samples from 29 patients from 10 different states around the country and looked at 12 different chemical tests. And we found 29 of 29 patient specimens had vitamin E acetate.
Vitamin E acetate: the nutritional supplement is inexpensive, unregulated and widely available. It’s fine to ingest or use topically, but when inhaled, the sticky substance interferes with normal lung functions.
It nevertheless became a favored choice in the black market as a way to dilute pure cannabis oil, which has a similar color and viscosity. Testing labs in states where cannabis use is legal analyze marijuana for its potency and screen for contaminants, heavy metals, pesticides and mold.
But, before this crisis, they weren’t looking for vitamin E acetate.
We don’t have screen for everything. We’re not “Star Trek.” We can screen for specific compounds.
Michael Kahn is president and founder of MCR Labs in Framingham, Massachusetts.
As EVALI emerged, he and his team quickly developed a way to screen for vitamin E acetate.
It was an immediate public health concern to us, so we offered it for free, and we still do, to anybody who needs to bring in samples just to make sure they’re safe.
We have received 56 samples from regular walk-in citizens.
They found nine of those cannabis oil samples were tainted with vitamin E acetate.
Every instance of vitamin E acetate was from somebody who walked in, not through the marijuana establishment regulated market.
But the EVALI case is still not closed. Twenty percent of patients afflicted do not admit vaping THC. There is evidence other substances could pose a danger as well.
And so some urgent research continues. Pulmonologist Jeff Gotts is an assistant professor at the University of California, San Francisco. He has built a device that systematically exposes the aerosols from e-cigarettes to cells cultured from donor human lungs rejected for transplantation.
The work is ongoing, but, so far, cells exposed for an hour a day, three days in a row, to the chemicals used to dissolve nicotine in Juul e-cigarettes show preliminary signs of damage.
It may be the case that this had been going on for a while in different forms in a low level, and we’re going to be able to see a lot better what the real incidence of disease from all of these exposures is now that we have everybody’s attention.
First touted as a smoking cessation tool, e-cigarettes got very popular very quickly, with virtually no regulatory oversight, and no research on its implications to human health.
In many senses, it is a horrifying experiment that people are performing on themselves with these different inhalational exposures, that we have absolutely no sense of their long-term safety.
With THC vaping oil, not only is there the same lack of safety data, but there are extra daunting hurdles to filling the research gap.
The federal government still considers marijuana a controlled substance, in the same legal category as heroin and LSD. It means scientists can only procure marijuana for research from one federally sanctioned site in Mississippi.
And it doesn’t produce the sort of cannabis oil products people are inhaling.
To what extent is this a result of the confusion and the discontinuity in all the laws and regulations across this country?
Oh, I think it’s a direct result.
Kate Phillips is director of education for the Cannabis Community Care and Research Network in Massachusetts.
We have an industry that’s supported by the state, and then everything after that’s hands up. So, when a problem like this happens, everyone’s scattered, and nobody really knows who’s the point person to go to, who needs to collaborate, who needs to lead on this.
And, again, it’s up to the companies. It’s up to the public health officials in each state. And that’s where we got to where we are today.
Meanwhile, the vaping trend keeps growing, especially among teens.
Public health experts worry, if no action is taken, this health crisis will only get worse in the short and long term.
For the “PBS NewsHour,” I’m Miles O’Brien in Gurney, Illinois.
Such important reporting.
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