Contaminant found in vaping products linked to deadly lung illnesses, state and federal labs show
State
and federal health officials investigating mysterious lung illnesses
linked to vaping have found the same chemical in samples of marijuana
products used by people sickened in different parts of the country and who used different brands of products in recent weeks.
The
chemical is an oil derived from vitamin E. Investigators at the U.S.
Food and Drug Administration found the oil in cannabis products in
samples collected from patients who fell ill across the United States.
FDA officials shared that information with state health officials during
a telephone briefing this week, according to several officials who took
part in the call.
That same chemical was also found in nearly all cannabis samples from patients who fell ill in New York in recent weeks, a state health department spokeswoman said.
Vitamin E is found naturally in certain foods, such
as canola oil, olive oil and almonds. The oil derived from the vitamin,
known as vitamin E acetate, is commonly available as a nutritional
supplement and is used in topical skin treatments. It is not known to
cause harm when ingested as a vitamin supplement or applied to the skin.
Its name sounds harmless, experts said, but its molecular structure
could make it hazardous when inhaled. Its oil-like properties could be
associated with the kinds of respiratory symptoms that many patients
have reported: cough, shortness of breath and chest pain, officials
said.
“We knew from earlier testing by New York
that they had found vitamin E acetate, but to have FDA talk about it
from their overall testing plan, that was the most remarkable thing that
we heard,” said one official who took part in the briefing who was not
authorized to speak publicly.
The FDA also told
state officials Wednesday that its lab tests found nothing unusual in
nicotine products that had been collected from sick patients, according
to another person who took part in the call.
State health departments are reporting new cases
weekly. As of Aug. 27, there have been 215 possible cases reported from
25 states. Additional reports of lung illnesses are under investigation,
according to the Centers for Disease Control and Prevention, which is
leading the investigation.
On Wednesday, Oregon health authorities said a middle-aged adult who died in late July of a severe respiratory illness
had used an e-cigarette containing marijuana oil purchased from a legal
dispensary. It’s the second death linked to vaping nationwide and the
first to be linked to a product bought at a store. Illinois officials reported the first death last week. They did not specify what kind of product was used in that case.
State
and federal health authorities have said they are focusing on the role
of contaminants or counterfeit substances as a likely cause of vaping-related lung illnesses.
Many patients have told officials and clinicians that they bought
cannabis products off the street. Many of those who have fallen ill say
they have vaped products containing marijuana, but some also used
traditional nicotine e-cigarettes. Many report using both. Authorities
said they are not ruling out adulterants in nicotine vaping products.
Although the discovery of a common chemical in lab
tests from the FDA and New York’s highly regarded Wadsworth Center lab
offers a potential lead, officials cautioned that they are a long way
from understanding what exactly is making so many people sick.
An
FDA spokesman said the agency is “looking into potential leads
regarding any particular constituent or compound that may be at issue.”
The FDA is analyzing sample for a broad range of chemicals, including
nicotine, THC, other cannabinoids, “cutting agents” that may be used to
dilute liquids, other additives, pesticides, opioids, poisons and
toxins.
“The number of samples received
continues to increase and we now have over 100 samples for testing,”
spokesman Michael Felberbaum said Thursday.
Not
all the samples are suitable for testing. The FDA analyzed 12 viable
nicotine samples and 18 viable THC products, state officials said.
Vitamin E acetate was found in 10 of the 18 THC products.
“This
was the only thing that seemed to show up in 10 of the 18 cannabis
products,” said one state official who took part in the call.
The
federal lab results seem to confirm findings from New York State. Late
last week, its lab found “very high levels of vitamin E acetate in
nearly all” its cannabis samples tested. More than a dozen cannabis
samples were tested, a health department spokeswoman said Thursday. At
least one vitamin E acetate containing vape product has been linked to
each patient who submitted a product for testing, the department said.
“Vitamin
E acetate is not an approved additive for New York State Medical
Marijuana Program-authorized vape samples and was not seen in the
nicotine-based products that were tested. As a result, vitamin E acetate
is now a key focus” of New York’s investigation, New York State Health
Commissioner Howard Zucker said in a statement Thursday.
As
of Thursday, New York had received 34 reports from doctors of severe
pulmonary illness among patients who ranged in age 15 to 46 years old
who were using at least one cannabis-containing vape product before
becoming sick. All patients reported recent use of various vape
products, officials said.
The second report of a
death has emphasized the danger of this lung disease. “It was
surprising that the patient suddenly appeared without any other
underlying health conditions and became ill enough to die from this
syndrome,” said Ann Thomas, a physician with the Oregon Health
Authority.
Vaping refers to the increasingly popular practice
of inhaling vapor from an e-cigarette device, which frequently involves
heating a liquid that can contain nicotine, marijuana or other drugs.
Vitamin
E acetate is basically grease, said Michelle Francl, a chemistry
professor at Bryn Mawr College. Its molecular structure means that “you
have to heat it up pretty hot” for it to vaporize. Its boiling point is
363 degrees Fahrenheit, which is well above the 212 degrees F boiling
point for water, and nearly four times higher than normal human body
temperature.
Once the oil is heated hot enough
to vaporize, it can potentially decompose and “now you’re breathing in
who-knows-what,” Francl said.
When that vapor
cools down in the lungs, it returns to its original state at that
temperature and pressure, she said, which means “it has now coated the
inside of your lungs with that oil,” she said.
In
Utah, clinicians have treated several patients with acute lung injuries
who were diagnosed with a rare condition known as lipoid pneumonia,
whose symptoms include chest pain and difficulty breathing. Those
patients had abnormal immune cells filled with lipids, doctors said.
Unlike
the human digestive tract, which can break down and get rid of foreign
substances, the lungs aren’t designed to handle anything except gases,
experts said.
Laura Crotty Alexander, a lung
inflammation and e-cigarette researcher at the University of California
in San Diego, said it’s not clear whether the chemical itself or its
byproducts could be toxic.
“We haven’t looked
at the toxicity of vitamin E in the lungs,” she said. “The lungs are
designed to exchange gas molecules, they’re not designed to be exposed
to other chemicals.”
When the lung cells die,
that often provokes an inflammatory response and “other cells need to
come in and clean up the cell debris,” Alexander said. But the lungs are
very delicate. Any time extra cells come in, “they get in the way of
gas exchange,” she said. That makes it more difficult for oxygen to get
into a person’s bloodstream. The inflammation can cause liquid to
accumulate in the lungs, making it difficult for someone to breathe, she
said.
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