Category: EVALI

  • Yale Study: Flavor Bans Can Make Vaping More Dangerous

    Yale Study: Flavor Bans Can Make Vaping More Dangerous

    Credit: Yale University

    Increased rates of vaping nicotine and marijuana products in the U.S. did not result in more e-cigarette or vaping-related lung injuries (EVALI) cases, according to a new study from the Yale School of Public Health (YSPH).

    “If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviors should show a higher EVALI prevalence,” said assistant professor Abigail Friedman, the study’s author. “This study finds the opposite result. Alongside geographic clusters of high EVALI prevalence states, these findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”

    Published in the Journal Addiction, the research estimates the relationship between a state’s total number of reported cases of EVALI per capita as of January 2020, and pre-outbreak rates of adult vaping and marijuana use, according to a release from the YSPH. Results show that higher rates of vaping and marijuana use are associated with fewer EVALI cases per capita.

    The U.S. Centers for Disease Control and Prevention (CDC) announced in February that it had officially classified vitamin E acetate, an additive long linked to EVALI and most common in THC e-liquids that are informally-sourced—i.e., purchased off the street or home-mixed—as “a primary cause of EVALI.”

    The EVALI outbreak has motivated a variety of state and federal legislation to restrict sales of nicotine e-cigarettes, including a temporary ban on all e-cigarette sales in Massachusetts in late-2019 and bans on flavored e-cigarette sales in several states and localities. However, if the goal was to reduce EVALI risks, the study suggests that those policies may have targeted the wrong behavior.

    The study found that the five earliest states to legalize recreational marijuana—Alaska, California, Colorado, Oregon and Washington—all had less than one EVALI case per 100,000 residents aged 12 to 64, according to the release. None of the highest EVALI-prevalence states—Utah, North Dakota, Minnesota, Delaware and Indiana—allowed recreational marijuana use.

  • Acetate Culprit in Recent Minnesota Vaping Illnesses

    Acetate Culprit in Recent Minnesota Vaping Illnesses

    cannabis vape
    photo: Jeremynathan | Dreamstime

    Minnesota state health officials say the 12 people who were hospitalized with vaping-related lung illness in June and July all had used products containing vitamin E acetate.

    Five of the 12 cases required ICU care and ventilators, and all are now recovered or recovering. The average age was 18, but patients were as young as 14 and old as 46, according to a news release from the state, according to news reports on twincities.com.

    Vitamin E acetate is an additive sometimes used as a solvent for bootleg versions of the vaping cartridges containing THC, the psychoactive ingredient in marijuana. The U.S. Centers for Disease Control and Prevention previously identified the additive as dangerous when inhaled.

    The Minnesota Department of Health said that most of the patients identified had reported vaping products containing THC, though some reported vaping only nicotine.

  • Massachusetts Releases Quarantined Cannabis Vapes

    Massachusetts Releases Quarantined Cannabis Vapes

    marijuana in jar
    Credit: Add Weed

    Last September, Massachusetts became the first state to ban sales of all vaping products, for both tobacco and cannabis, in response to a mysterious vaping-related lung illness known as e-cigarette or vaping product use-associated lung injury (EVALI). In November, the state’s Cannabis Control Commission ordered a quarantine on all cannabis vaping products, except for products for flower used by medical cannabis patients.

    That quarantine is being lifted, releasing more than 600,000 vaping products manufactured before December 12, 2019, which is when the Commission allowed for new cannabis vaping products to be sold, according to ap press release. The Commission announced Monday that “licensees may retest and release—or destroy—certain products with enhanced warning labels,” under certain conditions.

    “Since the Commonwealth declared a vaping public health emergency last fall, the Commission has dedicated significant energy and resources to investigating the additives, hardware, and storage practices that licensees use to produce and sell cannabis vaporizer products,” Shawn Collins, the executive director of the Commission, said in the announcement. “Fortunately, repeat tests of licensed product samples did not return any detectable levels of [vitamin E acetate]; unfortunately, they did establish that heavy metal contamination may increase in vaping products over time.”

    Vitamin E acetate became the primary culprit in the investigations into the vaping-related illnesses by the Centers for Disease Control and Prevention.

    Cannabis licensees have three options when it comes to their vaping products: dispose; retest and release; or reclaim, meaning, “repurposed into other products,” which would also require retesting. Re-released products must have a label indicating that they “passed retesting for heavy metals and Vitamin E Acetate,” and that they, or their contents, were “previously quarantined.”

  • CDC: States No Longer Need to Track EVALI Data

    CDC: States No Longer Need to Track EVALI Data

    The U.S. Centers for Disease Control and Prevention (CDC) said states no longer have to track lung-related injuries caused by marijuana-based vapor products, partly because cases have dropped.

    The CDC said it stopped requiring states to report the numbers in February after it pinpointed vitamin E acetate as the culprit in THC e-cigarettes making people sick, according to wftv.com.

    The CDC said it is monitoring EVALI cases and hasn’t seen an uptick nationwide. However, It said the agency will continue to provide assistance to states as needed.

    EVALI (e-cigarette or vaping product use-associated lung injury) is the name given by the CDC to a lung disease linked to vaping THC vapor products. 

  • Boston: $25 Million of THC Vape Products Await Testing

    Boston: $25 Million of THC Vape Products Await Testing

    Credit: Martijn Baudoin

    Worth a collective $25 million, roughly 620,000 vaping products are gathering dust. The products have been awaiting testing since September.

    The devices have been quarantined under Massachusetts Gov. Charlie Baker’s ban on the sale of vaping products, according to an article in the Boston Globe. Massachusetts Cannabis Control Commision (CCC) is under pressure to do something.

    ″(Businesses) have reached out to us … and we’ve talked to them,” CCC Chairman Steven Hoffman explained. “We’re trying to find a position that works for everybody, but at the end of the day, we won’t compromise on public health and public safety.”

    Baker instituted a ban on the sale of vaping products in September amid an outbreak of severe lung ailments associated with e-cigarettes and vaping products containing marijuana.

    The ban was lifted in December for shops that met certain requirements — including posting signs warning of the dangers of severe lung disease and other health risks; keeping all vaping products behind the counter; and prohibiting the sale of unpackaged tobacco or vaping cartridge refills — and the CCC began allowing marijuana retailers to sell newly manufactured marijuana vaping products that were tested for contaminants such as vitamin E acetate, which was suspected to have caused the illnesses, according the article.

    It also further regulated the requirements for testing of vaping products.

    But that meant that a large amount of inventory — nearly 620,000 units, according to CCC Executive Director Shawn Collins — had been removed from circulation, according to the article.

    Moreover, the testing of that product has been “a mixed bag of results,” Collins said.

  • Wisconsin Officials: Dramatic Decline in EVALI Cases

    Wisconsin Officials: Dramatic Decline in EVALI Cases

    cannabis vape
    photo: Jeremynathan | Dreamstime

    The number of lung disease cases in Wisconsin has seen a dramatic decline. Only eight vaping-related injuries have been reported as of May 31. Last year, there were 103 cases, according to the Wisconsin Department of Health Services, which tracks vaping-related injuries.

    State health officials said they don’t know the reasons for the decline but suggest it could be due to the changes in the formulation of THC vaping products and fewer people using them, according to an article on wkow.com.

    In 2019, CDC identified Vitamin E Acetate as the potential culprit behind thousands of vaping illnesses that sent several Wisconsin teens to the hospital resulting in significant lung damage.

    “People producing these THC products have learned from this and have really improved their manufacturing standards and are doing a better job of keeping out the Vitamin E Acetate out of the products,” said Megan Piper, a researcher at the University of Wisconsin Tobacco Research Center.

    Last year a DHS investigation found 89 percent of the 27 cases that reported lung disease due to vaping was tied to THC, the active ingredient in marijuana.

    Another reason for the decline could be due to a flavor ban on Juul products and raising the tobacco age to 21 in Wisconsin, according to Piper.

    “If your source for vaping products was informal, meaning you got it from someone from school, you no longer have those connections and your supply may have gone away,” said Piper.

  • Experts: Possible Post-Covid Boom for Vapor Market

    Experts: Possible Post-Covid Boom for Vapor Market

    Credit: Timothy S. Donahue

    The marijuana market took a big hit last year after consumers of black market THC vaping products started to become ill, often with fatal consequences. As a result, companies have been on high alert, making safety a priority when crafting both nicotine and cannabis vape products, according to an article on Forbes.com.

    With Covid-19 still a reality, experts are foreseeing a boom in the vaping market this summer. So, what else do they see in their crystal ball post COVID-19? Find out below. Among those weighing in are Tom Brooksher, CEO of Clear Cannabis Inc; Cortney Smith, CEO and founder of DaVinci; Dan Gardenswartz, chief financial officer of Spherex; and Elizabeth Hogan, vice president of brands at GCH Inc (parent company of Willie’s Remedy and Willie’s Reserve).

    The Forbes article expresses that the following Q&A has been edited for conciseness and clarity.

    Iris Dorbian: Why do you think the vape market will see a boom in the summer?

    Tom Brooksher: Traditionally, summer is a strong season for cannabis sales as people purchase our products to enhance their vacations and time spent outdoors. As restrictions are lifted, we expect a pent-up demand for cannabis products that can be conveniently used in conjunction with outdoor activities. We also expect the phased reopening of tourism in key tourist/cannabis markets, such as Nevada, California, Colorado and Florida, to positively impact vape product sales.

    Cortney Smith: Even as we enter an uncertain economy amid a recession, I still believe the vaporizer market has been growing steadily over the past few months and will continue to flourish. If anything, the pandemic has opened more people up to the possibilities of cannabis during a stressful time, and we’ve seen an uptick in new consumers

    Elizabeth Hogan: We’re seeing people return to their favorites and stock up on proven winners—vape products included. With the fear of spreading germs, vapes sales will continue to grow as consumers move away from shared joints or bowls. Vapes are less harsh on your throat and lungs than smoking and take effect more immediately than edibles. This summer, it’s going to be a good idea to be prepared and bring your own. We’re sharing in spirit only these days.

    Brooksher: We’ve done very well, all things considered. Our sales would have been even stronger in Colorado and Nevada had the pandemic not hit. In general, we’re seeing strong brands – high quality products with name recognition – holding their own or even growing during the pandemic, and weaker brands struggling or potentially failing.

    Gardenswartz: We definitely felt some pressure during April and May. We also engaged in aggressive social media messaging to maintain communication with our consumers, as well as daily contact with our dispensary partners in all jurisdictions to mitigate any downward pressure. For vaping specifically, our customers reported a notable shift from typical joints to vape pens, which was largely driven by health and sanitary concerns. They are also cleaner and longer lasting. We don’t see this trend changing anytime soon.

    Dorbian: How is your company positioning its vape line in response to the anticipated boom in the vape market?

    Brooksher: Perception of value on the part of consumers is always important for cannabis brands and we don’t see that changing. That doesn’t mean cannabis consumers are focused on the cheapest product. They’re willing to pay for a quality product, but only if they perceive that it’s a good value – specifically that it’s safe, will provide a good experience, and matches their needs and preferences.

    Smith: We recognize the need for personal vaporizers, especially in a time when cannabis consumers are shifting from a culture of sharing devices to more individual consumption. My team and I also continue to dream up new innovations, because I never want us to rest on our laurels. We’ve spent the past three years developing a new limited-edition iteration of the IQ2, that allows for cooler temperatures, and we’re finally launching it this summer. There’s no time like the present to be innovative and bring new solutions to the public.

    Gardenswartz: During the lockdown, we worked aggressively to fine-tune quality control and production efficiency across the company, and those initiatives will benefit us not only this summer, but over the long-term. We view our products as “accessible luxury” – premium products priced at accessible levels. With Spherex, consumers can have the best of both world: the best products out there at very accessible prices.

    Hogan: Willie’s Reserve vape line product offering has been expanding over the last year, adding CBD:THC ratio products, collaborations with musicians (Nathaniel Rateliff and Margo Price) and introducing 1-gram cartridges for consumers looking for more value. We have also seen a growing consumer demand for different forms of concentrate in vape cartridges. The combination of distillate and cannabis-derived terpenes is becoming very popular. In response, we launched our new line of live resin craft cartridges in Colorado. The live resin cartridges offer an even more flavorful draw than distillate.

    Dorbian: What precautionary measures is your company enacting to ensure the safety of its vape lines?

    Brooksher: We were fortunate in that our products were very safe to begin with. We’ve never used vitamin E acetate or any other toxic fillers, and we eliminated the use of MCT oil prior to it becoming an issue. In addition, we only use CCELL ceramic heating cartridges and hardware that are made with food and medical-grade material of the highest quality. As a result, we’ve had zero problems with product safety.

    Smith: We’ve always built safety into the very DNA of our devices from the start. Beyond the specific safety measures we’ve taken to protect our employees and maintain best practices throughout the pandemic, we haven’t changed a thing about the device itself. DaVinci devices are created responsibly with clean hardware, with medical-grade components like a zirconia air path and feature an array of safety certifications such as Rohs, FCC and CE.

    Gardenswartz: Fortunately, Spherex didn’t experience a notable negative impact from last year’s crisis. Spherex has and will continue to use only the best material, run through the cleanest process, put into the best hardware and packaging, resulting in clean, potent and superior end products. We plan to keep most, if not all, of the precautionary measures we enacted around COVID, even beyond the point that the virus is under control, which could be never.

    Hogan: Transparency and cooperation in every direction are the two most important ingredients in safe cannabis. At Willie’s Reserve, we have alway been cognizant of how some negatively view the cannabis industry and our goal is to combat their doubt with clean products and safe procedures. Since this has always been a focus of ours, we have not had to change in wake of last summer’s illicit market issues. Our motive and the motive of some of these illicit market manufacturers are very different and our product quality is a testament to that.

  • Opinion: Terminology Causing Confusion Between Nicotine and THC Vapes

    Opinion: Terminology Causing Confusion Between Nicotine and THC Vapes

    train

    By Charles Gardner 

    The authors of a recent editorial published by a prestigious medical journal write, “most patients with EVALI had inhaled vapor from e-cigarette liquids containing THC.” [emphasis added] In this piece, I will explain why I used to consider the term ‘THC e-cigarettes’ a logical fallacy, and how I have come to believe this original conclusion was wrong. 

    First, let’s review some basic terminology. The word ‘vape’ is a verb; those who vape are ‘vapers’; their devices are ‘vaporizers’. Some vape nicotine, others tetrahydrocannabinol (THC), according to an opinion piece from Foundation for a Smoke-Free World.

    ‘Vaping’ involves heating a liquid to release a liquid aerosol called ‘vapor’. Unlike smoke inhaled from burning plant leaves, vapor contains fewer – and lower levels of – harmful toxins, no solid particulates and no carbon monoxide.

    Products, people, and purposes

    THC and nicotine vaping involve different devices, liquids, supply chains, people, and purposes. The former gets you high (and may relieve pain). The latter may help smokers quit. Evidence suggests that nicotine vaping is safer than tobacco smoking, and this constitutes the central tenet of tobacco harm reduction.

    Because nicotine is not soluble in oil, nicotine vaporizers are designed to produce vapor from aqueous ‘e-liquids.’ In contrast, THC dissolves readily in oil, so THC vaporizers are designed to produce vapor from oils. They use different heating coils and operate at different temperatures than nicotine vaporizers.

    The problem with e-cigarettes

    The term ‘e-cigarette’ was originally chosen to encourage adult cigarette smokers to switch to what many believe are vastly safer alternatives. Advocates for THC vaping and cannabis legalization deliberately avoid the term ‘e-cigarette’ to prevent confusion.

    Over time, however, the perception of ‘e-cigarettes’ has changed, perhaps in part because of negative associations with the deadly products that they were invented to replace. Recently, researchers at the University of California, Davis, made a similar argument.

    Terminological confusion

    During the fall of 2019, health officials in the United States observed a sudden cluster of vaping-related lung injuries. The cause of those injuries was ultimately found to be an adulterant in the bootleg (illicit) THC vape oil supply chain: vitamin E acetate (VEA).

    VEA is soluble in oils, but not soluble in nicotine vape liquids, which are aqueous. So, the US Centers for Disease Control and Prevention (CDC’s) disease terminology — e-cigarette, or vaping, product-use associated lung injuries (EVALI) — seemed problematic for several reasons.

    First, multiple lines of evidence pointed to illicit THC vaping as the cause of EVALI. Second, omitting ‘illicit THC’ from the name could cause real harm if THC consumers continued to vape bootleg products. Third, highlighting ‘e-cigarettes’ in that scary acronym runs the risk of simultaneously encouraging legal nicotine vapers to relapse to smoking, and discouraging adult smokers from quitting.

    The ‘E’ in EVALI still makes many nicotine vapers bristle. “No one calls joints cigarettes,” they say, so “why is the CDC claiming that THC vapes are e-cigarettes?” I used to agree. But there is a problem with that argument.

    ‘Cannabis cigarettes’ are a thing

    Merriam–Webster’s dictionary defines a ‘joint’ as a ‘marijuana cigarette’. Just Google ‘cannabis cigarettes’. They are a thing. They are especially a thing in countries and American states where recreational cannabis is legal, and companies use modern manufacturing methods to produce them.

    The authors above, who referred to “e-cigarette liquids containing THC,” were not deliberately trying to confuse their colleagues by conflating bootleg THC vape oil harms with legal nicotine vaping products. Yet confusion remains. Most people who hear the word ‘e-cigarette’ will think nicotine, not THC.

    Finding a solution

    In my view, there is only one way out of this terminological muddle. In this post, the only way that I could clearly distinguish ‘nicotine vaping’ from ‘THC vaping’ was to use exactly those terms. I now see the term ‘e-cigarette’ itself as a potentially deadly source of confusion. In the COVID-19 era, avoiding terminological confusion could be a matter of life and death.

  • FDA Extends Comment Period  for Information on EVALI

    FDA Extends Comment Period for Information on EVALI

    Edgars Sermulis – Dreamstime.com

    In response to requests from the public, FDA is extending the comment period for a request for information (RFI) seeking data and information related to the use of vaping products that are associated with lung injuries

    The RFI, initially published in the Federal Register on Feb. 18, responds to direction from Congress to gather additional information that could help identify and evaluate additional steps that could be taken by the agency to “address the recent pulmonary illnesses reported to be associated with the use of e-cigarettes and vaping products.”

  • Study: States With Legal THC had Fewer EVALI Cases

    Study: States With Legal THC had Fewer EVALI Cases

    cannabis vape
    photo: Jeremynathan | Dreamstime

    States with laws legalizing recreational marijuana had fewer cases of e-cigarette/vaping-related lung injury (EVALI) than states without such policies in 2019, researchers reported.

    In states that had legalized recreational marijuana, the EVALI case rate averaged 1.7 per million population (95% CI 0.3-3.1), far lower than states where it’s legal only for medical purposes (8.8 per million, 95% CI 5.1-12.5) or completely illegal (8.1 per million, 95% CI 4.1-12.0), reported Alex Hollingsworth, PhD, of Indiana University in Bloomington, and colleagues, according to an article on medpagetoday.com.

    Moreover, the number of cases was significantly lower in states with legal recreational marijuana compared to those where it was not after adjusting for vaping rates (difference 7.2 cases per million, 95% CI -11.8 to -2.6, P=0.003), they wrote in a JAMA Network Open research letter, according to the story.

    “It appears states that have legal access to marijuana have lower rates of EVALI cases, which is consistent with the hypothesis that people have demand for marijuana products, and in states where they don’t have access to them in this regulatory fashion, they end up purchasing them elsewhere,” Hollingsworth told MedPage Today.