After the initial vape scare over the summer, things have been fairly quiet. The flavored vape ban was put into effect in October. Since then, the public has waited on more answers.

Recently, some answers have come. It seems vitamin E acetate is to blame for at least some of the vape-related lung injury sweeping the nation. 

Lots of folks in the cannabis community have long thought vitamin E acetate was responsible for the vaping health crisis. Recently, health officials concurred. 

Vitamin E Acetate Study

On November 8, 2019, the CDC released a study “Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury.” The study examined the lung fluid of 29 patients affected by vaping. 

Of the 29 patients, 100% of them had vitamin E acetate detected in their lung fluid.

The methods used to detect vitamin E acetate were also able to detect plant oils, MCT oil, petroleum distillates, and diluent terpenes. None of those components were detectable in the lung fluid. The CDC also tested fluid samples for the presence of THC and nicotine. THC was found in 82% of the samples and nicotine in 62%.

Washington state health officials have taken this study seriously, and it has informed state policy.

“We are deeply concerned by a new study finding vitamin E acetate at the primary site of injury in patients’ lungs,” said Secretary of Health John Wiesman. “While we still need more research to identify a definitive cause, the evidence we have linking vitamin E acetate to the outbreak demands immediate action to protect the public’s health.”

The action taken was to add vitamin E acetate to the current flavored vape ban. 

“Today’s action by the Board of Health to remove vitamin E acetate from the vapor product market in Washington is based on the most current information from the national investigation into severe lung injury associated with vapor products,” said Keith Grellner, chair of the State Board of Health. “The Board knows this investigation is ongoing; as such, we will be monitoring the investigation daily and will be prepared to take further action as we learn more.”

Washington State Flavored Vape Ban

The current emergency flavored vape ban went into effect in October. The affiliated law will go into effect in January 2020. 

One of the upcoming regulations licensees must comply with is disclosing all of the ingredients in vapor products. The disclosure form is due December 1. 

Before the CDC study’s release and the Board of Health’s announcement, cannabis manufacturers and retailers were taking action.

“WE DO NOT use cutting agents or any other fillers including Vitamin E Acetate in our products. And never will,” Brian Hildebrand, sales executive for Avitas said in a statement following the initial scare. “We are actively working with our lab partners to institute voluntary vitamin E acetate screening as soon as possible.”

Cannabis vaporizer company AiroPro also released a statement. The statement promised, ‘Vitamin E acetate has never been used, and will never be used as an ingredient in our products.’

Retailers Taking Action

Cannabis retailers Green 2 Go, Mainstreet Marijuana, and Uncle Ike’s are all participating in the OK Cannabis program. The program provides voluntary retail-level cannabis product testing.

In September, following the initial vape scare, the OK Program chose to test 47 vape cartridges for the presence of vitamin E acetate. None of the cartridges selected tested positive for vitamin E acetate. 

Additional Concerns

Health officials are quick to point out that we can’t confirm that vitamin E acetate is solely responsible for the crisis. 

“While it appears that vitamin E acetate is associated with an e-cigarette, or vaping, product use associated lung injury (EVALI),”  The CDC’s Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products explains. “Evidence is not yet sufficient to rule out the contribution of other chemicals of concern to EVALI.  Many different substances and product sources are still under investigation. It may be that there is more than one cause of this outbreak.”

In an article titled “What are Vapor Products?” by the Washington DOH, several additional additives are named as potentially hazardous or toxic. 

Toxic Artifical Flavors

The DOH identified chemical flavors benzaldehyde and 2, 5-dimethyprazine as potentially toxic when heated and inhaled. Some vape manufacturers use those flavors in cherry and chocolate-flavored vapes, respectively.

The September 2018 study Aldehydes in Exhaled Breath during E-Cigarette Vaping: Pilot Study Results, examined benzaldehyde toxicity when inhaled, and found “a potential health risk associated with carbonyls (i.e., formaldehyde, acetaldehyde, acrolein) generated by e-cigarettes.” Benzaldehyde is an aldehyde, and aldehydes are carbonyls. 

Risks Vaping Propylene Glycol and Glycerin

Before the ban, some vape manufacturers were using artificial chemical flavors such as these. Many cannabis vape manufacturers also use propylene glycol and glycerin as additives in vape cartridges. The DOH named these additives as being potentially harmful when heated and inhaled. 

In the October 2017 study, “Exposure to electronic cigarette vapors affects the pulmonary and systemic expression of circadian molecular clock genes,” examined the safety of e-cigarette additives, including propylene glycol and glycerin. 

 “This study reveals that the major solvents used in electronic cigarettes have unsuspected effects on the expression of circadian molecular clock genes that are not to be taken lightly,” The study reads. “Most importantly, these effects are not mediated by nicotine or flavors but by propylene glycol and glycerol, two compounds with next to no toxicity when ingested and at the very source of the perceived ‘safety’ of electronic cigarette.”

The Future of Vaping

The ingredients in cannabis vape cartridges manufactured in Washington state will be disclosed and available to the public soon. It will be interesting to see which cannabis cartridges contain additives, and which retailers continue to sell problematic products.