Regarding short-term risks, the epidemic of vaping-related illnesses that are sweeping the country — currently 530 patients with eight deaths, according to the Centers for Disease Control (CDC) — do not appear to be due to standard e-cigarettes. Why? Because the damage to the lungs appears to be the result of oil — a condition known as lipoid pneumonia — whereas most if not all e-cigarette products available in convenience stores are water-based.
I spoke with Dr. Scott Gottlieb, former Food and Drug Administration (FDA) commissioner, who has focused extensively on the potential harm of e-cigarettes among our teens. He told me that “the acute injuries are likely to be tied to illegal vapes, probably containing THC, the psychoactive compound that can give the sensation of being high; and CBD, the non-psychoactive component that can help with pain relief. The damage is likely due to toxic emulsifying agents used to mix those active ingredients. These oils are toxic for the lungs.”
New York state health officials already have traced a number of the cases to vitamin E acetate, one oil being inappropriately used in some of the illegal THC and CBD vape products.
Why is the outbreak occurring now? “The most significant new event in the market recently was the launch of some nationally sold brands of CBD vape products,” Gottlieb said. “These launches drove much wider use of CBD vapes over the past summer, and I think the growing popularity of CBD vapes and the emergence of these lung injuries is unlikely to be a pure coincidence. There is likely to be some causal relationship.”
In states where THC or CBD vape products are legal, Dr. Gottlieb told me, it is not clear that FDA has jurisdiction unless the product is making inappropriate medical claims. This regulatory gap is part of why there are no set standards. CBD oil, derived from hemp, is now legal throughout the U.S., provided that it doesn’t have more than 0.3 percent THC and it is no longer a controlled substance, making it even more difficult to regulate.
Whether the current outbreak is due to illegal bootleg products or uncontrolled CBD or THC oils in states where they are legal, these products are causing a significant public health risk.
So, what should we do now?
All vaping devices share the hype of a perceived medical benefit, whether they state this benefit openly — but without proof — or not. This is bad science and worse medicine. It must be contested with a public information campaign and more scientific research. We already know enough to say that vaping is bad for you and vaping oil-based products is far worse.
Unfortunately, it is far too late to turn back the clock and make vaping available by prescription-only. But it is not too late to define a standard for devices and mixtures and apply it across the board. The Senate is currently considering bills to extend the age for legal vaping to 21, banning flavors, and to create a standard for the product along with a public information campaign. I applaud these initiatives but would add a ban on oil-based vapes, including those containing CBD and THC in places where these are legal.
It is imperative that we do a better job of policing the suppliers of illegal vapes, too. The life and lungs of so many young people are at stake.
Marc Siegel M.D. is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter @drmarcsiegel.