As of November 30, 2,290 Americans have been diagnosed with an unknown vaping-related lung illness — 47 more have died. Epidemiologists have been on their feet since July trying to figure out not only what is causing the injury to the patients’ lungs, but also what the resultant illness precisely is, thanks to a wide range of symptoms the patients have been presenting. They were able to narrow it down to vaping: almost all the patients had reported vaping (using e-cigarettes) nicotine or marijuana-related products before experiencing any symptoms. But what wasn’t clear was: why was this spurt in vaping-related illness occurring in the first place, when people have been vaping for decades? Was it a new kind of e-cigarette, the brand or the substance being smoked that is at fault for this mysterious illness?
Recently, the U.S. Centers for Disease Control and Prevention (CDC) announced that scientists had made a breakthrough: vitamin E acetate, an oily chemical added by illicit cannabis suppliers to bootleg THC (the chemical compound found in marijuana) vaping products to ‘cut,’ or dilute, them, has emerged as “one very strong culprit of concern,” Anne Schuchat, principal deputy director of the CDC, said at a press briefing.
Vitamin E acetate is a synthetic form of vitamin E. It’s found in many foods and is also present in nutritional supplements and cosmetic products like skin creams. It doesn’t usually cause harm when swallowed as a supplement or when applied to the skin, but previous research suggests that inhaling vitamin E acetate interferes with normal lung function. Honey-like, it coats the lungs’ airways.
Investigators from Minnesota tested samples of fluid taken from the lungs of 29 patients with vaping illness across 10 U.S. states for a CDC “Mortality and Morbidity Weekly” report. They found vitamin E acetate in all 29. No other toxins such as mineral or plant oils were found at high levels. However, testing showed none of 10 products recovered a year ago contained the substance. Additionally, the chemical was specifically found in THC-containing products; it was not found in products that contained only nicotine. “These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lung,” Schuchat said.
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In a separate report also published by the CDC recently, health officials in the U.S. state of Illinois reported the majority of patients with the vaping-related illness in their state said they’d used pre-filled THC vape cartridges that they had gotten from friends, off the street, or from other informal sources. They arrived at this by comparing patients who vaped and fell ill to more than 4,000 people who said they vaped but never became ill. Health officials have independently found the sticky substance in vaping cartridges in several U.S. states as well; of the 419 THC-containing products tested by the U.S. Food and Drug Administration, 49% contain vitamin E acetate.
With this, vitamin E acetate — being used to dilute recent batches of unregulated, and in some cases even legal, THC-related products — has become the most likely culprit behind why we are seeing these cases of severe lung injury now. Still, the Minnesota researchers stress that their study found only an association and can’t prove that vitamin E acetate actually causes lung injury. In addition, there may be more than one chemical or ingredient involved in the outbreak, they said. Notably, their study was also too small — only 29 patients.
India is taking note of these developments. On November 27, the Lok Sabha passed a complete ban on the production, manufacture, import, export, transport, sale, distribution, and advertising of e-cigarettes in the country.
Even though there is no e-cigarette being manufactured in India, in July, “the government had informed Parliament that e-cigarettes worth [US]$191,781 were imported to India, mostly from China, U.S., Hong Kong, and Germany, between 2016-17 and 2018-19,” Quartz reported. If its track record is anything to go by, given how the ban on marijuana or chewing tobacco have panned out for India — it’s an open secret that both are supplied and consumed extensively — it’s only a matter of time vaping-related illnesses or their understudied long-term consequences stop being something happening several oceans away.
