UPDATE: Finally some clarity!
This week the CDC (Center of Disease Control and Prevention) came to America with an important update about the so-called lung disease (EVALI) in America. What we have indicated in the previous edition of this update appears to be true; THC is the only common thread in research into lung disease.
Several authorities now report the new preliminary results. See for example CNN (link below), the Washington Post (link below) and even the AD (link below).
What exactly was the matter again?
The e-cigarette has been in the news a lot lately. Various sources in the United States have reported cases of a mysterious lung disease in recent months. Although the US government agency that led the investigation could not directly identify concrete products as the culprit, multiple sources soon mentioned THC cartridges (Abbot, B. & Maloney, J. 2019; Dickson, E., 2019; Downs, D. , 2019). These small pre-filled tanks / atomizers would contain impurities and thickeners in addition to the psychoactive constituent of cannabis (Eustachewich, L. 2019). The contaminated cartridges would come from the black market. An addition that was soon linked to acute lung damage was vitamin E acetate (Eustachewich, L. 2019). This substance has previously been linked to "lipid pneumonia", a condition that is now being found in many of the cases in America (Forbes).
What else do we know?
The CDC has released new figures on "the mysterious lung disease" last week. The percentage of cases that used THC-containing liquids has since been increased to 85% (75% last month). In addition, the percentage of cases that used excluding liquids containing THC has been increased to 34% (Center for Disease Control and Prevention, 2019). In the most serious cases, the percentage that used excluding THC is even 65% (Nedelman, M., 2019).
Following the new figures, there was a briefing where Dr. Schuchat (CDC) and Mitch Zeller (FDA) answered a number of questions from the press. The entire transcript can be found here (link below). From the first question and the subsequent answer it can be seen that the number of new cases of mysterious lung disease is declining. This is also apparent from the graph that the CDC has made available on its website (Figure 1). Further questions elaborate on the substances used on which Dr. Schuchat indicates that the vast majority of patients have indeed indicated that they have used THC. She adds that many of them have obtained these products through "informal" (friends, family, illegal sales) channels (Center for Disease Control and Prevention, 2019). Mitch Zeller further adds that much of the information about the use comes from self-reporting. He states that especially teenagers, but also people from states where THC is illegal may have a different reason to indicate that they have not used THC. Regarding possible cases in the past, Dr. Schuchat says she does not believe the outbreak is due to a better understanding of the symptoms. She says about this that in all likelihood there is a riskier product in circulation which is now being used more often (Center for Disease Control and Prevention, 2019)
The CDC's warning not to use e-cigarettes at all (as we saw it a lot in the Dutch headlines) has therefore not changed into a message about e-cigarettes with THC. The FDA's ruling also suggests that the percentage of cases linked to THC will increase even further.
Vaping is, and remains, harmful and is not recommended for non-smokers. We still see the investigations of both NVALT and the newly announced investigation by RIVM as positive developments. It is also still our hope that both parties will come forward quickly with accurate and transparent research.
Kind regards, Team Puff Store
Abbott, B., Maloney, J. (2019) People Urged to Stop Vaping Following More Deaths, Hundreds of Illnesses via: https://www.wsj.com/articles/authorities-investigating-450-vaping-illnesses-and-a-third-death-11567794441 (accessed at: 12-09-2019)
Burnes, J. (2019) Vaping Illnesses Could Link To Vitamin E Oil via: https://www.forbes.com/sites/janetwburns/2019/09/06/vaping-illnesses-could-link-to-vitamin-e-oil-officials-say/ (accessed at: 12-09-2019)
Diskson, E. (2019) Counterfeit Weed Vape Cartridges Are Everywhere — and They’re Making People Sick via https://www.rollingstone.com/culture/culture-features/counterfeit-thc-vapes-cdc-vaping-health-alert-875931/ (accessed at: 12-09-2019)
Downs, D. (2019) Amid Vape Pen Lung Disease Deaths: What Exactly Is Vitamin E Oil? via: https://www.leafly.com/news/health/vape-pen-lung-disease-vitamin-e-oil-explained (accessed at: 12-09-2019)
Downs, D. (2019) Vape Pen Lung Disease Has Insiders Eyeing Misuse of New Additives
via https://www.leafly.com/news/health/vape-pen-lung-disease-thc-oil-additive-investigation (accessed at: 12-09-2019)
Eustachewich, L. (2019) Vitamin E acetate could be causing vape-related illnesses: officials
via: https://nypost.com/2019/09/06(/vitamin-e-acetate-could-be-causing-vape-related-illnesses-officials/ (accessed at: 12-09-2019)
NOS Nieuws (2019) Onrust bij gebruikers van e-sigaretten via: https://nos.nl/artikel/2303374-onrust-bij-gebruikers-van-e-sigaretten.html (accessed at 26-09-2019)
Public Health England (2019) via https://twitter.com/PHE_uk/status/1172166081181605891 (accessed at: 12-09-2019)
RTL Nieuws (2019) Nieuwe longziekte eist vijfde leven in VS: 'Stop met roken e-sigaret tot dit is onderzocht' via https://www.rtlnieuws.nl/nieuws/buitenland/artikel/4840936/longziekte-amerika-sigaret-elektrische-esigaret-vapen (accessed at: 12-09-2019)
RTL Nieuws (2019) Zes doden na gebruik e-sigaret in VS: moeten Nederlanders zich zorgen maken? via https://www.rtlnieuws.nl/nieuws/nederland/artikel/4845352/e-sigaret-dampen-roken-doden-verenigde-staten-vs-zorgen-trimbos (accessed at: 12-09-2019)
US Food and Drug Administration (FDA) (2019) Vaping Illnesses: Consumers can Help Protect Themselves by Avoiding Tetrahydrocannabinol (THC)-Containing Vaping Products via: https://www.fda.gov/consumers/consumer-updates/vaping-illnesses-consumers-can-help-protect-themselves-avoiding-tetrahydrocannabinol-thc-containing (accessed at: 12-09-2019)
Nedelman, M. (2019) Deaths linked to vaping often involved THC products, not nicotine, CDC says: via https://edition.cnn.com/2019/10/28/health/cdc-vaping-death-data-mmwr/index.html (accessed at: 28-10-2019)
Centre for Disease Control and Prevention (2019) Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products: via https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (accessed at 30-10-2019)
Harris, R., (2019) Behind The Scenes Of CDC's Vaping Investigation via: https://www.npr.org/sections/health-shots/2019/10/25/773138356/behind-the-scenes-of-cdcs-vaping-investigation?utm_medium=RSS&utm_campaign=storiesfromnpr (accessed at 30-10-2019)
Centre for Disease Control and Prevention (2019) Transcript of CDC Telebriefing: Lung Injury Investigation: via https://www.cdc.gov/media/releases/2019/t1025-lung-injury-investigation.html (accessed at 30-10-2019)
Trouw (2019) Fruitsmaam in e-sigaret mag blijven, zegt Blokhuis. Via: https://www.trouw.nl/binnenland/fruitsmaak-in-e-sigaret-mag-blijven-zegt-blokhuis~b2d47a8a/ (accessed at 01-11-2019)