The onset of the vaping disease in the US has brought attention to dangers of vaping and also evidence that some of the ingredients used in the mixtures that are smoked are potentially harmful. Vitamin E acetate is strongly linked to the EVALI outbreak. Vitamin E acetate has been found in product samples tested by FDA and state laboratories and in patient lung fluid samples tested by CDC from geographically diverse states. Vitamin E acetate has not been found in the lung fluid of people that do not have EVALI. CDC.gov

As of January 21, 2020, a total of 2,711 hospitalized EVALI cases or deaths have been reported to CDC from all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands). Sixty deaths have been confirmed in 27 states and the District of Columbia (as of January 21, 2020). CDC.gov

MCT oil (Multi Chain Tryglecrides) such as coconut oil, have been shown to have been present in products used by patients with lung disease. The FDA Preliminary Lab Analysis found that patients with vaping related lung disease had used products containing the Vitamin E Acetate and Triglycerides. From the FDA web site -“As of Feb 12, 2020, approximately 677 samples are directly linked to 95 patients with CDC case numbers and samples from 93 of these patients have been analyzed.
As of Feb 12, 2020, approximately 677 samples are directly linked to 95 patients with CDC case numbers and samples from 93 of these patients have been analyzed.
73% of these 93 patients were connected to products containing THC.
Of these:
81% of cases included products with vitamin E acetate as a diluent
32% included products with aliphatic esters as diluent (e.g.,triglycerides)
9% included products with polyethylene glycol as diluent”

Recent evidence has shown that there have been some patients that used just THC products, some that used just Nicotine or flavored products and some that used both products.

Symptoms of Lung Injury Reported reported by Some Patients in This Outbreak:

Cough, shortness of breath, or chest pain nausea,
vomiting, or diarrhea
Fatigue, fever, or abdominal pain
Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks.

The CDC advises that if you use e-cigarette, or vaping, products, you should:
Not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and not modify or add any substances to these products that are not intended by the manufacturer.See a healthcare provider right away if you have symptoms like those reported in this outbreak as noted above.

Vaping Disease and Marijuana Vaping

The states with regulations for the legal marijuana and medical marijuana have developed their own guidelines and testing requirements for vaping marijuana products. The use of “Black Market” THC products has been shown to be a possible culprit as there has been a large percentage of patients reporting the use of those products before symptoms showed up as shown in table 2 of in reports from Illinois and Wisconsin. Also, just because you spent the time and expense to travel to a dispensary where there are regulations for testing are in place to buy your product does not mean that you are completely safe from harm. Some manufacturers use Vitamin E Acetate, Vegetable Glycerin, Propylene Glycol, and Poly Ethylene Glycol to keep their products oils flowing freely without clogging the device. There is evidence that formaldehyde-containing hemiacetals are produced upon heating in some of these compounds. Some might contain Vitamin E Acetate that could be a possible ingredient that contributes to the damage to the lungs. The New York State Department of Health announced this last year about Vitamin E Acetate that was found in some Marijuana products tested there. It has been shown for some time that certain oils and additives that are used in both the E-Cigarette and Marijuana vaping industry can cause problems if not used properly. One of the issues with both is the users that heat the vape product to a high temperature to produce more smoke when exhaled. This high powered vaping produces more dangerous compounds when heated at higher temperatures. Depending on the oils and additives used, different harmful chemicals are created. One thing to note from the information from the preceding report shows in figure one is that vaping with a voltage higher than 4 volts greatly increased the levels of carbonyl compounds released into the lungs. The same report showed in table 2 that the sample with 40% PEG (Poly Ethylene Glycol), the level of those compounds were less than the samples with vegetable glycerin (VG) and propylene glycol (PG). The use of flavorings in the Vaping products has caused some concern, with some states banning the flavored oils. It has been known for some time that certain flavors are more harmful than others, such as popcorn, caramel, and coffee flavors.

Take it for what it’s worth.

If you feel you must continue using the vaping cartridges instead of Edibles or consuming the Flower in a vaporizer, then proceed cautiously. Just for what it’s worth, perhaps some investigation into the oils used in the vape cartridge you use would be of benefit to see what oils are actually used. States with any form of legal Marijuana regulate and test the products to their own laws and standards. These testing standards are still being updated. Just some more “sage” advice is to only buy from reputable Dispensaries with products from reputable manufacturers. And do not modify the cartridges or batteries. If you have batteries that are not adjustable and put out more than 4.5 volts, it might be a good idea to purchase another product. If you have vape device with a variable voltage, keep it at about 4 volts. And try to find the manufactures that use DISTILLATE process and don’t add cutting oils or other agents If they do, then try to find products with PEG instead of PG or VG. And it might be wise to avoid anything with Vitamin E Acetate and MCT oils (Multi Chain Triglycerides/Coconut Oil) completely. There is also the possibility of buying counterfeit cartridges that look just like the real product. Again, only purchase from licensed Dispensaries, and try to buy verified products when possible. Refraining from smoking Marijuana in the cartridge form until the CDC and FDA can determine the actual cause of the lung disease is in order. There are so many factors affecting the investigation into the lung illness, such as how it is smoked, what is in the product, and possibly other related factors so far undiscovered, that cautionary advice is in order.

Maybe the cost to make an extra trip to a legitimate Dispensary to buy Edibles or Flower to replace your questionable vape cartridges, would be a lot lower than the cost of Doctor and Hospital visits.

More information about the effects of smoking marijuana without a vaporizer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072387/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151740/

https://www.fda.gov/news-events/public-health-focus/lung-injuries-associated-use-vaping-products