There's little research or regulation on vape products sickening Minnesotans

THC vape cartridges
The New York State Department of Health has found lung disease associated with illicit vape cartridges like these.
New York State Department of Health

Public confusion and concern have followed reports of a rash of lung diseases linked to vaping, including a death in Minnesota.

Federal authorities have identified more than 450 cases of severe lung disease nationwide as of Friday, the New York Times reported. There have been at least five deaths, linked to both nicotine and marijuana vaping products.

At this point, public health investigations haven’t turned up conclusive evidence on what’s causing the injuries, often described as lipoid or chemical pneumonia.

But the impacts are scary: symptoms include shortness of breath, chest pain, fever, cough, vomiting and diarrhea. Several Minnesotans have been hospitalized.

On Friday, Minnesota health officials announced that a man who was over 65 died after an extended hospitalization following a severe lung injury tied to “vaping illicit THC products.” THC is the primary compound in marijuana that causes a high. Cartridges of THC-infused oil have become a popular source of cannabis consumption on the legal and illicit markets.

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Here’s what we do and don't know about vaping and the recent injuries and deaths.

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About 30 hurt in Minnesota; one death reported

Electronic cigarettes and pods by Juul on sale in Chicago.
Juul is a popular brand of e-cigarette, sold in cartridges called pods.
Scott Olson | Getty Images

The Minnesota Department of Health says at least 17 cases of severe lung damage appear to be linked to vaping, with another 15 potential cases under investigation.

Nationally, there have been at least five deaths tied to vaping. There’s the Minnesota case and two deaths in Indiana and Illinois tied to e-cigarette use, as well as one in Los Angeles. Officials in Oregon have linked one death to THC vaping cartridges that were apparently purchased legally from a store. Recreational marijuana is legal in Oregon and several other U.S. states, yet questions remain about how even legal cannabis marketplaces institute quality control.

Some sickened people report using vapes for nicotine and THC

Vape devices come in all shapes and sizes. They’re commonly marketed as a safer alternative to traditional cigarettes or, in legal cannabis states, marijuana flower.

But no matter how you slice it, the fact remains: Vaping is inhaling chemicals into your lungs — not a healthy act.

It’s heating up oils, sometimes with unknown additives, to the point that they become vapor infused with the user’s drug of choice. That could be nicotine, THC (the primary compound in cannabis that causes a high) or CBD (a cannabis compound that’s legal and doesn’t cause a high).

Nicotine vapes range from box-like devices to so-called e-cigarettes including Juuls. THC and CBD vapes are commonly sold in two parts: a heating element and an oil-filled cartridge that attaches to the heat source.

Some cartridges could be from counterfeit sources flooding the market

It’s feasible anyone could make a fake THC cartridge that looks like it came from a store in a state where it’s legal.

All the raw materials can be found on Amazon — from bulk, empty cartridges and packing materials to oils to tamper-evident seals and warning labels, shipped free via Amazon Prime.

Some investigations have zeroed in on Vitamin E acetate as a possible cause of the lung disease. The theory is that THC oils have been diluted with Vitamin E or some other oil, which could be causing the health issues.

In New York, the state health department says lab tests showed “very high levels of vitamin E acetate in nearly all cannabis-containing samples.” Medical marijuana is legal in New York, but Vitamin E acetate is not approved as an additive for the medical cannabis products.

Vitamin E is most often used in skin care products and dietary supplements, according to Healthline.

With the THC cartridges, it’s the unknown additives that are concerning health officials, said Minnesota Department of Health Epidemiologist Stacy Holzbauer.

“We don’t know exactly what [is] in the cartridges,” she told MPR News. “But what is different about this outbreak is that we‘re seeing essentially a cluster of cases that are presenting with severe lung injury and that is unusual.”

THC oils are growing in popularity on the legal cannabis market, which doesn’t exist in Minnesota. Reports suggest they’re becoming ubiquitous on the black market, too.

A THC vape cartridge inside a plastic bag
A packaged THC oil vaporizer cartridge is displayed at a pot shop in Seattle.
Elaine Thompson | AP

Marcus Harcus, executive director of the Minnesota Campaign for Full Legalization, said contaminated cannabis products are a “serious public health problem” and will continue as such without legalization and regulation.

Part of the solution, he said in an email, is “full legalization at the federal level with smart regulation in every state — prohibition is stupid regulation because it fails to stop most of the distribution and consumption, and criminalizing people ruins more lives than contaminated products.”

Nicotine vapes’ health impacts seem severe, but little researched

A man smokes an electronic cigarette in Chicago on April 23, 2014.
A man smokes an electronic cigarette.
Nam Y. Huh | AP file

Vaping is a relatively new phenomenon and there’s not much evidence on how it affects long- and short-term health. A 2016 study in the scientific journal Toxicology said as much:

“Inadequate research and lack of regulatory guidelines for both the manufacturing process and the content of the vaping solution of the e-cigarette has become a major concern,” the study’s authors wrote.

Despite the lack of knowledge, vaping caused tobacco use among Minnesota youth to increase last year for the first time since 2000.