Mysterious vaping-related lung illnesses have cropped up across the US this year. On Friday, the Centers for Disease Control and Prevention said it had tallied more than 450 possible cases so far.
At least six people have died after vaping, across six different US states.
The safest thing to do, the CDC says, is "consider not using e-cigarettes."
It's still not clear why these cases are popping up now, or what the source of the illnesses may be, but vaping oils may be to blame.
The mysterious crop of deadly vaping-related lung illnesses continues to grow.
At least six people have died after vaping, with the sixth death of a "Kansas resident over the age of 50" announced Tuesday by the Kansas Department of Health.
"If you or a loved one is vaping, please stop. The recent deaths across our country, combined with hundreds of reported lung injury cases continue to intensify," Secretary for the Kansas Department of Health and Environment Dr. Lee Norman said in a statement.
On Friday, the CDC announced that at least 450 total possible cases of vaping-related lung illnesses had been reported across 33 states this year, and other recent deaths have been tallied in Minnesota, California, Oregon, Illinois, and Indiana.
"While the investigation is ongoing, CDC has advised that individuals consider not using e-cigarettes, because as of now, this is the primary means of preventing the severe lung disease," Dr. Dana Meaney-Delman of the CDC said on a call with reporters Friday.
It's still not clear what's causing these life-threatening lung issues, but they tend to sprout up in a matter of days or weeks after people use e-cigarettes (though some of the people who've gotten sick said they'd been vaping for years before they fell ill).
Initial symptoms often include shortness of breath, fever, nausea, gastrointestinal issues, and weight loss. Some symptoms can be debilitating enough to put people on life support, and many have had to be hooked up to machines that help them breathe. Other vapers have suffered collapsed lungs.
"One death from this outbreak is one death too many," Minnesota Commissioner of Health Jan Malcolm said in a release announcing the first death in that state on Friday.
While no specific e-cigarette or vape juice has been linked to the illnesses, doctors and public-health officials have noticed that the illnesses tend to pop up among young people (and especially young men) who are vaping cannabinoids like THC. But adults are not being spared, either. At least half of the deaths reported so far have been in older adults.
A striking number of cases are associated with "Dank Vapes"
"All of the patients that we saw had used or consumed THC through their vaping devices," Dr. Daniel Fox of WakeMed Health and Hospitals in North Carolina said on the CDC press call. "That seemed to be a common feature."
Doctors in Illinois and Wisconsin agreed. They studied 53 cases of vaping-related illnesses between April and August in those states and found that "84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices," they wrote in The New England Journal of Medicine on Friday.
"The most common THC product that was reported was marketed under the 'Dank Vape' label," the study said. Twenty-four of 41 patients interviewed said they used Dank Vapes, which are emerging as a shadowy, black-market way to sell relatively cheap marijuana-based vapes in places where they may not be legal.
"If you're thinking of purchasing one of these products off the street, out of the back of a car, out of a trunk, in an alley, or if you're going to go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice," Mitch Zeller, the director of the FDA's Center for Tobacco Products, said on the call.
The CDC cautioned that while "many" of the cases involved THC, there were "some" vapers who used only nicotine and still got sick. (Seventeen percent of the patients in the study said they used only nicotine in their e-cigarettes.)
The US Food and Drug Administration said it had received "over 120 samples for testing" in this outbreak and was testing for a broad range of chemicals.
"This includes nicotine, THC, other cannabinoids, along with cutting agents or dilutants, additives, pesticides, opioids, poisons, and toxins," Zeller said.
He encouraged anyone with "any unexpected tobacco or e-cigarette related health or product issues" to report them on the federal agency's website.
Some of the pneumonia cases may be related to vaping oils that help deliver drugs
Because the vaping industry is largely unregulated, there are hundreds of different chemicals in vape liquids on the market, and it is nearly impossible for people to know whether the ones they're using are safe. It could be the case, as Harvard's Dr. David Christiani pointed out in a NEJM editorial, that some vapes are contaminated, or that there's a dangerous chemical cocktail being created by novel vape juice mixtures.
Regardless of the drugs or flavors that they deliver, almost every vape on the market includes some propylene glycol and vegetable glycerin (PG-VG). These are both in the e-liquids that help vapes deliver drugs like nicotine and THC.
There's a chance that these oils could be getting into people's lungs and causing harm, or that they are irritating the lungs in new ways, prompting more pneumonia cases and lung illnesses.
Vitamin E acetate, for example, is in oils including canola, soy, and corn and it vaporizes at 363 degrees Fahrenheit, well above temperatures at which some people vape. The compound has been found in some, but not all, of the vape samples examined so far by the FDA.
"The samples we're continuing to evaluate show a mix of results, and no one substance or compound — including vitamin E acetate — has been identified in all of the samples tested," Zeller said on the call.
FDA commissioner Ned Sharpless later mentioned in a tweet that "we are leaving no stone unturned in following any potential leads, including vitamin E acetate found in many of the samples containing THC."
Professor Thomas Eissenberg at the Virginia Commonwealth University Center for the Study of Tobacco Products says that the oils found in many vape juices, like vitamin E, could be a major cause for concern, even if they're not involved in every single case.
"It makes me wonder whether, if we pulled a hundred electronic cigarette users off the streets and got some of their lung fluid, how many of them would have lipids in their macrophages?" Eissenberg said to Insider last week. "They're not experiencing symptoms, but they have the underlying cause."
Update: This story was originally published on September 6, 2019. It has been updated as the death toll mounts.