The headlines about vaping over the past week have been dominated by the news of a severe respiratory illness that has killed five people, and hospitalised many more, in America. As the deaths are being linked to vaping cannabis related products, we felt compelled to investigate further.
As of 6th September 2019, the CDC (Centers for Disease Control and Prevention) has reported over 450 possible cases, across 33 states, of mysterious lung illnesses. Although they haven’t officially identified a cause, all patients have a history of using e-cigarettes.
Predictably, this has caused the anti-vaping contingent to come out waving their pitchforks and brandishing their torches. Peak vape panic ensues as US public officials, and the media, escalate their war on e-cigarettes. E-cig users are being warned to ‘stop vaping NOW’. State Governors call for immediate bans and declare vaping a ‘public health emergency’ and an ‘epidemic’.
In order to deliver a more balanced report, and make sense of the facts behind these headlines, we wanted to find out if vaping really is a public health crisis, or if its risks are being blown out of all proportion.
What is the diagnosis of the illness?
All reported cases are pulmonary in nature, which means the diagnosis is related to the lungs. All affected individuals experienced respiratory symptoms including cough, chest pain, shortness of breath, and fatigue. Some also reported vomiting and diarrhoea. Symptoms worsened over days or weeks until the patients required hospital admission. Tragically, in five known cases so far, the illness has led to death.
There seem to be two main conditions being attributed to the outbreak. The first is a specific form of lung inflammation called lipoid pneumonia.
Lipoid (or lipid) pneumonia is a rare form of pneumonia that can occur when either oils or lipid-containing substances enter the lungs. Once in the lungs, the substance causes an inflammatory reaction; the severity of the reaction depends on the type of oil and the length of exposure. Severe inflammation can permanently damage a person’s lungs.
The second condition being widely diagnosed in these reported vaping cases is Acute Respiratory Distress Syndrome (ARDS).
ARDS is a type of respiratory failure characterised by rapid, widespread lung inflammation and is caused by fluid building up in the tiny air sacs (alveoli) in the lungs. The fluid prevents the lungs from filling with enough air which means that less oxygen reaches the bloodstream and organs.
ARDS usually follows a major illness or lung injury. One of the most common underlying causes of a lung injury capable of triggering ARDS is the inhalation of certain chemical fumes. Many people who develop ARDS don't survive; the risk of death increases with age. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs.
What’s causing the illnesses?
Since each of the patients has reported a history of vaping, e-cigarettes were immediately seized upon as the culprit. However, if a person dies or is injured in a house fire because they put a foil tray in the microwave, you wouldn’t tell people to stop using microwaves. Instead, you’d remind them not to put metal objects *IN* the microwave.
In all cases, evidence is pointing to what was put *IN* the e-cigarette that is causing the illness.
Bootleg THC and CBD vape juice
As more cases are thoroughly investigated, reports suggest that there are links to people using illicit ‘bootleg’ vaping fluid. Either bought from black market sources, or homemade, the counterfeit vape juice is created so that people can vape THC oil, CBD oil, or synthetic cannabinoids, like Spice.
A new ingredient, known as Honey Cut or Clear Cut, is being (mis)used in these bootleg THC and CBD vape cartridges. The product is made from Vitamin E oil (tocopheryl-acetate) and is used in black-market e-liquid as a cheap way of diluting the THC or CBD without thinning the viscosity, which makes it suitable for vaping.
Tocopheryl-acetate was found in nearly all the samples taken from patients who fell ill across New York State in recent weeks. It is the first common element to be discovered since, to date, officials have found no commonality amongst brands of e-cigarette or vape juice used by patients.
Why does Vitamin E cause a problem in vape juice?
Vitamin E is found naturally in certain foods such as olive oil and almonds. The oil derived from vitamin E (tocopheryl-acetate or vitamin E-acetate) is available as a food supplement, and is commonly used in topical skincare products. It is safe when ingested or applied to skin; so why is it causing people to fall ill?
The problem lies when it is taken into the lungs. The molecular structure of vitamin E-acetate can make it hazardous when inhaled. It is definitely credible that the oil-like properties are what is causing the two main respiratory conditions that we outlined above.
Is there cause for concern for UK vapers?
The US outbreak has led to fears that UK vapers could be affected by these terrible lung conditions. However, Martin Dockrell, head of Tobacco Control at Public Health England, was quick to remind people of the distinction between vaping in the UK compared to the US. He said,
“Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare Products Regulatory Agency and they operate the yellow card scheme, encouraging vapers to report any bad experiences.”
Further to this, the chief executive of health charity Action on Smoking and Health (ASH), Deborah Arnott, said that to date none of these serious side effects had been reported in the UK. She went on to state,
“In Britain, you can check on the Medicines and Healthcare Products Regulatory Agency (MHRA) website whether the product you’re using has been notified and can be legally sold.”
Although these notifications to the MHRA only apply to products containing nicotine, as set out by the Tobacco Products Directive (TPD), manufacturers of high quality CBD oil e-liquids use the tried and tested ingredient formula of TPD regulated nicotine based e-liquids to ensure a safe product.
Why do some American states want to ban vaping?
Short-sighted knee jerk reactions are, unfortunately, all too prevalent across the pond. If e-cigarettes are a common denominator in this outbreak of illnesses, then banning vaping is their (il)logical conclusion.
However, history has shown us that blanket bans and prohibition simply don't work. When consumers have no legal alternative, they will invariably turn to black market options.
If we look at the number of outbreaks by state, the majority come from states where legal access to tested cannabis products is restricted, or completely prohibited. Therefore, we can safely conclude that if the product is illegal now, and people are still getting hold of it, how will a further ban help?
Vaping CBD is legal in the UK
In the UK, anyone looking to get the known benefits of CBD via vaping can do so completely legally. This means that you have access to high quality, winterised CBD oil without the need to source it from the black market.
However, THC is still classified as a Class B controlled drug in the UK, and therefore illegal to sell and to purchase. Our Full Spectrum CBD e-liquids fall under the legal 0.2% THC restriction, and our Isolate ranges contain only CBD.
If you are looking for a vape juice that contains THC, or a synthetic cannabinoid, in order to get high, you may be tempted to look to the black market. If this is the case, we would urge you to take careful note of the current health situation in the US and avoid these bootleg vape cartridges like the plague.
Deaths linked to vaping takeaways
However tragic the current events in the US are, it is always worth remembering that the truth is often hidden behind scaremongering headlines. The US media, in particular, has an anti-vaping agenda which is influenced by the Master Settlement Agreement (MSA). Any decrease in cigarette sales means less money for the individual states because the major tobacco companies are contractually obliged to split their profits with the US government. Hence, they are very wary of e-cigarettes becoming too popular.
If you’re concerned about harmful additives in your CBD e-liquid, make sure you only purchase your vaping products from reputable sources. Never be tempted to purchase ‘cheap’ CBD e-liquid from unscrupulous merchants. It could be bootleg and made from unregulated ingredients - your health simply isn’t worth the cost savings.
The research into CBD continues
As more studies are undertaken, and more research published, we will continue to update you with all the latest findings regarding CBD.
If you still have more questions or concerns, we are always happy to help. Just get in touch with any queries you have about CBD or vaping in general.
About the author - Nicola Webster
Nicola Webster works as a researcher, consultant, and content creator for Vape UK. She holds a CIM Level 6 Diploma in Professional Marketing and has developed her skills and knowledge of analytics and research over a 12 year career in product marketing. Her research led approach to campaigns and content writing ensures the articles she writes for Vape UK always have a basis in fact and cut through the noise. A strong advocate for tobacco harm reduction, Nicola is an ex-smoker thanks to vaping and wants others to understand the benefits of vaping compared to smoking. 
