Sen. Tammy Baldwin (D-Wisconsin) is continuing to push for a wider response to the outbreak of vaping-related illnesses reported across the country. Over 2,100 cases have been reported to the Centers for Disease Control and Prevention (CDC), across every state except Alaska. Cases have also been reported in the District of Columbia, Puerto Rico and the Virgin Islands. Across 24 of those states and the District of Columbia, 42 deaths have been reported as being related to the vaping illnesses and lung damage.
Baldwin helped organize a hearing in Washington to discuss the outbreak, held by the Senate Committee on Health, Education, Labor and Pensions (HELP). As a member of the committee, Baldwin said, “I’m pleased that we are here to discuss both the outbreak of this illness, as well as the increasing number of children using e-cigarettes.” Baldwin warned, however, “Our work is far from over.”
The vaping outbreak became a public health crisis earlier this year, after teens and adults in several states began arriving in hospitals suffering from an unknown lung illness. Symptoms of the disorder included chest pain, weight loss, difficulty breathing, nausea, vomiting, and fever. In early September, the number of cases reported to the CDC peaked before trickling off, “due in part to a reporting lag,” according to the agency’s website.
The exact cause of the illness is still being investigated, and initially baffled hospital staff. Although vaping was identified as a commonality among the patients, other factors were inconsistent. Many, though not all, reported having used THC (tetrahydrocannabinol) vapes which they’d bought on the black market. Others only admitted to having used e-cigarette products, which are legal and widely available.
About 86% of patients reported that they had used THC-containing products, although only 34% said they used them exclusively. Some 40% of the patients nationally are 18-to-24 years old, and 70% are male. The ages of patients who have died range from 17 to 75 years, with the median range being 52 years old.
In one recent CDC analysis examining samples taken from the lungs of 29 patients, THC was identified in 82% of the samples, while nicotine was found in 62%. In the same study, vitamin E acetate was found in all of the samples.
Vitamin E acetate first appeared on the public-health radar in September, after New York State released findings from its own tests. New York has a legalized medical cannabis program, which includes legally-sourced THC vape products. Vitamin E acetate was found in black market counterfeits, and the substance is not allowed in New York’s legal market. As of November 14, the CDC identified vitamin E acetate as “a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).”
However, the agency states, “While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern. … Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.” Wisconsin Examiner reported in October that the Department of Health Services (DHS) sent samples to the CDC for further testing. Some 92 “confirmed and probable cases” have been identified by DHS, with no deaths having occurred to date in Wisconsin.
“Most patients are adolescents and young adults but some patients are adults in older age groups,” reads an informational page on the outbreak, updated by DHS every Thursday morning. “The majority of patients went on to develop severe breathing problems requiring hospitalization, and in some cases, had to be put on ventilators in order to breathe.”
Sen. Baldwin applauded the identification of vitamin E acetate as a chemical of concern. “Now that the CDC has detected one potential chemical of concern,” she said, “the committee should hear from individuals on the front lines who can speak to the challenges of identifying, containing and preventing outbreaks.”
The committee hearing, however, largely focused on regulatory holes in the mainstream e-cigarette market. “If you walk into a convenience store to buy Aspirin you assume that the Food and Drug Administration has said it’s safe and effective.” Committee ChairmanSen. Lamar Alexander (R-Tennessee) said during the hearing.
“If you pick up a package of peanut butter crackers, you assume FDA assured it was packaged in a clean space. Then as you go to check out, you grab an apple from a basket on the counter, you assume FDA has established rules on how it was grown.” Alexander then held up an e-cigarette pen, stating that many consumers assume the same due diligence applies to that product. “But you’d be wrong,” said Alexander, “because this is an e-cigarette, and the Food and Drug Administration has not used its authority to say whether its okay to be sold.”
Sen. Patty Murray (D-Washington), highlighted growing concerns among families about the lung illnesses. “My heart goes out to all of the victims and their families,” said Murray, saying the committee is interested in learning “what steps we can take to stop it in its tracks and prevent similar outbreaks in the future.” She emphasized the role companies like Juul had in perpetuating the use of flavored vape products among teenagers.
Flavored vape products may contain nicotine, though some are nicotine-free and are popular because of their flavors and because they provide users with a way to do smoke tricks and show off to friends. Despite the focus on nicotine and nicotine-free vape products during the committee hearing, cracking down on that industry would do little to change the black market, where dangerous products are still available.
Many counterfeit THC products seized by law enforcement during the outbreak have been linked back to China. In Wisconsin, a large bust involving a 20-year-old and his mother yielded high-quality THC products, made from oil which originated from the legal cannabis market in California. But high-quality THC products haven’t been linked to the kind of lung disease associated with vaping in the past. Cannabis advocates point to unregulated products in non-legal states as the culprit, and as examples for why legitimate markets are needed.
“The latest national and state findings suggest products containing THC, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak,” the CDC states on its regularly update web page on the crisis.
Regulatory pushes against the legal e-cigarette industry appear to be outpacing the actual investigation process into the illness and its cause. The CDC has developed guidance documents to help laboratories and doctors synchronize the reporting of potential cases, and testing of samples.