Journalists and Health Officials Finally Focus on Fake THC Carts Amid Crisis

SAN FRANCISCO—Unregulated cannabis vaporizer cartridges tainted with a potentially deadly lung toxin have hospitalized seven people with pneumonia-like symptoms in Hanford, California, officials there reported Wednesday.

The cluster of tainted vape cart poisonings caused the Kings County public health department to issue a rare warning this week urging consumers to avoid buying cannabis e-cigarettes from unlicensed sellers. Street cannabis products are not subject to the rigorous testing that licensed products undergo in California.

“If you’re going to vape THC, get it from a licensed dispensary where you know there’s a certain amount of testing required to do. It sounds like it’s going to cost twice as much as the stuff on the street, but you don’t want to end up in with a life-threatening respiratory condition,” said Dr. Milton Teske, a health officer with the Kings County Department of Public Health.

Officials haven’t yet determined the cause of the lung illness, the public health warning says, but they’ve determined that all cases so far have involved cartridges purchased from unlicensed pop-up markets. Some think the cases could be tied to similar clusters of vape-related poisonings that have recently been reported elsewhere in the country.

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Teske suspects Hanford hospital pulmonologist Dr. Vishnu Bezwada identified a vape cart poisoning cluster that’s part of a rash of similar poisonings going on across the US.

A Monday call with Centers for Disease Control and public health representatives from other states indicated a suspected cluster of 15 poisonings in Wisconsin, plus reports from Illinois, and Nebraska.

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Teske and a Kings County public health investigator reviewed all seven case files and conducted follow-up interviews with patients in the hospital and at home. A common theme emerged—all had been using vape carts bought off the street around Kings County, in rural Central California. All reported doing it to save money. They were buying them at local, unlicensed pop-up markets, advertised by word of mouth.

At these markets, vendors sell untested THC products that look similar to tested goods. The empty vape cartridges come in from China. Producers then fill the carts with raw THC oil cut with agents such as propylene glycol, vegetable glycerin, medium-chain triglycerides (MCT) oil, or more exotic chemicals.

“Almost every patient had a different brand name,” said Teske. “And everyone had purchased it on the street.”

Teske suspects the lung illness comes from an additive, though he’s not sure what. “Whoever is mixing it up in their garage, they’re adding other flavors, I suspect, or it’s how they’re diluting it. I suspect it’s some type of hydrocarbon.”

Officials are narrowing the possible culprits to adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products.

The sudden onset of these mysterious illnesses and the patients’ severe and distinctive symptoms have led investigators to focus on contaminants, rather than standard vaping products that have been in wide use for many years.

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The investigation is “starting to point to what solvents are being used, and that can vary a lot”— especially in counterfeit or black-market products, including potentially mislabeled solvents that consumers buy themselves to make do-it-yourself “home brews,” said an official at the Centers for Disease Control and Prevention, which is heading the investigation.

Vaping refers to the increasingly popular practice of inhaling vapor from an e-cigarette device, which frequently involves heating a liquid that can contain nicotine, marijuana or other drugs. Those active ingredients are delivered in solvents.

As the CDC prepared this week to send out its first national health alert about the illnesses — a sign of growing urgency about a health threat that has claimed one life, while hospitalizing scores of others — officials caution they’re a long way from understanding what exactly is making so many people sick. The victims report vaping different products, purchased in different places and used for different lengths of time. Many of those who have gotten ill say they have vaped products containing marijuana, but some also used traditional nicotine e-cigarettes. Some report using both.

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In the meantime, federal and state officials are urging the millions of Americans who use e-cigarettes to stop vaping until the cause of the illnesses is identified. They have suggested that those using e-cigarettes quit smoking conventional cigarettes and contact their doctors about alternatives, such as patches or nicotine gums.

Some of those warnings have drawn criticism from both industry and health groups for being overly alarmist and broad about which products might be dangerous.

“People need to stop using these illicit THC products now — and it’s the CDC’s responsibility to say what we do know,” said Michael Siegel, a professor of community health services at Boston University, who believes that e-cigarettes can be helpful to those trying to quit smoking.

“Yes, there are unknowns. Yes, there may be other products implicated as well. But a large number [of confirmed cases] seem to involve THC oils purchased from ‘pop-up shops,’” he said, referring to unlicensed shops that move frequently, advertise by word of mouth and often fail to follow safety regulations.

Former Food and Drug Administration commissioner Scott Gottlieb, a harsh critic of San Francisco-based Juul, said he believes it’s unlikely that Juul — or other large national e-cigarette companies — are associated with the recent cases because the illnesses appeared to have developed suddenly and do not appear to be spread evenly across the nation.

Traditional vaping products could cause chronic problems, Gottlieb said, but these patients have acute illnesses.

“What’s likely causing the harm is something that they are putting in to make it easy or cheap to mix,” he added.

Some state health officials and clinicians are increasingly focused on contaminants in THC products.

In a conference call Thursday, Utah health officials told physicians the state department is focusing on THC products, said one doctor who took part in the call. The physician spoke on the condition of anonymity because he was not authorized to speak for the health department. Utah has reported at least 21 possible cases in recent weeks. A health department official said they are looking at both THC and nicotine products.

Pennsylvania’s UPMC health system, which includes 40 hospitals, including the University of Pittsburgh Medical Center, has treated at least 14 individuals with acute lung injuries related to vaping THC products in recent weeks, doctors said. Several patients told clinicians they bought products online from a popular brand called Dank Vapes. Industry sources say marketers often fill an empty cartridge with potentially unsafe ingredients and sell to unsuspecting customers.

“We suspect adulterated or contaminated products, because these [marijuana] products have been out there for some time, and we’ve not seen these cases until this summer,” said Phillip Lamberty, a pulmonologist and critical care specialist at the University of Pittsburgh Medical Center, who cared for three patients in recent weeks. Two of them used products containing THC, he said. He wasn’t sure what product the third was vaping.

THREAD: An important story tonight from @washingtonpost on the vaping related illnesses. Some thoughts on this article and the tragedies that are being reported around the nation with what appear to be illegaly marketed vapes based on current reports:  [Dr. Gottlieb links to previously discussed WaPo article]

E-cigs aren’t safe but they’re a less harmful alternative to combustible tobacco for currently addicted adult smokers. At a time when I was seeking to regulate nicotine in cigarettes to render then minimally or non-addictive we saw e-cigs as an alternative for some adults smokers

FDA should continue to advance the regs to reduce nicotine in combustible cigarettes and ban flavors like menthol to reduce youth smoking and accelerate declines in adult addiction to nicotine and cigarettes. This is the single greatest public health effort that we can undertake.

We should acknowledge and incorporate into our policy response three facts about the current tragedies related to vaping and kids. 1) Many are likely caused by illegal and counterfeit products, some laced with THC....

2) Legal vapes while not safe are subject to regulation on manufacturing, sales, marketing, ingredients, warnings. These regs took effect Aug 2017; and 3) If we outlaw all vapes, and pull legal products off the market, problems with illegal and counterfeit products will get worse

FDA should continue to advance the PMTA process to evaluate which vaping products meet the public health standard, proving they provide a net public health benefit by helping adult smokers quit. And responsible manufacturers can take steps right now to submit those PMTAs.

But youth use of these products continues to be a major public health crisis and an existential threat to the entire category. Even the legal products, while less harmful than cigarettes, are not safe. And no child should be using them. They are for adults and to help quitting.

Many current illnesses are likely caused by constituents being used in illegal products. Not legal, regulated brands. We shouldn’t conflate legal with illegal products. Nor can we ignore fact that legally sold products have shirked obligations of their own to address youth use.

Even if the cause is the illegal brands it doesn’t mean big companies like Juul, with its sleek, USB-like technology and easily inserted cartridges — should be let off the hook, Gottlieb said.

“The manufacturers bear some responsibility here because these things are being vaped on top of legitimate hardware,” Gottlieb said. “The manufacturers are responsible for their legitimate hardware getting in the hands of the kids.”