ATHRA reported in August 2019 that the US outbreak of vaping-related lung injuries was not due to nicotine vaping, but rather contaminated street drugs, mostly THC (cannabis). Finally, US authorities have acknowledged this.

There is still NO evidence that nicotine vaping has played any role in the epidemic and Australian vapers who purchase nicotine suppliers from reputable suppliers have very little cause for concern.

ATHRA's handout on the lung injury outbreak is available here.

Almost all cases due to contaminated THC

Almost all cases of lung injury (if not all) are due to black-market THC oils. According to the Centers for Disease Control and Prevention (CDC), 86% of victims reported using THC products in the 3 months prior to symptom onset.

It is now clear that it is the contaminants or additives that are making people sick, not the THC. The CDC recently analysed samples of lung fluid from 29 cases. All contained Vitamin E acetate, a thick oily chemical added to some illicit THC vaping liquids. This is likely to be one of the major contaminants causing lung disease but other additives may be playing a role.

Are nicotine vapes safe?

No cases have been linked to nicotine vaping and no laboratory testing of nicotine liquids has revealed any contaminants of concern.

Eleven per cent of victims have reported vaping nicotine products only. However, the CDC has stated that these reports are unreliable and many are likely to have been using THC as well. Vaping THC is illegal in most states and many users would be reluctant to admit an offence, as would underage users. Others who bought their supplies on the street may not know what they were vaping.

According to the CDC, some patients "who initially denied THC-containing products in interviews … were later found to have used THC through review of medical charts, re-interview, or cross-referencing with friends who were also interviewed as patients.

Furthermore, in the recent analysis of samples of lung fluid, only 20 users admitted using THC, but the drug was found in 23 samples, a 13% underestimate.

There are 14 million adult nicotine vapers in the US and commercial nicotine vaping products have been available for over 10 years. There have never previously been any serious respiratory adverse effects or deaths from vaping nicotine according to a recent review.

Advice for Australian vapers and smokers

Contaminated black-market THC 'carts' (cartridges) are now available in Australia, including the Dank Vapes brand which has been associated with many cases of lung injury.

Legal, regulated THC products prescribed for medicinal purposes are not involved. It is not the THC which is causing the problems, it is the contaminants.

ATHRA's advice is simple:

1. Do not buy black-market THC vaping liquids, especially the Dank Vapes brand. Many illicit products are professionally packed and labelled and look authentic

2. Recreational THC (cannabis) vaping is illegal in Australia. However, if you do wish to continue vaping THC it is much safer to vape dry cannabis in a special herb vaporiser or use 'dabbing' (vaporising wax in a special device)

3. Always buy your nicotine vaping products from reputable suppliers, never on the black-market

4. If you are vaping nicotine to avoid relapsing to smoking, do not go back to smoking. Vaping nicotine is far safer.

Australian authorities need to provide clear advice to Australians and differentiate the use of toxic THC products from relatively benign nicotine vaping.

Until that is made clear, some people will be at great risk from using black-market THC. Worried vapers may return to smoking and fewer smokers may make the switch to nicotine vaping, a far safer alternative.

This outbreak demonstrates why nicotine and vaping products should be legalised and regulated. Prohibition kills and consumers need protection from unscrupulous operators.

Posted by Colin Mendelsohn, colin@athra.org.au