Health officials increasingly are pointing to THC-based products as key elements in the growing outbreak of lung injuries linked to vaping, putting industry advocates on the defensive as companies and states heighten their efforts to ban flavored e-cigarettes.

The District of Columbia, 49 states and the U.S. Virgin Islands reported 1,299 confirmed and probable vaping-related lung injuries as of Thursday, according to the Centers for Disease Control and Prevention. Twenty-six deaths have been confirmed in 21 states.

The CDC found that 76% of 573 patients who suffered lung injuries reported using products containing THC, also known as tetrahydrocannabinol, the psychoactive ingredient in marijuana, with or without nicotine-containing products 90 days before they developed symptoms.

“Given continued occurrence of life-threatening new cases, CDC recommends that you do not use e-cigarettes or vaping products that contain THC,” Dr. Anne Schuchat, principal deputy director of the CDC, said during a Friday telephone briefing.

She noted national findings show that THC products, particularly from off the streets or an unknown source, are linked to most of the cases and play a major role in the outbreak.

Due to reports of exclusive use of nicotine e-cigarettes and combined use of nicotine and THC products, Dr. Schuchat said nicotine products cannot be ruled out from the investigation.

Among the 573 patients, 32% reported exclusively using THC products while 58% reported using nicotine products, with or without THC-based products. Only 13% reported exclusively using nicotine products.

Gregory Conley, president of the American Vaping Association, said the CDC’s findings confirm that illicit THC-based e-cigarettes are to blame for the outbreak.

“Each day of this crisis brings more evidence that street vapes containing THC or other illegal drugs are responsible for these illnesses, not nicotine vaping products. If state and local health departments want to see these illnesses stop, it is incumbent upon them to issue clear and specific warnings about the dangers of street-bought marijuana oils,” Mr. Conley said.

While the CDC has said THC might play a role in the outbreak, no single product, substance or brand has been ruled out as the cause of the lung injuries. Dr. Schuchat said she suspects there are multiple causes behind the spate of illnesses.

Erika Sward, national assistant vice president for advocacy for the American Lung Association, said it is important to consider the breakdown of THC and nicotine product use among patients, stressing a cause behind the lung injuries is still unknown.

She said no one should use any e-cigarette products.

“The fact that people are dying and other people’s lungs are being severely injured is very troubling,” Ms. Sward said. “And we certainly have been sounding the alarm about these products for more than a decade now.”

New York health officials have focused attention on vitamin E acetate, a common supplement in skin creams found in nearly all cannabis products as a possible cause of the vaping-related lung illness outbreak.

In 225 THC samples tested by the Food and Drug Administration, 47% of those products contained vitamin E acetate, according to Mitch Zeller, director of the FDA’s Center for Tobacco Products. Concentration levels of vitamin E acetate ranged from 23% to 88% in the first 37 samples tested.

THC concentrations in the first 28 samples tested ranged from 13% to 77%, Mr. Zeller said during Friday’s briefing.

A recent study of 17 participants with vaping-related pulmonary injuries also found that the damage to the patients’ lungs were similar to those exposed to noxious chemical fumes. Twelve of those patients (71%) vaped THC, cannabis oils, cannabidiol (CBD) or other non-nicotine products.

As vaping injuries continue to rise, more states are taking action against e-cigarettes. Montana joined six other states this week in banning flavored e-cigarettes. Washington, Oregon, Michigan, Rhode Island, New York and Massachusetts instituted bans earlier this year. Utah also passed emergency rules limiting where e-cigarettes can be sold.

Both Walgreens and Kroger became the latest retailers to ban the sale of e-cigarettes this month as investigations into lung injuries continue, following Walmart’s similar move in September.

Last month, the Trump administration proposed a ban on non-tobacco flavored e-cigarettes.

“America is in the middle of a moral panic about vaping, and as history has shown us with panics about alcohol and marijuana, the general public tends to endorse prohibitionist policies during those times,” said Mr. Conley.

Every nicotine vaping product legally sold in the U.S. has an FDA-mandated ingredient listing and warning on its packaging, according to Mr. Conley. He noted cannabis cartridges are “very easy to spot” since they contain a thick oil that doesn’t instantly move when the cartridge is tilted. THC cartridges, even on the black market, are also much more expensive than nicotine cartridges.

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