Health Vape pen lung injury: Here’s what you need to know David Downs January 10, 2020 A suspected tainted black market vape cart seized in New York. (Courtesy of New York State Department of Health)

As of Tuesday, Jan. 7, the CDC has reported 2,602 confirmed and probable cases in all 50 states of severe acute respiratory distress syndrome associated with a recently inhaled drug aerosol (commonly known as vaping). As many as 57 deaths across 27 states may be directly or indirectly related to the seven-month-old injury series. Here’s what you need to know.

Should I stop vaping?

What is the suspected diagnosis?

In many cases, symptoms and treatment mirror a condition called lipoid pneumonia

Subsequent biopsies of 17 victims indicate “airway-centered chemical pneumonitis

A third biopsy series looked similar to the first two, adding organizing pneumonia to the diagnosis cluster.

What’s causing it?

Why vitamin E oil?

As Leafly reported in early September, a new diluent known as Honey Cut entered the illicit vape cart market in late 2018. The product, which dilutes THC oil without thinning the viscosity, is manufactured by Honey Cut LLC registered to a Joshua Temple of Los Angeles. Officials at the terpene manufacturer True Terpenes, based in Portland, OR, told Leafly they tested Honey Cut earlier this year and found it to contain Vitamin E oil, aka tocopheryl-acetate. Two brands—Mr. Extractor of Oregon and Constance Therapeutics of California—told Leafly they’ve been selling forms of vitamin E oil into the vape cart market. Mr Extractor’s Drew Jones told Leafly he believes up to 40 companies sold a copycat oil, and the oil is in 60% of carts in the US. Lab tests have found the oil in multiple thickener products, including Peak Terpenes’ Thicc Stretch.

What are the symptoms?

Anyone who has vaped a black market cart in recent days or weeks and subsequently developed shortness of breath, dizziness, nausea, weakness, and tiredness should see a physician. Bring the cart.

What are the latest numbers?

Why is this happening now?

Leafly has reported that a new ingredient—next-generation cutting agents (thickeners)—are being misused in THC vape carts. Legal chemical thickener makers said they do not approve of use in vape carts. Chemical thickener makers also do not approve of dilutions greater than 10%. However, their web sites are unclear about the products’ approved and unapproved uses. The chemical makers have no information on what inhaling thickener aerosol does to your lungs, especially if it is heated or burned.

How can I protect myself?

Only buy tested, regulated adult-use and medical cannabis products in legal stores like California, Washington, Oregon, and Colorado. Licensed supply chains are much harder to contaminate. By contrast, street traffickers are filling carts with harmful chemicals, and they go straight into your lungs. Here’s how to spot an illicit market, or counterfeit THC vape cart

Though licensed markets have more safeguards, suspicious additives are not yet banned Oregon banned tocopheryl acetate in vapes mid-November. Colorado intends to ban tocopheryl-acetate, MCT oil, and PEG this winter.

Oregon banned tocopheryl acetate in vapes mid-November. Colorado intends to ban tocopheryl-acetate, MCT oil, and PEG this winter. Cheap illicit market vape carts also routinely malfunction. Malfunctioning carts can get very hot, and burn additives and thickeners, releasing an unknown noxious gas. Run them at low, controlled temperatures.

If you’re concerned about additives in your cannabis, stick to tested flowers from licensed adult-use stores. Check store licenses on regulators’ websites, like California’s license lookup tool. In terms of extracts, additive-free extract is called “rosin”, and it also comes in vape carts in mature adult-use markets. There’s also tinctures, sublinguals, edibles, topicals, and transdermals, for those who want to avoid all cannabinoid inhalation products.

Leafly originally published this story Sept. 6. We updated it again Jan. 10 at 3:20 p.m. PST.

David Downs David Downs directs news and lifestyle coverage as the California Bureau Chief for Leafly.com. He's written for WIRED, Rolling Stone and Billboard, and is the former cannabis editor of the San Francisco Chronicle, as well as the author of several cannabis books including 'Marijuana Harvest' by Ed Rosenthal and David Downs. He co-hosts The Hash podcast. TW: @davidrdowns | IG @daviddowns View David Downs's articles