As stories pile up of sicknesses, side effects, and the potential for long-term consequences, it’s clear that “safe” and “safer than smoking cigarettes” are vastly different things.
When the regulation of most tobacco products came under the U.S. Food and Drug Administration’s control in 2009, the agency was involved in a lawsuit with an e-cigarette manufacturer over efforts to classify vapes as drug-delivery devices, which would have put placed them under a much higher level of regulatory scrutiny than other tobacco products. That bid failed in 2010, and the consumer tobacco market quickly filled with clever marketing tactics for equally clever—and in many cases addictive—vaping products. E-cigarettes devices themselves didn’t officially come under FDA tobacco oversight until 2016.
Now government agencies such as the FDA and the CDC have to play catch-up. The most immediate concern is the illness that has landed hundreds of people in the hospital this summer. Its laundry list of potential symptoms includes fatigue, nausea, dizziness, and extreme shortness of breath. Vape juice can contain dozens of different chemicals, so reverse-engineering what hundreds of sick people across the country have in common is tricky. Some of the problematic substances might be long gone by now, or they could be part of black-market cannabis products that patients are reticent to turn over to federal authorities.
The FDA has emphasized that it is too early to know for sure what’s causing the worst health problems, but testing so far points to cannabis products as the likeliest source of the most dire symptoms. Most patients have reported using vape products with tetrahydrocannabinol, the psychoactive ingredient in cannabis. No common chemical has been found yet across all the samples the FDA has tested, but public health authorities in New York have suggested vitamin E acetate is a possible culprit. Vitamin E acetate is sometimes found in the oil base for vape juice and can be harmful when inhaled in high concentrations.
In much of the country, cannabis’s cultural acceptance far outpaces its legal availability, which means that its users rely on products with unknown origins and ingredients, manufactured with no regulatory oversight. Marijuana is still illegal at the federal level, so even states that have legalized it are left on their own when regulating its manufacture and sale. One of the deaths has been linked to a cannabis vape purchased from an Oregon dispensary.
Advocates for the nicotine-vaping industry have been quick to point to black-market cannabis products as the real source of health problems, which they claim are being used misleadingly by anti-tobacco advocates to fuel their own crusades. But that argument belies the fundamental lack of information available when evaluating nicotine vaping’s impacts on health and its potential interactions with other drugs. Many of the people who are known to have fallen sick this summer use nicotine vapes in addition to cannabis, and it’s possible that lung irritation caused by frequent use of nicotine e-cigarettes could hasten or worsen the impacts of chemicals found in black-market cannabis products.