THC, Vaping, and the New “Mystery” Lung Illness

Six people have died from a “mystery illness” that authorities like the CDC are linking to e-cigarette use.

Understandably, this has made many vapers concerned about their own health. Most people switch to vaping under the assumption that it’s a safer form of nicotine use than smoking combustible cigarettes, and if the over 450 cases and six deaths in the recent outbreak are linked to nicotine e-cigarettes, it’s very understandable to be concerned. It might even lead you to think vaping is more dangerous than smoking traditional cigarettes. 

At Black Note, we’ve always said that Black Note’s liquids are the second-best alternative to smoking cigarettes. The first is stopping using nicotine altogether. 

That said, there are some very important things about the recent outbreak that have not been covered adequately by many traditional outlets talking about the story. Based on what we know so far, the finger is strongly pointing at THC (i.e. cannabis) vaping products, in particular black market products, and not traditional e-cigarettes. 

There are still unanswered questions, but as investigations continue, the potential causes and the products that are not implicated are becoming more and more clear. 

Here’s what you need to know and how to stay safe.

The Basics of the Outbreak

Before we get into the specifics, it’s worth a quick recap of what’s happened. Business Insider has put together a useful timeline of events, starting on August 17th, when the CDC reported that they were investigating around 94 cases of vaping-related illnesses in 14 states. The number quickly rose to 200 cases across 22 states. 

Some of the main symptoms of these cases include a rapid onset of lung-related problems, including non-productive cough, shortness of breath and sharp “pleuritic” chest pain. According to a New England Journal of Medicine report on the outbreak, the most common symptoms are shortness of breath, cough, chest pain, nausea, vomiting, diarrhea, abdominal pain and a fever. There is much more information in the report if you want more information and particularly if you have a medical background. The key points are that it appears to be an acute illness, with similarities to lipoid pneumonia (caused by oil in the lungs), that causes mainly breathing-related symptoms.  

On August 23rd, the first death related to the outbreak was reported in Illinois. The details about this are scant, but the patient was hospitalized with severe breathing difficulties. On September 3rd, Oregon’s Health Authority begun investigating the death of a middle-aged man who had fallen ill after vaping marijuana oil he bought at a legal dispensary. Over the next week, further deaths were reported in Indiana, Minnesota, California and Kansas. 

The CDC claimed 380 confirmed and probable cases related to the outbreak on September 12th, across 36 states and 1 U.S. territory. The true number is often reported as higher, but this CDC figure doesn’t include possible cases, only those that have been investigated to a sufficient level to say they’re definitely involved in the outbreak. They also point out that most of the cases have involved products containing THC, but they stress that some have only reported use of e-cigarettes containing nicotine. 

The Role of THC Vaping Products

Based on what we know so far, it appears that the majority of cases involve vaping THC products. For example, the New England Journal of Medicine article cited earlier found that 80 percent of cases reported using THC vaping products, compared to 61 percent reporting use of nicotine vaping products. While 37 percent reported only using THC products, only 17 percent reported only using nicotine vaping products. Other information – for example, reports from specific states involved – also report that most cases relate to THC vaping products. 

On top of this, it’s worth noting that some people might be wary of admitting to the use of often-illegal THC vaping products. So it’s possible, though obviously in no way confirmed, that the true proportions are higher than this. 

This is very important information that, until recently, has been left out of much of the discussion of the outbreak. The use of terms like “e-cigarette” or even just “vaping” without further clarification create a lot of confusion which appears to be unjustified. The FDA, for example, is clearly focusing its efforts on THC vaping products, and slowly but surely, the mainstream media is catching up and focusing more and more on the real likely cause of the issue. 

There is still some confusion and genuine uncertainty, though. While there is one lead in particular, the FDA is keen to point out that, “No one substance has been identified in all of the samples tested.” 

However, it’s important to be clear about what it can’t really be related to. Vaping has been increasingly popular around the world since 2009. Why would a decade-old phenomenon be just causing acute lung issues in the last couple of months? And, arguably more importantly, why would these cases be confined to the US, with no reported cases or deaths from elsewhere? As Dr. Konstantinos Farsalinos points out in his blog post on the issue, it simply doesn’t make sense from an epidemiological perspective that this would be related to traditional nicotine vaping. 

The illness is also similar to conditions relating to the inhalation of oils and fats, and there are no such substances in traditional e-liquid. Similar substances are used in THC vaping products, though. These basic points have been largely ignored, and unfortunately the sloppy use of language has conflated the issue with traditional vaping in the minds of the public. 

Black Market THC and Vitamin E Acetate

The investigation has actually provided some clues as to the actual cause of the illness, a chemical called vitamin E acetate. While any vitamin inherently sounds healthy, the reality is that inhaling any type of oil is not a good idea. Vitamin E acetate isn’t technically an oil, but it’s soluble in oil and likely has the same risks when it comes to inhalation. 

New York State’s Department of Health found that vitamin E acetate was found in “very high levels” in 13 of the samples obtained from eight of the patients who’ve developed the illness in New York. Health commissioner Dr. Howard Zucker said, “That’s the best theory, or hypothesis, we have right now. We haven’t ruled out there isn’t something else in the vaping material.” He also added that the products containing this chemical were from the black market, and not used in the state’s medical marijuana program. 

The FDA has also found this substance in its own tests, and while it’s keen to point out that we can’t definitively establish this as the cause based on what we know so far, it’s better to avoid inhaling anything containing this substance. None of the tested samples of nicotine e-liquids contained the substance.  

The Washington Post quotes Michelle Francl, chemistry professor at Bryn Mawr College, who described vitamin E acetate as “basically grease,” and stressed that it has to be heated to high temperatures (of over 363 degrees Fahrenheit) to vaporize, after which point in can potentially decompose into “who-knows what.” However, when the vapor reaches your lungs and cools down, it returns to its original state. She says, “it has now coated the inside of your lungs with that oil.”

Leafly, a leading cannabis publication, has a detailed article about the problem and discussing the reasons it’s found in about 60 to 70 percent of US street THC cartomizers. In short, black market sellers often dilute the THC oil in other substances to increase profit margins, but consumers had begun judging purity based on the viscosity of the liquid they were buying. This new technique for judging purity encouraged sellers to produce a thicker (but not necessarily stronger) product, and they’ve been increasingly doing this with the use of thickening agents. Vitamin E acetate is often used in these products, sold under names such as Honey Cut, Uber Thick and Pure Diluent. 

This trend really started taking off late last year, and so it’s much more closely linked with the timing of the outbreaks than the availability of nicotine e-liquids. As Jim McDonald at Vaping360 points out, “E-liquid for nicotine (or non-nicotine) vaping doesn’t contain thick cutting agents, which are as dense as cannabis oil itself and would be useless in liquid-based vape juice.”

In short, there is no evidence that traditional vaping products are responsible for any of the cases, and in fact, it’s looking increasingly likely that the problem is really to do with the completely unregulated practices of black market sellers of THC carts, under names such as Dank Vapes and West Coast Carts. 

To Be Crystal Clear: This is Not Related to Traditional Vaping

Although this should be clear from the previous section, it’s crucial that vapers understand: these cases are not related to e-liquid vaping, based on everything we know so far. 

Authorities are keen to point out that there isn’t a definite cause yet, but it’s foolish to create confusion for smokers using vaping products to avoid smoking cigarettes. It goes without saying that if you don’t smoke, you shouldn’t try vaping, that youths shouldn’t vape and that if you can quit vaping (and want to), then you probably should from a health perspective. However, there is no link between the vaping products ex-smokers are using and these cases. 

The danger that people might return to smoking after this news is very real, and it’s completely understandable why customers might be concerned. However, the idea that there might be a link between the practice of e-liquid vaping – that’s been happening for the last decade, worldwide – and this recent, geographically-isolated outbreak of illnesses, is not tenable. 

Black Note’s Liquid and the Outbreak

Our customers are our biggest priority here at Black Note. We don’t use oil in our e-liquids, and certainly not vitamin E acetate. In fact, we go further than many e-liquid companies in terms of taking care over what goes into our e-liquid. They are flavored by naturally-extracted tobacco, with carefully-chosen tobacco leaves steeped in pharmaceutical-grade propylene glycol and vegetable glycerin to extract the pure, nuanced flavor from the leaf. We don’t use artificial flavorings, we would never use diacetyl, acetyl propionyl or other potentially-dangerous flavoring chemicals, and we lab test our e-juice so you can know exactly what you’re buying. 

Our mission is to help create a smoke-free world, and if you can’t stop using nicotine entirely, we want you to have the best product possible, free from any potentially risky ingredients apart from the nicotine you need. 

Black Note’s Science, Culture, & Motto

The technology and mentality we use to produce our Natural Vaping tobacco extract are in general near to high-quality wines, perhaps beer brewing and far apart from chemical mixed (synthetic) Vaping products. Our Vaping extracts, unlike synthetic or chemically treated natural products, are genuine natural products. Our ingredients are as follows: 

1. Our nicotine is Free Based and is 100% Natural from carefully selected tobacco leaves with near-zero impurities significantly exceeding EP/USP monographs sourced and certified by Alchem International in Switzerland.
2. Our tobacco flavors are naturally extracted directly from real tobacco leaves, leading to a complex, nuanced taste that comes closer than most e-liquid can to the genuine character of tobacco.
3. We use the highest USP Kosher Certified Propylene Glycol (PG) with a minimum of 99.7% purity.
4. We use the highest USP Kosher Certified  VG (vegetable glycerin) is FU ( Farmacopea Ufficiale ) which is the highest level of certification (from purity standpoint) plus USP Kosher certificated.
5. We use only non-GMO tobacco seeds, hand-selecting the very best cultivar lines of Nicotiana Tabacum that are susceptible to natural cold extraction.

Black Note is 100% committed to the technology and science of the world’s best tobacco vaping experience available, and we exist to create a truly superior alternative to the pleasures derived from conventional combustible tobacco.

Conclusion – Staying Safe When You’re Vaping

So it’s pretty clear that there is very little chance that the recent outbreaks have anything to do with nicotine vaping. If you are still  concerned in general, there are a few things you can do: 

• Only buy your e-liquid from reputable companies. 
• Check lab reports to ensure you know exactly what you’re vaping. Diacetyl is almost certainly not the cause of the recent outbreak, for instance, but this should be a reminder to take care more generally too. 
• Avoid chemicals in vaping products that might put you at risk. 

And, above all, do everything you can to avoid returning to smoking. Don’t let this tragedy set you on a path to a slow-motion tragedy a few decades down the road. Although we are the best tobacco vaping liquid company on earth, we don’t want non-smokers to start vaping. We don’t encourage vapers to vape more, nor do we discourage vapers from quitting. We don’t want you to vape forever. We encourage people to quit smoking cold turkey if that works better for them, without even putting Black Note into the mix. 

Black Note is the second-best alternative to smoking. Quitting altogether is the first.

Footer Note

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This email message is in no way meant to construe health claims relating to vaping nicotine-based e-liquids. It is simply meant to relay the facts around the news stories that we have all seen in the news lately.Age-restricted product. Not for sale to minors.Warning: This product contains nicotine. Nicotine is an addictive chemical.California Proposition 65 Warning: This product contains chemicals known to the state of California to cause cancer and birth defects or other reproductive harm.

FDA Vaping Rules vs. Europe Vaping Laws

Read More »

Letter From CEO

Read More »

What do I do When Vape Liquid Gets on My Skin?

Read More »