Health officials across the country are scrambling to find out what’s causing severe lung disease in some e-cigarette users.
The Centers for Disease Control and Prevention (CDC) on Friday said it was investigating 450 possible cases of lung disease tied to vaping, including five deaths.
“While we don’t have all the answers yet, we are getting clearer about things that we should be looking at to understand the situation,” said Ileana Aris, acting deputy director of non-infectious diseases at the CDC.
“The focus of our investigation is narrowing. And that's great news. But we're still faced with complex questions and that will take time to answer.”
Here are five things to know.
‘Most’ patients used products containing THC
According to a CDC analysis of 215 possible cases published Friday, “most” patients reported using e-cigarette products containing elements of marijuana, including THC.
In New York, health officials reported that all 34 people who have become ill said they used at least one vape containing cannabis, while some said they also vaped nicotine.
In North Carolina, five lung disease patients said they vaped THC, and three also vaped nicotine.
And in Wisconsin, 89 percent of the patients interviewed by health officials said they had vaped THC.
Officials are warning against using ‘black market’ or ‘street’ vapes
Health officials are warning consumers against buying vapes on the black market or modifying products themselves.
New York officials said they suspect many of the products tested are “counterfeits” of recreational cannabis vapes available in other states.
“If you’re thinking of purchasing one of these products off the street, out of the back of a car out of a truck in an alley, or if you’re going to go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice,” said Mitch Zeller, director of the Center for Tobacco Products at the Food and Drug Administration.
But in Oregon, health officials say the THC vape linked to a man who died there appears to have been bought from a legal marijuana shop. Officials said it’s unclear as of now whether the product was contaminated or if something was added to the liquid after it was purchased.
Vitamin E could be a culprit
New York health officials said they’re focusing their investigation on vitamin E acetate after they found high levels of it in nearly all of the cannabis-containing vapes tested.
Vitamin E isn’t known to be harmful if ingested as a vitamin supplement, but it could be dangerous if inhaled because of its “oil-like” properties. It has not been approved as an additive for New York’s medical marijuana program.
At least one vape containing both cannabis and vitamin E has been linked to every patient who submitted products for testing, the New York health department said.
But federal health officials are warning that vitamin E is likely only one piece of the puzzle. The CDC is running its own tests on more than 100 samples for vitamin E, pesticides, opioids, poisons and other toxins.
“No one substance or compound, including vitamin E acetate, has been identified in all the samples tested,” Zeller said. “The samples we’re continuing to evaluate show a mix of results.”
Many patients are young and otherwise healthy
Many of the patients nationwide are young and otherwise healthy, illustrating what health experts describe as an epidemic of e-cigarette use among teenagers.
Patients examined in Illinois and Wisconsin have a median age of 19, said Dr. Jennifer Layden, chief medical officer for the Illinois Department of Health.
In North Carolina, patients were adults 35 and younger; in New York, the youngest patient is 15.
Surveys show vaping among teenagers has hit a record high. Nearly 21 percent of seniors in high school last year said they had recently vaped, compared to 11 percent in 2017, according to findings released by the CDC.
All types of e-cigarettes should be avoided, CDC says
Because it’s not clear what substances are causing the illnesses, the CDC is recommending that people don’t use e-cigarettes during its investigation.
“While the investigation is ongoing, the CDC has advised that individuals consider not using e-cigarettes because as of now, this is the primary means of preventing lung disease,” Dr. Dana Meaney-Delman, an incident manager with the CDC, said Friday.
"As more information comes out and we can nail down the specific e-cigarette products, we intend to revise that."
For those that continue to use e-cigarettes, they should buy them from authorized sources and monitor for symptoms including difficulty breathing, chest pain or vomiting.