‘An evil I’ve never seen before’: Doctors scramble to understand vaping-related lung disease
Thousands of people are experiencing severe pulmonary issues from vaping, and some are dying.
16 November, 2019
Image source: Aliaksandr Barouski/Shutterstock
- Scientists now believe that the primary culprit in this health crisis is vitamin E acetate, though research continues for other toxic factors.
- Vitamin E is a gooey thickener often used in black-market cannabis-based vaping products.
- Vapers who feel like they may have pneumonia should consult a physician immediately.
<p>Surgeons are not squeamish people, so when one of them <a href="https://www.sciencealert.com/vaping-injury-caused-this-young-athlete-to-need-a-double-lung-transplant" target="_blank">says</a>, "This is an evil that I haven't faced before" it gets your attention. The doctor is Hassan Nemeh, surgical director of thoracic organ transplant at Detroit's Henry Ford Hospital. The evil is the stunning wreck that vaping made of a 17-year-old double-lung transplant patient's lungs. </p><p>"What I saw in his lungs was nothing that I've ever seen before, and I've been doing lung transplants for 20 years," says Nemeh. That vaping, particularly of cannabis products using THC oils, has become a major public health crisis is indisputable: Since March, vaping-related illness has landed over 2,000 individuals in hospitals nationwide, and at least 39 of those people have died.</p>
The patient in Detroit
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjA4NTYwOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMjY0MzY1NX0.nMJ3e_PGjaGAZhLZZ6mkrdQzOpIGo5Pw6fgqAlWFNHs/img.jpg?width=980" id="76c62" class="rm-shortcode" data-rm-shortcode-id="b3f851c1c51829cdf57cc83c4c221610" data-rm-shortcode-name="rebelmouse-image" />mage source: James R. Martin/Shutterstock
<p>Not much information regarding the individual described by Nemeh has been released, since he's a minor. What we do know is that his family has described him as an otherwise-healthy young athlete.</p><p>The teen was admitted to the first of three hospitals, St. John Hospital, September 5 with what seemed to be pneumonia. His breathing, however, became increasingly difficult until he was put on a ventilator September 12. He was soon transferred to Children's Hospital of Michigan to be connected to an <a href="https://www.thoracic.org/patients/patient-resources/resources/what-is-ecmo.pdf" target="_blank">extracorporeal membrane oxygenation device</a> (ECMO) in order to maintain heart and lung functioning. Still failing, he was transferred to Henry Ford for a six-hour, double-lung transplant on October 15, without which, doctors say, he would certainly have died.</p><p>"There was an enormous amount of inflammation and scarring in addition to multiple spots of dead tissue. And the lung itself was so firm and scarred, literally we had to deliver it out of the chest," recalls Nemeh.</p>THC and vitamin E acetate
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjA5MjAyOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3MjY2MDQwMX0.9UdDk9npfALZ7TID0jTz_NyZYcw1ATYSyOAb8tEm_CM/img.jpg?width=1245&coordinates=171%2C347%2C333%2C1&height=700" id="330c1" class="rm-shortcode" data-rm-shortcode-id="59ef23123cb005117607f305cb6a4d9f" data-rm-shortcode-name="rebelmouse-image" />Vitamin E acetete
Image source: ibreakstock/Shutterstock
<p>When the medical community first became aware of the pulmonary problems, it was unclear what aspect of vaping was causing them. Likewise, it was unclear whether it was tobacco or THC vaping that was causing the problems, or both.</p><p>Scientists from the CDC tested for the presence of potential culprits in victims' lung fluid, looking for plant oils, petroleum distillates including mineral oils, or any other suspicious contaminants common to the individuals' cases.</p><p><a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e2.htm?s_cid=mm6845e2_w" target="_blank">What they found</a> — though there could still be additional substances involved — was vitamin E acetate, or tocopheryl acetate. Collecting 29 lung-fluid samples from 29 people who had been sickened or who had died of lung issues, <em>all</em> 29 contained vitamin E acetate. The CDC's Dr. Jim Pirkle says that's "pretty much unheard of," and constitutes a "very strong signal" that vitamin E acetate is at the very least part of the reason for vapers' pulmonary damage.</p><p>CDC officials have concluded that most of the patients had vaped cannabis-based products. This is supported by state testing — New York's reports finding "very high levels of vitamin E acetate in nearly all" of the samples from cannabis vapers they tested. While the federal FDA remains cautious about putting all the blame on vitamin E acetate, they, too, have found it to be prevalent in afflicted vapers' lungs. Medical authorities are continuing to test for other possible factors in the frequency of pulmonary illnesses among vapers.</p><p>Legitimately manufactured and sold cannabis-based vaping products don't necessarily contain vitamin E acetate. However, the sticky, honey-like substance is commonly used as a thickener in black-market THC products. Unlike THC itself, vitamin E acetate lingers in users' lungs. These unregulated, illicit cannabis-based vaping products, say experts, have indeed been linked to most of the cases medical professionals are seeing.</p><p>"This is a preventable tragedy," says Nemeh. While vaping is presumed by many to be safer than smoking, this current public health crisis makes clear that caution is advised, especially when buying vaping products off the street.</p>
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Cannabis Compound to Be Reclassified as Medicine in the UK
Studies have shown that cannabidiol (CBD) can help with epilepsy, heart disease, diabetes, and even schizophrenia.
06 January, 2017
Medical marijuana advocate makes cannabis oil.
Cannabinoids are certain chemical compounds found only in cannabis. Delta-9 tetrahydrocannabinol is (THC) is the most commonly recognized. This is what gives users that telltale euphoric feeling. THC may also play a role, should medical marijuana continue to become mainstream, as a painkiller. In fact, one study found that those states that passed a medical marijuana law saw a drop in opioid painkiller-related deaths.
<p>THC can ease nausea, while inducing sleep as well as appetite. This is why Marinol—whose active ingredient is THC, is prescribed to certain cancer patients undergoing chemotherapy. There is some indication that it may have <a href="http://www.alternet.org/drugs/cbd-users-manual-everything-you-need-know-marijuana-medicinal-compoiund" target="_blank" title="Alternet">anti-cancer properties</a>. Far more studies will need to be conducted to tell whether or not this is so. </p> <p>Though THC itself may have some medical uses, this isn’t the most exciting of the cannabinoids from a medical standpoint. Rather, cannabidiol (CBD) is the one advocates push for. It has no psychoactive properties, yet may have a number of clinical uses. Initially, interest grew across the US and the world in the wake of a CNN special. Children with rare but potentially deadly forms of epilepsy, such as Dravet syndrome, were seeing dramatic turnarounds after taking CBD oil.</p> <p>The TV special centered on Charlotte Figi, a little girl who went from having up to 80 severe seizures per day to a mild one, once a month. Unfortunately, most of the data we have is anecdotal, due to restrictions and red tape which slows down research. In the US, marijuana is considered a schedule I narcotic under the Controlled Substances Act. This means it is among the most deadly substances on Earth, such as heroin and LSD, and has no medical uses. The FDA recently considered rescheduling marijuana, but failed to do so.</p> <p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xODMzODMwMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MDYyMDcyN30.2KLx1bn6OnxMShVp2vGGXuh9bGZk9IKcNdrIktkKDVQ/img.jpg?width=980" id="1359d" class="rm-shortcode" data-rm-shortcode-id="9830ec3ff96f29694b8cb4f325a42274" data-rm-shortcode-name="rebelmouse-image"><br><em>A patient in Israel received CBD oil. </em></p> <p>Though few, there have been some studies on the substance. And more and more are coming in from overseas. Research suggests that in addition to improving the condition of epileptics, CBD can be effective in treating <a href="https://www.washingtonpost.com/national/health-science/a-powerful-new-form-of-medical-marijuana-without-the-high/2016/12/29/81bbf7c0-b5b2-11e6-b8df-600bd9d38a02_story.html?utm_term=.1d4d331ae4e2" target="_blank" title="The Washington Post ">heart disease, diabetes, schizophrenia</a>, and more. Today, researchers aren’t sure which pathway CBD takes. The most likely is it interacts with the endocannabinoid system, a series of receptors which control cell death and regeneration.</p> <p>These receptors are found in organs and tissues throughout the body. Despite illegality federally, almost half the states in the US now allow some access to medical marijuana, and most often it’s to CBD. One wonders if the incoming Trump administration will allow such a dichotomy to continue, or plans to clamp down on these states.</p> <p>Other countries have had similar trajectories. The UK’s Home Office last year, in response to a petition on recreational marijuana, wrote that cannabis “can unquestionably cause harm to individuals and society.” Even so, recently, in that same country, The Medicines & Healthcare products Regulatory Agency (<a href="http://news.sky.com/story/cannabis-ingredient-to-be-classed-as-medicine-in-uk-10714967" target="_blank" title="Sky News">MHRA</a>) announced a policy change, reclassifying CBD as medically useful rather than a dangerous substance. This wasn’t due to the activism on the part of patients and families, such as it was in the states.</p> <p>Instead, according to <em>Sky News</em>, the director of the MHRA Gerald Heddel said that the change came as a consequence of companies making claims about the cannabinoid’s ability to heal. Heddel stated that after a review of the evidence, it was clear that the change made sense. Up until now, those in the UK interested in CBD either had to move out of the country or source it illegally, as it was only available to those with M.S. Now, manufacturers interested in bringing CBD products to market will need to have them scrutinized by regulators for quality, safety, and effectiveness.</p> <p>Some patients in the UK fear losing access, while others are afraid such a move may send the wrong message, that cannabis is safe. In their statement the MHRA admitted CBD has a positive effect on <a href="http://www.independent.co.uk/news/uk/home-news/cannabis-legality-uk-government-finally-admits-marijuana-has-a-medicinal-effect-a7355941.html" target="_blank" title="The Independent ">“physiological functions.”</a> Yet, the UK is still a long way from legalizing pot for recreational purposes. What’s interesting is this reclassification came at a time when a British company, GW Pharmaceuticals, announced completion of a phase III clinical trial. They tested a CBD-based drug. The trial’s conclusions were highly positive.</p> <p>To learn more about the debate surrounding cannabis, click here: </p> <div class="video-full-card-placeholder" data-slug="altering-perception-with-cannabis" style="border: 1px solid #ccc;">
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