FDA & CDC Explore Deaths Linked to Vaping

The U.S. Food and Drug Administration (FDA) is currently collaborating with the Centers for Disease Control (CDC) to explore several deaths linked to the practice of vaping. As of September 19, 2019, the total number of reported cases of lung disease due to vaping is over 450, and seven people have died.

The deaths have all involved the use of electronic cigarettes (“e-cigs”) to vape nicotine, THC, CBD, or a combination of these substances, said Dana Meaney-Delman, MD, of the CDC. (E-cigarettes are small devices that heat a liquid- containing nicotine, flavorings, and other chemicals- to form an aerosol, which the user then inhales.) The victims range in age, geographic location, and particular product purchased. The victims also purchased their products at different places and reported vaping for different amounts of time. This makes it difficult to nail down a common factor.

However, the fact that it wasn’t a single product or a single geographic area should be cause for alarm. In other words, it wasn’t just a bad batch of something. This emerging lung disease is the result of something that is widespread about vaping, or perhaps even the practice of vaping itself.

Chasing Down a Lead

One compound under suspicion is Vitamin E acetate. This compound was present in many of the samples tested as part of this ongoing investigation and was often found with tetrahydrocannabinol (THC). Vitamin E occurs naturally in foods, particularly oil-rich foods like nuts. The acetate form is derived from vitamin E, but it is not the same compound- it is slightly modified. Vitamin E acetate is used in nutritional supplements and cosmetics. It is not known to cause harm when ingested but there is no data on the effect on the body when it’s inhaled. Although the FDA cautions that it does not yet have enough evidence to demonstrate causality between Vitamin E acetate and lung disease, the agency warns that this substance could be hazardous to vape.

Why Are Oils Hazardous to Inhale?

The suspect products all contain oils, with either Vitamin E acetate, marijuana-derived oils, or both. Why would oils be hazardous to inhale? The simple answer is that these oils are liquids at room temperature. In an e-cigarette, they are heated to high temperatures, causing them to vaporize. The user then inhales the vapor. But once these oils are no longer near the heating element (i.e. in the lungs), they cool down. And when a vapor cools down, it condenses. So basically, the inside of the user’s lungs become coated with oil.

That’s a problem, experts say, because your lungs are designed to handle gases, not liquids. Inhaling oils causes a form of pneumonia known as lipoid pneumonia. Lipoid pneumonia occurs when white blood cells show up in the lungs to try to clean up all the oil and the dead cells associated with it. It can be life-threatening. Many have recovered, but the number of those affected- and the death toll- is rising. Seven people have died. The actual number could be higher, as early cases may not have been attributed to vaping.

Guidance

Both agencies have issued statements that advise against buying vaping products off the street, as these products could be tampered with. The CDC has also warned that if you don’t vape, don’t start. And if you’re struggling to quit smoking, FEHB’s got you covered.

Erica Bakota is a GovLoop Featured Contributor. After earning her PhD in chemistry at Rice University, she joined USDA as a research chemist, where she studied lipid oxidation and alternatives to partially hydrogenated oils. She then returned to Houston, Texas to join the Harris County Institute of Forensic Sciences, where she led method development and validation for the Forensic Toxicology Laboratory. In March 2018, she made a move back to the feds and is now with the FDA as a chemist at the Kansas City Laboratory. Her work at FDA focuses on active ingredients in dietary supplements and pesticide residues in foods. You can read her posts here.