The vaping-related lung illness that has stricken 380 mostly young persons from 36 states, killing six, may have offered up a real-life window on CSI-type public health epidemiology, and even drawn calls for product bans from the White House, but from the viewpoint of an expert in lung disease, it's always been a disaster in the making.
"Vaping oil is dangerous," says Dr. Paul Scanlon, who as medical director of the Pulmonary Clinical Research Center at Mayo Clinic has worked on landmark studies of environmental lung disease. "It's predictably dangerous and you shouldn't do it."
"Acute lung injury is the common denominator," says Scanlon, who has not treated any patients but is aware of one case in the Mayo health system. "People have symptoms of shortness of breath, cough and other respiratory symptoms present with low oxygen in the bloodstream, and in cases can go on to respiratory failure. It's a life-threatening injury to the lungs. It occludes portions of the lungs so that the lungs cannot exchange gases, and it causes inflammation that damages other portions of the lung."
With one death reported in Minnesota and all cases in the state linked by the use of vaping products containing THC or the psychoactive component in marijuana, state officials have advised residents to cease use of illicit THC products, adding that those who vape and have symptoms should cease all use of e-cigarettes and seek medical care. Nationally, some cases have arisen in patients who say they only vaped tobacco. Thus the CDC has recommended stopping the use of e-cigarettes altogether.
If the speed and morbidity of the outbreak appears to have caught the nation's health officials off guard, it's because vaping-related lung disease has sprung up in something of a perfect storm. The variables converging to produce the current health emergency begin with the explosion of interest in e-cigarettes among youth, over 3 million of whom have tried e-cigarettes according to the latest CDC tobacco survey.
That trend has been compounded by the lack of FDA scrutiny, in the absence of federal marijuana legislation, into the safety of heating THC or various vaping chemicals in the first place.
Lastly, there has been the rise of shadowy, internet-driven cottage industry for the packaging and sale of bootleg illicit THC, often working with used cartridges refilled in home operations. The cartridges in question, known as carts for short, look commercially manufactured, bear popular brand names used without permission, and beat the prices of legal THC products, according to news reports from marijuana advocacy web sites.
"We don't know how many cases are attributable to which exposure, nicotine or THC," Scanlon says. "All I can tell you is THC containing oils may contribute a substantial amount of cases." One ingredient of interest to federal investigators is vitamin E acetate. Another factor, says Scanlon, is that marijuana plants contain oils which, prior to the rise of vaping, have not previously been widely inhaled.
"When you smoke it, it's burning away the oil and leaving the THC," Scanlon says. "With vaping, it heats the product but leaves the oils, so your'e getting gram quantities of the oil into your lungs, which predictably will cause lipoid pneumonia."
"The lungs don't have a mechanism to clear oil out of the lungs," he says, "if you inhale it, it just sits there. Lipoid pneumonia is an inflammatory response to this. It's [oil] that's just stuck in the lungs and it has no way of getting out."
When asked if vaping illness survivors could face problems later in life due to these inhaled oils, Scanlon doesn't miss a beat.
"Yes," he says, because the lungs have no way of getting rid of it."