Lung Disease Outbreak Caused by Black Market, not Vaping

During the past month, news stories around the world have reported on a sudden outbreak of lung illnesses supposedly linked to vaping. In the United States, federal and local authorities haven’t yet identified what is behind the illnesses, but the news media has already made its diagnosis. Headlines insinuate that vaping is to blame, fueling fears about the dangers of e-cigarettes. It’s fake news.

Vaping is a delivery system (usually for nicotine), like food is a calorie-delivery system and drugs are a drug-delivery system. When there are outbreaks of E. coli, headlines rarely read, “E. coli outbreak linked to food,” because the relevant fact is not that food caused the illness, but which foods are infected with the E. coli bacterium. Stories about tainted drugs do not merely state that ill-effects were “drug-linked” because people usually want to know which drugs caused the problems. Similarly, in these cases of “vaping-linked” lung disorders, the most important factor is not that the victims were vaping, but rather what they were vaping that caused them to fall ill. While details have not been made public for all of those hospitalized, in every case where a product has been identified, the culprit was not “vaping,” but vaping illicit THC oil.

It started in July when the Children’s Hospital of Wisconsin made a public announcement about eight teenagers who had been admitted with severe lung disorders. (It is likely that the outbreak of acute lung disorders linked to THC oil began earlier, but the media didn’t pick up on it until July.)  Hospital officials, while not identifying an exact cause, noted that many of the patients reported vaping nicotine and THC prior to admission. Since then, 153 people have been hospitalized with a variety of serious lung disorders after reporting a history of “vaping.”

News media around the world have picked up on the story of “vaping-linked” hospitalizations. Most have omitted the fact that black market marijuana e-liquid has been identified as the culprit in some of these cases, while not a single case has been linked to nicotine-only e-cigarettes. Interestingly, most of those falling ill are in states where marijuana for recreational use is only available through the black market. 

Of the 22 states that have reported hospitalizations due to vaping-related lung ailments, only one—California—currently has legalized marijuana available for purchase. Unable to purchase the products legally, some of the patients now hospitalized have admitted to purchasing and using illegal THC e-liquids. For example, 26 year-old Dylan Nelson of Wisconsin reported using the Dank Vapes (a widely derided THC knockoff) prior to his illness. Similarly, a patient in Utah admitted to buying THC cartridges in Las Vegas that appeared to have been opened. In fact, doctors in Utah have commented that every case they’ve seen so far has been associated with marijuana oil.

To be clear, it is unlikely that THC e-oil in and of itself causes these sorts of illnesses. Rather, it appears that black market THC products, possibly tainted, are the root of the problem. In California, where recreational marijuana is legal, at least 21 people have been hospitalized with severe lung issues, and the state government has issued warnings that the cases seem to stem from unlicensed cannabis products. Officials speculate that the reason these consumers risked buying on the black market when regulated THC products are legally available is because of cost.

“It sounds like it’s going to cost twice as much as the stuff on the street, but you don’t want to end up in with a life-threatening respiratory condition,” Dr. Milton Teske of the Kings County Department of Health warned in August. He cautioned that “if you’re going to vape THC, get it from a licensed dispensary where you know there’s a certain amount of testing required to do.”

To their credit, some news outlets have made an effort to clarify that black market marijuana appears to be the primary source of these illnesses. But, alarmingly, many more refer only to “vaping,” which most people associate with traditional nicotine-containing e-cigarettes. E-cigarettes, like Juul, have long been a target for anti-tobacco advocates. These advocates are now exploiting the confusion, using the misleading coverage to bolster efforts to restrict or ban e-cigarettes.

 

For years, groups like the Campaign for Tobacco-Free Kids, the Truth Initiative, the American Cancer Society, and others have lobbied for restrictions and outright bans on e-cigarettes and e-liquid flavors. In July, Congress held two days of hearings on the e-cigarette brand, Juul. During the subcommittee hearing, members went on fact-free rants against e-cigarettes, with Rep. Rashida Tlaib (D-Mich.) even accusing Juul officials of “killing people.” Ironically, unlike actual cigarettes, which kill about half a million Americans a year, e-cigarettes have killed a grand total of zero people in the U.S., despite being enjoyed by millions of adults for more than 12 years. (Or one person, if you count the man killed when the lithium ion battery in his modified e-cigarette exploded.)

Even as research continually demonstrates e-cigarettes are far less harmful than smoking, serve as effective smoking cessation aids, and do not cause non-smoking adolescents to begin smoking, activist calls to eliminate these products have only grown louder. Efforts to raise the minimum purchasing age for tobacco products, including e-cigarettes, have been successful in several states and will likely be approved by Congress in the near future. Some cities have already banned most e-cigarette flavors. San Francisco banned the sale of all e-cigarettes (but not real cigarettes). And, the Food and Drug Administration is expected to implement regulations by 2021 that will make 99 percent of e-cigarette products illegal in America. 

The careless coverage of the vaping-related lung disease outbreaks will only aid anti-tobacco activists in their efforts to extinguish the legal vaping market. But they should hold off popping open the champagne bottles and making self-congratulatory speeches, because such an outcome will not be good for public health and it won’t prevent outbreaks like this from happening again. In fact, it will make incidents like this more frequent and widespread.

As the current outbreak demonstrates, when the legal market fails to supply people with the products they want at the prices they want, illegal purveyors are always happy to step in. We have seen this before with alcohol, drugs, and now with vaporized marijuana. Even with nicotine e-cigarettes, still legal in most of the U.S., an underground market has emerged to supply consumers with the flavors that have been removed from the legal market.

Bans don’t protect people—they only force them into the black market, which has no oversight and no precautions against tainted products. As access to legal e-cigarettes declines, consumers will increasingly rely on illicit street vapes and “bathtub” e-liquids. As a result, more will end up sick and more will die. These deaths, whether due to adulterated black market vapes or simply because people return to smoking, will be on anti-tobacco activists’ heads.

The post previously stated that recreational marijuana was legal in both California and Michigan, however, legal sales will not begin in Michigan until the end of 2019. The number of states with confirmed “vaping related” hospitalizations, according to the CDC, was also updated. https://www.cdc.gov/media/releases/2019/s0821-cdc-fda-states-e-cigarettes.html