The number of people afflicted and hospitalized with serious lung disease connected to vaping continues to grow. This week, multiple states reported similar cases, and the toll of confirmed and possible victims has climbed into the dozens. Right now, health officials and outside experts still seem to be in the dark as to what exactly is going on.
On Thursday, the Wisconsin Department of Health Service reported that it had found 15 confirmed cases of the cluster, and suspect another possible 15 cases. In Illinois, health officials reported at least six people with “severe breathing problems after vaping,” and another five possible cases that are being looked into. Earlier this week, Minnesota health officials reported that four similar cases have occurred in the state recently.
And on Friday, the AP reported that health officials and doctors in three other states—New York, California, and Indiana—have found similar cases of lung illness in people with a recent history of vaping. The majority of these cases involve teens and young adults.
Though no deaths have been reported as of yet, some patients have endured weeks of hospitalization before they were able to recover, and some still have lingering lung and heart problems. There remains little concrete about what could be causing these symptoms.
“We’re all baffled,” Melodi Pirzada, a pediatric lung specialist at NYU Winthrop Hospital who has treated two cases in New York, told the AP.
Scientists have found evidence that the ingredients normally found in e-cigarettes can cause potential health effects, including lung damage, in users. But more serious effects from these products would probably appear with long-term, chronic use, much like they do with traditional tobacco cigarettes. That hints that something else is happening here, beyond typical vaping.
Many patients reportedly vaped nicotine prior to their symptoms, but at least some vaped THC, the chemical responsible for the high in cannabis. And according to Sven-Eric Jordt, an anesthesiologist, pharmacologist, and cancer biologist at Duke University who has studied vaping, a THC product could very well be capable of causing the sort of lung damage seen in these cases.
“I was approached recently by a pediatric pulmonologist from California who is caring for a teenager who experienced severe lung burn injuries after vaping a THC oil,” he told Gizmodo in an email. “THC oils have highly variable compositions and many may be dangerous to use in e-cigarette devices, due to the presence of oils and solvents that can burn when heated. Some even may have alcohol in them that could combust.”
Some vaping products themselves could also raise the risk of injury, Jordt added, because they can overheat, which could then generate a “high load of toxic chemicals, together with toxic metal released from coils.” Patients have reportedly used a wide variety of products, with different delivery methods.
According to Scott Weaver, an epidemiologist at Georgia State University who has studied vaping trends, some of the fault could lie in the black-market nature of vaping cannabis and THC.
“Cannabis is not legal in Wisconsin,” he noted in an email to Gizmodo,“which would increase the likelihood that these teens and young adults acquired their e-liquid from an underground source that may use unsafe manufacturing and handling practices.”
Last week, Wisconsin health officials reported that these cases may involve the consumption of not only nicotine and THC, but illicit synthetic cannabinoids, too. These chemicals, meant to mimic the psychoactive effects of THC, are thought to be far riskier and more potent than THC alone, due to their chemistry and lack of safety during their manufacture. But it’s unclear whether these chemicals could be more acutely dangerous to the lungs if vaped, according to Ziva Cooper, research director of the Cannabis Research Initiative at the University of California Los Angeles.
“[I am] not sure if vaping synthetics would produce greater adverse effects relative to THC or nicotine... they would certainly produce more severe behavioral and physiological effects than either,” she told Gizmodo via email.
These cases aren’t the only indication that vaping, even in the short term, might be riskier than assumed. The Food and Drug Administration has been looking into more than 100 incidents of people coming down with seizures soon after vaping. And even prior to these clusters, doctors have reported cases of people developing inflamed “wet lungs” from vaping, due to a hypersensitivity to one of the ingredients they inhaled.
These worst-case scenarios will likely never happen to the vast majority of people who vape—estimated to be at least 10 million adults in 2016, and over 3 million teens in 2018. But to experts like Ilona Jaspers, deputy director of the Center for Environmental Medicine, Asthma, and Lung Biology at the University of North Carolina at Chapel Hill, they signal the urgent need for regulations on the industry (the FDA has said that major new rules will be implemented by 2021) and caution from anyone who vapes.
“Will everyone who vapes be hospitalized? Probably not. But I think what’s really alarming is that these are popping up all over the place, and affecting the young and perfectly healthy,” she told Gizmodo by phone. “We don’t know what the cost of these health consequences will be, in say 20 years. It took us decades to figure out, to really link cigarette smoking to all these health effects. And e-cigarettes have only been popular with young adults for maybe the past four years.”