Federal officials on Friday advised people to stop using e-cigarettes, in particular those containing the marijuana component THC, until scientists gain better understanding of the epidemic of serious vaping-related lung disease that has sickened as many as 450 people and killed five people across 33 states.
The latest deaths were reported Friday by health departments in Indiana, California and Minnesota, following deaths in Illinois and Oregon. Officials say a large number of cases involve marijuana products, but caution against drawing any conclusions and say there may be multiple causes.
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No device, product or substance has been linked to all cases, Dana Meaney-Delman, who heads the CDC’s response to the epidemic, told reporters on an afternoon call. “While this investigation is ongoing people should consider not using e-cigarette products,” she said, adding that people should avoid buying products off the streets or modifying them in any way.
Late Friday, the FDA said it had tested enough samples containing THC to issue a recommendation that vaping product users avoid any product containing the chemical, which is the psychoactive component of marijuana.
Most of the samples contain large amounts of vitamin E. While the FDA isn’t sure that vitamin E is a cause of the lung injury, “the agency believes it is prudent to avoid inhaling this substance” while federal investigations continue.
And because consumers cannot be sure whether any THC vaping products contain vitamin E, it urged them to not buy any products that contain THC. At least one of the five deaths involved a man who had used illegal THC products, the agency’s news release said.
The agencies say they have confirmed 215 vaping-related lung disease cases and are investigating another 235 that may be related to vaping. Public health experts have been urging the government to tell consumers to stop vaping any product until scientists can clarify the cause or causes of the outbreak.
Minnesota’s first vaping-related death involved a 65-year-old man with a history of lung issues, the state’s health department said. Indiana and Los Angeles County also reportedly had deaths. The first fatality was reported last week in Illinois. Earlier this week in Oregon, officials said a man who bought marijuana vapor from a dispensary had died.
A major case study published Friday found that 84 percent of 41 Illinois and Wisconsin patients reported using THC — the psychoactive ingredient of marijuana. But more than half of them also used nicotine.
A variety of products and devices were employed by the vapers, and distinct lung disorders were reported, according to the report, authored by top health officials in the two states, which appeared in MMWR and the New England Journal of Medicine. Most of the patients had nausea or vomiting as well as breathing problems and a third were sick enough to be intubated.
New York state officials on Thursday said they had found vitamin E in all the confirmed cases in their state. But FDA officials said earlier that no single substance has been identified in the more then 100 samples it tested. Also, since vitamin E is present in most vegetable oils, its presence might not signal a cause of the disease, scientists said.
Mitch Zeller, director of FDA’s Center for Tobacco Products, said the agency is seeing a “mix of results and no one substance or compound, including vitamin E acetate, has been identified in all of the samples tested.” He also cautioned against establishing a link simply because a substance was in each product, saying it was “just one piece of the puzzle.”
Scientists who have been studying vaping’s health risks for years, such as University of North Carolina physiology professor Robert Tarran, say there are many damaging chemicals in vaping products. “Sad to say, I’m not surprised this is starting to come out,” said Tarran, who has seen lung damage in nicotine vapers.
At least six groups of potentially toxic compounds are found in e-cigarette liquids, including nicotine, carbonyls, volatile organic substances like benzenes, trace metals, poisonous flavoring compounds and microorganisms, Harvard public health expert David Christiani said in separate NEJM editorial.
No conclusions can be drawn just yet, Christiani wrote, but “physicians should discourage their patients from vaping.”
Arthur Allen contributed to this report.