Vaping nicotine eliquid is a harm reduction strategy used by millions of smokers all over the world. Since the injuries only occurred in North America, it was clear the injuries were being caused by something other than standard nicotine eliquid.
Almost 100% of the injured patients reported using illegal THC cartridges. Despite the evidence, the injury was named EVALI (E-cigarette or Vaping product use-Associated Lung Injury) implying the cause was nicotine eliquid.
To identify the substance causing the injuries, lung samples from the patients were analyzed. The fat based substances identified as causing the injuries can not be disolved in nicotine eliquid because they would separate in the container.
The patients submitted the products they were vaping to help identify the cause of the injuries. Nicotine eliquids contained no unexpected or harmful chemicals but 9 out of 10 illegal THC carts contained vitamin E acetate which is used as a cutting agent.
The Food and Drug Administration issued warnings that were specific to the injuries. To best ensure the public can make informed decisions about safety, the more specific information about the dangers, the better.
Word spread on the street that illegal THC cartridges were making people sick. Law enforcement busted several illegal THC cartridge makers and distributors. A legal thinning agent, ‘Honey Cut’ was removed from the market. The injuries declined.
EVALI patients use of vaping products vs vapers without injuries
Vaping habits of 66 vapers that suffered with the lung injury were compared to the vaping habits of 519 vapers that didn’t have the lung injuries. The injured vapers clearly showed a significant increase in THC vaping, illegal THC use and purchased the illegal brand that was associated with the lung injuries. This study further confirmed the safety of nicotine eliquid.
Confiscated illegal THC cartridges from 2018 and 2019 found that the vitamin E acetate was only detected in the 2019 cartridges and not the 2018 cartridges. This shows that the causative agent was recently introduced to illegal THC cartridges.
Illegal THC cartridges caused the death of 68 people. Smoking kills half a million Americans and over 45,000 Canadians every year. Vaping nicotine eliquid has helped millions of smokers quit and has killed no one.
Despite the overwhelming evidence, the public were constantly bombarded with claims that nicotine eliquid caused EVALI. Thousands of vapers that had successfully quit smoking with vaping, returned to smoking out of fear.
Because illegal drug use has very serious legal consequences, patients sometimes lie about what they have taken because they are afraid of getting into trouble. Canadian authorities neglected to test lung samples, perform toxicology screening and analyze vaping products used.
Since May, 2018, eliquid has been regulated by the Canadian federal government. Nicotine based eliquid from a vape shop is a 95% reduction in risk compared to smoking. This is called tobacco harm reduction or simply “vaping”.
The public was bombarded by media, gov’t, nonprofits and health authorities blaming tobacco harm reduction (vaping regulated nicotine eliquid) for what was causing EVALI. Utah Department of Health were one of the few health authorities that told the public the truth.
When we say “smoking” we think of smoking cigarettes. When people smoke something else, we specify such as smoking a pipe or cannabis. Just the word “vaping” or “e-cigarettes” is referring to nicotine eliquid. Vaping THC carts is vaping cannabis products.
North American health authorities recommended people stop all vaping and did not specify the injuries were caused from THC cartridges. Cannabis users were left at risk because “vaping” is commonly known as vaping nicotine eliquid.
With a disease outbreak, it’s important to notify the public & the population at risk. Vape shops across Utah were utilized to get the word out about the cause of EVALI & ensured their customers could make informed decisions about harm reduction
30 mice were studied: 10 for vitamin E acetate; 10 for eliquid (propylene glycol & glycerine); and 10 for air (control). The first group were given the equivalent of human dose for a THC cart user and labs results showed the same lung injury. The injury was not present in the eliquid nor air groups.