A Vaping Illness That’s ‘Becoming an Epidemic’ | Hacker News Reader

A Vaping Illness That’s ‘Becoming an Epidemic’

nytimes.com

238 pointsmhb162 comments

As someone who has experience in this industry I can point to the cause.

Biomass ("trim") was very easy to source leading up to CA recreational legalization in 2018. For those of you who don't know the majority of cannabis nationally comes from CA and OR. Legalization brought with it enforcement against unlicensed NorCal farms that drastically reduced supply. This was amplified by the massive overproduction of the 2017 market that had many farmers leave the market due to extremely low prices. This is evidenced by the shutdown of soil/grow supply warehouses throughout NorCal.

By February 2019 the last of the October 2018 harvest had been processed to distillate. Many operators started reprocessing waste material. At the same time, distillate started to make it's way over from Mexico. There is a drought of product in the black market but wholesale buyers were reluctant to pay higher prices after becoming accustomed to the low prices of 2018. In the beginning unscrupulous sellers started diluting their product by 60%. Buyers eventually caught on to the charade and started paying attention to the reduced viscosity of the oil as an indicator of cutting agents. Sellers countered this by adding thickening agents.

Now you have an illicit market with high demand, not enough supply, and customers that represent established black markets across the country that don't want to pay a risk premium for oil.

The cutting agents themselves are expensive so people have started making their own. Now people are getting sick from the cutting agents.

Isn’t the vast majority of vaping not marijuana? I’m surprised there was such conflation in the article. And this reply speaks solely about cannibus.

The article implies that the problem seems to be caused not necessarily vaping as such, but by two things:

1) vaping things that really should not be vaped, resulting in oil droplets getting in your lungs. e.g. "cannabidiol oil, which is not designed for vaping but has been used that way." Apparently some vaping fluids are much worse than others, thus the recommendation to "stop buying bootleg and street cannabis and e-cigarette products, and to stop modifying devices to vape adulterated substances."

2) people not seeking timely medical attention and lying about the causes, as marijuana possession is still a crime where they live.

The vast majority of vapers are unaffected.

From the article:

-----

> The patient’s older brother, a police officer, was suspicious. He rummaged through the youth’s room and found hidden vials of marijuana for vaping.

> Health investigators are now trying to determine ... whether the risk stems from a broader behavior, like heavy e-cigarette use, vaping marijuana or a combination

> Many vaping ingredients are not listed on the products. Vitamin E oil appears to have been a common substance associated with the severe and sudden respiratory problems in some of the New York cases, according to state health officials. It is not known how it was used. Vitamin E is sometimes advertised as a supplement in cannabidiol oil, which is not designed for vaping but has been used that way.

-----

Nicotine is typically in a base of propylene glycol or vegetable glycerine (I think I got those right). I believe both are cheaper than the "adulterants" such as vitamin e oil being used to cut the THC oils, so it is unlikely that people vaping exclusively nicotine products are being affected.

There's been some concern around certain flavorings being much riskier than others (i.e. popcorn lung) though I suspect it'll be some years yet before the effects from those start playing out.

Judging from the handful of vaping articles linked here on HN over the past few weeks, they seem to involve cannabis or cbd oil, whatever it's called. But they are all titled in a way that doesn't reveal this potential link for whatever reason.

Do you think that pesticide use could be a contributing factor as well?

I ask because my hemp mentor will never touch concentrates. He argues that even the tiniest bit of pesticides or inorganic fertilizers will also be more concentrated and he’s not willing to gamble on it. There’s just too many unknowns when it comes to that.

If they are extracting from trim and other low-value parts of the plant, yeah that is a possibility. Myclobutanil has a boiling point around 200 C, THC around 155 C. They have similar hydrophobic nature. So any extraction process favoring THC will also likely partition myclo. If you are making concentrate from buds, this isn't an issue, as your ratio of active components to pesticide is going to be similar. However if you are extracting low-density plant matter, your ratio of myclo to actives will be higher.

However, the highest number I've seen reported was just shy of 1 ppm myclobutanil. Not great, but that's still pretty low.

https://www.thestranger.com/slog/2018/12/20/37272899/no-one-...

I've seen 700ppm total pesticides and typically between 50-300ppm in the CA medical market of 2015-2017. Myclo up to 150ppm was pretty common in the crude I was testing. I tested at SClabs, Anresco, Steep Hill, CW Analytical, etc. depending on client preferences.

Is this specific to vaping supplies, or would it also impact CBD oil tinctures?

Got it. Thanks for the extra reference. Definitely seems like it’s a moot point and something else is at play, giving more credence to the OPs speculation.

No, I don't. There's some talk about neem oil(azadirachtin) being the cause of cannabis hyperemesis syndrome.

People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis.

I run a cannabis copacking company and one of my clients was the first to go pesticide free back in 2016. It was near impossible to source material for them. Prior to 2018 about 95% of material was sprayed with pesticides. Because black market distillate is typically made from mixed batches of oil there was higher contamination rates than that.

I think it's questionable to consume cannabis in general and especially concentrates. The safest method is likely oral consumption. I have seen contaminants in concentrates, such as fire retardant, that pass all screening tests. Neem oil, for example, is an approved pesticide for CA but is really nasty stuff to be smoking.

> People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis.

This. People have been vaping THC e-cig cartridges for years. Same for using other concentrated products like wax. Yet it seems only very recently that this has become some kind of 'epidemic'.

I'm not saying that it's safe, but it seems very sudden that all these cases show up. Or maybe they were happening before, but because it seemed so hard to diagnose, people weren't connecting the cases?

> There's some talk about neem oil(azadirachtin) being the cause of cannabis hyperemesis syndrome.

My worst episodes of CHS I've had from smoking synthetic cannabinoids, I'm not aware of neem oil having any relevance in the production of those.

Imho a large factor could simply be an overabundance of product leading to people overconsuming because "Cannabis has no negative effects", so nobody cares about basics like tolerance breaks anymore [0], instead people just keep upping their THC doses to get past their tolerance threshold.

[0] https://psychonautwiki.org/wiki/THC#Dependence_and_abuse_pot...

Hemp mentor? Is that a thing?

So you’re a hemp protégé?

I guess you could say that. I’m in my first year as a farmer growing hemp. It’s pretty fun and interesting stuff!

You should write something up and submit it here. I'd read it for sure.

That said, those prepackaged preflavored vape carts are all over Amazon, eBay and AliBaba and seem to be doing well. Sadly.

This comment was great, until the last sentence. What is your basis for that claim? Do you know of some particular cutting agent that causes these symptoms?

Speculation should not be presented as fact.

We don't know what is causing these cases but you have presented a reasonable hypothesis.

None of these cutting agents are approved for human inhalation and no studies will be done. From an epidemiological perspective these cases are tightly clustered both temporally and location wise which really limits the possibilities.

Common cutting agents in the licensed market are PEG200, PEG300, and MCT oil. None are those are proven safe from what I know.

In the black market the initial cutting agent was PEG600. Then TrueTerpenes came out with Viscosity ( https://trueterpenes.com/products/diluent/viscosity-extract-... ). Initially they said it was all terpenes (simple alcohols found in cannabis responsible for some effects and flavor) to sell it. It later came out that it was "mineral oil" but the reality is no one knows exactly what it is but it's a petroleum-based product of some kind. There was backlash against TrueTerpenes for this but selling mineral oil at $1500/liter (price point for cutting agents) is profitable. Some reports have described the symptoms as consistent with lipid pneumonia.

Next FloraPlex released their thickening agent. Then HoneyCutt. I started hearing stories of people selling 0% THC epoxies to unsuspecting buyers as distillate starting a few months ago.

Now there are people making their own thickening agents.

Is it a theory? Yes. I'm normally scientifically conservative but I'd place a friendly wager on this one.

I perform with and breath fire as a hobby. The single biggest risk to firebreathers isn't burns, but chemical pneumonitis, due to fuel inhalation (basically synthetic mineral oil with chain lengths 12-18). Took one look at that xray and thought, "yup, chemical pneumonitis" [1]. Also known as lipoid pneumonia.

In my research, one finding that stuck out [2] was that natural oils (triglycerides, saturated or unsaturated) are more pro-inflammatory than straight-chain mineral oils. MCT oil would absolutely cause acute inflammation and in severe cases, collapse of alveoli.

However, the long chains, longer than C14, have half-lives measured in months to years. The effects of these is harder to know, but excessive exposure causes essentially COPD.

Edit: oh look, here's an article specifically pointing out lipoid pneumonia [2]. I actually disagree with their thesis, that vegetable glycerine is causing the inflammation. I would bet it's more likely to be one of these thickeners, or a carrier agent for a flavor, causing the inflammation. I know people who go through over an ounce per day of VG solution that aren't getting chemical pneumonitis, but inhalation of sub-milliliter amounts of oils has sent friends of mine to the hospital.

Basically, if it's not air, it doesn't belong in your lungs. However, the degree and character of the damage done depends on the chemical composition.

Shorter molecules, molecules with more hydrophilic nature (alcohols, polyols, ketones, acids), biologically active molecules, are more acutely inflammatory, but usually the body can deal with them. Longer molecules, biologically inert ones, are less acutely reactive to the immune system, but can cause disruption of membranes and long term toxicity. Unsaturated fatty acids are especially bad because they can be oxidized directly into inflammatory signal chemicals. [4]

[1] https://en.wikipedia.org/wiki/Chemical_pneumonitis

[2] pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040

"Mineral oil (a mixture of inert, long-chain, saturated hydrocarbons obtained from petroleum) and vegetable-based oils tend to cause minimal to mild inflammatory reactions (Fig. 3). The intraalveolar oils can coalesce in the alveoli and become encapsulated by fibrous tissue, resulting in a nodule or mass (paraffinoma) (Fig. 4). Conversely, animal fats are hydrolyzed by lung lipases into free fatty acids that trigger a severe inflammatory reaction that manifests as focal edema and intraalveolar hemorrhage [5]. "

[3] html - https://casereports.bmj.com/content/2018/bcr-2018-224350

[4] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048...

"unsaturated fatty acids can be oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators. "

I have used an MCT vape before. I've made some of my own carts with it as well.

I wonder if you have any words on "MCT" being too broad a term. I made my carts with Bulletproof's Brain Octain, which claims to be 100% caprylic acid (C8).

I'm not naive enough to ask "Is it safe?" But I'm curious if you think an 8-chain MCT would treat your lungs significantly different than a 12-chain MCT?

I could easily imagine someone learning that you can make carts with MCT, and finding something cheap, only to be unknowingly using 100% C12. Cue the lipid pneumonia.

I've breathed fire with MCT oil (the storebought stuff that is basically liquid coconut oil). It's somewhat irritating, and I imagine if deliberately inhaled chronically it would cause harm.

C8 is really fascinating because, I reckon, it's too short to set off the inflammation cascade directly, so it would be up to macrophages to alert the body "hey this doesn't belong". However you still have the usual risk from hydrophobic product in the lung.

Personally, I would use vegetable glycerine and nothing else if you can at all avoid it. PG is a bit more irritating than VG, but any short polyol is going to be diffused away into the mucous much more easily than hydrophobic products.

100% agree with the VG (Vegetable Glycerin) recommendation, you will have to add a small 20-30% percentage of PG Propylene Glycol to decrease the viscocity (or alternately use pure VG and cut with small amount of normal saline but it won't make as nice a vapor) and then can use it in any actual vape device used for nicotine as these are meant to use water-based not oil-based mixtures.

For marijuana/hemp you can make a water-based tincture using VG as the solvent just using dried plant matter. A magical butter machine can do it, putting it in a bottle and shaking it up every day for a few months, there are likely other methods. It's similar to making a CBD/THC oil but instead using VG as the carrier.

Making your own tincture from decent-quality dried plant matter is the most economical and surefire way to know that it unadulterated and limited in contaminants.

Isn't MCT saturated?

Yes, sorry the wording was a bit ambiguous. MCT is almost entirely saturated. Any natural oils can be broken down into free fatty acids which have a pro-inflammatory effect when "not where they belong", i.e. in the interstitial space. However, unsaturated fats have the fun additional property that they can be "oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators" [1]. So MCT oil is probably pro-inflammatory in the lungs, but vegetable oil even more so.

[1] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048...

Why aren't propylene glycol or glycerine used as cutting agents?

THC oil doesn't mix with glycerine. You can mix it with propylene glycol if you are using other diluents as well.

They decrease viscosity, making it obvious that a product was diluted.

Scientific wild-ass guess: Polyols (ethylene glycol, propylene glycol, glycerine) are very hydrophilic. It would be trivial to detect presence in oil concentrates - just shake with a known quantity of distilled water. The polyols will be pulled into the water layer and increase the volume. It's not quantitative but if you know the 'ol in question you can calibrate a curve and get within a few percent of actual with just graduated cylinders.

Is "approved for human inhalation" a thing? Don't regular cigarettes have tar that people inhale?

The only thing I know of approved for deliberate human inhalation are things like inhaler and nebulizer based drugs. Those are usually carried in a fluorcarbon (HFA-134a aka 1,1,1,2-tetrafluoroethylene in Ventolin inhaler, which just evaporates) or saline in the case of nebulizers.

Theatrical fog causes "irritation of mucous membranes such as the eyes and the respiratory tract associated with extended peak exposure to theatrical fog. " Another study "also found long-term exposure to smoke and fog was associated with both short-term and long-term respiratory problems such as chest tightness and wheezing".

Cigarettes are terrible, but vaping ain't vitamins.

https://en.wikipedia.org/wiki/Fog_machine#Adverse_health_eff...

The only instances I could find of respiratory irritation requiring medical intervention related to fog machine use where involving oil based fog machines, or mixed-use but have so far been unable to find case reports of Glycol or Glycerin based fogs alone.

Not all theatrical fog is the same as vaping as far as I am aware. If you have any articles specifically dealing with the components used for vaping I would be interested to read them. Vaping does not use oil.

Vitamin vapes are a product that is actually being sold now, I know someone who has tried one.

I would agree that your guess is probably better than mine and I would be disinclined to bet against you. I hope the CDC has access to all this information so they can evaluate this as a potential cause.

My issue was only that you followed a bunch of informative facts with an untested theory that was not differentiated from the facts that preceded it.

My apologies, I didn't mean to come off as abrasive. Yes, I see your point about the presentation of facts.

I didn't find you abrasive and I appreciate you sharing your information and insights with us.

This is a casualty of state governments dragging their feet when it comes to legalization.

You can get very "legit looking" THC cartridges very easily where I live (New York). They're Chinese-made copies of legit dispensary brands which are then filled with whatever junk. It doesn't surprise me at all that some of them are tainted.

I find it interesting that the article is targeting vaping in general rather than buying tainted products.

(My money is on THC extraction using Butane that is meant for fuel (that's heavily contaminated) rather than lab-grade/ pure.)

Seems unlikely, though IANAChemist. Butane is a volatile (BP ~0 centigrade) short-chain hydrocarbon, and its isomers would likely (?) be similar. Contaminants of butane might be what?

If they were longer chained they'd be less volatile but still disappear quickly. If they were long enough to hang around to mess up lungs then they'd probably not vapourise well in the first place so wouldn't make good solvents. Just a guess though.

Any solvent used at any stage of extraction from crude oil (?) to product, for starters. Random shit that was in the crude to start with. By products of heating any of these. For starters.

Anything that got into the container holding the butane would have to be as volatile as the butane, I think. So it wouldn't be a long-lasting contaminant as it'd evaporate very quickly, along with the butane.

But if I'm wrong, if it wasn't volatile at room temperature & pressure, it would remain in the container as the butane was released so probably never meet the THC/weed anyway.

I dunno, but that's my reasoning.

Wrong on all accounts. If any of that was correct, distillation could be one stage and we wouldn’t need a dozen plates to separate components. And then there’s the azeotropes of butane, most famously acetaldehyde.

Surprised terpenes aren't mentioned in article -- when heated too hot they can degrade into benzene. Seems like they are targeted for something to extract not remove (although I know nothing about cannabis - only industrial contaminants).

Not sure how hot the heating elements are supposed to get but if they get too hot you're inhaling stuff that basically creates pneumonia symptoms.

The mighty vape is pretty well respected and ranges from 180C to 200C. Would that be hot enough to convert some into Benzene?

Limonine is a terpine, and it certainly causes lipid pneumonia, or something much like it...

> I find it interesting that the article is targeting vaping in general rather than buying tainted products.

Yea, I don't vape anything but I think it's a pretty fascinating public health issue and I'm very interested in potential developments in our understanding of its health impacts. I read the first couple of paragraphs and realized that the article has little to do with what its headline implies. I suppose I should've known better than to credulously read a headline from a clickbait rag like the NYT.

The teens who are being hospitalized for this wouldn't legally be able to buy thc cartridges anyway, so they may still resort to black market goods.

But, a percentage that would have bought black market goods may instead go the stereotypical route for underage drinking - getting someone of age to legally buy the product and pass it on.

That still seems preferable to black market goods.

Legal marijuana puts the unscrupulous dealers out of business and allows law enforcement to target them directly.

Possibly. But under-age drinkers don’t regularly source moonshine. If the legal market is there it’s more likely they’ll find ways to acquire store-bought stuff.

I believe these vaping cases are from using elicit, underground THC vaping products and not the usual e-cigarette / nicotine vaping we usually associate with the word “vaping.”

There’s some details over on Reddit:

https://www.reddit.com/r/electronic_cigarette/comments/cxov1...

That thread seems like speculation without much to back it up. Not everyone showing symptoms smoked THC cartridges and the article makes it clear that experts have not yet identified a specific cause

>Not everyone showing symptoms smoked THC cartridges

Are we sure about that? The article doesn't seem to say that to me. It also says that patients sometimes lie about what they vape.

Minor quibble: a doctor would write "Patient reported no thc use" not "Patient did not use thc".

Patients are notorious liars

This comment section is also a bunch of speculation without any evidence. Seems to be the same with every other story or conversation about this topic.

Yeah I wish the article gave more details instead of just spreading FUD

Whereas people on Reddit have no bias at all? Why is it FUD? Why do we equally blindly believe "oh, no, this is all Chinese tainted shit - 'real' vape cartridges are all goodness and light"?

Having an article titled "Mysterious [XXX] illness" is pretty much the dictionary definition of FUD but even if you can't accept that, the national health organisations of UK[1] and New Zealand[2] have conducted studies about vaping, you can find a lot of data there (something that can't be said about the NYT article).

[1] https://www.gov.uk/government/news/e-cigarettes-around-95-le...

[2] https://www.health.govt.nz/our-work/preventative-health-well...

Well, some of us have been vaping (in the traditional sense - nicotine/PG/VG) since those people in the article were in kindergarten. This kind of problem hasn't been a thing until recently.

And the article specifically mentioned this.

If you're coming from the oversimplified perspective that things are always horribly evil or "goodness and light", then sure. But you have to understand that many of us here are different in that we're capable of understanding nuance, and that facts and details matter in building a model of a complex world.

The health effects of vaping still aren't settled science, but that doesn't make these article any less FUD: The fact that headlines like this and others are eliding the critical fact that the cases they describe are limited to bootleg cartridges is pretty much a central case of FUD.

The Reddit article there _literally_ describes it as "our wonderful alternative".

Where in my comment am I saying anything about the Reddit post? The GP comment by mastazi says "I wish the article gave more details instead of spreading FUD", you responded with a complete non sequitur about people who assume legitimate products are risk-free, and I pointed out that disliking FUD doesn't automatically mean you're Pollyannaish about the risks of legitimate products.

Again, what I'm trying to explain to you is that for some of us, there are more than two possible positions here. Mastazi complaining about FUD in a WaPo article (or the original nyt one posted here) doesn't mean he agrees with a random Reddit commenter who also disagrees with the article.

The reddit post links to this article.

https://www.washingtonpost.com/health/as-vaping-related-lung...

Lethal FUD, as vaping standard PG+VG+nicotine mixtures without adulterants is orders of magnitude safer than smoking.

> safer than smoking.

The problem is that vaping is NOT safer than NOT smoking.

The issue is that vaping is seen as "absolutely safe" rather than "relatively safer". Since vaping is now seen as "cool" (look at the "Game of Thrones" stars being shown vaping--especially the attractive, young women), it is converting non-smoking, non-vaping people into vapers.

That's a problem.

On what basis do you know this?

People have been vaping for a decade. There is no epidemic of vape-related pulmonary issues anywhere else than in the US right now.

Smoking kills over eight million people every year, 480,000 of them in the US alone.

Even if the current epidemic turns out to be global, vaping is still several orders of magnitude less lethal.

Given how long smoking was deemed to be safe, what studies have you seen that show that vaping hasn't and won't turn out to have long term health effects on par with smoking? A decade is not a very long time to run the kind of large scale longitudinal studies that are needed to accurately gauge long term health effects. Making significant claims about the long term safety of e-cigs without this data seems quite irresponsible.

Edit: lots of downvotes but still nobody actually willing to provide evidence for these ridiculous "several orders of magnitude safer" claims.

It’s so strange to me how vaping is seen as this miraculous thing and any criticism is seen as being a hater.

10 years is not nearly long enough to measure long term health effects, sorry. Being “safer than cigs” isn’t worth anything at all.

It's worth a lot if people vape over smoking cigarettes. It's worth negative if people who wouldn't otherwise smoke cigs take up vaping.

More complex question would be if I vape my dessert flavor with or without nicotine is that better for me than eating said dessert? I have had so many people tell me how they 'cant resist' sweets, and I'd rather vape my cake.

Before I switched from smoking 12-ish years ago my lungs would physically hurt in the morning and I would cough when I woke up. To me, and other people who legitimately view vaping as something that was life-changing in a very positive way that comes off as a very uncaring attitude. Vaping dramatically improved my health.

A lot of the resistance you describe comes from the fact that vaping is illegal in many countries (interestingly, smoking is legal in almost all of those places) and people living in places where vaping is legal, are concerned that there might be a push towards prohibition.

I agree with you that the amount of evidence we have is not conclusive and if you browse the various vaping forums online, you can see that most vapers openly admit that as well, the problem arises when the lack of conclusive evidence is used as an argument in favour of prohibition, that is what drives many vapers to respond.

In other words, if something is “possibly harmful but we’re not sure yet”, is that a sufficient reason for making it illegal? Most vapers think that the answer is no.

> people living in places where vaping is legal, are concerned that there might be a push towards prohibition

Spreading false, misleading information doesn't help legitimize your cause.

> the problem arises when the lack of conclusive evidence is used as an argument in favour of prohibition, that is what drives many vapers to respond

I haven't see anyone here doing that, I certainly haven't.

> In other words, if something is “possibly harmful but we’re not sure yet”, is that a sufficient reason for making it illegal? Most vapers think that the answer is no.

I do not thing there is any doubt that vaping is harmful to some degree (that appears to be the scientific consensus). The unresolved questions are "how harmful?" and "is it a net negative for society?". However, even if the answers are "almost as harmful as cigarettes" and "yes, it increases public health risks overall despite reductions in smoking", I still would not support banning e-cigs (though I would support advertising restrictions).

I wasn’t replying to you, not sure why you feel the need to resort to personal attacks.

Possible reasons were discussed in https://www.abc.net.au/radionational/programs/backgroundbrie... (transcript coming later AFAICT). Basically: libertarians and tobacco lobby groups.

From EPA "Propylene glycol and dipropylene glycol were first registered in 1950 and 1959, respectively, by the FDA for use in hospitals as air disinfectants. At one point, there were approximately 190 pesticide chemical companies having active propylene or dipropylene glycol registrations." This entire report details safety information, including aerosol use for almost 70 years.

https://archive.epa.gov/pesticides/reregistration/web/pdf/pr...

Another related Glycol saves sick infants from infection and no long-term sequelae reported: https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.37.11...

Vegetable Glycerin: https://monq.com/science/vegetable-glycerin/

The more research you do on pharmacodynamics and pharmacokinetics the more the 96% less harmful than smoking figure appears likely to be in the correct ballpark for harm-reduction vs smoking. Source: https://pneumonia.biomedcentral.com/articles/10.1186/s41479-...

One way of knowing this would be by reading studies conducted by the national health organisations of several countries, see my other comment in this thread.

The one study says that current best estimates place vaping at ~20x safer, or a single order of magnitude. The other provides no concrete numbers.

There appears to be a lot of dispute about those numbers are unrealisticlly high and concerns about conflicts of interest. The wikipedia article provides lots of references on those disputes:

[1] https://en.wikipedia.org/wiki/Safety_of_electronic_cigarette...

Specifically, the study itself states "A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria"

Specifically, the study itself states "A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria"

You could apply the same assessment to strawberries, no? Can't estimate the harm caused by something for which we don't have evidence of harm.

It is unclear what your point is. Did somebody claim that strawberries are orders of magnitudes safer than cigarettes?

My point is that there are good reasons to view the number presented in that report as very preliminary and unreliable.

Smoking tobacco is remarkably dangerous. It would be surprising for vaping to be anywhere near as dangerous as smoking tobacco, especially because you don't have the tar.

I agree in that I would also be surprised to find out that smoking is overall safer than vaping. (Though I do suspect there are certain risks that are still higher with vaping while others are lower than with smoking)

Claiming that vaping is orders of magnitude safer than smoking, without proof, is still highly irresponsible. We simply don't know how safe vaping is.

The history of making safety claims about addictive products is quite fraught with delibratly misleading and false statements. Please take care not to exacerbate this.

We simply don't know how safe vaping is.

Why do you say this so categorically?

"...[R]ats were nose-only exposed to filtered air, nebulized vehicle (saline), or three concentrations of PG/VG mixtures, with and without nicotine...Compared with vehicle exposure, the PG/VG aerosols showed only very limited biological effects with no signs of toxicity."

https://www.ncbi.nlm.nih.gov/pubmed/28882640

Propylene glycol has been used as a carrier for pulmonary inhalers as well as in food and cosmetics for decades.

While there is evidence showing the short term safety of inhalation, there is no evidence as to the long term effects of consistent repeated exposure.

> Propylene glycol has been used as a carrier for pulmonary inhalers as well as in food and cosmetics for decades.

Propylene glycol was deemed safe for oral consumption, not inhalation. I have not seen any sources of information indicating its use in pulmonary inhalers, do you have some sources you can link?

s/inhalers/nebulizers/

See, e.g., https://www.ncbi.nlm.nih.gov/pubmed/12425745

It's also listed as approved as an inactive ingredient by the FDA, including for inhalation:

  PROPYLENE GLYCOL | RESPIRATORY (INHALATION) | LIQUID   | 57556 | 6DC9Q167V3 | 10%w/w
  PROPYLENE GLYCOL | RESPIRATORY (INHALATION) | SOLUTION | 57556 | 6DC9Q167V3 | 25%w/w

Source: https://www.accessdata.fda.gov/scripts/cder/iig/index.cfm?ev..., page 39.

I remain cautiously pessimistic because there are two main possibilities: (1) there is one product (or a series of products manufactured/purified in the same way) that causes respiratory failure in many or all users, (2) all vaping products have a low level risk of causing respiratory failure. I don't think there is enough data to make a conclusion yet, but I am worried this will end up being a low-level persistent problem with vaping products—bootleg or not—for the rest of our lives.

Maybe the culprit truly is dirty oil based extraction of THC... but if so, that will remains a problem for as long as there is no regulation of the official market as well as an operating black market.

OTOH we may end up with a situation like we have in the world of muscle builder / hormone supplements where most people are fine but some users get really sick (e.g. deer hormones sold at regular stores causing severe kidney injury), but not enough of them get sick to get the CDC/FDA involved. I've seen those cases in the hospital and the patients are always confused as to how this could happen because they got the supplement from a vitamin store.

With respect to some of the European posters below who have been using vape products for years: I would not be surprised if there were health consequences to those devices that had not been identified in Europe. The US has one of the best disease identifying-apparatuses in the world (the Centers for Disease Control) and a tradition of surveillance and reporting that is unparalleled. If a substance is harmful to health, it's got a better chance of being found here than anywhere else.

Only tangentially relevant, but does anyone have any insight on how applicable this broader topic might (or not) be to the "essential oil" industry?

Specifically talking about the business of "essential oil diffusers" and the sales of essential oils. From my understanding, the diffusers are largely akin to ultrasonic humidifiers containing oil instead of water (though several forms of diffuser exist including ultrasonic, evaporative, heat, etc) -- which I would imagine is basically just putting oil into the air for later inhalation...

The article mentions several times, and somewhat unsurprisingly, that the inhalation of oil is not good for you or for the health of human lungs. Is this the case with all types & classes of oils (ie "essential oils"), or are oils used for vaping specifically bad/worse, or is there just not much data on the broader topic of inhalation of atomized oils yet?

I've read the relevant Wikipedia articles and read through the studies/sources that are freely available, but if anyone has any further insight or knowledge I'd really love to better understand it.

FWIW, my personal guess would be that the inhalation of most any non-gaseous matter is probably bad for you -- but if there's any science/data out there on it I'd love to hear about it.

I bought an Awair some months ago, having been diagnosed with Alpha-1 antitrypsin deficiency and slightly freaking out, I wanted to have a bit more data on my living conditions. It measures PM2.5, VOCs, humidity, CO2 and temperature. Luckily my indoor air quality was pretty good, except for low humidity. The Awair app kept nagging me to get a humidifier, so I relented and bought one. Just some minutes after switching it on, the PM2.5 skyrocketed!

I googled for answers, and found out that Awair warned about this: https://blog.getawair.com/awair-investigates-how-your-humidi...

The humidifier was spewing crap out into my air!

I switched to distilled water and the measurements were OK again, but a bit scary to see how bad it was with regular tap water.

> Luckily my indoor air quality was pretty good, except for low humidity.

What's the problem supposed to be with low humidity? All of the humidity-related problems I know of, including discomfort, come from high humidity.

In my experience, dry, cracked lips, asthma attacks, and a stuffed-up nose. The reason that humidifiers are a business is because low humidity can be uncomfortable.

Discomfort due to dry air is a major problem in airplanes. You may already have experienced it.

One of the main reasons why they recirculate some air instead of making it an open circuit is to conserve moisture. Outside air at high altitude is extremely dry. Moisturizers could be used but that would require heavy and therefore expensive water tanks.

To me the most noticeable problem is dry eyes, which makes me feel like I'm exhausted and falling asleep, even if I've had a good night's sleep. Before we got humidifiers it started the minute I walked into the office.

Also occasional nosebleeds.

If you have sensitive or dry skin, or something like eczema, it can (usually over long periods of time) cause some pretty severe issues if you don’t have enough humidity.

Just one relevant bit of information: in “classic” vaping (the one where the goal is to inhale nicotine through the use of liquid “e-juice”) there are no oils involved whatsoever, in fact vapers who make DIY juice, actively avoid any ingredient that contains any kind of vegetable oil in their composition (which is unfortunately often the case with some types of food flavouring). This is because oils could combust and combustion is the very thing people want to avoid when switching from smoking to vaping.

I’ve heard that there are other forms of vaping where e.g. cannabis oil is involved but that type of device works very differently and has nothing to do with “nicotine e-juice” vaping. (Edit: the NYT article is just conflating many separate phenomena under the umbrella term “vaping” which is very unfortunate).

PS Ex smoker and ex vaper here (I went from smoking to vaping to quitting everything, couldn’t have done it without vaping), I‘m fairly technical since I was involved in DIY juice making and device “modding” so hit me if you have questions.

Yes you could have done it without vaping. Yes, you didn't do it, but that's no proof.

When I look back at my personal story I don’t look for proof, I look at my past experiences and decide that something has value to me.

If proof is what you’re looking for, scientific studies about the effects of vaping abound.

It is a bit of a stretch to say there are no oils involved whatsoever. Glycerol/glycerin is almost always produced from triglycerides such as vegetable oil. (Edit: as the article states, the potential for left over oil from this process being present in the glycerol is one of the causes being explored)

Additionally, I believe the flashpoint for glycerol is lower than most vegetable oils so your argument doesn't make sense.

You naturally inhale essential oils when you walk through a forest and some of those (i.e. phytoncides) have been studied and linked to a range of positive health benefits, by for instance boosting immune system function and reducing negative stress. Those health effects have been reproduced by adding wood essential oils in the air of indoor environments. Example: https://www.ncbi.nlm.nih.gov/pubmed/20074458

However, different essential oils may have adverse effects as well and it seems like this is definitely understudied. It wasn't until I started looking into essential oils that I realized that almost every type of commercially available essential oil is toxic to cats. I would exercise extreme caution when using diffusers and stick to the few essential oils that have been well studied and considered safe for humans & pets.

I think concentration and magnitude is key. Frying definitely vaporises oils into the air but it doesn't seem to be causing lung issues.

I believe there are heath issues with frying oil. Just the first Google hit...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881732/

https://www.thelondoneconomic.com/food-drink/bad-fry-news-fr...

And a meta-analysis: https://www.google.com/amp/s/www.researchgate.net/publicatio...

Breathing the smoke and grease from frying is definitely not good for you. That’s one reason kitchens tend to have serious ventilation.

But people accept a certain amount of risk, since everyone needs to eat and cooking is a career for many people. Cooking is nowhere near as dangerous as smoking cigarettes.

Most cooks I know do both unfortunately

Do we have reliable data about the incidence of smoking among cooks and food preparation workers? How does it compare to the general population? Smoking is supposed to affect negatively your ability to recognise taste and smell, which are very important if you work in a kitchen but, at the same time, I too know several people who are in that line of business and are smokers.

You know why? Because all the chefs I know say the same thing - smoking is the only way to get any sort of break while in the kitchen, going outside and standing still doing nothing for 5 minutes is not acceptable, but somehow going out and smoking for 5 minutes is absolutely ok in most kitchens. I know some people who picked up smoking only to have an extra break at work.

On the plus side, I also know someone who bought himself an e-cig and somehow buys "blank"(saline/water filled) cartridges for it, just so he can have a short break but without any side effects of actually smoking.

Honestly, depending on the establishment you work in, your sense of taste and smell don’t matter much as a line cook or a regular prep employee. You are outputting dozens of the same dish repeatedly in the same order with the same ratio of ingredients. More of an assembly line with a series of predetermined steps than a creative expression through food. A batch of soup may be tasted once at the beginning of the shift when it is prepared but it usually isn’t being checked on the fly.

You usually don’t fry for the entire day. The diffusers spew stuff 24x7 in many cases, and folks try to inhale as much as possible for the quack health and wellness benefits.

That said, the “oils” are pretty dilute.

Search for "`chemical name` msds". You may need to look for the specific chemical name [1] rather than trade name. You should be able to find an occupational safety limit, lower exposure limit, or similarly worded section, which tells you how much (roughly) you can be safely (roughly) exposed to per unit time, usually 8 hour workday.

Anything that isn't air doesn't belong in your lungs. Period. Some things are less bad than others. However diffusers are unlikely to increase the concentration to harmful levels for healthy individuals. As an asthmatic though, I can definitely feel it when lots of diffusers are running.

[1] http://www.chemspider.com/

Without knowing for sure, I guess the concentration makes a big difference. Many things are toxic in high doses. The purpose of a vaper is to get as much oil in your lungs as possible. Not sure that compares to an essential oil diffuser.

With essential oils you put a few drops into something like 300ml of water. So the amount of oil getting to your lungs in a large room out of that few drops of oil is pretty trivial. Maybe say you get one drop of oil exposure, over 4 hours. I doubt lungs have much trouble clearing that out.

Vaping has much more history in Asia and Europe and seems to be without cases like this. The products from the cigarette industry aren't very prevalent in those contintents and also not vaping of THC and other such fluids. That plus the limited geography and timeframe seems to point only to contaimated juice.

I've been vaping for about 10 years and would be happy to see tighter regulation of juices. Some of the stuff available is scary, and the purity is always up for question. There simply isn't any framework for this kind of thing yet. It's not all that surprising people are getting injured

I'm fine with this as a long time vape user as well. Or at least have a food safety type agency looking at the products and fining bad actors to create disincentives for mislabelling and poor/unhealthy ingredients.

Of course many people are rushing to ban it before we fully understand it and like any controversial topic FUD is everywhere. But that doesn't mean careful small steps cant be made today.

Vaping vials of THC in Long Island, NY, as what happened in this article, isn't something sold through legal channels AFAIK though so I'm not sure how much an agency could help with this specific problem (other than to highlight them).

Everyone loves to bash Juul (which is a garbage product I'd never touch) and the big tobacco company which owns it, but there's tons of small mom-and-pop style juice makers, shops, and device manufacturers which run a big part of the Vaping industry. These are the ones who will be impacted the most by the policies so we should keep them in mind when designing policy and not let Juul and their lobbyists write the legislation, in response to Juuls own bad behaviour (as always seems to happen), so we only end up with Juul type big companies.

> Or at least have a food safety type agency looking at the products and fining bad actors to create disincentives for mislabelling and poor/unhealthy ingredients.

That seems like a tricky needle to thread, though. How do you formulate a rubric that somehow places nicotine on the "fine to put into consumer products" bucket, while placing everything else that might hurt you in the "dangerous and should be banned" bucket?

The purpose of the government is not to ban everything that might hurt you. It’s simply made the decision that smoking is so harmful that it should be regulated. Just about anything can be harmful depending on how you consume it. Eat too much sugar? You’ll become obese. Eat no sugar at all, you’ll die.

Nicotine by itself is not particularly harmful. It can have acute effects if you overdose on it, but it doesn’t cause cancer. The harmful part of cigarettes is all the burnt plant matter you’re inhaling. You don’t see anybody discussing the risks of nicotine patches or gum.

I used vaping to quit smoking (and then eventually quit vaping). I’m sure vaping is better for me than smoking, and I’m sure not vaping is better for me than vaping. I’m all for safety regulations and more research to be done. But regulating or taxing the hell out of it just because it looks like smoking seems incredibly short sighted to me. Id want any regulation to be based on sound safety practices, and a legitimate understanding of the health affects.

Sorry, perhaps I was too blunt. I'm not looking to pass any sort of moral judgement against nicotine or tobacco users, here.

I'm more trying to call attention to some tension. The idea that vape juice should be tightly regulated to keep harmful chemicals out implies that we should be defining some sort of toxicological ceiling on what things are allowed. And I'm wondering what that would look like, and how it would work out in practice. If we focus on LD50, I doubt there's much that goes into vape juice with a higher LD50 than nicotine, aside from perhaps something egregious like what's killing all these kids in TFA. If we focus on some long-term health outcome, it's probably similar - nicotine in isolation hasn't been as well-studied as whole tobacco, but it seems unlikely that, upon closer scrutiny, a chemical with such strong acute physiological effects wouldn't turn out to have some fairly serious chronic health effects, too. We narrow in on cancer, sure, but that seems like a standard that's more specifically for establishing that vaping is less harmful than cigarettes than it is for establishing an overall consumer product safety standard.

My inclination would be to say that a better starting place might be just to require vape juice to post ingredients labels, and set up some enforcement there. It's possibly not as strong a regulation as tightly controlling what's allowed to go into vape juice in the first place, but I'm guessing it also has a lower risk of creating a "be careful what you wish for..." situation for people who vape.

> Nicotine by itself is not particularly harmful.

... if being a highly addictive drug isn't considered harmful.

Or being a teratogen. Or messing with sleep cycles. Or harming brain development.

In utero nicotine increases the likelihood of hypertension and diabetes.

No medical study considers nicotine harmless. Yes, it won't cause cancer. But that's not synonymous with "not particularly harmful".

No medical studies consider alcohol or caffeine harmless, and no study has been able to tell if nicotine is more harmful than caffeine, and everyone agrees alcohol is worse than nicotine (for the doses used typically of both).

Pregnant women should definitely not drink, they probably shouldn’t use nicotine either.

It would appear, based on this fairly recent survey of the available literature, that nicotine is probably more harmful than caffeine:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

Which is kind of also where I'm going, saying, "by what standard?" There are plenty of ways to play gotcha with any potential regulation, based on the list of findings in this survey. I mean, let's assume, for the sake of argument, that GP was thinking that maybe we shouldn't allow vape juice manufacturers to deliberately add any banned pesticides such as DDT or arsenate. . . well, it turns out that nicotine is a banned pesticide, too.

Like I said in another comment, the research on pure nicotine doesn't seem to be as extensive as one would expect. It's been overshadowed by research on smoking and chewing tobacco. But it is there, and it's not that equivocal. I've heard this meme that nobody's proven nicotine is particularly harmful plenty of times, especially among ex-smokers who still use nicotine lozenges or vape juice or whatever, and I'm not sure where it comes from, but my guess is that it's based on a motivated interpretation of the situation. Like Upton Sinclair said, "It is difficult to get a man to understand something, when his ability to not spend the next longwhile feeling crappy due to withdrawal symptoms depends upon his not understanding it." Or something like that.

Which, again, at least in a vacuum, I'm not particularly worried if people want to vape. Me, I like alcoholic beverages. But I fully acknowledge that alcohol is a toxic chemical that's probably shortening my life. What worries me more is when people decide they're OK with vaping based on what amounts to a sort of conspiracy theory, because it's impossible to give informed consent when you're uninformed.

I should have specified, for a fully developed adult. The risks of nicotine consumption alone are very low. Poor diet, poor physical activity, consuming alcohol, riding a skate board, walking on an icy sidewalk all present risks to your health. The role of government isn’t to prohibit anything that may cause you harm, because that’s just about everything. The reason vaping gets so much scrutiny is simply because it looks so much like smoking. Like I said, I think some safety regulation is a good idea. But “does this have any potential at all to cause harm” is not a reasonable threshold for regulating imo, and certainly not to the extent that tobacco is.

Being fat or excessive weightgain whilst pregnant increases the liklihood of your children being obese... Can I please see your sources?

> .. if being a highly addictive drug isn't considered harmful.

https://pediatrics.aappublications.org/content/139/1/e201634...

> Or being a teratogen.

https://www.cambridge.org/core/journals/journal-of-developme...

> Or messing with sleep cycles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188825/

> Or harming brain development.

https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes...

> In utero nicotine increases the likelihood of hypertension and diabetes.

https://www.atsjournals.org/doi/full/10.1164/rccm.201407-119...

The EU started work on that in 2014 with new regulations that "set requirements on purity of ingredients, require that the devices deliver consistent doses of vapor [and] require disclosure of ingredients and nicotine content". Sadly most of the other EU regulations seem to be focused on limiting use and access instead of safety.

Yes, a good investigation would be to analyse what all of these people vaped, and if they all came from a common source.

I'm 90% sure they just gave right up when they figured they'd vaped.

what else do they have in common, that's what I'd like to know, maybe they'd eaten that day, or consumed water.

I don't think that is how the CDC works...

Which is exactly what's happening at this moment.

So in NY everything seems to point to one juice with THC and very high levels of vitamin E acetate.

https://www.health.ny.gov/press/releases/2019/2019-09-05_vap...

yes thats because this article isnt about vaping nicotine/vg/pg, its about vaping thc/mineral oil (or any oil) which causes inflammation/damage to the lungs+death

I'm not sure what you mean by "limited geography." The cases cited in the article cover nearly 3,000 miles from Utah to Illinois to New York.

You can make excuses and dismiss what's happening any way you want, but citing geography undermines your argument.

> I'm not sure what you mean by "limited geography." The cases cited in the article cover nearly 3,000 miles from Utah to Illinois to New York.

This is not an impressive response to

>> Vaping has much more history in Asia and Europe and seems to be without cases like this.

Uh, did you not notice that you've only managed to describe geographic locations limited to within United States borders. Borders constrained by trade agreements, and availability dictated by import/export and interstate trading jurisdictions for regulated psychoactive substances like nicotine and THC?

I'm in the military. Some cadets visited our unit recently and I dropped in to say hi. One of them, a 13yo, asked about using a Juul while on duty. Our tour guide didn't know what a Juul was. Then a dozen kids showed him. Maybe 1/4 of the cadet group were carrying the devices.

This has a HUGE sampling bias of only 13-year-olds that end up in a military recruitment program while still being the age of a child.

Cadets /= "a military recruitment program". Cadets are more like the boy scouts, at least what scouts were a few generations ago. It is more like a summer camp where, if you are the best camper, you get to go on a helicopter ride on the last day of camp.

Does cadets = JROTC?

Maybe in the US. There are other countries on this planet.

After seeing them, what was his or her reply?

The actual number of cases isn't given, only a minimum:

> Dr. Pirzada is one of the many physicians across the country treating patients — now totaling more than 215 — with mysterious and life-threatening vaping-related illnesses this summer.

215 is a much smaller number than I would have guessed based on that headline, and it's also an oddly-specific number to just say, "More than" with. This stinks of sensationalism. Shame on you, New York Times, you're better than this.

Why does it matter? Vaping only has to be a tiny bit healthier than smoking and prevent a small percentage of people from smoking, to save "more than 215" lives. The research into the effects of vaping doesn't seem to be conclusive, so I don't know yet whether vaping is safer, or by how much. But when research does come to some concusions, I want public policy with regard to vaping to be written based on facts viewed in context, not sensationalized fearmongering.

Don't think it's a weird number. i would certainly hope they know _exactly_ how many cases have actually presented - plus there will always be some more that never see a doctor's office.

If they know _exactly_ how many cases have presented, then they could have said _exactly_ how many cases have presented, instead of saying "more than 215".

And this is the number of cases, it's the number of patients. You're not a patient until you see a doctor, so that doesn't include people who don't see a doctor.

There are a lot of numbers that are more than 215, but with such a specific number, it makes me think that the number is something like 217, and they just said "more than 215" to sensationalize it.

And to be clear, 215 cases in a nation the size of the US is not "becoming an epidemic".

I'd like to remind everyone of the trial of Tim Heidecker, which was a case similar to this

https://www.youtube.com/watch?v=WWotb3gci0A

He was fully exonerated though!

common don't spoil the ending like this

Holy fuck haha

I don't know how founders and investors of vaping startup sleep with blood in their hands. Outside this epidemic, there is real epidemic among school students making an entire future generation of adults addicted to nicotine.

1) Vaping is far safer than smoking, and I applaud any efforts, profit-seeking or otherwise, that induce smokers to switch to vaping now. And though some claim that e-cigarettes didn't hasten the decline of cigarette smoking, and are possibly slowing it, if you look at the data you can't make that inference. In fact, if you look at the data it's just as possible that vaping was hastening the long-term decline. The problem is that of those who claim to both vape and smoke cigarettes, nobody is reporting the ratios--are they vaping in addition to smoking the same number of cigarettes, mostly vaping but smoking a few cigarettes each week, etc?

2) The source for the epidemic of vaping comes from the yearly youth drug survey. And if you look at the survey results, youths are experimenting with vaping in the same numbers as marijuana. And just like with marijuana, the activity is mostly only once or twice a week, not daily smokers. Where's the concern about the "epidemic" of pot smoking among youth? There's ample evidence that smoking pot is much more harmful for youth, both for their mental and physical development.

Would you tell people that are on SSRI antidepressants that they are addicted to antidepressant medication?

On a bed made of money :(

Maybe I'm showing my age but it brings back memories of Legionnaires Disease.

> But vaping has its own problems: To become inhalable, nicotine or THC, the high-inducing chemical in marijuana, must be mixed with solvents that dissolve and deliver the drugs.

This is not strictly true; there are vaporizers that take regular dried cannabis buds and deliver THC. No chemicals are involved.

Mass hysteria / moral panic perhaps? Isn't the greater, real threats are people are inhaling massive quantities of nicotine and propylene glycol, and not sufficiently cleaning their atomizers?

This is all weed pens and concentrates right?

Local news said "89% report using products which contained THC" I've not seen it stated online

I vape dry herb, should i be worried?

We already know exactly what's causing this, and it has nothing to do with THC or vape juice (vegetable glycerin).

These people are vaping grey market THC carts. Grey market being the operative word, because the process used to make wax relies on using butane and other heavy solvents to dissolve the plant while keeping the THC intact. These small, backyard producers are dumb as shit and don't know how to properly remove the solvents.

Reply on news.ycombinator.com