Vaping-related lung injuries primarily linked to black-market products | Hacker News Reader

Vaping-related lung injuries primarily linked to black-market products

cei.org

161 pointslysp81 comments

I hope this spurs the government into action. NYC is absolutely flooded with perfectly legitimate looking vape cartridges filled with questionable product. They're often sold as being from a "dispensary brand" although they're obviously not. As an example, these were readily available for years despite the fact that the brand never even existed in the first place:

https://merryjane.com/culture/are-smart-cart-vapes-legit-and...

Was surprised when I visited NYC to see California stamps on products my friend had. I assumed another friend had brought them from California, but it totally makes sense that it's black marketeers trying to look legit.

How would the government identify what is legitimate?

They do alright with alcohol and tobacco, and even general goods! Black and grey markets make it very hard to get trustworthy information. Imagine if any product in a grocery store could poison you! The threat of recourse through the legal (and criminal) system does not provide protective pressure to black markets.

Regulate the same way the FDA regulates all other products.

As someone outside the US who has to work with the FDA, Americans should be very proud of how thorough FDA inspectors are at auditing and how good they are at identifying non-conformances and just plain criminal lack of due diligence.

There is a database of 'offenders' that are no longer allowed to sell their products it's seriously scary what some companies/people are willing to do for a quick buck.

You could argue that in the US there is a considerable amount of lobbying and influence that defeats the impartiality of some federal bodies but overall they do an amazing job at keep everyone safe.

Why should the FDA use up government resources to regulate vaping?

Put another way, why do we think the solution for people with no integrity or no clue or both trying to make money out of vaping (Juul included) is to spend taxpayers money helping them behave themselves?

I find this attitude pretty crazy to be frank. Consider that whatever happens from here, however much joy everybody gets from vaping and blowing smoke in the future, it isn’t ever going to be worth 50 dead people.

There is that, and then Juul pretending to be a benefit to society while getting children addicted to nicotine and then selling themselves to big tobacco... what exactly is the benefit of vaping? The argument it minimises the harm from smoking is nonsense and unproven. There are well established methods of reducing smoking on a societal level (put up the taxes), which return money to the government to pay for all the negative externalities of smoking which big tobacco isn’t held accountable for.

Anyway, the USA has a funny attitude about these things. Personal choice and optionality are considered paramount. Someone else can pick up the pieces. Applying it everywhere is obviously flawed if you ask me.

With the risk of creating a slippery slope, you could make the same argument for spending federal budget regulating breast implants, they are only fractionally used for breast reconstruction, so for the majority of cases they are elective and used by someone who has made that choice.

The substance is legal and consumed by your citizens. Either make it illegal or regulate it, I am not sure there is much point in making moral judgements.

*Breast not brest

It's very hard to addict anyone to nicotine. Basically, doesn't really happen all that much.

Cigarettes on the other hand are highly addictive. There's lots more in their smoke than just nicotine.

See https://www.gwern.net/Nicotine for more than you ever wanted to know.

I respectfully disagree. I was easily able to switch from cigarettes to vaping, but every time I stop vaping I get withdrawal.

How does the withdrawal look like?

I was quoting the research quoted by Gwern here.

Sweats, nervousness, anxiety.

No matter how much joy people get from driving, it is not worth 37,000 deaths per year. There are proven ways to reduce road fatalities (busses). The government should not be in the business of wasting taxpayer money regulating private pleasure cars.

You could apply this to virtually any product category. Liquor, beer, tobacco, soda, meat, toothpaste, soap, on and on and on.

Well you don’t need soda it’s a vice so we aren’t going to regulate it and make sure products are safe.

Who defines the start and end for what should be regulated? You? Legal products in the US should be safe to purchase. If marijuana is legalized it should be safe to purchase also.

I don’t see your point. I argue vaping should be banned. All those other things you list are already in widespread use, it’s irrelevant.

You actually didn’t argue that.

Alcohol and tobacco are in use but surely we could save money by making them illegal. Why waste money and continue to regulate?

Again, who is deciding? Is it you? It should be illegal because... reasons? Reasons that don’t apply to other vices because... reasons?

> All those other things you list are already in widespread use, it’s irrelevant.

I'm guessing you don't live in a major city or college town? I can't walk two blocks without seeing someone with a Juul.

Why do you hate individual freedom?

> Why should the FDA use up government resources to regulate vaping?

Precisely because people are putting adulterants in black market cartridges.

> however much joy everybody gets from vaping and blowing smoke in the future, it isn’t ever going to be worth 50 dead people.

However much joy everybody gets from swimming in a pool, it isn't ever going to be worth 3,536 dead people.

If you're advocating for banning vaping, you're advocating for the creation of a black market. Prohibition didn't work for alcohol, it's not working for drugs, and it won't work for vaping.

That’s correct, we should ban the ability to profit from selling harmful products. The swimming pool analogy is completely off base.

You are supposing that prohibition won’t work. But it is the easiest and cheapest approach. All the problems with prohibition apply equally to regulation, but with much greater complexity and cost. Eg there will still be a black market for cheap unregulated vape juice, just like there is for cigarettes. So just put a moratorium on sale for 5 years, and if the pros outweigh the cons, ban it permanently. If not then come up with some other solution, regulation, whatever.

> there will still be a black market for cheap unregulated vape juice, just like there is for cigarettes

Is there a sizable black mark for unregulated cigarettes? My guess would be that the black market for vapes has already surpassed it multiple times.

>That’s correct, we should ban the ability to profit from selling harmful products.

Can't tell of this is actually serious or not. There are so many products that can cause harm you might as well just make a whitelist of allowed products at that point.

>You are supposing that prohibition won’t work. But it is the easiest and cheapest approach.

Yet it's never worked and always just created dangerous unregulated black markets that causes more deaths and health issues than regulation and as far as cheapest, I think you're forgetting the cost of enforcement of prohibition.

Licensed dispensaries in California undergo testing and inspections and have to get their products from licensed cultivators who also undergo testing and inspections. It's a regulated industry.

However, you could be driving down a major street in LA and see a highly advertised dispensary with neon lights and a guy dancing with a sign in the road, and it still could be an unlicensed dispensary.

Enforcement is practically nonexistent, but when they do crack down they like to make it a big show with a dozen cops with long arms and body armor pushing the kid at the counter working minimum wage to the ground, handcuffing everybody. Then they just fine the owner and close the store and the cuffs come off and everyone goes home. It's surreal.

The big problem seems to be that vaping has never been proven to be safe or safer than cigarettes. There's always been the assumption that it is.

My suspicion is that something like this outbreak will happen again.

I'm not a fan of the vaping companies since their goal seems to be to get users addicted to their product but they should go through the process of proving that vaping is safer than cigarettes so they don't get blamed for the next outbreak. And cigarette users have a choice that's less harmful than smoking cigarettes.

Cigarettes kill almost 500,000 people a year in the US alone.

We could have 10 of these "outbreaks" a day and still be way ahead.

>Cigarettes kill almost 500,000 people a year in the US alone.

I really feel like such statistics, for other topics as well, are unnecessarily sensationalist. Yes, people are dying from smoking related diseases, but they're not dropping dead from smoking. They smoke (and derive pleasure from doing so) for decades and increase their chances of lung disease. The truth doesn't sound quite as urgent, IMO.

But I do agree with your general sentiment.

Smokers live, on average, 10 years less than non-smokers. That sounds pretty fucking urgent.

That 500,000 number includes those who have been smoking for many many years from a wide age range. Also the total number of smokers is also a large number (across years). So it is really not a fair comparison

That assumes there’s no long term cancer risk from vaping, which we simply don’t know yet.

Is there any plausible theoretical basis for a cancer risk from vaping?

Nicotine is a carcinogen

Anything I've read on the matter suggests this is not the current understanding, although I've read various theories that it may contribute to the development of cancer.

Do you have any convincing articles you could share?

Nicotine is not a carcinogen.

https://thorax.bmj.com/content/66/4/353

https://stacks.cdc.gov/view/cdc/21569/Share

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

It seems like people shouldn’t be equal when in one case it means 50 or 60 year olds dying from a four pack a day habit that they refused to quit after a lifetime of warning and in the other case it’s a teen or young twenty year old that vaped the wrong thing once not really knowing what they were getting into

I assume many of the effects are long-term and would be hard to quantify in a short-term clinical trial. In that case, what could be done to prove vaping is safer than cigarettes within a reasonable time to market?

Burning carbon chains and directly afterwards ingesting it into the lungs has been proven to be quite bad, it does cell and tissue damage and hinders a healthy cell respiration. Is there any reason we should expect worse effects from vaping which, as I understand it, if done correctly doesn't produce harmful carbons?

There is reason to consider this a possibility, since many molecules may be potentially harmful when inhaled as vapor, with unknown health effects (ie vitamin E acetate), but under combustion would deteriorate mostly or entirely into the carbon forms that have well understood effect on health -- as a previous commenter mentioned, 10yr lifespan reduction from long term continuous cigarette use.

There is just not longitudinal data available for vaporizing plants or synthetic nicotine/thc concentrates. It could be an even higher lifespan reduction than smoking!

> with unknown health effects (ie vitamin E acetate)

The effects of Vitamin E Acetate is actually well known and thoroughly documented. It's just that these black-market producers don't care.

That assumption is there because in the US, things are generally assumed to be safe until proven it isn't. I don't see people asking if the cups they buy are safe to drink from (e.g. many BPA free cups are worse than BPA cups but no one seems to care), or the food they eat. They don't ask for proof their humidifier is safe.

The reason why people are concerned is because vaping is a smoking replacement and people hate smoking in all its forms, safe or not. It's a political thing.

Care to share some info about those dangerous non-BPA cups/plastics?

I don't have any links handy, but there's been a slow stream of articles over the past decade or so talking about how what some companies used to replace BPA have similar or worse chemical characteristics than BPA. There's been studies showing BPA replacements are still bad, including one within the past month, but I don't know the veracity of them.

My general view is that glass has been used for thousands of years and is well understood when compared to plastics. So when I had my kids I bought glass everything. After using glass bottles with 3 kids, only 1 of them ever broke one.

Suggesting that smokers should not vape because its dangers have not been fully established is like suggesting taking the stairs might be dangerous, so you should rather jump out of the window, as we know the dangers of that precisely.

Of course for non-smokers, it's a totally different equation.

This seemed pretty obvious when all the stories were about cannabis vaping, not nicotine.

And now vaping is thought to be unhealthier than tobacco smoking.

Except Montana, and afaik other places, banned forms of nicotine vaping in response to this. Also the general public seems to think it's related to nicotine, not thc.

San Francisco, too?

Beverly hills banned all tobacco save for cigars in certain clubs.

Considering how the majority of the news releases and articles were written, it is not surprising that fear of vaping itself is the idea that remains in people's minds.

It reminds me of "the great hack". Disinformation is so disturbing.

I don't think this is a deliberate disinformation problem, it's simply that good information and proper investigations take time. In the meantime, people speculating (primarily on social media) dominates and those opinions become indistinguishable from good information to most people, if they ever even see the definitive results at all.

This dynamic has affected almost every thing I pay attention to on the internet. It's depressing.

If you wanna go another layer on “the great hack” the fun bit is Brittney Kaiser is full of crap. She ran election interference for the last Mexican presidential election.

That just finally leaked this week in The Guardian If she was actually remorseful for her roll in Cambridge Analytica, she would’ve admitted that from the start, instead of doing this whole reputation PR/ The Great Hack thing to make herself still hireable.

Yes, I think we should have another category for "whistleblowers" who only appear after somebody else has already blown the whistle

The stories were never about cannabis vaping either. They were about adulterated cannabis extract vaping.

Someone using a cannabis flower vaporizer (e.g. PAX 2/3, Firefly, Arizer, Volcano) with pure lab tested flower was never at risk for the lung disease that vitamin E acetate has caused.

The linked article doesn't mention vitamin E acetate, so here's one that discusses it:

https://www.theverge.com/2019/12/20/21031771/vaping-lung-inj...

> pure lab tested flower

There has been some trouble with that too. Washington state doesn't require lab testing for pesticides, and in other states there have been cases of fraudulent testing (https://www.nbcbayarea.com/news/local/industry-insiders-warn... https://www.leafly.com/news/industry/sequoia-analytics-surre... )

The industry is still maturing and I'm confident things will get better with time. But for the time being, consumers should exercise reasonable caution.

There have been a few issues due to mold and yeast contamination too. Still, better than the black market days because you can check the serial number against the contaminated batches.

That is true, and I didn't mean to imply that anything is risk free. Only that this particular risk is specifically caused by vitamin E acetate.

It’s irritating that Apple pulled the Pax app from the App Store because it was related to “vaping”.

What does a vap app even do? Mine works just fine without an app.

There exist multi-cart vapes where you can load up 4 different carts (one THC, one CBD, one Terps, one Flavoring agent, as an example) and control the dispensed amount of each via phone app.

The Pax app let's you set dosage controls so that you can always get a consistent hit each time. The new Era Pro even remembers the dosage based on which pod you're using, which is super useful for me since I have a sativa pod set to one dose and an indica pod set to two. The app also supports fine-grained temperature control in addition to surfacing information related to the pod like lab testing results.

Given the highly localised and sudden/synchronised bout of illness associated with vaping, to me it immediately seemed reasonable to assume contamination of a specific batch of products rather than the act of vaping in general being an issue.

I'm not saying vaping doesn't perhaps have long term negative effects, just that the pattern of illness suggested an issue with specific products.

it wasn't a contaminated batch. we know what caused it. it was a particular formulation of vape juice used by multiple suppliers.

That's what I meant. Specific products were using a harmful substance, rather than the act of vaping causing illness.

ok sure. contaminated often implies some kind of accidental addition of harmful substances which isn't the case here which is what I was clarifying.

This seems to be a rather simplistic/one-sided answer furthering a specific agenda.

* The responses that don't fit the narrative that 'legal' vaping is safe are'explained away' in this article - that's just unscientific and a matter of ignoring contrary evidence. * There are other dangers to vaping ignored in the argument (eg addiction, kids starting even earlier if there's 'bubblegum' or 'cherry' flavour rather than tobacco * No long term studies, so we really have no idea what's safe and what's not. * Overall there's no control or standards on the stuff in the vaping juice, so we still don't really know what effect which product might have. * The bans were not motivated just by the sick people but also the various other factors - so even if true that 'legal'vaping products weren't the cause there are many questions still to be answered. * ...

The world is never so black and white as this article paints it.

A) Is vaping better than cigarettes? Maybe. Is it better people switch to vaping? Maybe. Is it better we encourage/aid them to stop smoking and vaping? Absolutely.

B) Will flavoured vaping with sweet flavours, wild west unlicensed/non-regulatef ingredients and unchecked advertising get more young people and even children interested and hooked? Absolutely.

B is solved by a legal market and framework that we already have for tobacco. The problem is treating vaping as worse than cigs, which have an absolutely stunning amount of evidence against them, in particular with tar and a laundry list of additives you won't see anywhere else. You're telling people to stay out of the shed when their house is already on fire!

Harm minimization is the key to A. Is the system better or worse with regulated (sue-able!) market? Studies seem to show that we generally over-restrict relatively safe substances.

> Is vaping better than cigarettes? Maybe

There is simply no plausible way it's not.

> Will flavoured vaping (...) get more young people and even children interested and hooked? Absolutely.

What is known about cigarette and nicotine addiction makes it actually quite unlikely. Nicotine alone does not seem that addictive, in any case it's definitely much less addictive than nicotine plus the combustion products found in tobacco. Cf https://www.ncbi.nlm.nih.gov/pubmed/16177026

The "fun" flavors are also a key part of helping people quit cigarettes. They aren't designed to appeal to children, "fun" flavors are by far and away the most popular among adults. Somebody trying to quit tobacco products doesn't want to be reminded of tobacco flavor every time they use their vape.

It would be great if we had the time to collect all the answers around vaping, but we don't. People are dying of tobacco related health issues right now, and vaping looks to be a healthier alternative that can be extremely effective at helping addicts reduce tobacco consumption. I think you underestimate the health impacts of smoking, nearly 20% of deaths in the USA are caused by smoking according to the US government: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

This article is a reaction to the heavy handed reaction of the US government. Rather than implementing sensible regulation like manufacturing standards, age restrictions, nicotine content limits, state & federal governments are reacting by banning flavors, or banning vaping companies from manufacturing their products as helping quit tobacco.

Indeed. Flavoured alcohol should be banned too, as cherry liquor exists only to get the kids hooked, right? All alcohol should taste like misery and fire and should be sold in plain brown packaging featuring grisly photos of people who died in alcohol related accidents. I mean, prohibition worked perfectly last time, and definitely didn’t kill more people than the alleged problem it was trying to solve, right?

Very early on scientists identified vitamin E additives as being the cause. Most black market vapes added vitamin E acetate ,etc.. to enhance the flavor profile of the "carts". Overall this isn't super surprising.

I'm not sure if it was so much the flavor profile as it was being used to thin out the product using an inexpensive thinning agent. THC concentrate is very viscous, and needs to be cut with something to be viable for cartridge use.

Iirc terpenes are used in higher quality products.

From what I've read, the primary goal was to cut it without thinning it very much, in order to pass the "bubble test". Consumers would test viscosity by observing how quickly the airbubble in the cartridge moved. Vitamin E acetate is thick enough to deceive people into thinking the cartridge wasn't cut.

What's the state of all the laws brought in against vapes under the pretence that nicotine vaping is causing the outbreak in lung illnesses.

Last I checked they banned all cartridges with flavor at the federal level, but made an exception for the liquid you put into your homebuilt equipment.

I am not sure what this accomplishes. Perhaps making it difficult enough that teenagers don't vape?

Here is the source of the regulations: https://www.fda.gov/regulatory-information/search-fda-guidan...

(I used to vape, so I'm familiar with the landscape, but am no longer personally invested.)

I think there are two related problems -

one is contamination of black market carts

the other is the rise of teenage nicotine intake

My understanding is many of the federal laws are meant to address the latter, while the local laws like the MA vape ban meant to address the former are now being rolled back.

This article is an obvious propaganda piece. The CDC findings linked within, while boring to read, at least provide a more neutral view.

I feel like propaganda is more subtle or persuasive. I’d personally have used a less charged word like “biased.”

> This article is an obvious propaganda piece.

They're clearly an advocate for vaping, however title [1] and summary are accurate. Per the CDC study:

"Among EVALI patients reporting use of any THC-containing products, 122 of 130 (94%) of those aged 13–17 years acquired products through only informal sources"

"A recent case-control study found vitamin E acetate in the bronchoalveolar lavage fluid of 94% of 51 EVALI patients and in none of 99 healthy controls in the comparator group (4)."

"In addition, an analysis of THC-containing products seized by law enforcement in Minnesota found no vitamin E acetate in 10 products seized in 2018, and 100% of 20 products seized in 2019 contained vitamin E acetate (5)"

[1] CDC Confirms Black Markets, Not “Vaping,” Caused Outbreak

The Freakonomics podcast covered this: http://freakonomics.com/podcast/vaping-nicotine/

If the headline says that the CDC confirms something, shouldn't a CDC press release or paper be used? Article seems to be from some third party citing this paper[0] and claiming they predicted it before. Title seems a little misleading.

[0] https://www.cdc.gov/mmwr/volumes/69/wr/mm6902e2.htm?s_cid=mm...

And again, just as was the case with Boeing, the blame lands squarely on the shoulders of regulators who failed to adequately do their jobs.

In the case of Boeing, the regulatory approach was a joke, and in the case of vaping, regulators had their heads in the sand about a multi billion dollar black market for years.

The death toll resulting from backward recreational drug regulation in the US is mind boggling, not to mention all those still suffering in prison.

People have a knee-jerk reaction of blaming firms and assuming that regulators are doing their best, when in fact regulators are the ones who create the entire (black, gray, etc.) market landscape for all participants to operate in.

How do you regulate an illegal black market?

Just as many regulatory approaches don't work, outright bans is one that clearly doesn't work. They are rooted in a backward, dualistic view of the world.

In the case of banning recreational drugs, the history of those laws is among the ugliest bits of American history.

The practice of allowing firms to self-regulate crucial aircraft safety practices is also very foolhardy.

When will we start holding the right parties responsible for all these tragedies? We the people need to insist that regulators step up and make us safer, not cater to whatever interest group has achieved regulatory capture.

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