Summer epidemic proves legal markets and regulation protect patients

Officials around the country were baffled as the makings of a modern epidemic began to unfold in front of them.

A sudden rise in serious, life-threatening, and sometimes deadly, illness and respiratory injuries suffered throughout the summer. It began as isolated cases, then as more information about the symptoms became available, authorities at both state and national levels began to see a pattern.

Evidence and patient interviews quickly led health officials to come out against vaping and particularly against cannabis. But as is often the case, there was much more to the story than many were led to believe originally. Beneath the “pot,” ”weed,” and “THC” headlines was something much more concerning.
A series of deaths and a rash of serious health issues were traced to inhaling tainted, modified, black-market vapor products, and many mainstream media outlets and some public health officials were quick to use the surge of illness as an opportunity to stand against medical marijuana and adult-use legalization, framing a new paranoia. Using marijuana use as a scapegoat for a more serious problem, one solved by the exact things that so many were rallying against.

Evidence shows that issues and illnesses are not arising from tested and authorized products.

Instead the prohibition of marijuana allows black market products to become successful. With a push for medical legalization consumers know what they are purchasing, ingesting, smoking, or otherwise using to medicate – but in an illicit market testing and regulation don’t play a role.

In Missouri patients and caregivers are able to legally harvest their homegrown plants, but it is important to remember that per Missouri law, “Any person or facility that extracts resins from marijuana using combustible gases or other dangerous materials without a manufacturing facility license, shall incur a penalty. 1. In addition to revocation of identification cards pursuant to 19 CSR 30-95.030(3)(B)1.I., any patients or primary caregivers who extract resins in this manner will incur a penalty,” and “If a qualifying patient or primary caregiver uses combustible gases or other dangerous materials to extract resins from marijuana, the qualifying patient’s or primary caregiver’s identification card may be revoked for up to one (1) year.”

Anyone choosing to use vape products should never use unregulated or modified products. There are no THC cannabis-containing products legally available for sale in Missouri at this time. Any cartridges, vapor, etc. found in this state are unregulated and have not been legally manufactured, purchased, and, most importantly, tested. These unregulated, untested products may contain harmful substances that can lead to illness and even death.

Marijuana that is grown and distributed for dispensaries is tracked by seed to sale software, which tracks information including who grew it, what seed it was grown from, what nutrients were used when it was harvested and what pesticides were used. It is then tracked to manufacturers and is required to be tested before and after concentration prior to sale.

“None of that is true about the weed you buy illegally,” Jeannette Horton, vice president of global marketing for the cannabis supply chain technology company Akerna said in a statement. “Something unique is happening here. People need to be very careful.”

Health officials with New York state announced the focus of their investigation of vaping-related illnesses being vitamin E acetate after finding very high levels of the substance in marijuana-containing samples being examined. Vitamin E acetate’s molecular structure is similar to jelly or grease – meaning, for it to vaporize, it must be heated beyond its boiling point of 363 degrees Fahrenheit. Comparatively, the boiling point for water is 212 degrees F. Once the oil is hot enough to vaporize, it can potentially decompose. But even without the risk of decomposition or a chemical change, once the vapor cools down in the lungs, it returns to its original state at that temperature and pressure, coating the lungs from the inside. Additional investigations by health officials around the country, the FDA, and CDC also targeted the additives and chemicals being mixed into cartridges and inhalants, finding everything from heavy metals to myclobutanil, a fungicide that chemically changes to hydrogen cyanide when burned and heated beyond 205°C (400°F). Many vaporizers and almost all butane lighters and ignition systems heat above 450°F.

As part of a comprehensive study, NBC commissioned laboratory tests with the nation’s top cannabis testing facilities, including CannaSafe, to test a sampling of THC cartridges — 18 in all — obtained from legal dispensaries and unlicensed dealers.

Of the three purchased from legal dispensaries in California — Orchid, Tikun, and Select — CannaSafe found no heavy metals, pesticides, or residual solvents like Vitamin E.

In contrast, 13-of-the-15 illicit market THC cartridges were found to contain Vitamin E, and each of the unregulated cartridges tested positive for pesticides and contained Myclobutanil.

“Recently we started vetting and comparing licensed products we commonly test with those found in the illicit markets. The results were shocking, to the extent that every single illegal product tested would fail CA requirements for licensed product testing. On top of that, nearly all of these illicit market vapes contained significant amounts of Vitamin E Acetate and Myclobutanil, which are now being attributed as the main culprits in causing consumers to become very ill, resulting in 12 deaths,” said Aaron Riley, President of CannaSafe. “Today, many state officials are considering an outright ban on vaporizers. However, a ban would further perpetuate the problems that we are dealing with. The reality is these off-market products are not safe and are too readily available. Banning vapes would leave those illicit products as the only ones available.”

In the New York investigation, at least one vitamin E acetate vape product was linked to each patient who submitted a product for testing.

When it is “inhaled deep in the lung, [it] can cause problems,” Zucker told NPR in a statement. Zucker says the lab found very high amounts of vitamin E in 13 of the patient-submitted cartridges they’ve analyzed. “As high as even 50 percent of the liquid that is in the vaping [cartridge].”

Each of those tested cartridges were black market products, not tested and approved products available in medical dispensaries. “This is a situation of people buying products that have been laced with markedly elevated amounts of vitamin E.”

“We urge the public to be vigilant about any vaping products that they or any family members may be using and to immediately contact their healthcare provider if they develop any unusual symptoms,” he said in the health department statement. “In general, vaping of unknown substances is dangerous, and we continue to explore all options to combat this public health issue.”

Nationwide, health officials and doctors are advising people who are not legal patients to refrain from using any vape products.

In addition to THC products, neither E-cigarettes nor nicotine vape products are FDA-approved.
But despite the extreme headlines, and the blatant attempts by some to use misleading conjecture to besmirch medical marijuana and legal use, facts tell a different story. Legal markets and regulations create safer products and reduce patient exposure risks.

Anyone experiencing symptoms who uses vape products should contact their healthcare provider immediately. Healthcare providers should report possible cases to the local poison control center (1-800-222-1222). Patients using vape products reported a variety of symptoms, developing over a period of days to weeks, including:

• Pulmonary symptoms (cough, shortness of breath, chest pain)
• Gastrointestinal symptoms (nausea, vomiting, diarrhea)
• Fatigue
• Fever
• Headache
• Weight loss

//BRANDON DUNN
PHOTO//Mike Wren, New York State Department of Health