For the past several months, every news outlets’ top stories have swarmed with reports of the dangers of vaping. With the millions of new reports cluttering our purview and a myriad of headlines specifically created to grab attention and goviral, one thing is for sure: the general public is confused and too many misinformed. First let us start with…

What is vaping?

Vaping is the act of inhaling a vapor created by an electronic device. You can vape (inhale) tobacco, e-cigarette cartridges which are filled with nicotine, chemicals, and sometimes flavorings. You can also vape (inhale) marijuana flower or cannabis oil. Whether the product is recreational marijuana or medical marijuana (for which you must be registered as a medical marijuana patient) the process of vaping is the same. The product is heated into a vapor, which the person inhales, which is why the act is called “vaping.”

Current & Confirmed News Reports

As of November 19, 2019 at 2:00 PM EST the Center for Disease Control reports

“CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.

The CDC recommends that people should not use THC-containing e-cigarettes, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers. While this investigation is ongoing, vitamin E acetate should not be added to e-cigarettes, or other vaping products.

In addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.”

“As of November 13, 2019, 2,172 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).”

“Forty-two deaths have been confirmed in 24 states and the District of Columbia (as of November 13, 2019).”

“While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI.”

Key takeaways

• Out of the 2,172 cases of EVALI, this study is reporting only 29 patients’ samples
• This report is identifying the findings from bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs), which means you cannot directly connect what vaping products the samples came from. The patient could have been vaping e-cigarettes, THC products such as marijuana flower or cannabis oil, altered e-cigarettes with THC, or a combination of products.
• People should not use any products from informal sources like friends, or family, or in-person or online dealers
• People should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer
• The CDC is not confirming that Vitamin E acetate is the cause of EVALI, only that it was found in samples of 29 patients’ BAL fluid samples. There is not yet sufficient to rule out contribution of other chemicals of concern to EVALI.

Why are People Getting Sick from Vaping?

Because the CDC is not confirming that Vitamin E acetate is the cause of EVALI, we can only identify associations of each case and make educated conclusions to the findings. As a medical doctor board-certified in internal medicine, emergency medicine, and a licensed medical marijuana physician in the state of New Jersey, these are my educated conclusions to the reports:

At this time, there is currently not enough information to confirm that Vitamin E acetate is the cause of EVALI. Because the study included only 29 patients, I urge the CDC to continue studies to identify the cause of EVALI.

When I read the personal interviews of people who vape e-cigarettes or observe individuals in public, I can identify some associations:

• In 2010, a law went into effect which prohibited vaping everywhere that smoking was banned. However, because there is no smell from vaping or because it is more discreet, I observe individuals vaping in banned areas. 
• Most people believe that vaping e-cigarettes is less harmful than smoking cigarettes
• There is less harsh throat burn if you vape to0 much as there is with smoking cigarettes, which in my opinion could lead to excessive vaping practices as compared to the obvious and immediate impact of smoking too much.
• The actual act of smoking a cigarette versus vaping is longer. So for example, if it would normally take you 10 minutes to smoke one cigarette and then you switched to e-cigarettes, you may still vape for 10 minutes, and unknowingly deliver more nicotine and other chemicals into your body than smoking one cigarette
• We only have anecdotal reports of what products patients with EVALI were consuming. There is no concrete evidence of what product is tied to cases of EVALI. While some cases point to illicit, altered e-cigarettes (including THC), some patients reported purchasing products from licensed establishments and some patients vaped nicotine only.
• There is currently no proof that any preapproved e-cigarette suppliers use Vitamin E acetate in their products.
• There is currently no proof that any preapproved recreational marijuana suppliers use Vitamin E acetate in their products.
• There is currently no proof that any preapproved medical marijuana dispensaries use Vitamin E acetate in their products. In fact, pasted below are public statements regarding vaping concentrates from 2 of the largest New Jersey medical marijuana dispensaries on their products

Final thoughts

We have decades of confirmed research that cigarettes cause cancer and other deadly diseases, but we have never seen so many government agencies, headlines and news outlets calling for the banning of cigarettes. This publicity seems quite out of proportion to the actual problem, especially since there is currently no conclusive evidence of what is causing these illnesses. However, it is my firm belief that both the use of cigarettes and e-cigarettes is a health epidemic and all persons should refrain from recreational  use of smoked and vaporized products.

However, for those individuals who have a debilitating medical condition that qualifies them for medical marijuana, cannabis can be an extremely effective, beneficial, and safe method of treatment. Medicinally prescribed cannabis is most certainly less harmful and more efficacious than many substances that are prescribed (or abused) in an attempt to reduce chronic symptoms. Narcotic drugs, pharmaceutical sedatives, anxiolytics, mood stabilizers and antidepressants can all cause significant “side effects”, dangerously react with other medications and can lead to long term hormonal, neurologic, and immune system problems.

Additionally, medical marijuana can be delivered in many forms including edibles, topically, sublingually or by smoking or vaping the actual flower. If you do prefer consuming medical marijuana by vaporizing, I recommend vaporizing the natural flower rather than an extract.  Anytime you extract a component of the marijuana flower you risk the extraction technique altering the natural properties of the plant, or adding some other unwanted substance.  

If you would like to learn more about the benefits of medical marijuana or if you would like to enroll in the New Jersey Medical Marijuana Program, schedule a consultation by calling (732) 268-7663 or request an appointment online. Have you read the Medical Marijuana Blog Series by Dr. Michael Rothman? You can find them here:

• Introduction of Cannabis and its History of Use in Medicine
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in the Treatment of Chronic Pain
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in Disorders of your Immune System – such as Cancer and Autoimmune Diseases
• The Role of Cannabis, Cannabinoids and the Endocannabinoid System in Anxiety Disorders
• Pharmaceutically derived Cannabis Extracts Now FDA Approved – Good News or Bad News for Medical Marijuana Patients?
• Pharmaceutical Agents that Affect the Endocannabinoid System, Better than Natural Cannabis?