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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

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.

shkkmo 7y ago
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.
- cannaceo 7y ago
  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-liquifier/ 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.
  - shkkmo 7y ago
    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.
    - cannaceo 7y ago
      My apologies, I didn't mean to come off as abrasive. Yes, I see your point about the presentation of facts.
      - shkkmo 7y ago
        I didn't find you abrasive and I appreciate you sharing your information and insights with us.
  - kortex 7y ago
    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 https://en.wikipedia.org/wiki/Chemical_pneumonitis [2] pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040 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 https://casereports.bmj.com/content/2018/bcr-2018-224350 [4] https://www.frontiersin.org/articles/10.3389/fimmu.2014.00483/full 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. "
pbreit 7y ago
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.
- zdragnar 7y ago
  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.
- PeterisP 7y ago
  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.
- RenRav 7y ago
  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.
wcchandler 7y ago
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.
- krustyburger 7y ago
  So you’re a hemp protégé?
  - wcchandler 7y ago
    I guess you could say that. I’m in my first year as a farmer growing hemp. It’s pretty fun and interesting stuff!
    - wyclif 7y ago
      You should write something up and submit it here. I'd read it for sure.
- kortex 7y ago
  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-will-take-responsibility-for-this-pesticide-ridden-vape-cartridge https://www.thestranger.com/slog/2018/12/20/37272899/no-one-...
  - wcchandler 7y ago
    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.
numismatex 7y ago
That said, those prepackaged preflavored vape carts are all over Amazon, eBay and AliBaba and seem to be doing well. Sadly.

shkkmo 7y ago

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.

cannaceo 7y ago
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-liquifier/ 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.
- shkkmo 7y ago
  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.
  - cannaceo 7y ago
    My apologies, I didn't mean to come off as abrasive. Yes, I see your point about the presentation of facts.
    - shkkmo 7y ago
      I didn't find you abrasive and I appreciate you sharing your information and insights with us.
- kortex 7y ago
  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 https://en.wikipedia.org/wiki/Chemical_pneumonitis [2] pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040 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 https://casereports.bmj.com/content/2018/bcr-2018-224350 [4] https://www.frontiersin.org/articles/10.3389/fimmu.2014.00483/full 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. "

pbreit 7y ago

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.

zdragnar 7y ago
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.
PeterisP 7y ago
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.
RenRav 7y ago
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.

wcchandler 7y ago

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.

krustyburger 7y ago
So you’re a hemp protégé?
- wcchandler 7y ago
  I guess you could say that. I’m in my first year as a farmer growing hemp. It’s pretty fun and interesting stuff!
  - wyclif 7y ago
    You should write something up and submit it here. I'd read it for sure.
kortex 7y ago
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-will-take-responsibility-for-this-pesticide-ridden-vape-cartridge https://www.thestranger.com/slog/2018/12/20/37272899/no-one-...
- wcchandler 7y ago
  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.

numismatex 7y ago

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