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The thing causing this outbreak seems to have been someone using a vitamin e oil to increase the potency of their thx carts up to 95% or so. [0] I also believe

The thing causing this outbreak seems to have been someone using a vitamin e oil to increase the potency of their thx carts up to 95% or so. [0] I also believe they were out of Chicago. Or at least they shipped a lot of carts to Chicago/Illinois and then they spread out from there. But this is just from the cases I've read. Also from today Doctors have identified previously unrecognized characteristic of the vaping-related respiratory illness that has been emerging in clusters across the U.S. in recent months. Within the lungs of these patients are large immune cells containing numerous oily droplets, called lipid-laden macrophages. [1] [0] https://www.theverge.com/2019/9/5/20851866/cdc-fda-investigation-vaping-lung-illness-vitamin-e https://www.theverge.com/2019/9/5/20851866/cdc-fda-investiga... [1] https://www.reddit.com/r/science/comments/d17qm9/doctors_have_identified_previously_unrecognized/ https://www.reddit.com/r/science/comments/d17qm9/doctors_hav...

wp381640 7y ago
It might also explain why the cases seem confined to the USA and we're not seeing it amongst other large vaping populations like Canada and the UK There are too many fly-by-night and backyard operators in both the device and liquid industries - it is very reminiscent of the prohibition era where people died from bad batches of alcohol I'd really prefer to see a well-regulated industry as vaping is one of the best harm reducation methods for the billion or so smokers in the world
- moksly 7y ago
  Are you sure vaping is actually reducing potential harm? Because our national health agency isn’t[1]. As I understand it, a few brands come with a lower risk of certain tobacco induced cancers compared to smoking. Which is harm reduction, I guess, but research is suggesting that all vaping comes with greater risk to the respiratory system and heart. Of course the real issue in evaluating the safety of e-cigerates is that we need 30-50 years of people dying from them before we really know how they compare to regular smoking. [1] https://www.sst.dk/da/sundhed-og-livsstil/tobak/andre-tobaksvarer/e-cigaretter https://www.sst.dk/da/sundhed-og-livsstil/tobak/andre-tobaks...
  - slau 7y ago
    I’ve stated this before: cigarettes will kill me with a 100% probability (I was smoking over a pack a day). Maybe vaping will not kill me. Maybe I’ll grow a third arm in 20 years. I don’t know. But I have to play the odds; “100% certainty” vs “maybe not”, I know which one I’m going for. Also, I’ve gone from 9mg of nicotine to 1mg in 2 years, because vaping allows me to monitor and measure exactly how much nicotine I put in and consume. With cigarettes, I only grew more addicted, never less.
    - moksly 7y ago
      I appreciate your optimism about the unknown, but there is the frightening possibility that maybe e-cigerattes will kill you more efficiently than your regular smokes. If you’re using it as a way to stop completely, then that’s awesome, but all Danish research on the subject has led to vaping being on our “not-recommended” list for ways of helping people quit.
      - slau 7y ago
        Except for the fact that other ways don’t work. It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help. But that only adresses one part of the issue: the nicotine addiction. Smoking is a lot more complex than just the nicotine addiction. I know a lot of smokers who managed to take a break from cigarettes for a few months, but I’ve never met a vaper who went back to cigarettes. I’m slowly rewiring my brain to not need cigarettes or vaping. I smoked for 15 years, and started during my formative years, so I know this will be a long process. Just telling me to chew gum or apply patches is a cop out for the government to clear its conscience about not really helping its population kick the smoking habit. There’s a reason the tobacco industry doesn’t care about patches and gum: it doesn’t work for the majority of smokers.
        apexalpha 7y ago
        >It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help. Why not? Just go from 2 packs a day to 1.9, to 1.8 etc..
- cb504 7y ago
  Or just better identification/reporting: > The number of reported cases has skyrocketed, though this is likely a consequence of better information coming from state health authorities and hospitals, rather than a sudden epidemic.
  - MiroF 7y ago
    To the contrary, all indication points to this being an isolated issue introduced during the supply chain - not something that had been going on for a while and only just got attention.
synaesthesisx 7y ago
Wouldn’t diluting with vitamin E reduce potency?
- zrobotics 7y ago
  Which, ironically, would mean that someone vaping THC would need to vape even more to achieve the same effects; consuming more of the liquid containing the dilutants.
perseidbath 7y ago
From a thread on Reddit[0], written by a cannibis biologist: “The reason [vitamin e is] being found in black market carts is because black market manufacturers are incentivized to dilute out their product as much as possible to maximize profit. They don't have to provide you with potency numbers, they just need the cartridge to look plausibly full of distillate. This means they use any of the aforementioned dilution methods, or even other less safe methods and wind up with a thing and runny product that is obviously not high purity distillate. So what do they do? They thicken it back up to be more believable. This is where Vitamin E acetate comes in. It can reliably dissolve a large range of organic compounds but is also similarly viscous to Maple syrup. This means it can be used to dilute distillate or thicken up heavily cut distillate, but leave it looking comparable to an actual high quality distillate. Thus they can turn a 1g cart into 5 1g carts, for the low low price of the health of the end user.” [0] https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clearing_up_the_ongoing_vape_scare/ https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clea...
- kcmastrpc 7y ago
  Which is further compounded by the fact that heavy vape users often have tolerances which require large doses. If the liquid is diluted, they'll potentially vape 5x the product to achieve the same perceived effects. This is precisely why this industry needs to be regulated by the FDA .. or BATF? While I personally don't consume cannabis (it messes with my constitution way too much) there is no reason why it should still be illegal.
- milofeynman 7y ago
  That person is incorrect. I know a toxicologist who actually had one of the carts tested due to a patient with these symptoms and the high potency was accurate. Not something I can source but the data is out there in the toxicology circles.
  - MiroF 7y ago
    I've also heard talk that Vitamin E does something to increase the potency?
protonimitate 7y ago
I don't know if the vitamin e thing has been totally confirmed yet. This is from the New England Journal of Medicine published 3 days ago (Sep 6, 2019) >Until the investigation into the cause of this epidemic of vaping-induced respiratory injury is complete, no conclusions can be drawn as to which compound or compounds are the causes of injury. [0] Until they confirm or deny which compound(s) or mixtures are leading to these effects, don't assume any carts are safe to use (even if they're not "black market"). https://www.nejm.org/doi/full/10.1056/NEJMe1912032 https://www.nejm.org/doi/full/10.1056/NEJMe1912032

wp381640 7y ago

It might also explain why the cases seem confined to the USA and we're not seeing it amongst other large vaping populations like Canada and the UK There are too many fly-by-night and backyard operators in both the device and liquid industries - it is very reminiscent of the prohibition era where people died from bad batches of alcohol I'd really prefer to see a well-regulated industry as vaping is one of the best harm reducation methods for the billion or so smokers in the world

moksly 7y ago
Are you sure vaping is actually reducing potential harm? Because our national health agency isn’t[1]. As I understand it, a few brands come with a lower risk of certain tobacco induced cancers compared to smoking. Which is harm reduction, I guess, but research is suggesting that all vaping comes with greater risk to the respiratory system and heart. Of course the real issue in evaluating the safety of e-cigerates is that we need 30-50 years of people dying from them before we really know how they compare to regular smoking. [1] https://www.sst.dk/da/sundhed-og-livsstil/tobak/andre-tobaksvarer/e-cigaretter https://www.sst.dk/da/sundhed-og-livsstil/tobak/andre-tobaks...
- slau 7y ago
  I’ve stated this before: cigarettes will kill me with a 100% probability (I was smoking over a pack a day). Maybe vaping will not kill me. Maybe I’ll grow a third arm in 20 years. I don’t know. But I have to play the odds; “100% certainty” vs “maybe not”, I know which one I’m going for. Also, I’ve gone from 9mg of nicotine to 1mg in 2 years, because vaping allows me to monitor and measure exactly how much nicotine I put in and consume. With cigarettes, I only grew more addicted, never less.
  - moksly 7y ago
    I appreciate your optimism about the unknown, but there is the frightening possibility that maybe e-cigerattes will kill you more efficiently than your regular smokes. If you’re using it as a way to stop completely, then that’s awesome, but all Danish research on the subject has led to vaping being on our “not-recommended” list for ways of helping people quit.
    - slau 7y ago
      Except for the fact that other ways don’t work. It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help. But that only adresses one part of the issue: the nicotine addiction. Smoking is a lot more complex than just the nicotine addiction. I know a lot of smokers who managed to take a break from cigarettes for a few months, but I’ve never met a vaper who went back to cigarettes. I’m slowly rewiring my brain to not need cigarettes or vaping. I smoked for 15 years, and started during my formative years, so I know this will be a long process. Just telling me to chew gum or apply patches is a cop out for the government to clear its conscience about not really helping its population kick the smoking habit. There’s a reason the tobacco industry doesn’t care about patches and gum: it doesn’t work for the majority of smokers.
      - apexalpha 7y ago
        >It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help. Why not? Just go from 2 packs a day to 1.9, to 1.8 etc..
cb504 7y ago
Or just better identification/reporting: > The number of reported cases has skyrocketed, though this is likely a consequence of better information coming from state health authorities and hospitals, rather than a sudden epidemic.
- MiroF 7y ago
  To the contrary, all indication points to this being an isolated issue introduced during the supply chain - not something that had been going on for a while and only just got attention.

synaesthesisx 7y ago

Wouldn’t diluting with vitamin E reduce potency?

zrobotics 7y ago
Which, ironically, would mean that someone vaping THC would need to vape even more to achieve the same effects; consuming more of the liquid containing the dilutants.

perseidbath 7y ago

From a thread on Reddit[0], written by a cannibis biologist: “The reason [vitamin e is] being found in black market carts is because black market manufacturers are incentivized to dilute out their product as much as possible to maximize profit. They don't have to provide you with potency numbers, they just need the cartridge to look plausibly full of distillate. This means they use any of the aforementioned dilution methods, or even other less safe methods and wind up with a thing and runny product that is obviously not high purity distillate. So what do they do? They thicken it back up to be more believable. This is where Vitamin E acetate comes in. It can reliably dissolve a large range of organic compounds but is also similarly viscous to Maple syrup. This means it can be used to dilute distillate or thicken up heavily cut distillate, but leave it looking comparable to an actual high quality distillate. Thus they can turn a 1g cart into 5 1g carts, for the low low price of the health of the end user.” [0] https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clearing_up_the_ongoing_vape_scare/ https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clea...

kcmastrpc 7y ago
Which is further compounded by the fact that heavy vape users often have tolerances which require large doses. If the liquid is diluted, they'll potentially vape 5x the product to achieve the same perceived effects. This is precisely why this industry needs to be regulated by the FDA .. or BATF? While I personally don't consume cannabis (it messes with my constitution way too much) there is no reason why it should still be illegal.
milofeynman 7y ago
That person is incorrect. I know a toxicologist who actually had one of the carts tested due to a patient with these symptoms and the high potency was accurate. Not something I can source but the data is out there in the toxicology circles.
- MiroF 7y ago
  I've also heard talk that Vitamin E does something to increase the potency?

protonimitate 7y ago

I don't know if the vitamin e thing has been totally confirmed yet. This is from the New England Journal of Medicine published 3 days ago (Sep 6, 2019) >Until the investigation into the cause of this epidemic of vaping-induced respiratory injury is complete, no conclusions can be drawn as to which compound or compounds are the causes of injury. [0] Until they confirm or deny which compound(s) or mixtures are leading to these effects, don't assume any carts are safe to use (even if they're not "black market"). https://www.nejm.org/doi/full/10.1056/NEJMe1912032 https://www.nejm.org/doi/full/10.1056/NEJMe1912032