How counterfeits and illegal practices are tainting the image of legal cannabis

Officials around the country have been baffled by the sudden rise in serious, life-threatening, and sometimes deadly, illness and respiratory injuries suffered throughout the summer. Evidence and patient interviews quickly led health officials to come out against vaping and particularly against cannabis. But there may be more to the story than many were led to believe originally. Beneath the “pot,” ”weed,” and “THC” headlines was something much more concerning. 

The two deaths and the series of serious health issues have seemingly been traced to inhaling tainted, modified, and black-market vapor products, and many mainstream media outlets and some public health officials have quickly used this rash of illness as an opportunity to stand against medical marijuana and adult-use legalization, despite evidence showing that issues are not arising from tested and authorized products.

As Missouri’s patients and caregivers begin to harvest their homegrown plants, 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 using 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 on vitamin E acetate after finding very high levels of the substance in marijuana-containing samples being examined. Additional investigations by health officials around the country, the FDA, and CDC have all begun to target the additives and chemicals being mixed into cartridges and inhalants.

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

Vitamin E is usually safe as a dietary supplement or cream, but vaping it could be harmful, according to an NPR interview with state health Commissioner Howard Zucker.

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].”

Zucker says the cartridges they tested appear to be “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.”

On Wednesday, Oregon officials reported that a middle-aged adult who died of a severe pulmonary illness in late July had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary, according to the Oregon Health Authority. The death of a second person was reported in Illinois in late August. Mark Pettinger, a spokesman for the Oregon Liquor Control Commission, which regulates marijuana sales in the state, said the agency is using its tracking system to trace the origin of the vaping device involved. Pettinger continued, saying the agency is also prepared to issue a recall of any product deemed unsafe.

    

The FDA is working with the Centers for Disease Control and Prevention and state and local health officials to investigate incidents. The FDA says there have now been at least 354 possible cases in 29 states – nearly three dozen of the reported cases originated in New York state. A CDC source says that the dramatic increase in reported cases is most likely attributable to an increased awareness.

The FDA is providing laboratory assistance to state public health officials and is analyzing samples submitted by states to detect chemicals and what Felberbaum said are “cutting agents/dilutants and other additives, pesticides, opioids, poisons, and toxins.”   

“The results from the FDA’s laboratory analysis will be shared with the respective states to aid in their investigations and will help further inform the federal response,” said Felberbaum. 

Most of the patients so far have been teens or adults in their 20s or 30s, hospitalized with severe shortness of breath, vomiting, fever, and fatigue. Some have been put on ventilators or placed in intensive care units.

Health investigators believe that in addition to Vitamin E dozens of other possible chemicals inhaled through vaping could be causing the severe inflammatory reaction in the lungs.

Unlike infectious disease outbreaks, this investigation has been more difficult because investigators don’t have a specific culprit, an established national system of collecting information or even a consistent definition of the illness. Unlike certain infectious diseases, such as measles, which are required to be reported to federal authorities, this illness does not fall in that category. States are not required to report possible cases of vaping-related illnesses to the CDC.

The agency hopes to establish a data-collection system for states by early next week. State and federal officials are hoping to finalize an initial definition of a vaping-related lung injury or illness by week’s end. 

In California’s King’s County, all seven patients who had acute respiratory distress syndrome reported buying marijuana vape cartridges from “pop-up shops,” said Nancy Gerking, Assistant Director of Public Health.“The patients had switched from regular retailers to the pop-up shops,” Gerking said. The patients “found a difference between the potency of the products,” she said. “They had to use twice as much, so they were taking twice as much of the product into their lungs.”

Nationwide, health officials and doctors are advising people who are not legal patients to consider not using any vape products. In addition to THC products, E-cigarettes and nicotine vape products are not an FDA-approved. 

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