E–cigarette, or vaping, product use–associated lung injury (EVALI) has been linked to the use of tetrahydrocannabinol (THC)-containing products and vitamin E acetate. s
Three small patient clusters in Wisconsin reported frequent, shared use of THC cartridges obtained from informal sources before symptom onset. Vitamin E acetate was detected in all five THC cartridges used by two of the patients and in bronchoalveolar lavage fluid from two other patients.
Patients were aged 16–20 years, and six were male. All eight patients reported daily use of THC cartridges purchased from local illicit dealers in the month before symptom onset. This included use of the Dank Vapes brand by all patients and an average of 2.6 unique brands of illicit THC cartridges per patient. At least two patients in each cluster reported frequent sharing of THC cartridges in the month preceding symptom onset, including concurrent use of the same cartridge in the same device. On average, patients reported inhaling approximately one half of a 1-g THC cartridge daily in the month before symptom onset; two patients reported that this was more than usual for them. All patients also reported daily use of nicotine-containing e-cigarette, or vaping, products. These included commercial pods and refillable e-liquids purchased from retail locations or online. Patients reported initiating use of THC cartridges 9 months before onset of symptoms.
Injury severity and clinical course varied among these eight patients, with six patients requiring hospitalisation, five were admitted to the intensive care unit, and two required mechanical ventilation. Two patients received a diagnosis of EVALI in outpatient settings. One patient reported persistent respiratory symptoms 3 months after discharge.
Using THC-containing e-cigarette, or vaping, products more than five times per day was found to be significantly associated with EVALI in a case-control study of Illinois patients and might be a contributing factor in the EVALI outbreak.
These findings reinforce current recommendations to not use THC-containing e-cigarette, or vaping products, especially those obtained from informal sources. Moreover, vitamin E acetate should not be added to e-cigarette, or vaping, products. Adults using e-cigarette, or vaping, products as an alternative to cigarettes should not go back to smoking. Irrespective of the ongoing investigation, e-cigarette, or vaping, products should never be used by youths, young adults, or pregnant women.
– Authors Ian W. Pray, PhD; Sukhshant K. Atti, MD; Carrie Tomasallo, PhD; Jonathan G. Meiman, MD
