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CDC Confirms a THC Additive, Vitamin E Acetate, Is Culprit in Most Vaping Deaths (npr.org)
244 points by harmmonica on Dec 20, 2019 | hide | past | favorite | 163 comments



Vitamin E Acetate is not a THC additive. Sure, someone sketchy in the blackmarket added it to their product but its not a thing normal people using THC do intentionally.

The cause behind recent fear mongering over vaping is pure and simple. Some jurisdictions have become dependent on the revenue from the vice tax on tobacco and have seen vaping slashing their income more and more each year. Vaping must be made out to be dangerous so there is an excuse to tax and regulate it just like tobacco.


People dying from toxic cutting agents that managed to get distributed pretty broadly across the US seems like a pretty good reason on its own to regulate it like tobacco is. Added “sin tax” revenue is just icing on the cake.


There have been fewer than 50 deaths attributed to vaping.

It shouldn’t even make the top 1,000 list of things to bother worrying about.


Indeed. In the US we have the FDA and the CDC precisely so that all of us don’t have to worry about it. Per the linked article, they seem to be doing their jobs. The CDC has identified the likely vector for harm, and the FDA has been cracking down on unlicensed manufacturers and sellers.


The people using the cutting agents were sellers on the blackmarket. Do you really think they're going to collect and pay sin tax and follow regulations? This whole episode had nothing to do with the legal sale of THC products.


Actually, it seems some adulterated products made it into the legal market, which seems to indicate insufficient control and inspection along the supply chain: https://www.nbcnews.com/news/amp/ncna1097011

In any case, reasonable regulations are already going into place in states where THC products are legal: https://www.bostonmagazine.com/news/2019/12/12/thc-vape-mass...

The availability of known-safe, conveniently-available, regulated alternatives tends to erode black markets pretty successfully. See alcohol or Spotify as examples.


This isn’t the best refutation. In your first link, 80% of cases were confirmed black-market. The remaining were self-reported by users that would not name the dispensary or brand name of the product.

Then from your second link regarding new regulations:

...the CCC said it has not seen evidence that anyone stricken with the mysterious and in some cases deadly lung condition bought their vape products from a licensed pot shop or medical dispensary. They are instead believed to have been sourced from the black market.


Whenever you see "self reported" on an illegal product you know that it could be accurate or off by an order of magnitude, so I completely agree with you.


> A health-surveillance system put in place after the terrorist attacks of September 2001 has been used to pinpoint the cause of the...

That’s the interesting part of the article.


More:

> It was important to understand the timing of the outbreak as part of this investigation. Health officials wanted to know when exactly the problems first cropped up, and whether they had missed many cases before those initial reports. That's why they turned to the surveillance data, collected from more than 3,200 emergency rooms from most states.

>They found a gradual increase in emergency-room visits among people who vaped or used e-cigarettes, starting in January of 2017.

> The surveillance system doesn't automatically flag health concerns – often scientists dive into the data once their suspicion is raised, as it was in this case. The outbreak only became apparent in the data once researchers defined more closely what they were looking for and focused on one age group.


> The surveillance system doesn't automatically flag health concerns – often scientists dive into the data once their suspicion is raised, as it was in this case. The outbreak only became apparent in the data once researchers defined more closely what they were looking for and focused on one age group.

I'd be surprised if there wasn't some kind of outlier detection method that could automatically flag a sudden increase in unusual cases.


The web site has a lot of papers talking about that. They do detect spikes in defined syndromes.

But for stuff like this that isn’t a defined syndrome and isn’t really captured well at the hospital it’s not an outlier until scientists do a lot of analysis.


The ETL for 3200 emergency rooms worth of data must be a nightmare. It would have to be largely unstructured upon ingestion, and I can’t imagine normalising it enough for this sort of automated outlier detection would be possible.


The guide [0] shows like 20 defined fields and then free text notes.

It would be cool, but seems kind of impossible to tell a significant outlier (vape lung) from an insignificant outlier (misspelling).

The way the article describes it, epidemiologists define a new condition (vape lung) and then look for that.

[0] https://www.cdc.gov/nssp/documents/guides/syndrsurvmessaggui...


The program in question:

https://www.cdc.gov/nssp/index.html


Really, the WHO and other governmental health authorities should be throwing _billions_ of dollars at making vaping effective and safe. The RoI is absolutely insane - even if 10k people switch to a well researched alternative to tobacco and avoid serious health implications (probably costing $1million per person at a minimum in the US healthcare system), that's $10bn saved. You multiply that by around a billion worldwide smokers and the public health benefits are absolutely crazy. Probably on the order of tens of trillions of dollars, maybe even a quadrillion dollars over the next century.


Smokers don't use $1m more per person in healthcare costs than non-smokers. That doesn't pass the smell test. For comparison, total US healthcare spending is approx $3t/year, or $10k/person-year, or $750k/person-lifetime.

I don't know what the real number is. There are plenty of studies showing it's negative, mostly funded by tobacco companies. That might not quite be true, but it's not far off: a non-smoker who lives to 90 has similar levels of health issues in his last 5 years as a smoker who dies at 65.

Reducing smoking would be a huge public good, but the benefit mostly accrues to the smoker, not to the state. We don't need to pretend it's otherwise for these campaigns to make sense.


>$750,000 per person

You’re making GP’s point. If you filter for just tobacco users from the general population it could very well be above a million per tobacco user.


Sanity check. From 1990 to 2000 ~1/4 of US adult population smoked. Suggesting that smoking adds 750,000 * ~50,000,000 people / (75 years lifespan) ~500 Billion per year to US heath care costs is wildly off base.

It turns out smokers do cost more while alive, but die sooner which mostly erases the difference in medical costs. There are estimates for lost productivity amounting to 150 Billion per year in the US, but again these ignore the fact Nicotine is a stimulant.


Not all of them die early. Plus there are a variety of high priced treatments that they use along the way.


And some have almost no healthy issues. But the average is overall cheaper costs, which is what we're discussing.


The number is closer to $200 billion according to the CDC. Still crazy high and of the same order of magnitude, so hardly "wildly off base"


The CDC lists $170 billion in direct medical costs. https://www.cdc.gov/chronicdisease/resources/publications/fa...

Clearly the living have higher medical costs than the dead so some indirect savings exist. Thus, net costs are below that 170B and thus wildly off of a 500B net healthcare cost.


So I can't count the $ in lost productivity from these people dying early, but you can count their deaths as savings on healthcare?


You can and should count lost productively, though not as a healthcare cost as it’s not under healthcare budgets. However, you need to balance that with the productivity gain from people using a stimulant.

I don’t want to defend cigarettes which are I feel are very much a bad thing. However, I object to people misusing statistics and generally deceptive practices.

Cigarettes are bad because they kill people and cause direct suffering. The relative impact to your taxes and national GDP are irrelevant by comparison.


I would be surprised if the stimulating effects outstripped the dying early effects, given that in one case you are less performant and in the other you cease to exist.

I agree that we should be honest with the stats, which is why I think it was disingenuous to claim that $500 billion was wildly off when the reported costs from the CDC were a substantial portion of that. Sure, we can start considering secondary effects like cost savings from people dying early and productivity lost, etc. etc. But all I'm saying is that I don't think the original claim was on its face absurd.

Agreed that we shouldn't be doing some absurd cost-benefit analysis for the economy when considering whether to combat smoking, obviously people dying is sort of a priori bad.


That’s reasonable. Personally I doubt the stimulant effects come close to zeroing out the lost productivity from heath issues and early deaths. But, at these scales it’s a multi billion dollar effect and needs to be accounted for.

Also, if you object to wildly off base that’s fair. I would call even the 3x difference between the CDC’s 170B and my simplified 500B sanity check as wildly off base. But, that’s just my scale +/- 50% is fine, 2x raises read flags for me, but out at 3+x is a fundamental incompatibility in different estimates.


If you did that you would also have to count all the impossible to count effects like increased productivity from using smoking as a stimulant. It is possible that some smokers wouldn't have the willpower to maintain a job if they didn't have smoking as a stress reliever.


The entire idea is that vaping replaces the cigarette and most of the harmful substances in the tobacco. Cigarettes don't provide a kick because it's full of the shit that makes your lungs go black. It's the nicotine. And while nicotine is no saint, it's not the main culprit of the health problems smokers face.

Remove cigs, replace them with vapes. Presumably the effect is the same, but the vapers live slightly longer than they would've if they were smokers.


I feel like increased productivity from smoking tobacco wouldn't be impossible to calculate if you just compare performance of smoker vs non-smoker in aggregate.

I would be surprised if the stimulating effects outstripped the dying early effects.

edit: just did a brief search and apparently on aggregate former smokers who quit have increased productivity following quitting, so even while smoking there is decreased productivity effects


That is still the same order of magnitude.

$5T would be "wildly off"...

And you must concede that even "only" a $170B reduction in medical costs could change the entire market.


As I said it’s not a difference in net costs of 170B.

It may cost 20$ to eat out at lunch, but the alternative is not skipping eating. So the net cost for eating out is the delta between my options.

Random study: Results Smoking was associated with a greater mean annual healthcare cost of €1600 per living individual during follow-up. However, due to a shorter lifespan of 8.6 years, smokers’ mean total healthcare costs during the entire study period were actually €4700 lower than for non-smokers. For the same reason, each smoker missed 7.3 years (€126 850) of pension. https://bmjopen.bmj.com/content/2/6/e001678.


But we’re converting smokers to non-smokers, not executing them out of hand, so you’re only saving $250k. Of course, allowing smokers to buy their own vapes seems like a trivial cost to save $250k/person (and, you know, their lives).


Which also doesn't include the economic output of their still being fit enough to work (and still living).


No, I'm not saying that. I'm saying that even if 10k people in the US avoided 1million in catastrophic care due to tobacco (and believe me, there are many more than 10k cases per year - some cancer treatments cost $200k+ just in pharmaceuticals), that's $10bn in savings.

Considering how most vape products seem to be made on a shoestring in some factory in China, I think CDC and the FDA should be throwing enormous amounts of money into building high quality, super effective vape products.


Have you heard of a juul?


What you're not considering is the demand induced by a "safer" product. Look at the recent vaping epidemic among teen-age youth. How do you know continuing to improve vape technology won't continue to drive up demand to the point where the cost burden is spread more thinly across more people? E.g. instead of fewer people having very expensive cancer care, vaping could still cause some damage and incur costs across more people.


This is bullshit think of the children scaremongering. Even among teens smoking rates are dropping. Adults are responsible enough to make the choice for health reasons. And there's still zero indication that vaping is harmful, so at the very least it's not as bad as smoking since it's been around for a decade at least now and nothing obvious has come up.

And nicotine has this weird reputation as being dangerous, but beyond addictiveness it has not be shown to be harmful, even potentially neuroprotective. Not to mention scaremongers tend to ignore that it is a stimulant, and can help with anxiety. Schizos are known to self medicate with it, for example.

>https://time.com/5727662/smoking-vaping-rates-2018/


>This is bullshit think of the children scaremongering. Even among teens smoking rates are dropping.

Yeah, but your source also says that vaping rates are up, outstripping any decreases in smoking rates.

>It showed that 27.5% of high schoolers had vaped in the past 30 days in 2019, up from 20.8% the year before. Meanwhile, teen cigarette-smoking rates dropped from 8.1% to 5.8% in the same time period.

This seems to support what the parent post is saying:

> E.g. instead of fewer people having very expensive cancer care, vaping could still cause some damage and incur costs across more people.


Nicotine use and addiction among teens is higher than it has been in decades. The rates are staggering.

Agreed that is a completely different problem than smoking, but still worth discussing since it is so addictive.


I don't entirely disagree. There may be negative changes in brain structure associated with early onset use - though there may also be positive changes that will go unnoticed because of stigma.


I would love to see the numbers on that.

What i often seen is the number of teens who have vaped in the last year compared to habitual smokers


> there's still zero indication that vaping is harmful, so at the very least it's not as bad as smoking since it's been around for a decade at least now and nothing obvious has come up

Do you know how long smoking was around before we had actual evidence that it was harmful?

(Hint: The rough order of magnitude of the time is centuries.)


Modern medical care has advanced exponentially in the last 100 years. There weren't regular, organized, multithousand data point case studies back then.


> There weren't regular, organized, multithousand data point case studies back then.

Case studies can't spot harm faster than the harm occurs. The main harm from smoking is a significantly increased risk of lung cancer and other illnesses which can take decades to show up. That's why even with modern medicine advancing over the last century it took so long to nail down the health risks of smoking.


To be fair we’re much better at evaluating these things now.


How long did it take for us to figure out that washing your hands was beneficial?


Other commenters already pointed out that we didn’t have modern laboratory science when tobacco was brought over to Europe, not to mention that mechanized cigarette production is a much more recent development that the use of tobacco by western cultures.

I used to smoke, and now I vape. My lungs function so much better now that it’s easily discernible to me that smoking irritates lungs far more than vaping.


I think it's pretty unquestionable that smoking is worse for the lungs, and almost certainly worse overall than vaping. But smoking was on the decline; if vaping had never existed or gone mainstream, eventually very few people would have smoked. Instead now, there are many young people becoming addicted to nicotine via vaping. That's almost certainly better than if they were smoking instead, but it's likely worse than if they weren't using a nicotine product at all.

Now, you could argue that there's little evidence of nicotine being harmful aside from being highly addictive (although even then there would be an economic argument to be made), but if there is any harm, the addictive nature will make sure that harm is long-lasting.


> we didn’t have modern laboratory science when tobacco was brought over to Europe

Modern laboratory science is no help in figuring out fast whether vaping is harmful, because we don't understand how the human body works well enough to do laboratory tests that will tell us. So we're reduced to basically what we used to show that smoking was harmful: long-term data collection and analysis.

> My lungs function so much better now that it’s easily discernible to me that smoking irritates lungs far more than vaping.

Saying that vaping is less harmful than smoking (which is probably true) is a much weaker statement than saying that there's zero indication that vaping is harmful, so there's no reason to worry about it, which is the claim I was responding to.


My experience is that vaping feels easier on the body than smoking but both cause coughing and congestion. It probably isn't a good idea to inhale large quantities of anything other than oxygen.


You probably mean air. Inhaling pure oxygen is generally bad, sometimes even harmful.


This HN post is literally about vaping being harmful.


...in the same way that stories about trans fats were about eating being harmful.


More like how stories about trans fats were about eating trans fats being harmful.


No, but that's exactly what people have been and will be taking from sensationalist media. If anything this post confirms that at least in the acute timeframe, the overwhelming majority of vaping is safe, becaus vitamin e is not used in nicotine cartridges/juices or most thc carts.

I can't tell if media is ruining society or if society has ruined media.


Some vaping suppliers added at lest one harmful ingredient which caused some deaths.

I suppose you could make a case that it's not that bad, or that it'll not happen again, or that patrons of brightly-lit stores have lower risks.

Instead, you're making a case that this proves the safety of all vaping products not tainted with this specific ingredient. That was not very convincing.


How does anyone pay 10,000 a year on health care, unless you saying everyone is having major operations or procedures a year or expensive tests.

I certainly don't.


Bay Area family of four: $1870/month on Kaiser. Gold something plan. And this is just a pay to play for the extortion racket we call health care providers. And we live in east bay zip code which makes The plan cheaper than e.g. being in 95030 or some other South Bay zip codes. And it’s anyways cheaper than equivalent BlueShield of CA plans.

So yeah, I break 10k (for a family) before anyone even gets to visit a doc. Where they slap you with extra $$$ on anything.

We should mandate that everyone has to pay for their own health insurance (e.g. healthcare). Put a full stop on employer provided health plans. And have people actually pay from their hard earned $ to the health providers for the right to show up. Now for a lot of people who get benefits through employment, the absurdity of the cost isn’t visible enough to actually care / do something about the situation.


Or we could push for the us to actually join the rest of the world with public healthcare for all. If this is done, then we can push for the cost of a doctor visit to be reduced to a normal price. There is no reason for having the extreme pricing in healthcare except that it’s treated as a business. If most European countries can manage a public healthcare system and not have a doctor visit cost 1k+ , then it can happen in the US. But a mayor shift need to happen and it won’t as long as people refuse to accept universal healthcare


I don't get health insurance through my employer if that's what your implying. A family is different than an individual though, and that total cost is not per individual.


I'm a type 1 diabetic, and the costs for all the supplies related to it are easily over 10k a year. Just the insulin is ~250$ / bottle, and I use somewhere in the range of 5 vials / month, so that's $15,000. Admittedly, I've changed insulins recently, so the price may be reduced, plus the insurance company certainly isn't paying the full cost. But still, that's just ONE of the supplies for my diabetes.

And then I had an operation this year (unrelated to the diabetes.... kind of), so that adds another 10,000$, give or take.


My brother in law is taking a $750 monthly diabetes medication in the US. That same medication cost 50e here in Spain. There is no reason for the price in the US except to get as much $ as possible.


> How does anyone pay 10,000 a year on health care

$832.21 X 12 -> $9986.52


Because these are summary statistics drawn from a non-uniform distribution.

If one in 10 people is over 70 and some others get serious or chronic illnesses earlier in life, the mean cost per person could easily be much higher than the median cost per person.


I suppose, but why not report the median instead.


Because it’s much more difficult.

The mean can be calculated from the total: just divide by the population. That’s what the commenter to whom you replied did. The total was probably easy to estimate, as the largest healthcare providers’ revenues are in their public filings.

Calculating the median requires individual data. That is much harder to get because, in many cases, no one except the patient has the data.


Because medians don't let you extrapolate total costs or how population-wide changes will affect total costs. The tails of the distribution matter when we're talking about public health.


20 physical therapy visits alone could cost somewhere close to $10k when billed to insurance. A drilled cavity can be $500. Have a wart removed? $500. It's so absolutely easy to hit $10k in a single year.


Insurance premiums


I don't pay anywhere near that much.


I just checked and including my employer's contribution, my health insurance (1500 / 3000 family plan) has premiums of $32,000 / year.


And how much is your employer kicking in?


None.


Your claim was how does “anyone” pay $10k for insurance. It doesn’t matter what you pay. The answer is older people in high cost of living places.

https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...

And insurance is just insurance. out of pocket maximum is usually $10k+, so if you do need care, add that to premiums.


I did put a qualifier on that statement though, I said "unless". I doubt the average person is having constant surgeries, procedures, expensive tests or expensive medications every year.

Like I could see something happening in a year, but not every year.


Even without any healthcare events, anyone over 50 is facing close to or over $10k per year in health insurance costs.


According to our national health institute vaping doesn’t actually help people quit smoking, and this is an area we take rather serious in Denmark because we genuinely want people to smoking all together. There is no evidence to show that it’s safer either. It may be, but we’ll need to wait a few decades to see what the long term effects on the population actually are.

So it would be rather silly for the WHO to invest billions in moving people from one ”tobacco” industry to another at this point.

Even if we assume it’s safe, I’m not sure your suggestion is really sound. There is no evidence suggesting that smokers are actually that expensive to a society. Yes, they tax the healthcare system making up as much as 70-80% of the total expenses in some countries, but they also live shorter. There isn’t actual science on this, because it’s highly immoral, but the biggest expense of a lot of western countries isn’t healthcare, it’s elderly care, and that’s an area that benefits greatly if you die in your seventies after a relatively short period of lung cancer as smokers are prone to do.


Does it help with second hand smoking?

It certainly helps with the smell, the basic side products of burning, and so on, no?

Sure that might not mean much in terms of total impact on QALYs. (Because it might lead to prolonged exposure of lower dosages, ultimately resulting in the same grave health impact.)


> The RoI is absolutely insane

In purely financial terms, it's negative; premature deaths from tobacco (even with the health care costs of tobacco-related disease) actually significantly reduce health and net social welfare costs.

The benefit is in years and quality of life (mostly in the after-working-career years), not financial returns.


This doesn't account for the extra value those folks will create.


Yes, it does, but most of the years lost are when people are drawing social security or similar public pensions, not economically productive; there have been numerous studies on this, and while many have raised moral arguments against acting the way tobacco companies propose (as they have actively lobbied based on them in many places in the world) based on them, there has been no serious disputes of the facts of net financial savings.


I have very bad news for you.

Smokers (and the obese) are cheaper in health care costs than non-smokers. Why? To be blunt, because smokers die early.

Keeping someone alive into their 90s is more expensive than someone who dies of smoking derived illness in their 70s or younger. This is similarly true for the obese.

https://www.nejm.org/doi/full/10.1056/NEJM199710093371506


The obese have other very costly externalities, for example: https://onlinelibrary.wiley.com/doi/10.1002/oby.22657

They are more of a burden to society than smokers.


It reminds me of the misguided logic in mandatory helmet laws for motorcycles. They're more costly because people have higher survival rates. Whereas people who make the bad decision of not wearing a helmet are killed quickly - there's no crazy surgeries. Just send the coroner.

The laws should be taken off the books. It's cheaper to not have the bad decision makers around. (anti Idiocracy)

Disclosure, I ride a MC every day.


Plus, motorcyclists are excellent sources of organs.

They don’t call them donorcycles for nothing.


There is a fun poem about that:

https://imgur.com/a/isGWqU4

It is maybe dated a bit now. I think it refers to boomers (in the 90s/00s?) rather than modern riders. But still awkwardly accurate.


Yes, of course. Smokers and many other bad habits are great for the public purse - especially with less state pension payouts.

But this isn't an argument we accept in public health. If it was, we wouldn't provide any healthcare that prolonged life after someone was after working age.

Regardless there are still an awful lot of really dibilating conditions that massively affect productivity caused be tobacco related illnesses that isn't just death or cancer care.


I was replying to a comment proclaiming the financial savings. It isn’t a savings. It’s a cost.

It may well be a cost worth paying. I’m not arguing policy. OP’s math made incorrect assumptions. Just letting them know.


Yes and no.

The use less. But they also are able to contribute less.

That said, yes a whole lotta money is spent on the last 0 to 6 months (or so) of life. From what I understand, this is a USA only problem.


> From what I understand, this is a USA only problem.

The study I linked was based on the Netherlands. I suspect the cost difference will be true for most countries. Unless you just let people die earlier. But that’s a whole other discussion.

I don’t know if anyone has done any studies on productivity differences. That would be interesting.


I was referring to the big spend on med treatment at the end of life. That's pretty much USA only.


Don't people more or less stop producing economic value at age 60 on average?


Obese people? Dying of diabetes related or heart attack? They going younger than 60. Furthermore, they're missing work, are less effective, etc.


How many people do you think retire at 60 today? At what age do you think you're going to retire yourself? Your question is either senseless or stupid. What does "producing economic value" even means?


Ah, you’re assuming those 10k people are worth 1 million in cancer treatments. Their realized cost is probably going to be a lot less...


> The RoI is absolutely insane - even if 10k people switch to a well researched alternative to tobacco and avoid serious health implications

The problem is that vaping is converting non-smokers into vapers. That's a really BAD ROI.

Estimates are now as high as 25% of high schoolers vape and has snagged more women than cigarettes would have. That's undone 20+ years of anti-smoking efforts. So, yeah, public health officials are really pissed off.

Yes, vaping is a good replacement for smoking. It's not a good replacement for not smoking, however.


Tobacco isn't harmful because it contains nicotine. There's evidence that nicotine is good for you: it improves concentration [1] and reduces BMI [2]. Vaping gives people nicotine without the harmful substances in burning tobacco. Why should we bucket vaping with smoking? Hell, given the state of public health generally, maybe we should be encouraging people to vape.

[1] https://www.webmd.com/smoking-cessation/news/20021023/harnes... [2] https://www.sciencemag.org/news/2011/06/why-smokers-are-skin...


It looks like people are disagreeing with you without providing any rebuttal. Classy.

I agree that the "nicbacco" mindset is fallacious and not well-reasoned, but also that while vaping is significantly better than smoking, it's not better than not vaping.

For adults who want to derive the benefits historically gained through tobacco use without incurring the full extent of the damages, certain types of vaping aren't a poor method.


They seem to be focused on stopping it 100% instead of practicing harm reduction. I don't think it makes any sense at all except from a bureaucratic, elementary school, Zero Tolerance kind of perspective.

Is there are another reason why it seems institutions are so resistant to this? They seem more concerned with raising the age to buy these products to 21 worldwide.

https://www.nytimes.com/2019/12/19/health/cigarette-sales-ag...


I think there is an ethical consideration about addictive substances like tobacco. It's not okay for companies to use physical addiction to force further sales of their product, and many/most teenagers aren't able or willing to think through the ramifications of starting a long term addictive habit.


I'll take it a step further...not only is the product addictive and a known carcinogen. But, the gov approves its sale _and_ taxes it.

Imagine UBL saying he was going to "infect" America with an addictive carcinogen. There would be true outrage. But since we do it to ourselves - fed approved - it normal.


Do you believe alcohol sales are un-ethical? Alcohol can be extremely addictive, and in spite of the rampant use among youth, I don't hear public outcry against brewers. I'm not saying it's apples-to-apples, but I believe the fact that those crying out want alcohol more than a vape may play a role in the selection of Boogeyman of the Day.


Lockyer v. Reynolds demonstrates companies targeting children is considered a significant issue. Vaping seems to be sidestepping those regulations and actively targeting young teens.

Further, alcohol has a drinking age of 21 making it somewhat harder for young teens to regularly access. Vaping on the other hand becomes a regular habit due to easy access.


I see what you're saying, and while I personally don't consume much alcohol, I'm not convinced its sale is unethical. I think there's a difference that makes tobacco addiction more problematic: The large majority of smokers are addicted, but only a small proportion of alcohol drinkers are.


The tobacco Master Settlement Agreement with the states has a provision whereby they lose money if cessation programs are 'too' successful: https://www.reuters.com/article/us-tobacco-bonds-ecigs-insig...

& then also, I suspect the incumbent tobacco industry lobbying effort is already deeply entrenched and dwarfs anything that might be fielded by the e-cig industry.


In case you wondered where "Vitamin E Acetate" comes from:

> Further research focused on vitamin E acetate, which is used in some of these preparations to dilute the much more expensive THC oil.


It seems like there is probably a long history of these cutting agents being extremely toxic. I suppose it makes perfect sense. The person who takes the risk to sell you something illegal doesn't really care about your health.


> seems like there is probably a long history of these cutting agents being extremely toxic

A bit of an understatement, considering literal lead found in ganja (albeit rarely), any kind of dirt in hash, common use of amphetamines instead of psychedelics, and afaik some pretty deadly drugs instead of ‘regular’ opioids. And, I guess, antifreeze in wine if that's not a myth.

On one hand, a dead junkie doesn't buy junk anymore. On the other, the choice is often between selling something today or selling nothing, and apparently the short-term view wins.


There are actually even more unfortunate incentives. When people die from badly cut heroin (especially if from overdosing due to the presence of fentanyl), the bad batch is often incorrectly assumed to be more potent and pure and as such is sought after, causing more deaths.


Further, it’s synthetic. I don’t think it exists in any food sources naturally. Probably shouldn’t be in lung tissue:

“vitamin E acetate, is a synthetic form of vitamin E. It is the ester of acetic acid and α-tocopherol” (Wikipedia)


I'm not sure the addition of white vinegar should be of any particular concern...

https://en.wikipedia.org/wiki/Acetic_acid https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.... - "The substance readily hydrolyses" https://en.wikipedia.org/wiki/Lipid_pneumonia


Food safe doesn't mean its aerosol or combustion products are safe to inhale.


Yes, but the ester will probably only affect the hydrophobicity and will be hydrolised at some point. I wouldn't expect vast differences in specifity.


Mods- could we edit the title? Vitamin E is not a "THC additive"


That’s verbatim the title of the NPR article.


NPR can be wrong.


Sure, but a link to an article using the given title of that article is appropriate. The HN title isn’t claiming that thing; it’s a link to a publication saying that.


It's a vape juice additive and this problem only arose because of the prohibition.


Depends on where marijuana products end up on the regulatory spectrum. Vitamin E acetate is added to thicken the THC + solvent solution, because to users, a thicker solution appears to mean that the THC is less diluted than it actually is.

If marijuana products are regulated like supplements are today, there's really no reason why less than scrupulous vape cartridge manufacturers wouldn't do exactly what they're doing today. There's no regulatory oversight when it comes to supplements.


It's a black-market additive to make their watered down product appear genuine.


It’s an THC product additive, that’s not used in non-THC vape juices. The title is perfectly accurate, even if it could be a little more verbose. I know a lot of commenters here have a vested political interest in promoting marijuana and its derivative products as safe, but you can’t change the facts because of that.


I believe the CDC also found it in illicit nicotine cartridges


The CDC have not found it in any nicotine cartridges. The CDC have also not found the substance in the lungs of any vape users who didn’t use THC products. There are also jurisdictions which have reported finding it in 100% of seized THC cartridges.


It was found in carts that had THC and nicotine combined. That makes it about as much as a nicotine additive as a THC additive, if we are using the incredibly low standards of "found in coexistence with substance sometimes" as the definition of additive.


Many products which contain THC have Vitamin E (acetate) added to them. I understand the desire to not have "THC" and "carcinogen" in the same headline, but the headline is factually accurate.


“Additive” is a word that implies that it performs some function in the product. (The technical jargon equivalent word being “excipient.”)

The proper term for vitamin E acetate is “cutting agent.” Like talc in cocaine. Neither the original manufacturer nor the consumer wants it in there; it was effectively MITMed into the product.

A very precise analogy: you wouldn’t call cyanide a “Tylenol additive”, right?


As others in the thread have pointed out, manufacturers of THC products who add it do so as a thickening agent. I would term that performing a function.


Bakers who put alum in their bread as a whitening agent were "performing a function" with that alum, but it's still considered adulteration. The addition of Vitamin E Acetate to THC oil seems to be unambiguous adulteration.


Just because people are saying it doesn’t make it true. It doesn’t even make sense as a thickening agent. It’s not more valuable if it’s thicker and it becomes more difficult to handle and to fill cartridges.

It’s used to water down the product and sell more cartridges with the same amount of THC oil. The exact same thing cocaine dealers do with talc powder or some shady bars do watering down their bottles.


I have no idea why you've been downvoted since you're plainly right. Do people think it a coincidence that the products found to be doing this seem to all be black market? Adulteration is common practice in the criminal drug industry. That's one of the major reasons so many people supported legalization in the first place, how could people have forgotten this?


It performs the function to make the dealer more money, as others have pointed out, it is a cutting-agent not an additive.


The british have a perfectly sane and working way of handling vaping products and e-cigarettes, the USA could easily copy them in how it's regulated. The USA is just too damn proud to ever copy something another country is doing, even if it's vastly superior to what we're doing currently.


Given the scale, a Mexican cartel was almost certainly the source of the bad carts. It just makes sense that someone there ordered a few barrels of vitamin e acetate from China and the problem appeared suddenly across the US but not in Canada and much less in states with legal carts.


One of the most popular vitamin E acetate based additives was developed and sold by an American former small time actor who apparently used his marketing skills to become a force in the illegal vape market. https://www.leafly.com/news/health/toxic-vaping-vapi-evali-l...


You'd be surprised the extent of the domestic illicit pot industry. Cartels don't have to be involved even in large scale production and distribution and often aren't


If you’re going to go and blame Mexico, you ought to have at least a bit of evidence.


oh no, he's picking on the Mexican cartel that is the primary source the majority of drugs in the USA. That's really hurtful to them I'm sure.


What makes you so sure? The economics of any cartel filling vape cartridges and then smuggling them across the US/Mexico border is laughable.


Why would it being a Mexican cartel necessitate manufacturing in Mexico?


A valid point.


So how fast does this happen?

Taking a hit from a friends vape of unknown origin and substance still cool? Or is that insta KO


don't do it if people are trying to vape THC or just black market pods. Just get your own and do it legally or simply tell them nope and pass on the hit.


I am curious, how it wasn't already known to people working at these vape manufacturing companies?


Vitamin E dilutions have only found in blackmarket THC vapes. There's simply no need for legitimate vendors to dilute product with vit E Acetate.

THC Distillate which is the base for most THC cartridges is made from any and all cannabis biomass or 'leftovers' from other processes. Since it's a highly pure (~94%) extraction, in terms of cannabis extracts, there is no worry about the starting products' quality/looks/smell as is the case with most cannabis products. All this results in this high-purity substance being much cheaper, and very high value for the customer.

The legitimate cannabis industry has dabbled with other diluents though (such as PG/PEG/VG and most commonly terpenes), mostly to help the very viscous THC distillate work with the cartridge hardware. However, nowadays, cartridge technology has improved so much that it is possible to use very viscous THC distillate in most cartridges. These legit vendors have known about various issues related to health concerns, due to health-savvy cannabis users. PG/PEG/VG are almost completely phased out for terpenes, which are currently seen as the better alternative (compared to PG/PEG/VG, not that it's safe). I've never come across legal cannabis vendors discussing Vitamin E as a dilutant in my research.


Because this is blackmarket stuff, although I imagine contingent of otherwise legal home vape assembly people could in their ignorance get their hands on some off a friend and have the same issue. The big deal here is that some states are completely losing their mind and trying to completely stop or over regulate vaping, no doubt resulting in many more deaths as a result of former smokers going back to smoking and now they have blood on their hands because of it because it's obviously happening only in people who use vaping to get a THC high, which is already illegal and regulated and they really didn't care.


These, I suspect were most likely made in some guy's kitchen.


Obviously then ban Vitamin E, just as these imbeciles once banned Tryptophan and Ephedra.


You can buy ephedra in supplements, and ephedrine over the counter as Primatene or Bronkaid. Primatene is the perfect cold remedy--ephedrine to clear your nasal passages and guaifenesin to loosen mucus. Bonus that ephedrine gives you some zip, especially if you're in the minority of people whose viral-induced sneezing and runny nose is responsive to OTC antihistamines, which can sometimes make you drowsy (not as much of an issue for me since cetirizine went generic).

Warning: both ephedrine and guaifenesin increase blood pressure, so take care if that might be of concern.


> not as much of an issue for me since cetirizine went generic

Yes, fexofenadine is great (for me at least)


Vitamin E Acetate may be the cause of the fatalities, but that's not the full extent of the problem. Lack of testing or fraudulent testing for pesticides seems to be a serious issue as well: https://www.thestranger.com/slog/2019/01/07/37770867/why-eve...

Beyond pesticides, I'm also generally skeptical of some of the solvents used for extraction. Supercritical CO2 extraction should be perfectly fine, but apparently not every brand is using that.


I stopped all use of cannabis vape pens after reading a study that found lead often leaches into the oil cartridge over time (I believe from the pen and/or the metal contact on the cartridge). I imagine there could be other risks, as well.

Vaping is definitely safer if implemented ideally, but it looks like the ultra-portable solutions are mostly still pretty sketchy.


I don't vape or use cannabis so am ignorant. In what way is lead used? I would have thought that a metal with a low melting point out not be found near a heating element.


Lead still doesn’t melt that easily. 470 celcius is really hot.

You might be thinking of solder which is easily melted by resistive heating. But that is because its alloyed with Tin and the combination has a much lower melting point than either metals.


Lead can chemically dissolve in acidic solutions


Lead melts at 327.5°C.


Siri decoded to give me the number for Lead(II) nitrate. Neat. Still my point stands its not normal to hit that with simple resistive heaters like those in an e-cigarette.


Vaporizers that use ground up bud instead of concentrates seem ideal to me; it's much harder for producers to adulterate the product in that form.

I get the impression this style of vape has started to go out of style though. Which is a shame because it's much more efficient than smoking, particularly if you save the toasted weed to make edibles with (extraction using food-grade coconut oil, butter, etc in your kitchen is very easy, or since it's already toasted you can even consume it without any processing.)


You can also do a butane extraction of the THC left in that vaped bud, which can result in a super pure butane hash oil (BHO) that is also suitable for vaping. I say can because most butane has horrible additives (unlike the quintuple refined stuff you can buy at headshops), and the materials used in the extraction are also important (e.g. if you use a PVC pipe, the butane extracts some of the PVC as well -- I've known people who did this and smoked/sold the product out of ignorance). The whole operation is typically dangerous/flammable and releases some butane into the environment/unprotected-respiratory-system, unless you have a shwanky machine that cycles and reuses the butane. This comment isn't a how to guide, I'm just trying to note that while buying oil you don't know the origin of can expose you to crazy additives somebody who does their research can make their own BHO that is damn near 100% plant material once the quintuple refined butane evaporates away. It's not that hard, though it is either expensive or dangerous depending on the materials used.


There are a lot of new models coming out each year. However, the oil vapes tend to be easier to use when out on the street or in a place where it’s forbidden to smoke / vape as they leave very little trace and smell. But even with the dry vapes you have to be careful what you buy as some of the cheaper ones use plastics that can’t take the heat, causing you to inhale plastic fumes. For example, most of the snoop dog branded vapes.


I guess I don't understand people using black market oil based anything since you obviously never know where it came from or it's the same stuff that the CDC says is destroying people's lungs. Just seems like survival of the fittest (in this case brain power) after you hear about all the people dropping like flies.


Yeah I use a dry herb vape and I think it’s probably the best way to go about it.


I expect the other 90% of the iceberg is food and prescription drugs.

This is like how people gossiped about Boeing management for years before the 737-MAX finally demonstrated the consequences.

Or how people have smothered their doubts about the President because the market has been going up.




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