On Vaping and Lung Disease

Photograph Source: Mike Mozart – CC BY 2.0

A front-page story by Matt Richtel in the New York Times October 21 contains some useful info about the increasing incidence of lung damage caused by vaping, but gets the history wrong. And then gets it right. An editor should have caught the contradiction.

The online subhed sums up the story thus: “A technology initially promoted to help cigarette smokers has transformed marijuana use, too. Now, with cases of severe lung illness rising, health investigators are warning people to stop vaping cannabis.” The piece begins: “For years, a divisive debate has raged in the United States over the health consequences of nicotine e-cigarettes. During the same time, vaping of a more contentious substance has been swiftly growing, with scant notice from public health officials.”

The chronology is upside-down. E-cigs didn’t go on the market until 2007,  long after cannabis aficionados and medical users had begun vaping. In 2002 the German-made Volcano vaporizer hit the market in California (with an instruction manual that, for political reasons, made no reference to cannabis). In 2003 Dale Gieringer, PhD, ballyhooed vaping in  O’Shaughnessy’s first issue (Summer  2003) in a story headlined “Don’t Smoke, Vaporize”  Gieringer also published in the Journal of Cannabis Therapeutics a paper called  “Cannabis ‘Vaporization’: A promising strategy for smoke harm reduction.” It described an experiment showing “that an electric vaporizer can successfully generate THC at 185 degrees centigrade while completely suppressing benzene, toluene and naphthalene formation.”  The Spring 2004 O’Shaughnssy’s ram a piece called “Volcano is to Vaporizer as Porsche is to Automobile.”  Dr. Tod Mikuriya recommended vaporizing to all his patients and the Volcano to those who could afford the >$600 price tag.   Other devices that heated cannabis flowers short of the combustion point would keep coming on the market.

Excerpts from the Times story follow:

Millions of people now inhale marijuana not from joints or pipes filled with burning leaves but through sleek devices and cartridges filled with flavored cannabis oils. People in the legalized marijuana industry say vaping products now account for 30 percent or more of their business. Teenagers, millennials and baby boomers alike have been drawn to the technology — no ash, a faint smell, easy to hide — and the potentially dangerous consequences are only now becoming evident.

Most of the patients in the outbreak of severe lung illnesses linked to vaping — which has left 1,479 people sick and 33 dead so far — vaped THC, the ingredient in marijuana that makes people high. Until more information is known, officials at the Centers for Disease Control and Prevention have warned people not to vape cannabis products…

Last year, Dr. Neal Benowitz, a professor of medicine and a researcher on nicotine and vaping at the University of California, San Francisco, sent a letter to Congress warning of the risks posed by leaving a hugely popular practice unstudied.

“Very little is known about the safety or effects of vaped cannabis oil,” he wrote, cautioning that some ingredients mixed into the oils “could have harmful, toxic effect on users, including the potential for causing and/or promoting cancer and lung disease.”

“It’s disgraceful,” Dr. Benowitz said in a recent interview as reports of hospitalizations and deaths from vaping-related lung illnesses mounted. “I’m not able to take products we think are potentially harmful and do analysis. I can buy a vape device around the corner, but I can’t bring it into the lab and test it.”

The mounting toll of vape-related illness may turn into a boon for the regulated industry, which has long wanted law enforcement  to crack down on unlicensed producers. The president of the board of the United Cannabis Business Association, Jerred Kiloh, emphasized to Richtel that only vape pens and cartridges sold in regulated stores have been tested by California’s Bureau of Cannabis Controls. Kiloh (great name for a pot dealer) owns the Higher Path dispensary in Los Angeles. Richtel writes:

Vaping oils typically include other additives, solvents and flavor enhancers, and health investigators believe some such ingredients, including vitamin E acetate, could be responsible for some of the lung illness cases. The problem of unknown and potentially dangerous additives, Mr. Kiloh and others said, is vastly worse in a soaring black market in the nearly 40 states where recreational marijuana is still illegal.

Even in states where the drug is legal, counterfeit cartridges are cheaper than the licensed, tested and taxed products. It is hard for legal players who pay taxes to compete. A regulated vape pen with half a gram of THC costs $55, compared with $25 or less on the street for an untested product.

Richtel is evidently referring to Dale Gieringer’s 2003 paper, when he recounts:

In the earliest days of cannabis vaping, a small group of innovators saw the technology as a safer way to help medicinal marijuana patients. They hoped that vaping — which entails heating THC so that it turns to an aerosol — would be less harmful to the lungs than inhaling combusted marijuana.

But that ethos quickly gave way to a different lure: the pure convenience of vaping, which allowed users to avoid rolling joints, spilling ash, giving off a telltale smell — or getting caught. Vape pens brought the sheen of high technology to a drug associated with hippies and grunge, along with the discretion of, say, texting beneath the dinner table.

The harm-reduction ethos gave way to the generate-revenue ethos. Growers who sold manicured flowers to dispensaries could now sell to hash oil makers the leaves theywould have composted and the “shake” they would have donated to needy friends and family. The hash oil makers were given shelf space by dispensary owners and created a profitable niche for themselves in the industry. The market itself expanded because bringing cannabis in the form of oil  across state lines is so much less risky and more efficient than transporting bulky, odiferous flowers. As explained by Richtel in the Times:

Entrepreneurs began to extract oil by bathing the leaf in ethanol or butane, filtering out the solid material that remained and then evaporating the solvent to leave the concentrated oil. Another method used carbon dioxide, which, when pressurized, creates a fluid that can be used to extract the oil…

Once extracted, the THC oil could then be heated up using a small battery, kept in a cartridge or penlike case, creating aerosol, which is then inhaled from one end of the device. Consumers fell in love/

Businesspeople found they could use the entire plant to extract oil rather than throw away stems and other parts discarded by smokers, which maximized the value of the crop.

The oil also could be mixed with other additives to give flavor, to create the effect of big puffs of smoke or just to cut the THC to substitute less expensive chemicals.

You don’t have to be a regulated dispensary owner to assume that unregulated ganjapreneurs are making and selling the lung-damaging vape pens and cartridges. A looming  question is: which ingredients  are doing the damage?  A friend in the industry who suspects the fungicide Myclobutanil cites pathology reports of damage from “toxic fumes” and notes that “Myclo converts to Hydrogen Cyanide when heated.” He adds,  “The primary affected demographic is young adult males. This may or may not be simply representative of the user demographics. If there is a disproportionate effect on that population it may be due to a toxic conversion that is heat dependent. Healthy young males hit the pen harder, heating the oil hotter.”

The vaping boom has been facilitated by the War on Drugs and societal disapproval of smoking per se.  As Richtel observes, vape pens enable “discretion” by users. Drawing on a sleek little device can seem inobtrusve and respectable compared to firing up a joint. Maybe people forget —or maybe the news never got conveyed— that smoking marijuana does not cause lung cancer. A gold-standard study by Donald Tashkin and colleagues at UCLA established that cells damaged by cannabis smoke die off instead of metastasizing. Tashkin has established that smoking cannabis can cause bronchitis  —but not a higher rate of lung cancer (or emphysema or COPD),

Given that the real risk is bronchitis, maybe smoking marijuana will regain some of its popularity. Like vinyl LPs  The ecological impact of large numbers of people smoking American Spirits marijuana cigarettes would be close to zero. Till that unimaginable day, disposable vape pens and empty plastic cartridges made in China and purchased in the US will keep adding to the debris  coagulating in the ocean that everyone tsk-tsks about. Not to mention the poison leaching out  of the batteries.

Fred Gardner is the managing editor of O’Shaughnessy’s. He can be reached at fred@plebesite.com