Lung injury from vaping is caused by illegal marijuana cartridges, not by e-cigarettes

In August 2019, an outbreak of lung injuries in young vapers developed in the USA. A number of people were hospitalised and 68 died. The lung injury was caused by a toxin (vitamin E acetate) in illegal marijuana cartridges (called THC). It affected mostly young people who used these cartridges for a short period of time, and when these cartridges were taken off the market, the outbreak trailed off (1).

Most of the people affected also vaped nicotine, and a small proportion denied using marijuana. This led to concerns that nicotine e-cigarettes could have also played a role (2).

In theory, it is possible that two different substances in different products caused the same outbreak of identical symptoms at the same time and the same place, but the chances of this are extremely small. It is more likely that some people did not want to admit marijuana use, especially in states where it is illegal, and/or where their parents were present during their hospital admission.

Indeed, all laboratory samples taken from people with confirmed diagnosis, including some who denied THC use, contained the THC contaminant (3).

Many media reports created the impression that the problem was caused by nicotine e-cigarettes that smokers use, when it wasn’t. We encountered people in our studies who successfully stopped smoking with the help of e-cigarettes, and who reacted to these alarming headlines by stopping vaping and returning to smoking.

Journalists should be concerned that inaccurate reporting can have such negative effects.

In summary, this is a false alarm.

Peter Hajek

(1) Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Centers for Disease Control and Prevention, https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

(2) King B, Jones C, Baldwin G, Briss P. The EVALI and Youth Vaping Epidemics — Implications for Public Health. N Engl J Med 2020; 382:689-691

DOI: 10.1056/NEJMp1916171

(3) Blount B, Karwowski M, Shields P et al. Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. N Engl J Med 2020 Feb 20;382(8):697-705. doi: 10.1056/NEJMoa1916433.