Update: Trump Signs Vape Legislation; CDC Names Complicit Brands in Crisis

UPDATE: December 23, 2019 – 11:07 a.m. PDT – President Donald Trump on Friday signed legislation restricting the legal age to purchase tobacco products—including vape products—to twenty-one-and-over. The provisions were included in the $1.4 trillion spending bill Trump signed into law.

The tobacco bill reportedly enjoyed bi-partisan support from Senate Majority Leader Mitch McConnell (R-Ky) and Senator Mitt Romney (R-Utah); also, Senators Richard Durbin (D-Ill) and Tim Kaine (D-Va).


While some vape industry pundits wondered if the President would impose a restriction or ban on flavored tobacco (and vape) products, some speculated that age restriction could be another method to prohibit underage use.

Legal cannabis vape products are already restricted to consumers over twenty-one by licensed vendors; bootleg and counterfeit vape products have raised concern since late summer, when the emerging EVALI crisis saw its first reported fatalities and resulted in an multi-state investigation, involving the Centers for Disease Control, public health officials, and respiratory specialists.

The CDC on Thursday announced that vitamin E acetate is “closely associated with” thousands of cases. The CDC also said that cases of the vaping-related respiratory condition had leveled off since September, when the crisis was at its height. Currently, there have been 2,506 cases diagnosed and fifty-four deaths attributed to EVALI.

As part of their investigation, a study of fifty-one patients showed “Vitamin E acetate was identified in bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from forty-eight of the fifty-one EVALI patients.” The patients’ results were compared to the BAL fluid in test results of ninety-nine healthy patients.

In addition to vitamin E acetate, the study also looked for “plant oils, medium chain triglyceride (MCT) oil, coconut oil, petroleum distillates, and diluent terpenes,” but CDC did not comment on levels of those compounds.

Vitamin E acetate is commonly used as a thickening agent in topical products and ingestible supplements. It had been used in some tobacco and cannabis vape cartridge fluids to add viscosity, or to make up fluid volume.

The CDC and legal vape product manufacturers have pointed out that illegal vape products seem to also have some connection to the medical crisis. Many patients said they vaped THC products—some, in addition to tobacco products—and with some patients located in states where cannabis products are illegal.

UPDATE: December 12, 2019 – 1:55 p.m. PDT – Massachusetts’ three-month ban on nicotine vape products expired yesterday, though flavored products are still prohibited. Media reports indicate that in vape stores, products are starting to reappear on shelves. Shops are required to post signs warning of potential hazards with vape use.

Cannabis vape products remain “quarantined” in the state by the Cannabis Control Commission, as reported by CBS News. The commission is scheduled to meet on December 19, but there has been no indication if restriction will be discussed.

The Associated Press in early December reported results of a survey that sourced data from “interviews, court records, news accounts and official releases” and found that since 2017, officials have seized 510,000 illegal cannabis vape in the U.S. and arrested one hundred twenty people while investigating illicit marijuana vape manufacturers. New York state drug enforcement officials reported seizing 200,000 since summer.

In California, Minnesota, Wisconsin, Alabama, and beyond, illegal and counterfeit vape cartridges are produced on a large scale by unregulated manufactures that often operate out of their homes.

Law enforcement officials in states that do not have legal cannabis are learning new procedures for recognizing illegal vape products, in addition to more conventional dried cannabis flower.

Finally, yesterday: The City of Palo Alto, which is located in Santa Clara County, in the Bay Area of California, already has a countywide ban on flavored tobacco and e-cigarette products. But in an effort to increase enforcement—especially on underage vape users—Palo Alto city officials are considering a fine for vaping in public. 

WASHINGTON, D.C. – The Centers for Disease Control and Prevention (CDC) on Thursday released data from an ongoing investigation into the nationwide epidemic of vaping-related illnesses that surfaced in September. In its weekly EVALI update, the agency named several illicit THC vape brands that have been implicated in the crisis.

“While Dank Vapes was most commonly reported in the Northeast and South,” the CDC report said, “TKO and Smart Cart brands were more commonly reported by patients in the West, and Rove was more common in the Midwest.

“The data further supports that EVALI is associated with THC-containing products and that it is not likely associated with a single THC-containing product brand,” CDC added.

The report mentioned vitamin E acetate, which was singled out previously as having a connection to EVALI; lung fluid samples from twenty-nine EVALI patients contained the substance, used to add viscosity and volume to cannabis cartridge contents and e-fluids.

As of December 3, fatalities attributed to EVALI seem to have leveled somewhat at forty-eight, in twenty-five U.S. states and the District of Columbia. The number of cases was adjusted to remove non-hospitalized EVALI cases, leaving hospitalized cases at nearly 2,300.

Negative news about vaping also emerged with a new case study published in peer review European Respiratory Journal.  The report described “a patient who developed pathologically documented giant cell interstitial pneumonia following regular use of an e-cigarette. This disorder has been termed hard metal pneumoconiosis, or cobalt lung, due to its close association with exposure to hard metal (cemented tungsten carbide with cobalt).”

When researchers analyzed the fluid contained in the patient’s vape “device” or e-cigarette, they found a high level of cobalt, a toxic heavy metal. The patient’s condition is consistent with inhaled cobalt exposure from vaping over a period of time, the study said further. Media reports added that cobalt lung is a condition typically seen in steelworkers.

The patient was reported to be female, forty-nine years old, previously healthy, and a resident of California.

Vaping bans continue to expand, though no action has been taken at the federal level in the U.S.—or Canada, where concerns over vaping are growing though Canada and other countries do not seem to have sustained anywhere near the number of vape-related lung injuries as have been diagnosed in the U.S.

In early December, officials in Nova Scotia, Canada, agreed to implement a ban on flavored vape products, which will go into effect on April 1, 2020. Though Nova Scotia is the first province to place a ban on vape products, a spate of vaping bans have been implemented by municipalities, varying from region to region—much like U.S. officials have done in cities and states, while the CDC continues its investigation.

“This hodgepodge of rules and limits across Canada will lead to massive confusion, a lack of enforcement, and, most importantly, a lack of protection for millions of our kids,” wrote Jim Warren in the Toronto Sun.

Finally, in more bad news for vaping: Dentistry peer publication DentistryIQ.com last week posted a research study on vaping effects in periodontal disease. Titled Electronic nicotine delivery systems: Vaping away gum tissue, researchers said, “Evidence-based research has shown the use of electronic nicotine devices leads to changes in cellular activity, which manifests as a strong risk factor for periodontal disease and fibrosis of the oral submucosa.”

Ed. Note: This is a developing news story, more information will be added as it becomes available. See mg‘s previous coverage for earlier details about the epidemic.