A new "breakthrough" in research from the Centers for Disease Control and Prevention has brought cutting agent vitamin E acetate back under the microscope as the tally of people sickened from vaping-related lung injuries surged past 2,000.
New research from the agency, released on Friday, examined lung fluid samples from victims of e-cigarette, or vaping, product use associated lung injury (EVALI) and found vitamin E acetate in 100 percent of samples from 29 patients across 10 states. Previous testing had only found vitamin E acetate in vape liquids, rather than in the biological tissue of patients impacted.
"These new findings are significant because for the first time, we have detected a potential toxin of concern, vitamin E acetate, in biologic samples from patients," CDC Deputy Director Dr. Anne Schuchat told reporters on a call on Friday. "These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lung, and the samples reflect patients from states across the country.
Vitamin E Acetate is a common vitamin supplement found in cosmetics and food that is used as a thinning agent in (mostly illicit) vape liquids. Officials said it is still safe to consume this supplement in food or use it on skin, but that inhaling the product may have adverse effects.
Officials in some states, like New York, had previously suspected the thinning agent was to blame in the rash of illnesses, but the FDA and CDC have maintained more cautious language. Even on the back of Friday's reports, Schuchat emphasized that "these findings do not rule out other possible compounds or ingredients that may be causing these lung injuries."
"These findings tell us what entered the lung of some patients with EVALI," she added. "Although vitamin E acetate was universally detected in these 29 ... samples, additional studies are needed to determine whether a causal link exists between the exposure and EVALI."
The CDC also tested samples for plant oils, petroleum distillates, MCT oil, and terpenes. THC and its metabolites were found in lung samples from 23 of 28 patients — even three patients who said they did not use THC products.
"THC is not something we expect to find hanging around in the lung fluids," Dr. Jim Pirkle of the CDC's Environmental Health Lab, said on a call with reporters, emphasizing that urine is typically the place THC and its metabolites are found.
The CDC said Friday's findings reinforced the agency's previous advice to the public to "not use e-cigarette or vaping products that contain THC," especially those obtained illicitly.
Illinois researchers who compared survey results from THC users and from EVALI patients and found that EVALI victims were nine times more likely to have obtained their THC vape products informally — from friends, family, or the illicit market — than average THC vape users. Dr. Jennifer Layden, chief medical officer and state epidemiologist at the Illinois Department of Public Health, added that none of the EVALI victims in Illinois had purchased their products at licensed medical cannabis dispensaries.
But Schuchat said it is still too soon to exonerate licensed vape products and retail shops, considering anecdotal reports remain of illnesses related to products purchased at legal dispensaries, differences in the severity of regulations that govern additives state-by-state, and the severity of the illness.
"The majority of what we are seeing right now is pointing to informal spaces," she added. "We have cases now from 49 states, many of which have legal marijuana markets. The data are pointing toward the illicit supply, but this is a very serious disease which can be fatal, and I don't think we know enough yet to completely take dispensaries out of the question."
The CDC reported on Thursday that, as of Nov. 5, 2,051 people have fallen ill and 39 have died from EVALI across 49 states, Puerto Rico, and the U.S. Virgin Islands. That tally represents a jump of 163 illnesses and two deaths since last week's report.
"The trend in cases appears to be downward, but we understand that some states are still hard hit and this continues to be a very active investigation," Schuchat said.
Although THC vape products have been implicated in a majority of cases of EVALI, nicotine vapes have not been ruled out, and the CDC still recommends the public consider from refraining from use of all vapes or e-cigarettes.