As US health authorities raced to find what was sending hundreds of healthy Americans to hospital with sudden lung disease, Israel’s Health Ministry on Monday issued a public warning that use of marijuana oil in e-cigarettes “may cause death.”
The Israeli warning comes after US health officials again urged people over the weekend to stop “vaping” until they figure out why some are coming down with serious breathing illnesses.
US officials have identified about 450 possible cases, including as many as five deaths, in 33 states. The count includes newly reported deaths in California, Indiana, and Minnesota.
No single vaping device, liquid, or ingredient has been tied to all the illnesses, officials said. But many of the sickened, though not all, were people who said they had been vaping THC, the chemical that gives marijuana its high. Many are teens.
According to the Washington Post, one possible culprit has been identified: an oil derived from vitamin E that was found in many marijuana oil products sold to sickened vaporizer users in different parts of the US. The oil, vitamin E acetate, is safely used in skin ointment, but was not available for inhalation. Recently, producers of marijuana oil for vaping products have begun to mix it into the oil to thicken the liquid. Officials said it is considered dangerous if heated and inhaled.
New York state investigators found the substance in 13 cartridges collected from eight patients. In several cases, the ingredient made up more than half of the liquid in the cartridge.
In its Monday statement, the Israeli Health Ministry took note of the initial US findings.
“A preliminary investigation has found that most of the cases [of illness] have been linked to use of the vaporizer to steam cannabis oil,” the Israeli Health Ministry said.
Though “the investigation is still underway,” the ministry “emphasizes that cannabis oil is intended for consumption only via drops under the tongue, and is prohibited for use in a steaming device. Inappropriate use may cause death.”
A “vaporizer,” or “e-cigarette,” is a small device that uses electricity to steam various substances, usually plant-based, so they can be inhaled. They are sold commercially, and are marketed as safer ways to consume tobacco and marijuana than through burning in a cigarette.
But e-cigarettes “are harmful to your health,” the Health Ministry’s Director General Moshe Bar Siman Tov said in a YouTube video attached to the warning. “Be careful with what you put in your body.”
In another video, the ministry’s Deputy Director General Itamar Grotto says he is “in direct contact with the FDA” as the ministry “follows the investigation closely.”
The Israeli statement on Monday included a copy of the US Food and Drug Administration’s Friday warning, in which the FDA noted for the first time that “many of the samples [from patients’ vaporizers] tested by the states or by the FDA as part of this ongoing investigation have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the marijuana plant) and further, most of those samples with THC tested also contained significant amounts of Vitamin E acetate. Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data are limited about its effects after inhalation.”
The FDA noted it still “does not have enough data” to be certain that vitamin E acetate is causing the sicknesses and deaths, “the agency believes it is prudent to avoid inhaling this substance. Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”
Doctors say the illnesses resemble an inhalation injury, with the body apparently reacting to a caustic substance that someone breathed in. Symptoms have included shortness of breath, fatigue, chest pain, and vomiting.
The illnesses have all surfaced this year, and the number has been growing quickly in the last month, as more states have begun investigations. A week ago, US officials pegged the number at 215 possible cases in 25 states.
It is unclear whether such illnesses were happening before this year.
“We’re all wondering if this is new or just newly recognized,” Dr. Dana Meaney-Delman of the Centers for Disease Control and Prevention told reporters Friday.
An Illinois health official, Dr. Jennifer Layden, said officials there do not know when such illnesses first began, but she said there has been a marked increase since spring. Deaths previously were reported in Illinois and Oregon. Indiana officials said the person who died there was an adult, but they did not say when it happened or release other details. Health officials in Los Angeles said they were investigating a vaping death as well. And Minnesota health officials said that state’s first known vaping-related death was a person over 65 years with a history of lung problems who had vaped illicit THC products and died in August.
Officials have emphasized that it is not yet certain that vitamin E acetate is the cause of the illnesses. CDC officials said they were looking at several ingredients, while Meaney-Delman added that no single factor has been seen in every case. On Friday, the New England Journal of Medicine released a series of articles that give medical details about cases reported in Illinois, Wisconsin, and Utah. An article on 53 illnesses in Illinois and Wisconsin noted that nearly one-fifth of the cases were people who said they vaped nicotine and not anything that contained THC or CBD oil.
For that reason, doctors and health officials are continuing to suggest people stay away from all vaping products until the investigation establishes exactly what is at the root of the illnesses.
There has been a split among public health experts about the value of vaping nicotine. Some argue e-cigarettes are not as lethal as conventional cigarettes and can be a valuable aide to smokers trying to kick the habit.
But others say studies have not established that adult smokers who try vaping end up quitting smoking long term. And they fear that kids who might never have picked up cigarettes are taking up vaping.
The National Association of County and City Health Officials “has long been cautious about endorsing e-cigarettes even before the recent spate of illnesses, because little scientific evidence exists to show that e-cigarettes and other nicotine delivery devices are effective cessation devices,” spokeswoman Adriane Casalotti said in a statement.
The Israeli Health Ministry, for its part, concluded its statement Monday by urging Israelis to avoid vaping altogether.
“The Health Ministry’s position is clear: Using electronic cigarettes is harmful to your health!”