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THC products may be factor in outbreak of vaping-related lung injuries: CDC
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Products containing tetrahydrocannabinol, or THC, may play a role in the outbreak of lung injuries associated with use of electronic cigarettes, or vaping, CDC and state public health officials announced today during a telebriefing.
As of Tuesday, 805 confirmed and probable cases of lung injury associated with e-cigarette use have been reported by 46 states and the U.S. Virgin Islands, including 12 deaths in 10 states. These numbers will likely increase as more cases are recognized and reported, Anne Schuchat, MD, CDC principal deputy director, said during the telebriefing.
In terms of patient characteristics, more than two-thirds of patients are male, the median age is 23 years, about 62% of patients are aged 18 to 24 years and 54% are younger than 25 years, according to Schuchat.
In a national-level report published today in Morbidity and Mortality Weekly Report, researchers provided self-reported data from 514 patients about the e-cigarette substances that they used before becoming ill. Of these patients, 76.9% reported using THC-containing products, 40.9% reported using THC-containing and nicotine-containing products, 36% reported exclusive use of THC-containing products and 16% reported exclusive use of nicotine-containing products.
Despite these data, Schuchat noted that CDC has not yet homed in on only one product or substance.
“We are in the midst of a complex investigation that spans nearly all states, involves serious life-threatening disease in young people who report use of a wide variety of substances and products. The outbreak is occurring in the context of a dynamic marketplace for e-cigarettes or vaping products, which may have a mix of ingredients, complex packaging and supply chain, and include potentially illicit substances in any given state. Users do not know what is in their e-cigarette or e-liquid solutions. Moreover, many of the products and substances themselves can be modified by a supplier or user. They can be obtained from brick-and-mortar stores, online retailers, on the street or through social sources,” Schuchat said.
As has been previously stated, CDC currently recommends that people consider refraining from using e-cigarette or vaping products, now with the added caveat that people particularly consider refraining from use of products containing THC, she said.
Data from Illinois, Wisconsin
During the telebriefing, officials from Illinois and Wisconsin — two states that have been at the forefront of the investigation into the outbreak of vaping-related lung injuries — offered more in-depth details about cases that have occurred in their states.
According to data that were also published today in MMWR, public health officials from both states conducted detailed interviews by telephone, in person or through the internet with 86 of 127 confirmed and probable cases in Illinois and Wisconsin from July through September. Interviews primarily focused on the types of drugs used, names of specific brands and types of devices used, Jon Meiman, MD, chief of environmental and occupational health at the Wisconsin Department of Health Services, said during the telebriefing.
All told, he said, approximately two-thirds of patients are younger than 25 years and the population has been predominantly male.
Consistent with findings from the national report, 87% of patients reported use of e-cigarette products containing THC and 71% reported use of nicotine-containing products. Ninety-six percent of THC-containing products reportedly used were prepackaged, prefilled cartridges, with 89% being acquired from informal sources, such as friends, dealers or off the street. In contrast, 77% of products containing nicotine were sold as prefilled cartridges and 83% were obtained from commercial vendors, according to the data in the MMWR report.
Jennifer Layden, MD, PhD, chief medical officer and state epidemiologist at the Illinois Department of Public Health, also noted that among all 86 patients included in the study, 234 unique e-cigarette or vaping products across 87 different brands were reported.
“While no one brand was reported by all patients, prefilled THC cartridges labeled under the brand name Dank Vapes was the most common, with 66% of all patients reporting this name,” she said during the telebriefing.
Layden also reported that individual patients used numerous products and brands before becoming ill. On average, she said, patients who used nicotine-based products used 1.3 different brands and patients who used THC-based products used 2.1 different brands, with some reporting up to seven different THC-based products.
Most patients used products at least daily and often numerous times throughout the day, Layden added.
“These findings do highlight the predominance of prepackaged, prefilled THC cartridges obtained through informal sources. At this time, however, we can unfortunately not identify one product, brand, source or device that’s common across patients,” she said.
Current investigation status
As was emphasized earlier this week at the House Subcommittee on Economic and Consumer Policy hearing, it is not yet clear what is causing the outbreak, according to Schuchat. During today’s telebriefing, she noted that the data from Illinois and Wisconsin, coupled with the national data, “paint a compelling picture” that points to greater concern around THC-containing products. However, CDC is not narrowing its investigation nor is it comfortable with dropping its broader recommendation to consider not using e-cigarette products at this time.
“There remain many questions. We do not know even for the THC-containing products that seem to be closely linked with cases in Illinois and Wisconsin what substances within the products may be causing harm. We have many questions about the supply chain and the integrity of these products, so we need to have an open mind and understand a lot more about the supply chain as well as about the contents of various products that are used within e-cigarettes or vaping to understand which of many toxins might be leading to this type of lung injury,” she said. “To have over 800 cases in this short period of time, many leading to ICU hospitalizations and potentially longer-term lung damage, we really need to understand how many different kinds of products could be risky and how to stop their distribution.”
As Healio Pulmonology previously reported, the FDA’s Office of Criminal Investigation has also become involved. Schuchat noted that the Drug Enforcement Agency, FDA and CDC are working closely to share and investigate information about the products being used and samples from these products are being provided for testing at the FDA’s forensic laboratory. Investigation regarding supply chain traceback would be done through FDA or DEA, depending on the situation, she added.
“This may be more complicated even than we think in terms of more than one product being risky, more than one label on the product and more than one substance within the products, so I think we have to have a very open mind and recognize how dynamic this marketplace is right now and we really want consumers to recognize that it’s a difficult time, as they may not know what they’re purchasing, and we want to make sure families are talking to their kids and that people who are trying to get these products understand the potential risks,” Schuchat said. – by Melissa Foster
References:
Ghinai I, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6839e2.
Perrine CG, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6839e1.
Disclosures: The authors report no relevant financial disclosures.