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UPDATE: Big Picture in 'Vaping-Linked' Lung Poisonings

Over the last three months, the news has been filled with stories of people—mostly young—falling seriously ill from a mystery lung ailment supposedly caused by vaping. Some of the reporting has been good, particularly that coming from the cannabis industry media. But, the vast majority of the coverage has been incomplete, inaccurate, and done little more than scare and confuse the public. Anti-vaping activists and certain public health agencies that have long wished to ban e-cigarettes have skillfully exploited this confusion to convince people the outbreak is a manifestation of the health threat posed by e-cigarettes, of which they have long warned. Worse, they are using such scare tactics as justification for restrictions or bans on these products, which have helped millions of adult smokers quit their deadly habit.

As I have written previously, none of the evidence provided so far implicates traditional nicotine vaping in the outbreak of acute lung poisoning. Rather, it seems to implicate some new form of THC e-liquid (the active ingredient in cannabis), most likely one made by illegal operators. But even without the evidence implicating THC vapes, the focus on e-cigarettes as the main culprit betrays basic principles of epidemiology.

As Dr. Konstantinos Farsalinos, a cardiologist, recently wrote, a sudden outbreak in a short period of time and in a specific geographic region (so far this appears restricted to the U.S.) when e-cigarettes have been available and widely used around the world for more than 12 years, is not indicative of disease, but rather of poisoning. That is, it is unlikely that the cause stems from well-established products, but rather from a new product, ingredient, or manufacturing practice affecting products in the illegal market, legal market, or both. It does not, as some argue, prove that e-cigarettes or vaping causes long-term harms.

In an effort to provide the public (and the media) with an accurate and complete picture of the outbreak, I have gathered all of the current information. This includes details from the 36 states, and one territory, with confirmed cases, states with cases under investigation, and details about individual patients, where available.

Regarding individual patients, details are provided from all of the available sources with notes about missing details. For clarity, I have included all of the information from all of the patients publicly cited as being involved in the outbreak, regardless of the products they said they used, whether they were legally or illegally obtained, and without judgement about their behavior. I sincerely hope all involved have a speedy and complete recovery.

This list will be updated as information becomes available.

Update September 17: An Associated Press investigation recently reported that CBD products sold in several states found that 128 out of 350 samples tested positive for synthetic marijuana. Three samples also contained fentanyl. It is not clear at this time if these adulterated CBD products are involved with the current outbreak. 


States with Confirmed Cases per the U.S. Centers for Disease Control and Prevention

 

Arkansas

Four confirmed or probable and four cases under investigation as of September 3

 

California

70 possible cases and 2 deaths as of September 17

One death occurred in Los Angeles County. Health officials have not named the individual who died, but noted that the person was at least 55 years of age with unrelated chronic health issues, who had been vaping THC oil. It has not been noted if the patients was using other forms of vaping.

One death occurred in Tulare County and is the seventh death in the outbreak. According to a press release from the  Tulare County Health and Human Services Agency (which appears to no longer be accessible), the unidentified adult man died of “complications related to the use of e-cigarettes.” An unnamed person with the county health agency also told the Los Angeles Times that the man had been in the hospital for “several weeks” before his death. However, as the Washington Post later reported, the deceased man’s family indicated that he became ill only two days prior to his death and had been using both e-cigarettes and THC vape products.  

12 cases in Los Angeles County have been reported, in addition to the death. Eleven of the 12 have a confirmed history with cannabis, marijuana, THC, or a combination of these.

Eight cases in Kings County have been reported, all of whom recently purchased THC products from unlicensed retailers. In early August, the Kings County Department of Public Health issued a warning about the dangers of vaping cannabis or cannabidiol (CBD) oils, advising consumers that if they are going to vape THC oil, to buy it from a licensed retailer.

Four cases in Alameda County have been reported; “most involved teenagers or young people and the use of some form of cannabis,” according to Alameda County interim health officer Dr. Erica Pan.

Ricky D’Ambrosio, 21, was hospitalized with acute respiratory failure. The Placer County Department of Public Health says it is “unclear whether Ricky was vaping tobacco or cannabis.” He is now home and recovering.

Simah Herman, 18, was admitted to the hospital in August with pneumonia-like symptoms related to vaping. In a viral Instagram post, Simah notes that, “this is all because of vaping,” and warns that “whether [it’s] nicotine or weed vaping can be fatal.”  She admits to using “weed,” but it isn’t clear whether she vaped THC oil and, if so, whether it was purchased legally or illegally.

Fabian Castillo, 19 was put into a medically induced coma in August. In an Instagram post Fabian urged people to quit both vaping and smoking. Castillo said he used a SMOK e-cigarette and primarily used nicotine cartridges from smoke shops, but also occasionally vaped THC cartridges provided by a relative.

 

Colorado

Two confirmed and two cases under investigation as of September 16

Four people were hospitalized throughout the summer with vaping-linked respiratory illness, all of who had vaped liquids or oils containing either nicotine, marijuana, CBD or synthetic marijuana, according to Colorado’s Health Department.   

Two cases have been confirmed.

Piper Johnson, 18, of New Lenox, IL was admitted to the hospital in August. Initial reports noted only that she had been “vaping,” but later reports note that she had been vaping both nicotine and THC oil. She is now home and expected to make a full recovery. Given that reports note that Johnson’s symptoms began as she and her parents were driving from Illinois to Colorado, it is likely that whatever vaping product might have been involved was purchased in Illinois or, at least, outside of Colorado.

 

Connecticut

11 possible cases as of September 12

Seven patients are residents of Fairfield County.

Three patients are in New Haven County.

One patient is in New London County.

Cara Boyhan Fraser, 19, was hospitalized with a “very rare form of pneumonia” in March 2018. She insists the cause of her illness was her two- to three-year habit of vaping the e-cigarette Juul. She insists that she used no other form of vaping. It is not clear whether health authorities consider her illness part of the current outbreak since it occurred in 2018.  

 

Delaware

Three possible cases as of September 14

Delaware Division of Public Health medical director Rick Hong noted that, “many of the reported cases have a cannabis link,” but stressed that, “there are cases where it’s not related to marijuana.” It isn’t clear if Hong is referring specifically to Delaware’s cases or the nation at large.

 

Florida

Unknown number as of September 11

The Florida Department of Health has declined to provide many details, other than to say that there have been “several potential reports of illness” related to the use of “e-cigarettes.”

Chance Ammirata, 18, was hospitalized in August. In social media posts that have received wide attention, he blames his illness on the e-cigarette Juul. Ammirata recently told Buzzfeed news that he only used Juul, and no other form of vaping. Whether or not Juul is linked to his illness is unclear as some doctors have noted spontaneous lung collapse—unrelated to vaping—is fairly common in young, tall, thin men, like Ammirata.  

 

Georgia

Three confirmed and 10 cases under investigation as of September 13

All three of the confirmed cases involve patients with a history of vaping THC; one using both THC and nicotine, one vaping THC only, and the third vaping THC and hash oil.

The Georgia Department of Public Health has not provided details on the remainder of the cases under investigation.

 

Hawaii

One possible case as of September 16

An unnamed teenage girl on the Big Island was hospitalized with a severe “vaping-linked” respiratory illness. The Department of Health has declined to give details about what she had been vaping, but has cautioned people about using e-cigarettes and urged against “unregulated vaping products that contain THC.”

 

Idaho

Four confirmed cases as of September 13

Idaho health officials alerted the public to severe respiratory illness “associated with e-cigarette use, also known as vaping, juuling, or dabbing.” Officials have said they don’t know if the patients were vaping nicotine, THC, or both. Updates occur every Friday by 2:00pm MT.

 

Illinois

52 confirmed and 12 cases under investigation and one death as of September 16

Many of the patients reported recently vaping illicit THC oil, but not all. “We can't say if that was because they were scared to acknowledge it or because they never used it," said Dr. Ngozi Ezike, director of the Illinois Department of Public Health.

The first known death in the outbreak was reportedly female and in her 30s with a recent history of vaping. Health officials have not yet said if she was vaping nicotine, THC, or something else.

Adam Hergenreder, 18, was hospitalized after using a THC vape cartridge he said he purchased from a drug dealer. Hergenreder is now suing the e-cigarette company Juul, alleging it used “deceptive marketing tactics to target adolescents,” as well as a local gas station that allegedly sold him e-cigarettes while he was underage.

Brian Krasne, 20 was admitted to Northwest Community Hospital in Arlington Heights, with double pneumonia and a swollen pancreas. Krasne has a history of using THC “dabs,” but it is unclear where he purchased them or if he used any other form of vaping. Brian’s mother, Tracy Krasne, said she planned to provide samples of her son’s vapes to investigators.

 

Indiana

30 cases and one death are under investigation as of September 10

One death has been linked to the outbreak. Officials at the State Department of Health revealed that the diseased person was an adult, but have not provided any more details about the patient or what s/he had been vaping.  

John Porter, 19, was hospitalized in August with severe respiratory failure that ultimately resulted in both of his lungs collapsing. Porter admits to vaping both e-cigarettes—presumably with nicotine—and THC vape cartridges.

Kyle Lano, 21 was hospitalized in the summer of 2018 with a collapsed left lung. He says he continued to use e-cigarettes because he didn’t believe that they were involved. However, this summer his right lung collapsed and he now believes his vaping was the cause. Spontaneous pneumothorax is, however, not uncommon among tall, thin, young men like Lano.

 

Iowa

13 cases as of September 13

12 out 13 patients reported vaping THC, according to the Iowa Department of Public Health, as of September 13. Patients age range from “young to middle-age adults.”

 

Kansas

Three confirmed/probable, three cases under investigation, and 1 death as of September 15

One death occurred in an unnamed woman over the age of 50. She had a history of underlying health problems, according to officials

The Kansas Department of Health and Environment has not provided details about what any of those involved were vaping

 

Kentucky

5 cases under investigation as of September 14

As of August 30, there were no reported cases, according to the Cabinet for Health and Family Services. On September 14, however, it was announced that the state is investigating three to five cases likely linked to vaping. 

Eli Sirls, 23 of Marshall County says he had been vaping THC for about a month, but he became ill around August 30 after purchasing a cartridge from a friend. After developing a high fever and experiencing vomiting, Sirls was admitted to Baptist Health Paducah where, after being released and readmitted, his lung collapsed. He is still in the hospital, but expected to make a full recovery and be released in a few days.

 

Louisiana

13 cases as of September 16

There are no details yet on the individuals, diagnoses, or products involved in Louisiana. Dr. Joseph Kanter of the Louisiana Health Department stated that “investigators don’t know yet what’s causing it.” Ages of those affected range from 17 to 33 years old.

Scott Goldstein, 45, of Shreveport, was hospitalized in September with pneumonia-like symptoms. He says he started vaping to help him quit smoking. Though news stories have only mentioned Goldstein’s use of “vaping” as a smoking cessation method, there is some evidence posted to his Facebook page indicating that, in addition to Logic e-cigs, he also vaped THC. It isn’t clear yet if that THC usage was recent or where he might have obtained it.

 

Maryland

15 cases as of September 14

The Maryland State Health Department notes that “some” of the cases are linked to THC vape cartridges. Reports also state that the patients who became ill included individuals who used either devices that contained both nicotine and marijuana or THC products. It is unclear if they meant the patients had used both nicotine and marijuana or only one of the two.

Some of the THC products used by the patients in Maryland have tested positive for vitamin E acetate, but not all. 

 

Michigan

Six cases of vaping related illness are under investigation as of September 16

Some of the cases involve individuals who used THC vaping products, according to the Michigan Department of Health and Human Services. They also note that all of the cases (as of August 28) occurred in the Lower Peninsula and patients ranged in age from 19 to 39 years old.

 

Minnesota

33 confirmed or probable and 18 cases under investigation, and one death as of September 17

All patients interviewed so far have reported vaping illicit THC products, according to the state Minnesota Department of Health on September 6.  

One death occurred in August. The individual was 65 years of age and became ill after using illicit THC, according to media reports and the MDH.

 

Nebraska

One confirmed and five cases under investigation as of September 4

All patients were male and ages ranged from late teens up to early 40s.

All patients had either been vaping or “dabbing” (using a THC vape) in the 90 days prior to their illness, according to the Nebraska Department of Health and Human Services.

 

Nevada

One confirmed case as of September 11

A minor from Clark County was hospitalized in September with an illness linked to vaping, according to the Southern Nevada Health District. No other details were provided.

 

New Jersey

Three confirmed and 19 suspected cases as of September 17

Ages of the patients range from 16 to 45. The patients reported using a variety of devices containing nicotine or THC, according to the New Jersey Department of Health.

 

New Mexico

12 cases as of September 11

Eleven cases out of 12 have been linked to vape pens containing THC, according to an epidemiologists with the state Department of Health.

 

New York

71 reported cases reported as of September 16

Patients ranged in age from 14 to 46 years old “who were using at least one cannabis-containing vape product prior to becoming ill,” according to the State Department of Health.

All of patients who submitted products for testing were found to have used at least one product containing vitamin E acetate.  vitamin E acetate.

Nearly all of the samples tested contained “very high levels of vitamin E acetate.”

Some patients also report vaping nicotine.

Jonathan Doneson, 52, of Long Island was admitted to North Shore University Hospital in August with pneumonia. Doneson reported that he “frequently vaped THC.” He hasn’t revealed where he obtained his THC vape, but after testing, his vape was found to contain contaminants, including “pesticide, vitamin E, and a little dab of THC,” according to Doneson.

 

North Carolina

Five cases as of September 14

All of the patients were between 18 and 35 years old and shared a history of recent history of vaping illicit THC or marijuana oils, according to the CDC.

All of the patients have been diagnosed with acute exogenous lipoid pneumonia.

Three patients reported also using nicotine e-cigarettes.

 

North Dakota

One case as of September 3

The North Dakota Department of Health has not provided any more details.

 

Ohio

3 confirmed and 11 cases under investigation as of September 13

The ages in the three confirmed cases range from 18 to 26 and occurred in Lucas, Richland, and Union counties.

Cameron Collier, 20, of Lincolnshire, was hospitalized on September 1 with a sudden illness caused, he believes, by his “prolonged e-cigarette use, including THC.” He is urging “everyone to stop [vaping.]”

 

Oregon

Two cases and one death as of September 11

A middle-aged man died in July after using “an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary,” according to the Oregon Health Authority. It is not clear if the man purchased or used other kinds of vapes (legal or illegal.)  

 

South Carolina

Three confirmed and eight cases under investigation as of September 13

 

South Dakota

Two confirmed cases as of September 13

One patient was an unnamed person, 20 years old.

One patient was an unnamed person, 24 years old.

 

Tennessee

10 cases as of September 12

Four patients are teenagers who were admitted to Vanderbilt Children’s Hospital in August.

 

Texas

17 confirmed and 12 cases under investigation as of September 13

Of the 29 cases, most have occurred in north Texas and approximately half involve teenagers.

14 out of 29 cases occurred in Dallas County (as of September 17) and  90 percent of those report vaping THC products. They ranged in age from 16 to 44 with a median age of 19.

Eight cases have occurred in Tarrant County as of September 13.

Three cases have been reported in Brazos County as of September 14.

One patient is an anonymous male, age 18-22 hospitalized with a serious lung illness related to “vaping.” The product was not specified.

Whitney Livingston, 17, was admitted to Children’s Medical Center Dallas in August with pneumonia in both lungs. Her mother reports that Livingston had been vaping for two years. No other details have been made public. 

Tryston Zohfeld, 17, was hospitalized at Cook Children’s Medical Center in Fort Worth with fluid in his lungs and put into a medically induced coma in July. His parents say they learned he had been vaping since he was 14 years old. He is now home recovering.

 

Utah

42 confirmed and 14 cases under investigation as of as of September 16

The health departments says the cases involve a mix of people who used nicotine, THC, or both.

90 percent of the cases involve patients who report vaping THC.

All six patients at the University of Utah health were found to have oil accumulation in their lungs (macrophages), according to doctors at University of Utah Health, who produced the first lung scans now used as a marker for the illness.

Utah state Rep. Paul Ray (R-District 13) claimed that tests of retail vaping liquids found that “roughly 84% of the product tested, tested positive for an illegal drug.” However, the lab that performed the tests, Beechtree Diagnostics, disputed the claim, noting that their tests were unofficial, presumptive, not particularly accurate, and “not to be taken as evidence.”

Alexander Mitchell, 20, was hospitalized with pneumonia-like symptoms. Doctors found evidence of oil in his lungs. Mitchell says he mostly vapes nicotine, but “has used THC a few times with friends.” Mitchell believes his illness stems from a different brand of e-liquid (peach-menthol) purchased at a licensed vape shop in mid-June. He is now home and recovering, but his doctors say it make take years for his lungs to fully recover.

Maddie Nelson, 18, of Nephi, began vaping three years ago. After weeks of feeling ill with nausea, chest pains, vomiting, and high fever, she was admitted to the hospital on July 27. In a viral Facebook post, Maddie notes that her diagnosis of Acute Eosinophilic Pneumonia “came from something in the many different brands of pens I had been using.” She has since joined an awareness campaign to warn about the dangers of vaping, noting that “anyone who thinks vape is a safe alternative to smoking you are wrong. It doesn't matter if it's a regular vape or special thc pen or [J]uul…”

Also on Facebook, she notes that she had been using “vapes” and “special pens.” It’s not clear whether she used anything other than nicotine e-liquid, but an Instagram post from October 28, 2018, indicates that she has—in the past—used cannabis products.  

A GoFundMe for Maddie is raising funds for her recovery and an awareness campaign. 

 

Vermont

One confirmed and five cases under investigation as of September 16

 

Virginia

Eight confirmed cases as of September 16

Patients report “using e-cigarettes or vaping in the weeks or months before they became ill.” No more details are yet available.

 

Washington

Three cases as of September 16

A teenager from King County fell ill in early August. The patient reported having used “e-cigarettes” for three years, containing nicotine and saffron in a vaping cartridge. King County’s public health department said it did not know the specific vape device that was used or if the teenager had used other cannabis-infused vaporizers.

A teenager and patient in their 20s comprise the other two cases which occurred in Spokane County and were announced in September.

 

West Virginia

One confirmed one probable case as of September 11

 

Wisconsin

34 confirmed cases and 20 under investigation as of September 12

Most of the patients reported using vaping devices to inhale THC-containing products, according to the Wisconsin Department of Health Services.

24 out of the 27 patients interviewed admitted vaping THC prior to their illness, in late August. According to a study published in the New England Journal of Medicine in September, 84 percent of the patients in Illinois and Wisconsin collectively admitted to using some form of cannabis vaping product.

Dylan Nelson, 26, was put into a medically induced coma at Aurora Memorial Hospital in Burlington, WI in July. He told the Milwaukee Journal Sentinel he had been vaping nicotine and an illegal THC oil cartridge (Dank Vapes). Both Dylan and his family believe the THC cartridge is to blame. Asked what he wanted people to know, Dylan said, “don’t do drugs, period.”

Arrest: Brothers Tyler and Jacob Huffhines have been accused of running a large illegal THC cartridge operation out of their Kenosha home. Officers seized more than 30,000 THC cartridges. Authorities have sent samples of the seized cartridges to a laboratory, but it is not yet clear if they are involved in the lung poisonings occurring in Wisconsin and the rest of the nation.

 

U.S. Virgin Islands

Unknown number of cases as of September 10

The CDC lists the U.S. Virgin Islands as among the U.S. states or territories with cases, but no information has been made public as to how many.

Most cases involved are suspected to be “the result of adulterated or contaminated products involving THC or other cannabinoids from marijuana,” according to the U.S. Virgin Islands Health Department.

 

 

States not listed as part of the CDC’s outbreak map 

 

Massachusetts

38 cases as of September 16

38 cases of severe lung illness related to vaping have been reported in Massachusetts, according to an announcement on September 16 by the state Department of Public Health.

7 of the cases involve teenagers.

Missouri

Two confirmed and seven cases under investigation as of September 16

Two patients are hospitalized at the St. Louis Children’s Hospital.

All cases are still under investigation by the Missouri Department of Health and Senior Services.

 

Pennsylvania

17 suspected and 30 cases under investigation as of September 12

Initial findings indicate that the patients in Pennsylvania were vaping illicit products, primarily recreational marijuana or other unregulated products with THC, according to the Pennsylvania Department of Health.

Zero cases have been associated with medical marijuana bought at a Pennsylvania dispensary.  

Kevin Boclair, 19, was put into medically induced coma after coming down with an illness his parents believe is linked to his use of e-cigarettes. He may require a lung transplant. Specifics about his vaping were not specified.

 

Wyoming

One confirmed case as of September 13

One patient, described only as a “young adult” from Uinta County, was hospitalized with severe lung disease. No further details are available.

This post was updated on September 18, 2019.