Review of EVALI vaping lung injury links cases primarily to THC-containing products and vitamin E acetate
A review of the 2019 EVALI outbreak found it was primarily associated with vaping THC-containing products, particularly those from unlicensed sources containing vitamin E acetate as a solvent, with approximately 2% mortality.
Quick Facts
What This Study Found
EVALI presented primarily in young men as severe lung consolidation with respiratory failure. The outbreak was strongly associated with vaping unlicensed cannabis/THC products. Vitamin E acetate, used as a thickening agent in illicit THC vape products, was identified in the lung fluid of EVALI patients and is the leading suspected cause.
Key Numbers
Most cases reported June-October 2019 in the US. Mortality approximately 2%. Primarily affected young men. Associated with unlicensed THC-containing vape products. Vitamin E acetate identified in bronchoalveolar lavage fluid.
How They Did This
Literature review examining clinical features, investigations, and possible mechanisms of EVALI in the context of US and UK vaping practices.
Why This Research Matters
The EVALI outbreak demonstrated that unregulated cannabis vaping products can cause life-threatening lung injury, highlighting the importance of product regulation and quality control in the cannabis industry.
The Bigger Picture
EVALI was largely a consequence of unregulated cannabis markets. The outbreak subsided as awareness increased and vitamin E acetate was identified, supporting the argument that regulated cannabis products are safer than unregulated ones.
What This Study Doesn't Tell Us
The exact mechanism of lung injury is not fully established. Some cases did not report THC use, leaving the possibility of other contributing factors. The review focuses primarily on US and UK contexts.
Questions This Raises
- ?Are there other additives in vape products that could cause lung injury?
- ?Has EVALI truly been eliminated, or are cases going unrecognized?
- ?What standards should regulate cannabis vaping products?
Trust & Context
- Key Stat:
- ~2% mortality; linked to unlicensed THC vape products with vitamin E acetate
- Evidence Grade:
- Moderate: review synthesizing clinical and epidemiological evidence from a well-documented outbreak.
- Study Age:
- Published in 2020 in British Journal of Hospital Medicine.
- Original Title:
- E-cigarette or vaping product use-associated lung injury.
- Published In:
- British journal of hospital medicine (London, England : 2005), 81(4), 1-9 (2020)
- Authors:
- Ind, Philip W(2)
- Database ID:
- RTHC-02623
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
What caused EVALI?
The leading cause was vitamin E acetate, a thickening agent added to illicit THC vape cartridges. When vaporized and inhaled, it appears to cause severe lung damage. The outbreak was concentrated among users of unlicensed THC products.
Is vaping cannabis safe if products are regulated?
Regulated cannabis vaping products that have been tested and do not contain vitamin E acetate or other harmful additives have not been linked to EVALI. However, long-term safety data on cannabis vaping are still limited.
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Cite This Study
https://rethinkthc.com/research/RTHC-02623APA
Ind, Philip W. (2020). E-cigarette or vaping product use-associated lung injury.. British journal of hospital medicine (London, England : 2005), 81(4), 1-9. https://doi.org/10.12968/hmed.2019.0371
MLA
Ind, Philip W. "E-cigarette or vaping product use-associated lung injury.." British journal of hospital medicine (London, 2020. https://doi.org/10.12968/hmed.2019.0371
RethinkTHC
RethinkTHC Research Database. "E-cigarette or vaping product use-associated lung injury." RTHC-02623. Retrieved from https://rethinkthc.com/research/ind-2020-ecigarette-or-vaping-product
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.