Review of EVALI vaping lung injury links cases primarily to THC-containing products and vitamin E acetate | Research

The takeaway

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.

Pulmonologists, emergency physicians, cannabis vaping consumers, and product safety regulators.

~2% mortality; linked to unlicensed THC vape products with vitamin E acetate

What the researchers 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.

Why it 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 numbers in context

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 the study worked

Literature review examining clinical features, investigations, and possible mechanisms of EVALI in the context of US and UK vaping practices.

What this study cannot 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.

How to read the evidence

Moderate: review synthesizing clinical and epidemiological evidence from a well-documented outbreak.

When this study was published

Published in 2020 in British Journal of Hospital Medicine.

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.

Questions still open

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?

Common 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.

Read the original research

E-cigarette or vaping product use-associated lung injury.

British journal of hospital medicine (London, England : 2005), 81(4), 1-9

View on PubMed ↗Publisher’s paper ↗

Citation

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