Utah EVALI investigation: 92% of hospitalized patients had used THC vaping products | Research

The takeaway

Among 53 Utah patients with vaping-associated lung injury, 92% had used THC-containing products, and vitamin E acetate was found in 89% of tested THC cartridges.

Vape users, public health officials, emergency physicians, and harm reduction workers.

89% had vitamin E acetate

What the researchers found

92% of interviewed patients reported using THC-containing products, 66% used nicotine products, and 60% used both. Most THC products came from informal sources (friends, illicit dealers). Testing of THC cartridges found vitamin E acetate in 17 of 20 (85%) samples. 89% of patients were hospitalized and 49% required breathing assistance.

Why it matters

This investigation was part of the evidence that ultimately linked EVALI to vitamin E acetate in illicit THC cartridges, a finding that changed both public health messaging and industry practices.

The numbers in context

83 patients identified; 79 chart reviews; 53 interviews; 92% used THC products; 89% of tested cartridges contained vitamin E acetate; 89% hospitalized; 49% needed breathing assistance; THC products used 1-5x/day.

How the study worked

Epidemiological investigation of 83 Utah EVALI patients. Medical chart abstractions completed for 79 patients, detailed interviews with 53, and product testing of 20 THC cartridges from 6 patients.

What this study cannot tell us

Cross-sectional investigation with self-reported exposures. Product samples available from only 6 of 53 interviewed patients. Unable to determine definitive causal agent at time of publication.

How to read the evidence

Moderate: systematic public health investigation with laboratory confirmation, but limited product sampling.

When this study was published

Published in 2019.

The bigger picture

The EVALI outbreak killed 68 people and hospitalized thousands nationwide. Utah's investigation was among the first to systematically link the injuries to THC cartridges from informal sources contaminated with vitamin E acetate.

Questions still open

How widespread is vitamin E acetate contamination in current illicit THC cartridges? Have EVALI cases declined since the cause was identified?

Common questions

What caused EVALI?

Evidence from this and other investigations linked the lung injuries primarily to vitamin E acetate, a thickening agent added to illicit THC cartridges.

Were legal THC products involved?

Most THC products were acquired from informal sources like friends or illicit dealers, not from licensed dispensaries.

Read the original research

E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury - Utah, April-October 2019.

MMWR. Morbidity and mortality weekly report, 68(42), 953-956

View on PubMed ↗Publisher’s paper ↗

Citation

Lewis, Nathaniel; McCaffrey, Keegan; Sage, Kylie; Cheng, Chia-Jung; Green, Jordan; Goldstein, Leah; Campbell, Hillary; Ferrell, Deanna; Malan, Nathan; LaCross, Nathan; Maldonado, Alejandra; Board, Amy; Hanchey, Arianna; Harris, Dixie; Callahan, Sean; Aberegg, Scott; Risk, Ilene; Willardson, Sarah; Carter, Amy; Nakashima, Allyn; Duncan, Janae; Burnett, Cindy; Atkinson-Dunn, Robyn; Dunn, Angela. (2019). E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury - Utah, April-October 2019.. MMWR. Morbidity and mortality weekly report, 68(42), 953-956. https://doi.org/10.15585/mmwr.mm6842e1