Late 2019 saw a national outbreak in hospitalized cases of e-cigarette or vaping product use associated lung injury (EVALI). The United States Center for Disease Control (CDC) reported 2,807 cases from all 50 states, the District of Columbia, and two U.S. territories, including 68 EVALI-related deaths in 29 states and the District of Columbia. In response to this outbreak, Emerge Law Group and Greenbridge Corporate Counsel prepared a bulletin for its clients which is linked here entitled “Client Bulletin: Overview of State and Local Responses to EVALI” analyzing the responses of each state with legalized medical or recreational cannabis to the outbreak.
In November 2019, the CDC identified tocopheryl acetate, commonly known as vitamin E acetate, as a primary “chemical of concern” because 48 of 51 patients with EVALI tested had this chemical in fluid samples collected from their lungs. This chemical is sometimes used as a thickening agent or to dilute THC oil in vaping cartridges. The CDC reports that although vitamin E acetate appears to be associated with most of the cases, evidence is not sufficient to rule out the contributions of other chemicals of concern. However, due to continued declines in new EVALI cases in recent months and the CDC’s identification of vitamin E acetate as a primary cause of EVALI, the CDC stated that its February 18, 2020 update would be its final official update on the number of hospitalized EVALI cases and deaths nationally.
Today, March 6, 2020, JAMA Internal Medicine published an in-depth report on 160 EVALI cases in California. This report—the first to our knowledge to describe cases in a state with a legal adult-use cannabis market—appears to confirm patterns of clinical findings and vaping practices previously reported in other states and nationally. Although California has a legal adult-use cannabis market, the majority of affected patients (83% of those interviewed) reported using THC-containing products obtained from informal sources, such as friends, acquaintances, or unlicensed retailers. When asked specifically whether THC-containing products had been acquired at a licensed dispensary, patients answered affirmatively for only 25% of the THC-containing products. Of these products, only four products had a named purchase location verified as a state-licensed dispensary. In addition, 84% of THC-containing products tested contained vitamin E acetate, reinforcing the potential association between this chemical and EVALI. The report concluded that while use of THC-containing products and vitamin E acetate appear to be associated with the EVALI outbreak, additional investigation is needed to determine the cause or causes.
Both the CDC and the United States Food & Drug Administration (FDA) published recommendations to the public regarding EVALI and the risks of using vaping products, including warnings to stop using any vaping products containing THC. In response to EVALI and the CDC and FDA recommendations, several states with legalized medical and recreational cannabis products acted to address THC-infused vaping products, up to and including partial or complete bans on the manufacture, distribution and/or sale of vaping products.
The linked Greenbridge-Emerge Client Bulletin summarizes state actions undertaken (or proposed to be undertaken) regarding THC-infused vaping products as of March 2, 2020. A previous version of our client bulletin was cited in Marijuana Business Magazine’s February issue focusing on the vaping crisis. Our analysis was also incorporated into the NCIA Policy Council’s white paper on safe vaping entitled “The Key to Consumer Safety: Displacing the Illicit Cannabis Market – Recommendations for Safe Vaping,” which the NCIA has shared with key congressional committees. Check out the Client Bulletin and get in touch to learn more about how your business can successfully navigate the latest legal and regulatory reactions to EVALI.