As the outbreak of vaping-related illness that has sickened more than 2,000 people across the country and killed at least 39 continues, it’s been clear that THC vape products are playing a major role.

But what hasn’t been clear is which specific product or ingredient might be at fault. Finally, on Friday, the Centers for Disease Control and Prevention announced a “breakthrough” in the agency’s investigation.

Vitamin E acetate, an oily chemical added to some THC vaping liquids to thicken or dilute them, has emerged as “one very strong culprit of concern,” said Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, at a press briefing.

The chemical is a synthetic form of vitamin E, and it’s used — safely — in nutritional supplements and skin creams. But it isn’t safe to inhale. Sticky and honey-like, it can hang around in the lungs, health officials said, interfering with how they function. Samples taken from 29 patients in 10 states, for a CDC Mortality and Morbidity Weekly report released Friday, found the chemical in all samples, while other potential toxins — such as plant and mineral oils — weren’t. It’s “direct evidence of vitamin E acetate at the primary site of injury within the lungs,” Schuchat said.

But Schuchat also emphasized the CDC’s investigation isn’t over: Officials still can’t say for sure that vitamin E acetate is the source of harm in all cases. “Identifying a collection of information that points to vitamin E acetate as a concern for lung pathology doesn’t mean that there are not other components causing lung harm,” she added.

Right now, though, the chemical has emerged as a likely culprit. And the new finding adds to the evidence from federal and state investigations showing vitamin E acetate appears to be a common link in many vaping-related illness cases. Of the 419 THC-containing products the Food and Drug Administration has tested, 50 percent contained the sticky substance as of November 8. Recent data from Utah found the chemical in 89 percent of the THC-containing cartridges tested there. New York State — where health officials were first to signal concern about vitamin E acetate — found vitamin E acetate in many of the THC vaping cartridges used by patients suffering respiratory illness.

Black market cannabis suppliers have been known to use vitamin E acetate — but legitimate suppliers may be using the chemical, too

State and federal investigations have also found many of the THC products people reported using were THC cartridges purchased through informal or black market sources. And vitamin E acetate has reportedly been used as a cheap cutting agent by illicit cannabis suppliers.

But even in states where cannabis vaping products are manufactured by legitimate sources, regulators haven’t necessarily been checking for the presence of vitamin E acetate.

Cannabis is subject to a patchwork of state-level health regulations where it’s legal or decriminalized. As I reported recently, these regulations are generally weak and inadequate, revealing a problem in cannabis oversight in this country.

So in Washington state, for example, the Liquor and Cannabis Board regulates the recreational cannabis marketplace, and products are tested for “potency, moisture, foreign matter, microbiological, mycotoxins (fungi), and residual solvents,” according to a spokesperson there. But only medical-grade products are also tested for pesticides and heavy metals. The list of tests also doesn’t include checking for chemicals, such as vitamin E acetate, that have emerged as a health threat. “Until only recently with the outbreak of the vapor associated lung injury crisis, no one suspected additional safety tests should be considered,” a spokesperson for the board said.

That’s why, with the mounting death toll, some experts are calling for more stringent oversight.

“How confident [are state regulators] that some of the ingredients used in vape oils are safe?” said David Hammond, a public health researcher at the University of Waterloo in Ontario who studies the e-cigarette and THC vape markets in Canada and the US. “I don’t know if anyone knows that. It’s the manufacturer’s job to make sure products don’t include harmful chemicals. But the whole concept of vaping from liquids is fairly new and we don’t have a lot of certainty.”


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