Investigating a medical mystery

ISecond place, in-depth news writing

In April, the first of what would become thousands were hospitalized for lung injury associated with vaping use. Then, in August, the first patient died.

Numbers of hospitalizations and deaths ticked upwards. As the vaping issue grew to a so called “epidemic,” authorities quickly realized the severity of the crisis. The Centers for Disease Control and Prevention labeled the vaping illness as “EVALI,” which stands for “e-cigarette or vaping product use associated with lung injury,”

Governmental organizations, including the CDC and the Food and Drug Administration, started researching the cause. Much was and is still unknown; the only similarity is that all injuries were associated with e-cigarette use.

Initial Research and Concerns

One popular speculation was put forward as a potential cause in a Morbidity and Mortality Report by the CDC on Sept. 6. Their theory was that “aerosolized oils inhaled from e-cigarettes [were] deposited within [user’s] distal airways and alveoli.”

This meant some of the oils in the vaping solution were being inhaled as liquids, instead of being evaporated and inhaled as gas. The buildup of these liquids is referred to as lipoid pneumonia, a condition described by the CDC as the “aspiration of oil into the lungs.”

Problematic oils thought to be the problem included tetrahydrocannabinol (THC) oil, vitamin E acetate and vegetable glycerin.

Chemical Burns

However, a Mayo Clinic study published in the New England Journal of Medicine on Oct. 2 would soon counter that opinion. Researchers examined the lung biopsies of 17 patients. They found no evidence of the vaping illness being directly caused by oil buildup in the lungs.

The study instead found that the “pattern closely resembles the type of changes that are characteristic of toxic reactions to medications [or] chemical fumes.” The presence of these chemicals may be a result of user-added substances.

“[A] kid I know put vodka in his like an idiot,” said one student, who has been vaping for eight


However, substances from the black market, specifically THC, could also be the problem. The CDC found evidence to support this hypothesis with the discovery that many EVALI patients had used THC.

Black Market THC

According to the CDC, “findings suggest products containing THC, particularly those obtained off the street or from other informal sources […] are linked to most of the cases and play a major role in the outbreak.”

One student, who requested to be kept anonymous, agreed that the black market is responsible because “most [teenagers] don’t buy their carts from a dispensary.” He, along with many others, gets his vaping products online.

According to Billy Vernetti, the co-owner of Elixir Distro, a company that sells nicotine replacement devices, many products bought online are often through third party websites where products may be “counterfeit […] it’s very, very difficult to tell a counterfeit product from a genuine product.”

Through those online websites or third parties, black market manufacturers may be adding unsafe substances to these products that are causing the lung injuries.

UC Davis Study

In a small room at the Center for Environmental Studies, UC Davis professor Kent Pinkerton is leading experiments conducted on mice to find the effects of vaping. “Depending on the ratios of what you’re using [and] the temperature at which you’re vaping, you can produce all sorts of different products,” Pinkerton said.

Among those products, Pinkerton hopes to identify which ones can pose as toxins to humans. The different vape flavorings can dramatically change the products.

So far, Pinkerton believes cinnamon and grape are most problematic. Another factor the study is considering is the metal coil, the part that heats up to vaporize the liquid.

Heating the coil will cause metals to go into the vapor. Because “there are several different metals that are known to be carcinogenic,” Pinkerton said, this may also be a factor.

Looking Forward

As the vaping crisis continues, other researchers are looking into probable causes and solutions. Until the mystery is resolved, health organizations like the CDC recommend that no one vape or use products containing THC.

“Vaping is a very immediate crisis and nobody should do it at all,” said Marc Braverman, professor of social and behavioral sciences at Oregon State University. Addiction therapist Youssef Elmanawy urges people to start spreading awareness about the vaping crisis and campaign against the problem. Through this, he hopes vaping use will shrink as smoking did after the health campaign against it.

“We need to shift gears. This is the new smoking,” Elmanawy said.