State officials are reconsidering their marijuana regulations and quality control in the wake of investigators’ discovery that 29 patients with vaping-related lung illness tested recently had greasy vitamin E acetate from THC in their lungs.
Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said last week states are trying to decide whether their oversight needs strengthening as the monthslong national outbreak continues and the number of cases and deaths rise each week.
Colorado and Ohio banned vitamin E acetate, which is sometimes used as a thickening agent or to dilute THC oil in vape cartridges to make it go further. Tetrahydrocannabinol, known as THC, is the ingredient in cannabis that creates the "high."
States "should be banning vitamin E acetate. No question," said cannabis industry executive Tyrell Towle, who is on a Colorado government advisory committee. "There's no reason to use cutting agents because you can make high-quality vape cartridges using only cannabis-derived ingredients."
Towle is director of chemistry and extraction at cannabis manufacturer MedPharm Holdings. He was on the Colorado government work group on marijuana science and policy as it worked for about a year on the definition of dangerous vape additives. Last month, the state's Marijuana Enforcement Division decided to ban additives including vitamin E acetate.
Marijuana, which is governed by a patchwork of state regulations and banned federally, is difficult to police. The Food and Drug Administration, which allows vitamin E acetate as a supplement in cosmetic lotions, regulates tobacco-related products and oversees nicotine vape products. The Drug Enforcement Administration enforces laws surrounding "controlled substances," including marijuana, that are on "schedules" based on their potential for abuse, dependence and medical use.
Further complicating matters: the publicized lung illness cases nearly all involve people who vaped illegally obtained THC, either with or without nicotine.
People who smoked THC purchased from illegal sources were nine times more likely to be sick, according to a study co-written by Jennifer Layden, chief medical officer at the Illinois Department of Health.
Although Schuchat emphasized, "I don't think we know enough yet to completely take the dispensaries out of the question," she pointed out "data are pointing toward the illicit supply."
Legal vaping industry officials decry what they say is misplaced blame and a lack of police enforcement.
Cannabis testing company Anresco Laboratories tested THC samples sold in California and reported last month it found a high degree of vitamin E acetate contamination in illicit market samples. Of the 15 illegal-market cartridges tested, nine had vitamin E acetate at concentrations of 20%-50%. None of the more than 200 legally sold brands did.
"The intuitive thing to do would be to try to shut down the illicit market – which is about three times larger than the regulated market – and push users towards the legal market instead," said Anresco Vice President Zachary Eisenberg. "However, that is unlikely to happen in the short term."
Ben Burack, CEO of the cannabis company Himalaya Standard Oil, calls Los Angeles "the epicenter of bootleg vape manufacturing," because he said so much counterfeit vape packaging is sold openly at unlicensed shops and shipped out of state. Los Angeles and California law enforcement have tended to take "a hands-off approach to enforcing existing laws against these illegal operators," he said.
"The result is harm to public health and harm to the legal, regulated market," Burack said. "The solution is simple: The people manufacturing these counterfeit vapes for sale on the illegal market should be shut down and prosecuted."
California launched an ad campaign in July discouraging illegal purchases and promoting for consumers an online licensee look-up tool, CApotcheck.com. Alex Traverso, a spokesman for California's Bureau of Cannabis Control, defended the state's enforcement efforts and noted that even though regulations don't mandate vitamin E acetate testing, "that can obviously change. It would just require going through the regulatory process."
"Our enforcement efforts continue to pick up with each passing week, and our investigators are very diligent about following up on every complaint we receive," Traverso said. "That being said, enforcement is still going to be a challenge, and we have to just continue to work with local government and local law enforcement to maximize our resources and expeditiously shut down illegal operations."
In New York, state investigators have been trying to track vitamin E acetate through the black market marijuana vape supply chain since September, when authorities announced subpoenas of three companies that sell the additive.
This week, the New York State Health Department confirmed its investigation into three companies: Mass Terpenes in Massachusetts, Honey Cut Labs in California and Floraplex Terpenes in Michigan. The agency declined to comment further, citing the active investigation.
Of the companies subpoenaed by the state, Mass Terpenes posted on its website Monday afternoon, "Please refrain from the use of any THICKENER products. We will not be offering any diluents until more information is available." Floraplex Terpenes said in a statement that it planned to keep selling cutting agents.
New York Gov. Andrew Cuomo said last week that the CDC’s vitamin E acetate findings underscore the importance of homing in on the toxin of concern.
Here's how some other states are responding:
►Washington's Department of Health and Liquor and Cannabis Board issued a voluntary recall Friday night for any products containing vitamin E acetate. THC processors have to print ingredients on labels and none of 200 labels submitted to the health department had vitamin E acetate, said Liquor and Cannabis Board spokesman Brian Smith.
► Ohio banned vitamin E acetate from medical marijuana vape products Nov. 8 after the CDC’s announcement. None of Ohio’s medical marijuana vape makers was using it, so the move was preemptive.
► Massachusetts' Cannabis Control Commission issued a quarantine order Tuesday for all marijuana vaping products and devices except medical use of marijuana flower vaporizers. The Commission doesn't require testing for vitamin E acetate and acknowledged "it is possible that legal marijuana products sold in the state could contain vitamin E acetate or other potential ingredients of concern."
► Michigan lawmakers introduced bills last week that would revise the Medical Marijuana Facilities Licensing Act to prohibit the processing and sale of marijuana products containing vitamin E acetate. The FDA, which has been testing vape products associated with the lung illnesses, found vitamin E acetate in one sample from Michigan. A medical marijuana caregiver submitted two vape cartridges to a Michigan Marijuana Regulatory Agency-licensed safety compliance facility. It contained 40% or more of vitamin E acetate, according to the state Health Department.
Contributing: Jackie Borchardt, Cincinnati Enquirer, and Kristen Jordan Shamus, Detroit Free Press. Robinson is with the USA TODAY Network – New York.
If you or family members are struggling with issues mentioned in this story and you would like to connect with others online, join USA TODAY’s "I Survived It" Facebook support group.
This article originally appeared on USA TODAY: Vitamin E acetate, a deadly THC vaping additive, isn't fully regulated