Abstract
E-cigarette or vaping product use-associated lung injury (EVALI) is a serious pulmonary condition that is associated with the extended use of certain vaping products. EVALI was first characterized in the summer of 2019 and has since been reported in all 50 U.S. states. From August 2019 through June 2021, the New York State Department of Health has reported more than 197 confirmed cases emanating from all regions of the state. The Wadsworth Center at the New York State Department of Heath received vaping cartridges recovered from EVALI patients for chemical analysis of their contents. Untargeted analytical methods using gas chromatography-mass spectrometry and liquid chromatography-high-resolution mass spectrometry as well as targeted analyses for a variety of analytes including cannabinoids, pesticides, vitamin E acetate (VEA) and mycotoxins were used to characterize the composition of the vaping fluids and several commercial vaping fluid additives. From the analyses of the 284 e-cigarette devices recovered from patients, 82 were found to be nicotine-containing pods, and 202 devices containing cannabis oil, apparently from unauthorized or black-market dealers. The fluids from the cannabis-oil cartridges tended to have lower levels of THCs (Δ9-tetrahydrocannabinol + Δ8-tetrahydrocannabinol) and total cannabinoids compared with those of commercially produced formulations and contained significant levels of diluents including VEA, medium-chain triglycerides, polyethylene glycol, and castor oil. VEA was the diluent most frequently detected, which was present in 132 (65.3%) of the vaping fluids that contained cannabis oil. When present, VEA ranged from 2.0 to 67.8% of the total mass of the oil with a mean content of 37.0%. In some cases, two or three diluents were detected in the same sample. The ratio of VEA to THCs varied widely, from 0.07 to 5.34. VEA and specifically the high ratios of VEA to THCs in black-market vaping fluids may be causative in EVALI. The safety of additional components and additives that are present in vaping fluids are likewise of concern.
Highlights
Coincident with the development of the e-cigarette, vaping has become a popular way to use in both nicotine and cannabis products (Gaub et al, 2019; Kumar et al, 2019; DiSilvio et al, 2021)
For E-cigarette or vaping product use-associated lung injury (EVALI) cases in which cannabis vaping products were submitted to the laboratory for analysis, 84% of the time at least one vitamin E acetate (VEA)-containing fluid was among the samples received among the patients vaping products
On September 5th, 2019, based on the initial observations from our laboratory, the New York State Department of Health (NYSDOH) announced an update on its investigation into vaping-associated pulmonary illness and issued the first in the nation public health advisory about VEA after high concentrations of VEA were found in the vaping devices recovered from EVALI patients (NYSDOH, 2019)
Summary
Coincident with the development of the e-cigarette, vaping has become a popular way to use in both nicotine and cannabis products (Gaub et al, 2019; Kumar et al, 2019; DiSilvio et al, 2021). The composition of vaping fluids varies, but they generally contain either an aqueous-based nicotine solution or a cannabis oil. Changing regulations permit medical and/or adult recreational use in 47 U.S states; numerous restrictions regarding cannabis use remain (NCSL 2021), and black markets for cannabis products persist, including those for illicit vaping devices. The composition of these black-market vaping fluids is a major concern, since regulators cannot provide oversight of the manufacturing practices and the additives used. Consumers may be exposed to significant health risks when using illicit vaping products
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