This article will explore and explain the recent news of ‘Vaping Deaths’ linked to vaping vitamin E acetate and covers the following areas:
- The current situation in the US surrounding vaping deaths
- The Centers for Disease Control and Prevention have recorded 1300 lung injury cases and 26 deaths linked to vaping in the US, with use of THC products being common in the majority of cases.
- Vaping in the UK
- Nicotine vape products are regulated and monitored by the MHRA. Manufacturers are required to risk assess and declare all ingredients. Oils are prohibited.
- Oils and lung illness
- When oils are inhaled, they interrupt the transfer of oxygen from the lungs to the blood stream by accumulating on the lung lining. This has been known for many years and is called lipid pneumonia, the condition diagnosed in the vaping illness cases.
- What else is in THC products?
- THC products are oil based because the cannabis plant has naturally occurring oils, therefore need to be dissolved in oils like vitamin E which first appeared in illegal products in 2018.
- Why has the emphasis been on vaping in general?
- Vaping refers to turning liquid to vapour so the term is technically correct. However, what is being vaped it most important. You wouldn’t stop eating forever if you’d had food poisoning.
- What does all this mean for you?
- As a UK vaper you can be reassured that this tragic situation is not occurring in the UK because we have regulations and safeguards in place. The UK Government continues to support vaping and at Liberty Flights we are committed to continuing our high-quality products.
- A final word
- Liberty Flights e-liquid does not contain oils, and Lipid pneumonia cannot happen where there are no lipids/oils. Vaping regulated nicotine products from the UK continues to be an acceptable, reduced risk way of quitting smoking.
You cannot fail to have seen multiple headlines in the UK press, covering a number of tragic deaths and illnesses in the US as the result of vaping THC oils, we’ll explain what these are later on. What has happened is a new, sudden phenomena and is it vital to remember that there are no oils in regulated, UK manufactured Nicotine e-liquid. The reported injuries have been exclusively linked to oils and other chemicals being inhaled in THC products in the US.
The news of this terrible situation has been widely reported and often misrepresented. Understandably fear has taken hold and because the US Health bodies took their time to announce the ingredients common to each case that had been identified as likely causes, we’ve been faced with an incredible amount of misinformation.
It is again important to emphasise that nicotine vape products in the UK are regulated and the industry has much greater checks and oversight than the US. By linking the injuries and deaths in the US to the regulated industry in the UK, vaping faces yet another battle against poor reporting and deliberate misinformation, so it feels only right to provide you with the facts and reassure you that vaping nicotine e-liquid in the UK continues to be a 95% less harmful alternative to smoking.
The current situation in the US surrounding vaping deaths
The first reported illness related to a vape product was reported to and confirmed by the Centers for Disease Control and Prevention (CDC) on 17th August 2019. This was followed by the first vaping death being reported on 23rd August 2019. The CDC issued advice to stop using all vaping products (regardless of their origin or contents) without giving further details or reassuring vapers who have used vaping exclusively to quit smoking. Over the next few weeks through September the number of cases and deaths increased and the US news reports got increasingly more scaremongering, and were soon picked up by the UK media.
Currently the CDC have recorded almost 1300 lung injury cases, across 49 of 50 states in the US and 26 of the cases have resulted in death1. While the outbreak is being investigated, they have now amended their advice from ‘don’t vape’ to warn specifically against the use of THC containing products. This is because the data gathered so far suggests THC containing products are a common component. Additionally, THC products obtained off the street ‘play a major role’1.
Vaping in the UK
The vaping landscape in the UK is very different to the US.
Firstly, in the UK we have to follow strict regulatory2 guidelines that ensure use of quality (pharmaceutical grade) ingredients and testing of those ingredients, the results of which are then submitted to the UK regulatory body, the Medicines and Healthcare Products Regulatory Agency (MHRA)3. Products need to be notified 6 months before they can even reach the market. The MRHA work hand in hand with Trading Standards and the vaping industry to maintain compliance and keep products as high quality as possible.
Secondly, the regulations specifically prohibit the use of certain chemicals including those that are known to be carcinogenic, mutagenic (that can change genetic material), or are considered a reproductive toxicant. Manufacturers must also complete a toxicological risk assessment, which includes respiratory considerations, and testing on the full composition of emissions from both the e-liquid and vape devices.
Finally, any and all adverse health effects must be reported to the MHRA so they can be thoroughly investigated in a timely manner. This doesn’t just apply to manufacturers and retailers who are legal required to report adverse health effects; member of the public and health professionals may also alert the MHRA, without including the manufacturer, to any products using the Yellow Card Scheme4.
As a result of the acceptance of vaping as a reduced risk product within the UK, overall smoking rates are dropping, in every demographic, in a manner never seen before. This includes youth smoking rates which continue to drop, and evidence shows that teens are not turning to vaping when they are not current or ex-smokers.
As has been said many times, vaping is an exit from smoking, not a path to it.
A recent report from Action on Smoking and Health UK5 stated the following:
“Regular use remains rare in never smokers. Regular use of e-cigarettes remains largely confined to current or ex-smokers. The overwhelming majority, 93.8% in total, of 11-18 year olds who have never smoked have either never used an e-cigarette (87.8%) or are not aware of them (6.0%).”
The UK population are therefore benefiting from a huge public health gain by embracing vaping, with no cost to the public purse. On top of this, the money that vapers save by switching to vaping is helping to rebalance inequalities faced by the lowest socioeconomic groups who are disproportionately disadvantaged by high taxation on tobacco cigarettes.
Oils and Lung illness
To give a deeper understanding of why there have been fatalities and lung injuries in the US, we need to look at what happens when you inhale oils and why it is so damaging.
An oil is a term for a family of chemicals, that are typically made of large molecules (such as a fat or wax) that do not mix with water but do mix with other oils. Lipid is a term for fatty acids, a type of oil.
It has been known for many years that when lipids are inhaled, they cause an illness called lipid pneumonia. Due to the fact lipids do not dissolve in water, they are unable to be absorbed by the fluid lining of the lungs and are seen by the body as toxic. By gathering on the fluid lining, lipids inhibit the transfer of oxygen from the lungs into the blood stream. Ultimately this can cause serious damage, not only to the lungs, but to other internal organs as they are starved of oxygen and left unable to function.
So why are THC products and not nicotine products, leading to this condition? The answer is very simple, nicotine will dissolve in water so nicotine e-liquids can be water or alcohol based. THC is found in the cannabis plant, which contains naturally occurring oils and waxes which remain in the product. Because the extract is oily, it needs to be diluted with oils so that is dissolves and can be vapourised.
What else is in THC products
Firstly, lets touch on what THC is and why people want to inhale it. THC stands for tetrahydrocannabinol, and it’s the psychoactive chemical in cannabis, i.e. the chemical that gets you high. As described above, it is smoked as a dried leaf, or extracted from the plant to be inhaled or eaten amongst other things. People have used cannabis for generations, both recreationally and for certain health conditions where it is though to help such as pain management. It is often surprising to find, that despite their overly cautious approach to vaping, the US have a much more open view of cannabis use and this has resulted in relatively light touch regulation compared to the UK. In some states, cannabis is legal to buy and use recreationally, in others is can only be used medicinally under licence and in the rest, it is still illegal.
Aside from THC and plant extract, there are some other common ingredients in THC vape cartridges. The presence of cannabis leads to other contaminates such as pesticides and lead which are left from when the plant was grown. This has been widely reported and is summed up in the excerpt from an article in metrotimes.com below.7
“As many as 50 million cannabis cartridges are tainted with lead, pesticides, vitamin E acetate, or residual solvent butane.”
One substance that is widely quoted including above, as being involved is vitamin E (or vitamin E acetate). Vitamin E oil first appeared in vape cartridges on the illicit cannabis market in Los Angeles near the end of 2018 in a product called Honey Cut.8 Honey Cut proved so popular as a THC oil cutting agent that dozens of knockoff versions appeared in early 2019 and soon began to appear in street-market vape cartridges nationwide. A cutting agent is an ingredient used to bulk out the mix, so you get more product with the same amount of cannabis. You may have heard of vitamin E before as it is commonly used in cosmetics but the key difference is that while safe to apply to the skin, it has not been approved for use in inhalation products.
Vitamin E is a common name for a family of oils that can be made from hydroquinone, a controversial compound sold in the United States as a topical skin lightening agent. It’s used to get rid of dark spots or discolorations. The European Union has banned hydroquinone because of its potential carcinogenic effects. Inhaling residual hydroquinone aerosol from a cheap vitamin E oil would be very dangerous.
Why has the emphasis been on vaping in general?
This comes down to a question of semantics. The term vaping comes from the word vapourise, which means to convert a liquid to a vapour. So because the THC cartridges are being heated and the contents turned to vapour, using the term vaping is not incorrect. BUT vaping is the delivery method only. Consider another example, you would not warn people against eating because they got food poisoning, you would warn them against eating that particular source of food again. It is the contaminated food that has caused the illness, not eating. So what you vape is key, not vaping itself.
Sadly, this lack of clarity works for some campaign groups in the US as there are competing agendas when it comes to nicotine vape products, their public health gain, regulation and/or prohibition. This is a whole article in itself so we won’t cover it here, there are plenty out there already if you are interested.
For the UK, this leaves us continuing to correct articles where the specific cause has not been made clear, because the power of language will always be used to make headlines that sell.
What does all this mean for you?
Hopefully after reading this article you are clearer on the facts behind the headlines. But it is worth saying again, that as a UK vaper you can be reassured, as we said at the start of the article, that this tragic situation isn’t happening here because we have the right regulations and safeguards in place. The UK Government continue to support vaping and here at Liberty Flights, we are focused on maintaining our high-quality products, by following the rules to the letter and going above and beyond so we can take pride in our products.
“The UK is a vanguard of the vaping world and should be proud of what we’ve done in the wider industry as a whole. It is often levelled at me that my commercial interest in vaping makes me bias, but I genuinely feel it is the public health benefit that is most important. It’s the reason I started Liberty Flights over 10 years ago. People need to have the facts so they can have confidence in switching and make an informed decision. The propagation of misinformation causes direct harm to those it prevents from trying a reduced risk product”
Matthew Moden, Managing Director of Liberty Flights
We must all remember that the point of vaping is to stop smoking, and there is never a time when it is better to smoke than to vape. This has been repeated over and over again by Public Health England whose independent review of evidence found vaping to be ‘at least 95% less harmful to health than smoking’9 and have included vaping in their Stoptober campaign since 2018. Several leading experts have also come out to re-confirm this view and challenge the messaging that is coming from the US.10
Despite the different approaches on each side of the Atlantic, the science about vaping nicotine does not change just because you are on another continent.
A final word
To re-iterate: Liberty Flights e-liquid does not contain oils. It’s important to remember that Lipid pneumonia is not a new condition, (though this may be the first time you have heard of it). It is solely the result of lipids contaminating the lungs and affecting their ability to provide oxygen to your body. Lipid pneumonia cannot happen where there are no lipids/oils, so to link the condition exclusively to vaping products is a falsehood.
Vaping regulated nicotine products from the UK is an acceptable, reduced risk way of quitting smoking. If you have quit smoking with vaping, don’t go back, 1 in 2 smokers will die from a smoking related disease.11
1 https://www.medicalnewstoday.com/articles/326664.php
2 https://ec.europa.eu/health/tobacco/products_en
3 https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products
4 https://yellowcard.mhra.gov.uk/
5 https://ash.org.uk/wp-content/uploads/2019/06/ASH-Factsheet-Youth-E-cigarette-Use-2019.pdf
8 https://www.leafly.com/news/health/vape-pen-lung-disease-vitamin-e-oil-explained
10 https://youtu.be/f4ndMD68yxc
11 https://www.publichealth.hscni.net/publications/1-2-smokers-will-die-tobacco-related-disease
