November 26, 2019
MDH lab finds vitamin E acetate in 2019 illicit vaping products but not in 2018 products
Finding adds to national evidence associating vitamin E acetate with lung injuries
Testing by the Minnesota Department of Health (MDH) Public Health Laboratory has found that samples of vaping products from 2019, including some from patients with serious lung injuries, contained vitamin E acetate, while product obtained by law enforcement from 2018 did not.
These findings, reported in a special publication today, Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement — Minnesota, 2018 and 2019, from the Centers for Disease Control and Prevention (CDC), provide more evidence that vitamin E acetate is playing a role in the current outbreak of vaping lung injuries.
CDC announced on November 8 that it had completed testing of 29 bronchoalveolar lavage (BAL) fluid samples collected for clinical reasons from patients with e-cigarette, or vaping, product use associated lung injury (EVALI) in 10 states. Five of the samples were from Minnesota residents. A potential toxin, vitamin E acetate, was found in all BAL fluid samples tested by CDC. These findings provide direct evidence of vitamin E acetate at the primary site of injury in the lungs, although more research is needed to establish whether vitamin E acetate caused the injuries.
Separately, the MDH Public Health Laboratory looked at illicit THC products from several sources, including from 12 confirmed or probable lung-injury patients. Lab tests confirmed that 11 of the 12 lung injury patients vaped THC products that contained vitamin E acetate and the other patient vaped multiple products, some of which were not available for testing. Overall, 52% of 46 illicit THC products belonging to the 12 lung injury patients that were tested at the MDH Public Health Laboratory contained vitamin E acetate.
In addition, the MDH lab worked with local Minnesota law enforcement officials to obtain seized illicit THC products from 2018 and 2019. The lab found that all 20 of the 2019 THC products seized by law enforcement included vitamin E acetate, while no vitamin E acetate was found in the five cartridges from 2018.
Minnesota Commissioner of Health Jan Malcolm praised the MDH lab and partners for their work in the investigation to date.
“Thanks to the work of CDC, local law enforcement and MDH’s lab and epidemiologists, we now have evidence of vitamin E acetate in the lungs of Minnesotans and in illicit THC products from Minnesota during the outbreak,” said Minnesota Commissioner of Health Jan Malcolm. “We have more work ahead, but every bit of evidence gets us closer to a resolution.”Further work is needed to test additional pre-2019 samples. In addition, more research is necessary to evaluate how vitamin E acetate might cause lung injury and to evaluate the role of other components in causing lung injury.
“These are small samples, and the findings do not rule out other possible compounds or ingredients that may be involved in causing these lung injuries,” said MDH State Epidemiologist Dr. Ruth Lynfield. “However, these results are important and support a role for vitamin E acetate in the lung injuries associated with vaping THC.”
Cases of severe lung injury continue to be reported to MDH. In all cases, people should avoid vaping illicit THC products. If a person who vapes develops symptoms, they should seek medical care. Patients enrolled in Minnesota’s medical cannabis program should consult with their physicians and pharmacists at the dispensing centers about what is best for their situation.
Patients who have impairment or distress from use of THC-containing vaping products, should consider using behavioral treatment and recovery services for cannabis use disorder.
Beyond the acute lung injuries that are associated with vaping illicit THC products, MDH is concerned about the safety of vaping in general and recommends the following:
- If you don’t vape now, don’t start.
- Pregnant women and young people should never vape.
- If you are a smoker using vaping to quit, do not go back to smoking, but do consider switching to other FDA approved cessation methods (vaping is NOT an FDA-approved method)
As of November 26, 2019, 125 patients in Minnesota with confirmed or probable lung injury associated with e-cigarette use or vaping have been reported to MDH. Of those patients with complete interview information, 91% reported vaping illicit THC.The MDH Public Health Laboratory is one of 10 Level One chemical laboratories in the national Laboratory Response Network tasked with identifying chemical substances of public health significance.