If you’ve been paying attention to the news lately, you’ve probably noticed that reports regarding the vaping-related lung illness (EVALI) have begun to slow.

The lack of reports doesn’t mean that new cases of the illness have stopped appearing; it’s simply a normal artifact of the news cycle. When the reports stop receiving clicks, the publishers stop writing about it – and that’s why this article exists.

On this page, we’ll summarize the best available information about EVALI and explain what you can do to keep yourself safe whether you’re an e-juice or cannabis user.

Overview: What Is the Vaping Lung Illness?

E-Cigarette or Vaping Product Use Associated Lung Injury (EVALI) is a form of lipoid pneumonia that has stricken more than 2,700 users of vaping products in the United States. Of the 2,700+ victims of the illness, 60 people have died at the time of writing.

Symptoms of EVALI include fever, chest pain, shortness of breath, nausea, and lack of oxygen. The illness happens because the oil collects in the lungs and impedes the transfer of oxygen to the blood. The body’s immune system begins attacking the oil deposits as if they were pathogens – thus worsening the illness – but EVALI has no infectious cause.

Many EVALI patients have shown improvement with the systemic administration of steroids. Some patients, however, have required mechanical ventilation to stay alive.

It is unknown whether EVALI patients who have been discharged from hospitals will experience relapses or suffer permanent lung damage.

What Is the Most Likely Cause of EVALI?

When cases of EVALI first began to appear, doctors had little information about the cause of the illness apart from the fact that all patients used vaping products prior to the onset of symptoms. Most patients admitted that they had used vaping products containing THC, but some patients claimed that they had only used nicotine e-liquids. That created a great deal of confusion among researchers and the public. Initially, health authorities recommended avoiding all vaping products because they couldn’t be certain that anything was safe.

That created a great deal of confusion among users of nicotine e-liquids. After all, the FDA froze the e-liquid market in 2016 when the agency announced its regulations for the nicotine vaping industry. If e-liquid companies hadn’t been allowed to release new products or change existing products for three years, why didn’t EVALI appear until 2019?

Ultimately, health officials were able to determine fairly conclusively that no FDA-regulated commercial nicotine e-liquid product appears to be the cause of EVALI. Research, however, is still ongoing.

To date, the FDA has collected more than 1,000 vaping product samples relating to the lung illness. Of those, more than half have contained THC. Among the products containing THC, more than half have contained Vitamin E acetate. Many of the other samples contained other oil-based diluents such as MCT oil. In addition, lung fluid samples have been collected from dozens of EVALI patients. Most of those samples have contained Vitamin E.

In summary, these are the three things we know about EVALI so far:

  • We can say with great certainty that inhaling Vitamin E acetate is almost definitely dangerous.
  • It is likely that inhaling any vaporized oil is unsafe due to the possibility that the oil will settle in the lungs.
  • No commercial nicotine e-liquid product has been implicated as a cause of EVALI. The FDA and CDC have both removed their blanket statements warning consumers to stop using all vaping products and are now recommending only that people avoid using THC vaping products.

How Can I Vape Cannabis Safely?

Many states now allow the medicinal use of cannabis for conditions such as chronic pain, anxiety, and post-traumatic stress disorder. Cannabis is a popular medication among veterans because it has an excellent level of effectiveness along with an extremely good side effect profile compared to traditional prescription medications.

If you use cannabis, though, you have good reason to be concerned about EVALI. The information currently available suggests that you should do the following to ensure that you can vape cannabis safely.

  • Buy cannabis products only from licensed dispensaries. Avoid any product without a corresponding lab test confirming that the product contains no Vitamin E or other added oils.
  • If your only option for obtaining cannabis is to buy it privately, buy nothing but whole flowers. Avoid all cannabis vape oils and pre-filled THC cartridges because, if those products are produced without regulatory oversight, you have no way of knowing what’s in them.
  • Even if you do buy from a dispensary, it’s still wise to avoid all liquid THC vaping products until health officials have definitive information about what causes EVALI.

How Can I Vape Nicotine E-Liquid Safely?

As stated above, the FDA regulates the nicotine e-liquid industry and has not permitted a new e-liquid to reach the market since 2016. Common sense would suggest that, if commercial nicotine e-liquid caused EVALI, the illness would have appeared before now. As many health officials such as former FDA Director Scott Gottlieb have pointed out, the primary cause of EVALI is almost definitely THC vaping cartridges produced for illegal distribution.

That said, you should still exercise care when buying nicotine e-liquid. Buy e-liquid only from vape shops that are fully compliant with FDA regulations and order their vape juice only from the original manufacturers or from legitimate distributors.

Are you a JUUL user? If that’s the case, you should exercise extreme caution when buying refill pods for your device because fake JUUL pods – usually from China – do pose a serious potential health concern. When an expensive product becomes popular among consumers, you can bet that knock-off products will appear – and counterfeit JUUL pods from China are flooding the market by the thousands. When you buy JUUL pods, you should buy those pods only from major retailers who receive those pods through their existing tobacco distribution chains.

Finally, you should remain mindful of the fact that the FDA pulled all pre-filled vape pods in flavors other than tobacco and menthol from the market in 2020 in an effort to combat teen vaping. If you happen to find JUUL pods in other flavors at a local store or from a private seller, those pods aren’t just illegal – they’re probably fake.

Flickr Photo Courtesy of BlackNote.com

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