Nicotine vaping was not the cause of EVALI

The cause of EVALI was discovered to be vitamin E acetate, a prohibited ingredient under CCCR 2001 in regulated Canadian e-liquid. Vitamin E acetate has never been used by reputable e-liquid manufacturers globally. It was concluded by the CDC that illicit black-market THC products were using vitamin E acetate as a thickening agent.

Dr. Michael Siegel, Professor of Community Health Sciences at Boston University’s School of Public Health was among the first to identify illicit THC products as the culprit. “They tested lung tissue samples from 29 case patients and all 29 (100%) were found to contain vitamin E acetate oil. This finding does represent a major breakthrough for four reasons:

  1. The vitamin E acetate oil was detected in the actual lung tissue of the case patients.
  2. The vitamin E acetate oil was detected in every single one of the lung tissue samples from these 29 case patients.
  3. The samples came from 10 different states, confirming that the outbreak seems to have a common cause, rather than geographic variation.
  4. Three of the patients whose lung samples revealed vitamin E acetate had reported using only nicotine-containing products, thus confirming that there is significant under-reporting which may explain why about 11% of the patients do not report vaping THC.”

Many researchers have stated that due to there being only a small percentage of patients who reported never having used THC products, it is likely that they were reluctant to report having used illegal drugs, which was later confirmed by the CDC. Additionally, the CDC tested hundreds of commercially available e-liquids and no trace of vitamin E acetate was found.

“This is significant because although not all of the case patients admitted to using THC vapes, the finding of vitamin E acetate in their lungs essentially proves that they were indeed vaping THC oils,” said Siegel referring to the latest findings. “This does not mean that they were lying; they may simply not have known what was in the product they were vaping, especially since most of these products are purchased off the black market or obtained from friends or dealers,” he added.

The media was quick to point the finger at nicotine vaping products as the cause but failed to report the link to THC products with the same vigor. Due to this misinformation public health was seriously harmed. Public Health England released the following statement, “The mistaken belief that e-cigarettes are more harmful than smoking increased rapidly among UK smokers following the US lung injury outbreak in autumn 2019. US authorities have now confirmed that vitamin E acetate, a thickening agent added to cannabis vaping products, was a primary cause of the US outbreak. This substance is banned from UK-regulated nicotine vaping products,” said Public Health England.

Additionally, research from the Yale School of Public Health, found in their study, “Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States,” that the outbreak was not caused by regulated nicotine or cannabis vapour products, but instead unregulated products that flooded the market due to flavour bans.