Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Abstract

Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.

Oral Administration of Cannabis and Δ-9-tetrahydrocannabinol (THC) Preparations: A Systematic Review

“…However, vaporizers have been recently associated with acute respiratory illness, now referred to as e-cigarette or vaping product-use associated lung injury (EVALI) [ 21 , 22 ]. The cause of this condition is currently under investigation, although there is evidence implicating the vitamin E acetate used as a diluent in vaporizer liquids [ 23 ].…”

Deadly combination of Vaping-lnduced lung injury and Influenza: case report

“…Recent reports have revealed that constituents of Eliquids with Vitamin-E (alpha-tocopherol) acetate (VEA) is the likely culprit in worsening respiratory failure in these patients [16][17][18]. Vaping is the process of inhaling an aerosol that is created by heating a liquid or wax containing various substances, such as nicotine, cannabinoids causing acute lung injury that can be lethal.…”

“…Influenza associated rhabdomyolysis has been previously reported in case reports in literature [22][23][24][25][26][27][28][29][30][31]. Recent review of literature in 2015 revealed twelve case reports with CK levels ranging from 1317 to 1,127,000 with mean value of 206, 908, with survival of 83% [18]. An additional six cases have been reported in the literature since then [25][26][27][28][29][30][31].…”

Does ‘Dry Hit’ vaping of vitamin E acetate contribute to EVALI? Simulating toxic ketene formation during e-cigarette use

“…The rapidly growing number of clinically reported cases of e-cigarette, or vaping, product useassociated lung injury (EVALI) since August 2019 has placed this as a major public health concern in the United States [1][2][3][4]. The US Centers for Disease Control and Prevention (CDC) reported on the 14 th of January 2020 that at least 2,668 hospitalized EVALI patients and 60 deaths had been recorded across the country [5].…”